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Successes and failures in occupational injury prevention
  1. Jorma Saari
  1. Finnish Institute of Occupational Health, Laajaniityntie 1, Fin-01620 Vantaa, Finland

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    Occupational accidents are a major health hazard. According to International Labor Office, injuries killed 335 000 people at work in 1994.1 The good news is that there is a declining trend of fatal accidents in most industrialized countries. For too many, injuries are, however, like a fringe “benefit”. If one gets a job, one also has to accept the risk of being killed or seriously injured at work.

    Another element of good news is that the best companies have reduced their injury rates to very low levels. Especially the petrochemical industry, which has improved its safety performance in an outstanding manner. Many other industries are also putting serious efforts into promoting safety. For example, the steel industry recently published a book guiding steel companies towards “accident free production”.2

    Ethical issues are also receiving more attention in the global business world. Several events during the past two years have shown that many people mistrust global corporations. The business world counteracts positively by emphasizing ethical principles. Occupational injuries or other ill health arising from work are not deemed acceptable if a company claims to be following high ethical standards.

    Many people may not believe in voluntary ethical standards. In safety, we too often have to accept the good results of voluntary efforts. And, to be fair, at least some companies have excellent safety practices. For example, the chemical industry has been using the global “Responsible Care” program and this has lead to many examples of excellent safety at work. To better promote safety in the workplace, we need to better identify exemplary, landmark companies.

    The development of better communication systems appears to have had a positive effect on safety in the workplace. Benchmarking has also become popular. This permits companies to continually compare their performance with that of other companies, not only in the same country but also in other countries.

    Comparisons between countries are thus a critically important tool to support the creation of nationwide preventive programs. Therefore the paper by Feyer and her colleagues in this issue is an important step towards better understanding the effectiveness of prevention.3 In this paper, work related fatal injuries in the United States, Australia, and New Zealand are compared. The rate of fatal occupational injuries was highest in New Zealand and lowest in the United States. Much of this difference is accounted for by the differences in the structure of industry. For example, water transport injuries are more prominent in New Zealand, and this is almost certainly a matter of exposure.

    One surprising finding was that the largest difference among these countries was in the rate of intentional injuries in the workplace. Employees in the United States are subject to intentional injury much more often than in the other two countries. Homicide is most frequent in sales jobs. However, managers, professionals, and people working for public administration also experience violent injuries more often in the United States than in the other two countries.

    Differences are not the only interesting aspect in these international comparisons. Similarities are at least as important. It is noteworthy that mining, agriculture, forestry, and construction are in all three countries the work settings where there is the highest probability of being killed in a work related injury. Machinery, falling objects, and falls are consistently the leading causes of these fatalities.

    Why is it that the construction industry has high injury rates everywhere, while the manufacturing industry has been able to reduce rates considerably? The variability of working conditions is likely to be one answer. Yet, the manufacturing industry produces a wide variety of products. For example, the auto industry assembles different models with different colors and equipment packages on the same production lines.

    Another difference between the manufacturing industry and the construction industry is specialization. The manufacturing sector is highly specialized according to products and specialization continues, for example, in the form of outsourcing. The construction industry is much less specialized and has not developed standardized production processes.

    A further difference between manufacturing and construction is that manufacturing firms are much more international and, therefore, more transparent than construction firms. Construction has not faced similar competition as manufacturing. Agriculture is another sector of activity displaying high injury rates internationally and agriculture is also much more domestic than manufacturing in all countries.

    Feyer and her colleagues restricted their study to fatal injuries. Yet, they faced many problems in collecting consistent datasets from all three countries. These difficulties would be even greater if less serious injuries had been included. In spite of difficulties, we must continue to conduct international comparisons to learn more about success and failure in prevention. Why, for example, has the petrochemical industry in some countries been able to lower injury rates much more than in others?

    “Safety culture” became a popular concept among safety researchers during the last decade.4 The three countries Feyer et al studied were culturally different but similar in many other respects. However, their results quite clearly seem to reflect structural differences more than cultural differences. Is it that with safety culture we have invented “a face saving concept”? If we do not understand (or accept) what needs to be done to prevent injuries, one can always withdraw behind the mysterious “safety culture”. As culture changes so slowly, we cannot be blamed for not doing anything even if we actually do not know what to do... or so goes the rationalization.

    This rather cynical view of safety culture may not be justified. Perhaps there is a widespread culture about safety that includes a large dose of fatalism. As the same picture of work related fatal injuries prevails everywhere, there should be something in common. Common structural factors may the connecting factor. For example, agriculture is a family business in most countries.

    In addition to structural factors, there may also be common cultural factors. One could be the lack of belief in prevention. This may be universal and extend to other health areas, too. Finding success stories is essential to convince people about the feasibility and necessity of prevention.

    In the area of injury, we need to convince others that prevention is both important and feasible. Another thought provoking paper in this issue strongly supports this simple statement. O'Connor's article is about work related spinal cord injury.5 Such injuries are fortunately rare; there is no cure and the level of impairment does not improve substantially even after rehabilitation. Therefore, prevention is the only way to go.

    Falls are a common cause of spinal cord injuries and, of course, of many other types of injuries as well. As many people seem to be quite fatalistic about the possibility of preventing falls, we need more research on walking safely and maintaining body balance.

    Spinal cord injuries have a substantial economic effect. According to O'Connor, spinal cord injuries generated a long term care cost of more than 23 million Australian dollars each year. The long term care cost for a ventilator dependent tetraplegic is $4 million (Australian). It would seem that this shocking figure alone readily justifies even an expensive preventive program.

    In my opinion, the cost of injuries should not be the driving force of prevention: rather, it should be the improvement of the quality of life. Yet, these examples also demonstrate the economic value of injury prevention. Money saved is a bonus from successful injury prevention.