Beyond Exposures: Cummings Lecturer Calls for New Focus on Employment Quality

​By Ed Rutkowski

Minneapolis Convention Center (May 22, 2019)—Industrial hygienists must shift their focus toward the social aspects of work in order to protect workers in the new economy, argued Noah Sexias at yesterday’s Donald E. Cummings Memorial Award Lecture. Sexias, a professor at the University of Washington and chief editor of the Annals of Work Exposures and Health, is the 2019 recipient of AIHA’s Cummings Award, which recognizes outstanding contributions to the knowledge and practice of industrial hygiene.

Sexias observed that traditional occupational health and safety practice concerns itself with adverse health outcomes whose relation to work is well established: musculoskeletal injuries suffered at the workplace, acute illnesses such as occupational asthma, and a few chronic occupational diseases like asbestosis, coal workers' pneumoconiosis, and silicosis. But two major trends have led many practitioners to question whether traditional approaches are adequate to protect today’s workers. In the 2010s, as the economy has shifted away from stable employment to temporary work and contract labor, many workers, especially those in the lower economic classes, have suffered from epidemics of obesity, cardiovascular disease, other forms of cancer not traditionally thought of as occupational, and the “diseases of despair”: chronic liver disease, poisonings, and suicides.

“These epidemic conditions are not things that industrial hygienists talk about very much,” Sexias said. He suggested that the economic changes and the rise of these new afflictions are related.

“Initially, [these diseases] were not thought to be much about occupational exposures,” he said. But the data on poisonings, which the National Center for Health Statistics has identified as the leading cause of injury death in the United States, are closely associated with the opioid epidemic: according to NCHS, the vast majority of poisonings are caused by pharmaceutical and illicit drugs. “The opioid epidemic, at least in part, is due to occupational origins,” Seixas said. “We need to be paying attention to these large public-health impacts” from work.

Seixas’ thinking on these issues was informed by a project completed in 2015 at the University of Washington (PDF) that identified trends shaping the future of occupational health. These trends include demographic changes, with growing numbers of women, minorities, and immigrants joining the work force; the rise of nonstandard work arrangements; and a host of other phenomena such as climate change, automation in the workplace, decreased unionization, and federal dysfunction and deregulation. To address the health impacts of these trends, Sexias suggested that a new model of OHS is needed, one that focuses on what he called “employment quality” and incorporates knowledge from the fields of social epidemiology and sociology.

“Traditional exposures are clearly insufficient to describe the health risks of workers,” Seixas said. A focus on employment quality would broaden industrial hygienists’ concerns beyond exposures to include the stability of work, workers’ rights, work hours, training opportunities, and interpersonal power relations.

“The problem we’re confronted with is our view of the world is pretty much through the lens of the standard employer-employee relationship,” which is characterized by permanent jobs that pay adequate wages and benefits. But the new economy has given rise to industries where shift work, long hours, irregular schedules, and inadequate wages are common. These trends have the greatest impact on the most vulnerable workers, Seixas said. In addition, many industries are experiencing “fissuring,” a term that describes the use of subcontractors, franchisees, staffing agencies, and supply chains to perform an increasing share of a company’s non-core activities. One result of fissuring is that it has allowed employers to claim they are no longer responsible for the health and safety of workers carrying out these activities.

According to Seixas, to meet the challenges of the new economy and ensure that vulnerable workers aren’t left behind, industrial hygienists must change their ways of thinking about work. “Jobs play a very important role in the creation and maintenance of health disparities, and we need to keep that in mind,” he said. “Our job is now to think more holistically about what constitutes risk to whom, and what is needed to improve the health of the work force.”

Ed Rutkowski is editor in chief of The Synergist.

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