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Despite many advances in workplace health and safety globally, worker death at work or from work remains an unfortunately common occurrence, and an enormous public health challenge on a global scale. The most recent global estimates, produced jointly by the WHO and the International Labour Organisation (ILO), show that the number of worker fatalities from occupational traumatic injury has not shifted this century. The WHO and ILO estimate a total of 363 283 acute occupational injury fatalities in 2016.1 These are a subset of the total estimated 1.9 million annual worker deaths from occupational exposures.1 The main causes of these fatal injuries are road injury, poisoning, drowning, falls, fire and heat, firearms, animal contact and other unintentional injury. There have been large decreases since 2000 for some mechanisms, for example, in drowning (20.7%), carbon monoxide poisoning (49.1%), falls (4.9%) and pedestrian road injuries (8.4%). These have been offset by increases in road injury deaths, for example, motor vehicle (13.4%), cyclist deaths (10.1%) and motorcyclist (14.8%). However, the overall number of deaths has not substantially changed. At the turn of the century, other authors estimated a total of 360 000 fatal occupational injuries.2 This plateau in mortality from occupational injury is unacceptable. No person should become sick or die from doing their job. If we are to achieve the United Nations Sustainable Development Goals of ‘decent work’ and ensuring ‘healthy lives and promoting well-being’ we must aim to minimise this number. There is substantial opportunity to achieve this through prevention of unintentional injury including in the workplace.3
Occupational fatality data continues to be an important information source for monitoring the effectiveness of workplace safety policy and programmes. The same data provides valuable insights into social and demographic disparities in workplace safety—information that can support more effective resource allocation. Importantly, the WHO/ILO data also demonstrate that deaths at work are not equally distributed. Workers in low and middle-income countries are more likely to die at work than those in high-income countries.1 Further, among high-income nations with similar work environment contexts and safety regimes, differences in fatal occupational injury rates are still observed that cannot explained by demographic or industrial characteristics.4 These disparities, apart from illustrating the inequitable distribution of workplace risks across society, also suggest opportunities to target safety and prevention activities to groups at greatest risk.
In the December issue of Occupational and Environmental Medicine, a study by Martin and colleagues sheds some new light on this topic, examining disparities between sociodemographic groups within a single US state.5 They describe a retrospective cohort study of unintentional occupational fatalities in the state of North Carolina occurring between 1992 and 2017 and examine disparities in fatal injury rates between demographic groups, as well as time trends. Significantly higher fatality rates were observed in male workers (vs female workers) and Hispanic workers (vs non-Hispanic white workers). Adjusting for occupation reduced these disparities, though they remained statistically significant. This shows that men and Hispanic workers are more likely to perform higher risk tasks when working, than women and non-Hispanic workers, respectively.
The authors describe this as occupational segregation—a concept reflecting deeply ingrained societal biases around gender roles at work, and the relationship between employment and ethnicity, race and sexual orientation.6 One unstated but very important implication of this study is that eliminating the disparities in death at work will most likely require more than better (or different) occupational health and safety policies and practices. Action at a societal level to reduce occupational segregation is also likely required.
Another important finding from the study is that while overall fatal injuries declined over the study period, particularly in the first decade of this century, they increased in the period between 2009 and 2017. In supplementary analyses the authors show that this increase mirrors trends observed over the same period in occupations and industries that account for a high number of fatalities—construction, forestry and transport. This reflects the global data noted earlier, in which transport-related fatalities have increased this century.1 A number of other demographic and occupational factors were associated with risk of death at work. Self-employed workers recorded a higher relative age-adjusted fatality rate than privately employed workers, with government employed workers recording the lowest rate. An age gradient was also observed with risk increasing progressively with age. Overall, the study shows that there is still much work required to reduce deaths at work.
The Martin et al study reminds us of the influential socioeconomic gradient on worker health and safety that has been observed for decades,7 with the effects on mortality extending beyond working life and into retirement.8 This study demonstrates that these social and demographic forces continue to have a strong relationship with risk of death at work. It also suggests that making substantial inroads into workplace death is likely to require action outside of workplaces, to address ingrained social disparities in areas such as gender, ethnicity and race. We already recognise work as an important social determinant of health, but equally social determinants clearly influence health and safety at work. There are many laws and policies that affect the health of workers—our focus as a research community has mainly been on the domains that have a direct impact on workers and workplaces—for example, workplace safety, labour relations and social insurance systems such as workers’ compensation and healthcare.9 If our goal is to reduce or eliminate death and disability at work, it seems clear that occupational health and safety researchers and practitioners must actively extend our influence beyond this sphere, and into broader areas of social policy that have less direct, but nevertheless very powerful, effects on worker health and safety.
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Footnotes
Contributors AC is the sole author of the commentary.
Funding Author AC is supported by an Australian Research Council Future Fellowship (FT190100218).
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.