Linda Delp

Promoting integrated approaches to reducing health inequities among low-income workers: Applying a social ecological framework

BACKGROUND Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity. METHODS We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations. RESULTS Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work-related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers. CONCLUSIONS Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed.

Homecare Worker Organizing in California: An Analysis of a Successful Strategy

This paper examines the challenges facing California homecare workers in their historic struggle to unionize from the 1980s through the 90s. Three inter-related components were critical to their ultimate success: 1) grassroots organizing, 2) changing policy at the state and county level and 3) working in coalition with groups of senior and disabled care recipients. Now that the union repre sents more than 100,000 workers, consolidation of those victories involves challenges such as developing leadership among the new membership and strengthening the labor-consumer coalition that will be critical to further improvements in homecare services and working conditions. This campaign has already had significant impact on the structure of this emerging workforce, and will have long-term effects on social policy for care of the elderly and dis abled.

Fostering Youth Leadership to Address Workplace and Community Environmental Health Issues: A University-School-Community Partnership

Many communities of color are disproportionately exposed to workplace and community environmental hazards. This article presents the results of a pilot project designed by a university-school-community partnership to develop youth leadership to confront these exposures. Using a popular empowerment education approach, students applied peer education, research, and organizing skills learned in the classroom to community-based internships in a service-learning model. Evaluation results from pretests and posttests, focus groups, and in-depth interviews demonstrated that students shared what they learned about young workers’ rights and environmental justice with family and friends. They developed a critical analysis of environmental inequities, created a citywide youth coalition that advocates around legal, educational, and environmental issues affecting youth, and implemented campaigns to enforce child labor laws and to prevent school construction on contaminated land. This multifaceted model can serve as an important foundation to develop youth leaders to influence environmental policies in a variety of communities.

From Agricultural Fields to Urban Asphalt: The Role of Worker Education to Promote California's Heat Illness Prevention Standard

This article describes an innovative approach to reach and educate workers and worker advocates about Californias outdoor heat illness prevention standard. In 2010, Cal/OSHA initiated a statewide education campaign to reduce heat-related illnesses and fatalities and increase awareness of the standards requirements. In Southern California, the UCLA Labor Occupational Safety and Health Program (LOSH) focused on three principal strategies of community-based outreach, popular education, and organizational capacity building. Central to the LOSH approach was the integration of health promotores into core program planning and training activities and the expansion of campaign activities to a wide variety of rural and urban workers. We describe each of these strategies and analyze the possibilities and constraints of worker education to support implementation of this standard, particularly given the vulnerabilities of the impacted workforce, the often precarious nature of employment arrangements for these workers, and the resource limitations of Cal/OSHA.

Risk Amid Recovery: Occupational Health and Safety of Latino Day Laborers in the Aftermath of the Gulf Coast Hurricanes

After Katrina, the Bush administration suspended Department of Labor workplace regulations throughout the Gulf, a move consistent with their general emphasis on voluntary workplace protection programs rather than government oversight. This approach left many workers in hurricane reconstruction jobs unprotected, especially Latino immigrant day laborers who, facing language barriers and legal constraints, were least able to negotiate workplace safety or other labor conditions. Fifty-three immigrant workers and 28 key informants from community, union, church, and relief organizations in Louisiana and Mississippi were interviewed at job hiring sites and relief organizations using an inductive, exploratory approach. In this multihazard and changing work environment with a new and fluctuating workforce, enforceable policies mandating worker protection and education were sorely lacking. Free market conditions, driven by incentives to work as fast as possible, and the preponderance of unregulated small contractors and individual home owners as employers contributed to the unsafe environment. Although workers and home owners attempted to take precautions, they usually lacked adequate education about hazards, access to protective equipment, and training in its proper use. However, the labor conditions during the hurricane recovery in the Gulf Coast are likely to be duplicated throughout the country in workplaces employing Latino day laborers unless workers’ health is given greater priority by regulatory agencies.

Shaping the Future: Ten Years of the Occupational Health Internship Program

The Occupational Health Internship Program (OHIP) was initiated in 2003 to recruit a new, diverse generation of occupational safety and health (OSH) professionals and to advance OSH within union and community-based initiatives. It retains the principles of the original OCAW/Montefiore internship program while adapting to the changed landscape of the 21st-century workplace. Case studies of OHIP projects illustrate how students have contributed to key OSH policies—to regulate silica exposure among construction workers, apply principles of green chemistry with Vietnamese nail salon workers, and integrate OSH into “green” jobs in the recycling industry. They have supported innovative campaigns with immigrant workers in contingent jobs—from taxi drivers to warehouse workers. The students, in turn, have been inspired to enter the OSH arena as professionals and worker advocates with the potential to contribute new energy to an OSH movement.

Musculoskeletal disorders among clerical workers in Los Angeles: A labor management approach

Background Musculoskeletal disorders (MSDs) persist among clerical workers despite ergonomic advances. Methods A cross-sectional survey among 2,310 clerical workers investigated MSD cases, defined as musculoskeletal discomfort and seeking treatment for that discomfort in the past 12 months. A modified Poisson regression model was adopted to assess the association between work and individual factors and the risk of MSDs. Results Over half of respondents reported musculoskeletal discomfort. The prevalence of MSD cases was: 37.2% neck/shoulders, 21.7% upper extremities, 18% lower extremities, and 34.3% back region. Elevated risk of MSDs was associated with less workstation adjustability; work schedule, gender, age, and BMI were also significant. Positive trends were observed between computer use and MSDs for the neck/shoulder region and the effect was amplified among those reporting insufficient workstation adjustability and lacking computer ergonomics training. Conclusions Results demonstrate the need to limit continuous computer use and to improve the human–machine interface through adjustable workstations and worker training to enhance use of adjustable features. Am. J. Ind. Med. 56:1072–1081, 2013.

A Cross-Sectional Survey of Workers and Their Training Needs at 29 Hazardous Waste Sites

Abstract To better understand hazardous waste remediation workers and their training needs, 115 workers from 29 sites in Southern California were interviewed. Using a snowball sampling procedure, respondents from the following categories were sought at each site: project managers, prime contractors, subcontractors, safety officers, and on-line workers. The sample as a whole was predominantly young and well educated, 84 percent were male, and over 80 percent were nonunion. Forty-four percent of on-line workers were at a hazardous waste site for the first time. Actual cleanup activity was limited at the sites sampled; only 7 sites had more than 10 workers on site full-time. A variety of chemicals were reported on these sites, including chlorinated hydrocarbons, petroleum products, heavy metals, and asbestos. Air purifying respirators and dust masks were the most commonly reported types of respiratory protection. All of the prime contractors reported having an emergency response plan, 96 percent reported hav...

Worker Engagement in the Health and Safety Regulatory Arena under Changing Models of Worker Representation

This paper examines the efforts of a labor-community-university partnership in Southern California to confront violations of workplace health and safety standards by employers of nonunion workers in low-wage jobs. A worker engagement model has opened avenues for workers and worker advocates to participate in the regulatory arena absent union representation. This approach has achieved notable successes to date, including groundbreaking Cal/OSHA citations and nascent collaboration with agency officials to target enforcement of health and safety standards. We argue this model constitutes the foundation needed to support a potentially viable form of tripartism that allows nonunion workers a voice, albeit limited, in the health and safety regulatory process.

A LEGACY OF STRUGGLE: THE OSHA ERGONOMICS STANDARD AND BEYOND, PART I

In November 2000, the Occupational Safety and Health Administration (OSHA) issued an ergonomics standard to prevent debilitating work-related musculoskeletal disorders (WMSDs). It was rescinded by Congress within four months. We explore how this story unfolded over two decades of collaboration and conflict. Part I provides an overview of the historical context of the struggle for a standard, followed by interviews with key players from labor, academia and government. They provide a snapshot of the standard; discuss the prevalence of WMSDs in the context of changing work organization; give insight into the role of unions and of scientific debate within the context of rulemaking; and uncover the basis for the groundbreaking OSHA citations that laid the foundation for a standard. Part II interviews further explore the anti-regulatory political landscape of the 1990s that led to repeal of the standard, discuss the impact of the struggle beyond the standard, and describe creative approaches for the future.