Costs of Work-Related Harms Underestimated but Soaring

Even as the cost of serious workplace injury continues to soar, new research concludes that those costs are significantly underestimated. A recent report by insurance company Liberty Mutual revealed that the cost of serious workplace injuries has skyrocketed in recent years. After adjusting for inflation in both health care costs and wages, Liberty Mutual calculated that the cost of serious workplace injuries increased by 12.1 percent between 1998 and 2002, with over half of that increase occurring in 2002. In fact, the costs have soared while the number of serious injuries has actually dropped in those four years. Thus, even if there are fewer serious injuries in the workplace, they are costlier than ever. The problems of work-related injury and illness may well be greater than the Liberty Mutual data suggest. According to a new literature review in the June issue of the Journal of Occupational and Environmental Medicine, data on the incidence and cost of occupational illness and injury are significantly underestimated because of data gaps and systematic methodological flaws in research on the burden of workplace harm. These limitations include the following: Making the Link with Workplace Conditions Because many workplace illness and injuries are either not reported as work-related or not reported at all, their actual incidence rate is likely underestimated.
  • Occupational disease and injury have long been recognized to be underreported.
  • Many primary care providers are untrained in occupational health and, thus, may not recognize a disease as work-related.
  • The U.S. lacks a comprehensive occupational health data collection system. What we know about occupational health comes from "piecemeal data sets produced by systems not designed for surveillance. These systems filter out work-related health problems at each step," according to the report.
  • Diseases often have many possible causes. Workplace-related etiology may be neglected entirely in many cases.
  • For illnesses with multiple potential causes, some researchers assess the attributable risk (AR), counting only a fraction of disease incidence based on workplace exposure risk. (AR is the percentage of disease incidence that would be eliminated if the workplace risk disappeared.) "The standard definitions of attributable fraction of disease, resulting from an exposure, capture only excess cases and not all cases that are etiologically linked by the exposures in question," according to the report.
  • The limited time horizon of some AR methods can also miss cases with earlier or later onsets than assumed by the time frame of the study.
  • Job turnover can also limit studies of the burden of occupational illness and injury. Some more recent studies of occupational carcinogens and respirable particulates such as silica and asbestos are now beginning to account for turnover.
Getting a Good Count Some methodological flaws constrain efforts to assess the bigger picture of workplace-related illness and injury.
  • Some researchers measure the burden of occupational injury and disease through disability-adjusted life years, or DALYs. DALYs, like the much maligned quality-adjusted life years (QALYs) measure, are an attempt to count cases of occupational health problems in common units and in terms of time affected. If 0 is death and 1 is one year of perfect health, a DALY would take one year spent in some disabled condition as a fraction between 0 and 1. Moreover, the cases themselves are not counted as whole entities but, instead, as units of time in the disabling condition. The disabled health state fraction is multiplied by the number of years afflicted. "The definition of DALYs combines information on morbidity and mortality with value choices such as disability weighting, age weighting, and discounting. These value choices may lead to an inaccurate portrayal of the true burden of occupational disease and injury because of differential valuation of effects on young workers and failure to account for long-term effects in older workers and retirees," the study maintains.
  • It can also be challenging to get a birds-eye view of population patterns for occupational health, in part because the burden of work-related injury and illness is not distributed evenly among the population. According to the report, some occupations are riskier than others: "For example, although healthcare workers globally are 0.6% of the population, they experience an appreciable proportion of disease from bloodborne pathogens acquired through 'sharps' contacts."
Calculating the Cost Measuring the economic costs also results in underestimates of the burden of occupational illness and injury. Given that agency cost-benefit analyses for potential regulations sometimes use cost of illness estimates to put a cash value on the future benefits of regulation, these limitations could have significant policy consequences. Among the deficiencies are the following:
  • According to an earlier literature review, "most studies tended to underestimate the true economic costs from a social welfare perspective, particularly in how they accounted for occupational fatalities and losses arising from work disabilities. Many of the estimates of costs of occupational disease and injury depend on a combination of methodolgic assumptions, extrapolation methods, and known and unknown biases."
  • Most cost estimates ignore the wider social consequences of one person's injury for "labor relations, family dynamics, domestic activities, community involvement, and personal mental health."
The article concludes with recommendations for occupational health advocates to improve the evidence supporting their calls for workplace health and safety protections, including heightened surveillance and further epidemiological study. Given that this administration, which is already averse to workplace health and safety protections, demands a cost-benefit justification for new health and safety rules, these data limitations may make strong new safeguards even less likely.
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