Burden of Injury due to Occupational Exposures
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Occupational injuries, also called occupational accidents, have existed as long as the humankind. Such injuries have often been considered to “go with the business.” Injuries are, however, not caused by a law of nature. They are preventable as has been demonstrated by best practices elsewhere. This chapter provides an overview of important global trends of occupational injuries, with data sources coming mostly from developed countries. Moreover, good policy and practice solutions are emphasized.
The best available data and numbers of injuries have been estimated by the International Labour Organisation (ILO), based on thorough investigation. These findings indicate that, globally, the annual number of fatal occupational injuries is 380,000. This is composed mainly of an Asian burden of 250,000 deaths and 65,000 deaths in Africa, with only 10,760 deaths taking place in the high-income region. Occupational injury rates vary widely within and between regions, being highest in the riskiest sectors and occupations in less-developed countries. The average annual range between countries varies from 0.5/100,000 to 27.5/100,000. The range between the safest and most hazardous jobs annually varies between 0 and 500 deaths/100,000, the most hazardous jobs being in tropical logging. The estimated global cost of poor or non-existing safety and health measures has been estimated to be around 3 trillion USD, equivalent of 3.9% of the global GDP. Globally, the number of occupational injuries is still growing, despite successful reductions in the high-income regions. The human burden and economic price of occupational injuries are very high.
KeywordsOccupational injuries Accident prevention Safety at work Costs Burden of injury Exposures to risks
History and Background
More organized work started when individuals were not just working for the family but as requested or ordered to work for an outsider either as an exchange of services or for a leader such as a landowner, slave master, duke, king, pharaoh, or emperor. Employment as a concept and industrial work started when individual craftsmen were needed in larger scale and when industrial revolution took place.
Over the years, high-income (WHO classification) countries have done well to reduce occupational injuries (Hämäläinen et al. 2006, 2009, 2010, 2017; Takala et al. 1997, 1999, 2014; Takala 2017; García et al. (2007), despite having an increasingly complex work environment.
Improvements in technology, processes, and methods
Better leadership, management, and efforts in safety and health
Reduction of the number of workers in hazardous industries
Shift in economic structures
Furthermore, hazardous and labor-intensive workplaces, such as those in manufacturing and construction sectors, have decreased in most developed countries, and much of such work takes place in other locations, in particular in Asia. It is common that in developed countries, more than two thirds of all workers are already working in service occupations. The processes of mechanization, automation, and prefabrication are also foreseen to contribute to jobs less exposed to injury risks. However, most of the population is exposed to “new and emerging” work risks related to long-term health effects, such as psychosocial factors, stress, musculoskeletal disorders, and exposures to carcinogens.
Globally the population living in extreme poverty has been radically reduced to some 800 million people, and global life expectancy is today about 70 years (Rosling et al. 2018). The poorest group needs to be taken care of by eliminating extreme poverty. The rest or some seven billion of the global population have already been elevated from extreme poverty, and prevention of occupational injuries and work-related diseases has a major role in further avoiding also their hardship and in improving the well-being of workers and their families. The workforce including the household workers – some 3.5 billion workers – is the sole productive component of the society upon which children and students, retired and older population groups, and the disabled will have to rely on getting their livelihood. An occupational injury, fatal or non-fatal, and disabling disease or disorder immediately affect the well-being of the depending populations. The breadwinner becomes dependent on others as well.
This chapter reviews latest global and country numbers of occupational injuries within the framework related to not only work-related injuries but also related illnesses and presents data of selected countries and regions. It is a summary of the evolution, present state of art, and possible future trends in the global burden of injury and measures to reduce and eliminate such burden.
Materials and Methods
Sources of Data on the Burden of Injuries and Illnesses at Work
Employment figures, mortality rates, occupational burden of injuries, selected diseases, and reported accidents were reviewed for this chapter. These were complemented by surveys on self-reported occupational injuries, economic cost estimates of work-related injuries, and the most recent information on the problems from published papers, documents, and electronic data sources of international and regional organizations, in particular ILO, WHO, EU and ASEAN, safety and health institutions, agencies, and public websites (Driscoll et al. 2005; ‘t Mannetje and Pearce 2005; García et al. (2007), Hämäläinen et al. 2006, 2010; Takala 2005, 1997, 1999).
While it is difficult to compare national data related to occupational injuries due to differences in legal and compensation criteria, the comparison between the number of fatal injuries (accidents) is easier, and, although not completely, it is reasonably comparable when the recording criteria, denominators, and economic structures are well documented. Usually fatal injuries are expressed per 100,000 employed persons in national statistics or per 1 million working hours which may be converted to 100,000 full-time employed.
The standardized numbers in Fig. 1 included adjustments based on average industry structures in the EU. Countries that have a relatively high level of activity in high-risk industries, such as construction work, would otherwise show much higher rates as compared to those with a high service industry component even though within each economic sector, their safety levels and rates would be equal to those in another country. While Eurostat rates have been standardized, the added non-EU country rates have not been adjusted due to lack of comparable data. Fatal injury rates in industrialized countries are gradually going down, partly due to a shift in the countries’ economic structure from dangerous sectors to less risky ones, such as the service sector (Fig. 1).
Data from Singapore illustrates the trend in many industrialized countries where fatal occupational injuries are gradually becoming a smaller problem as compared to health issues (Fig. 2). However, this is not the case for most populous countries in the world where the injury rates are high and the rates are increasing in many areas. Furthermore, while several work-related diseases are the main killers, such as occupational cancer and work-related cardiovascular diseases, injuries take place for much younger worker groups. Long latency diseases and disorders are often linked to ageing. As a result, the fatal injuries form a much bigger share of the disability-adjusted life years, DALYs, as compared to those of deaths due to work-related diseases (GBD 2016).
The ILO statistics complemented with published data provide a reasonably reliable picture of a limited number of countries. Singapore data from the Ministry of Manpower provide a typical picture of the declining trend in high-income countries (Fig. 2). The fatal injury trend has gone down from 21.3 to 1.2 in 40 years. In small countries the random fluctuation of relatively small numbers can be compensated by calculating a rolling average of 3–10 years. The number of workers covered and gradual increase are better covered when rates/100,000 workers are used at the country level. In enterprises and workplaces, Lost Time Injury rates are often used where the denominator is the number of hours – or million hours – worked in the location concerned. One million working hours are roughly equivalent of 500 workers in a year if a worker performs 2,000 h a year.
Underreporting is common in both fatal and, in particular, non-fatal cases. Another major problem in comparing data from different countries is what is really required by the authorities. In some highly developed countries, work-related traffic accidents are not covered by reporting requirements and consequently do not appear in statistics. These could be injuries of bus, truck, and taxi drivers, pizza delivery workers, salespeople, and many others present in road, rail, sea, and air traffic and logistics. They may be well compensated but not counted in statistics. Usually travels in traffic from home to work and back are covered separately but not in direct occupational injury statistics.
There are often major further omissions of coverage. Some sectors and groups of workers are not covered, such as uniform workers, military, police, government in general, housemaids working in other peoples’ homes, agricultural workers, self-employed farmers, and other self-employed. In an Australian study, comparing all sources of information of injury numbers including compensation bodies, labor inspectorates, coronary reports, hospital records, deaths certificates, and media reports, none of the sources were complete and at best covered some 50–60% of the cases. The burden to find out such details makes it simpler to use fatal cases as a baseline when comparing the outcomes in different countries. The pyramid method in Fig. 8 can be useful for such estimates.
Fatal injury rates per 100,000 employed worldwide
EMRO Eastern Mediterranean
Occupied Arab Territories
The overall fatality rates in the whole economy vary considerably depending on the national practices and definitions of injury categories and coverage of legal requirements. As a result and to avoid over- or underestimates based on these statistics, a generally accepted method has been to use fatal injury rates of specific industrial sectors, in particular the three main sectors that have a wide difference of the risk level between them. The ILO practice has used this method in covering the three main economic sectors.
Selection of data for these sectors and using proxy countries was based on the reliability and credibility of such data based on national reporting and documentation and representativeness for the region concerned. The rates where then applied to the country concerned and the summing up of the sectoral estimates for the country. The description of the estimation method is presented below and covers all countries and regions in the world (Hämäläinen et al. 2017).
Estimates of work-related deaths
Total number of deaths due to occupational injuries (occupational accidents)
Number of fatal injuries reported to the ILO and EU28 based on member States reporting systems (ILOSTAT and Eurostat)
Included fatal injuries, injury rates in three major economic sectors separately, in particular, in agriculture, forestry, mining, and other basic (primary) industries. These rates included work-related traffic fatalities and suicides but excluded fatalities via commuting to work and back
As ILO data includes data from a limited number of countries, those countries where no information was available were grouped in specific regions, in particular WHO regions and subregions, and fatal injury rates per 100,000 employed of one or several countries of comparable production and economic systems that had produced injury rates were used as proxy values
To increase the accuracy, separate injury rates were used for (1) agriculture and fishing, mining, and other primary economic sectors, (2) industry sectors including construction, and (3) service (tertiary) sector. This balances some of the potential differences between reporting proxy countries and non-reporting countries
Identification of Fatal Occupational Injuries in the ILO Estimates 2017
Agriculture including farming, fishing and forestry
Industry including mining, manufacturing, energy production, and construction
High-income countries (HIGH)
Low- and middle-income countries of the African Region (AFRO)
Low- and middle-income countries of the Americas (AMRO)
Low- and middle-income countries of the Eastern Mediterranean Region (EMRO)
Low- and middle-income countries of the European Region (EURO)
Low- and middle-income countries of the Southeast Asia Region (SEARO)
Low- and middle-income countries of the Western Pacific Region (WPRO)
Identified fatal occupational injury rates per 100,000 employees
Fatality rates of each economic sector
The previous rates of fatal occupational injuries were used for HIGH, AFRO, and EMRO division because of lack of data. The percentage of labor force for each economic sector in each country was retrieved from The World Factbook of the Central Intelligence Agency (CIA). These percentages can also be obtained from ILOSTAT Database, but they are percentages of the employed instead of the labor force. Together with the labor force, total employment (comprising both paid employment and self-employment), and respective divisions’ fatality rates in 2014, the number of fatalities of each country was then computed.
Non-fatal Occupational Injuries
The estimated non-fatal injury is then finally obtained by taking the mean of the two limits.
Results and Trends from Statistical Sources
Cancer is a disease – occupational cancer is an administrative decision.
The same reservation applies to occupational injuries. It is easier to see the occupational causes for injuries but the coverage equally varies widely. For example, in many Asian and African countries, the legal coverage, the enforcement coverage, coverage of compensation systems, recording and reporting systems, and coverage of prevention services, such as occupational health services, are in the range of 0–10% of the workforce. Almost no country has a full 100% coverage of these systems.
Work-relatedness is usually based on epidemiological and scientific studies and based on the latest data. These may be based on risk ratios obtained through case-control studies and measured by related population-attributable fractions of various diseases. Work-relatedness of injuries – even though injuries are not recorded and compensated – is estimated through best practices of reporting and/or through household surveys. At best these two methods provide reasonably close results. This depends, however, on the knowledge, awareness, and cultures of different economies.
There was an estimated 2.78 million fatalities – injuries and diseases at work – in the latest survey results of 2017, based on data from 2015, compared to 2.33 million estimated in 2011.
Global trend of occupational accidents and fatal work-related diseases (1998–2015)
Fatal occupational accidents
Non-fatal occupational accidents at least 4 days absence
Fatal work-related disease
As a comparison to the global picture, in the European Union, EU28, cardiovascular and circulatory diseases account for 48% and cancers at 53%. They were the top illnesses responsible for 4/5 of deaths from work-related diseases in EU28. Occupational injuries (2.4%) and infectious diseases (2.5%) together amount accounts for less than 5%. On the other hand, in the non-high-income countries and regions, the share of occupational injuries is much higher; e.g., in Western Pacific Region dominated by China, it was 17% of all fatal injuries and diseases (Hämäläinen et al. 2017).
Long-term disabilities caused by musculoskeletal and psychosocial (mental) disorders are expected to affect the female population (GBD 2017) more seriously, while injuries are a much larger problem for males.
The method and results for EU28 are explained on the website of the European Agency for Safety and Health at Work (Elsler et al. 2018). The baseline for the cost estimates is the number of DALYs in a country in relation to DALYs in an ideal situation where no occupational accidents or work-related disorders take place.
Non-fatal Injury Surveys
Injuries by occupational accidents in selected countries including 1 day or longer absence Eurostat Statistics in focus 63/2009 (Eurostat 2009)
6.3% of the workforce
5.4% (data from WSH Institute, Ministry of Manpower)
Work-related ill health
24.5% of the workforce
10.0% (data from WSH Institute, Ministry of Manpower)
It appears that minor injuries are more frequent in Germany and the Nordic countries, in fact only the reporting of minor injuries appears to be better. The rates may also be obtained for just compensable injuries, which in many countries include accidents that cause an absence of work for 4 days or more.
The Relationship Between Serious and Less Serious Outcomes for Occupational Injuries
Occupational Injury Burden Is Unequally Shared by Various Groups of Workers
Workers in high-risk sectors in any country may have radically different risks; construction workers may have a 50 times higher risk of fatal and other accidents than in office or banking jobs.
Some occupations and jobs are particularly dangerous anywhere, such as logging with traditional methods in tropical forests, small vessel fishermen, coal and other miners, small plane pilots, farmers, pizza delivery drivers in traffic, street sweepers, carpenters, etc.
Injuries concentrate on male workers due to the selection of jobs and occupations, while even in exactly similar jobs such as female taxi drivers, they have less injuries; however female workers have more other types of occupational risks.
Small-scale industry workers have much higher injury risk than large enterprises.
Young workers and child laborers are, in particular, in a vulnerable position due to non-existing experience and training.
Some of the injury risks concentrate when work is carried out by young workers or even by children, often without any training, work in high-risk sectors, and jobs in a small enterprises in some low-income countries. Such work may be carried out for bigger enterprises as contractors or subcontractors. This sort of unethical treatment of vulnerable workers that have no choice to select a better job must be eliminated.
Rates and numbers of occupational injuries in selected countries
Fatal injuries at work (occupational accidents) including and excluding those related to traffic in selected countries and regions, absolute numbers (N∗) and fatal injury rate (N∗/100,000)
Year & Type/Area
China, IHME/GBD 2013
China. ILO 2010d
Rate, 2011–2013, excl. traffic@ work
N∗, 2011 excl. traffic@work
N∗, 2010–2011, incl. traffic@work
Cost Estimates of Injuries and Illnesses at Work
Various cost estimates have been carried out by Australia, the USA, Finland, Norway, EU, and others. The ILO and EU jointly updated their cost estimates in 2017. Usually such cost estimates cover direct and production losses only and not the intangible costs, such as the cost of the virtual statistical life, which could multiply the costs by a factor of 3–4. However, the share of occupational injuries is about 11% of this 3 trillion or 323 billion USD (323 ∗ 109 USD), roughly equal to that of occupational cancer globally 12.4% of all costs. These rates vary considerably, for example, the highest share is for the EURO Eastern European Region: 16.2% of the region’s total costs.
Policies and Practices to Prevent Injuries Include a Range of Traditional and New Measures
Establishing a Research Agenda setting priorities for the continuous search for evidence for policy and practice (Takala et al. 2014)
Building a Risk Observatory or Observatory for Workplace Landscape (OWL)
Often perceptions drive action more than real evidence, and it is important to highlight the difference between media interest, public attention, and real evidence for policy and practice. Media, including social media, are vital for communication, for reaching large numbers of stakeholders, workers, small and medium-sized enterprises (SMEs), the informal sector, migrant workers, and vulnerable groups, and to foster a safety culture at places of work. However, misperceptions in assessing risks exist. Statistical risks are not easy to assess and understand correctly. Further, common everyday risks are underestimated, and complicated technological risks that are not easily controlled by individuals are overrated.
Leadership, management, and systems thinking at all levels and related worker engagement have been identified as key for efforts to ensure workplace safety and health. Recent experiences from mega-projects such as the London Olympics construction effort were successful exactly because of emphasis on and continuous follow-up of these factors. The numbers presented in Tables 2 and 3 are alarmingly high and often poorly understood, and their importance has been underestimated. One should also keep in mind that the targets or “goal posts” are gradually moving due to changes in work, workplace, and work force. A systems approach is necessary at all levels. An enterprise management system is the strategic component for an organization, but an action program for risk assessment and priority setting for risk management are also needed. Collaboration between management and workers at the organizational (enterprise) level must be followed by a national-level mechanism, such as a tripartite advisory council, that looks after wider issues like new legal measures and better strategic enforcement.
Contrary to some perceptions – according to USA/OSHA (government) view – enforcement supports employers in reducing injuries and injury claims, and saving compensation costs, on average 26% or USD355,000, as a result of inspection of the company, and saving employers US$6 billion nationwide in the USA. This counts neither the costs of lost production of the injured workers nor the pain and suffering.
Several key processes have been gaining momentum, such as design for safety, and control banding based on the new Globally Harmonized System for Classification and Labelling of Chemicals (GHS) labelling requirements. One groundbreaking and new longer-term concept, or philosophy, is Vision Zero. The idea is to change the values and mindset of all stakeholders from business as usual and ensure zero accidents, zero illnesses, zero exposures, zero violence, zero harassment, and simply zero harm during an entire working life as the objective. So far it has been launched for selected special needs already, such as the Swedish traffic vision. It is not a key performance objective but a new mindset.
Globally, occupational injuries are still going up, while they have been successfully and continuously reduced in the high-income countries and regions. However, much of the progress has been achieved in “exporting” these injuries with the global production to locations where manufacturing – and construction – takes place, such as Asia. In the rapidly industrializing countries and regions, the injury numbers have gone up and may go down gradually only later, while the evidence is very limited.
This transfer of technologies has been incomplete. Machinery and production methods are easy to move from a continent to another, but the “software” or safety as a value, zero harm thinking, and concrete management goals as well as the measuring of progress through relevant indicators will need to be taken seriously.
While the negative outcomes, death, and permanent or temporary disability caused by occupational injuries are easy to detect, these are globally poorly recognized and reported. All injuries are avoidable; we do have all measures to prevent them everywhere in the world. This requires a paradigm change in thinking at workplaces around the world.
Key action programs should concentrate on finding solutions and reducing exposures to various injury risks and including for illnesses that have a long latency period. For each injury and illness, there are many factors with influence on the negative outcomes. Cultures that start from committed and capable leadership in the organization need to be developed, and presently known best practices as well as new innovations at an organization and country level need to be identified and used. In addition to laws, enforcement, and health and safety services, media including social media should be better used for promotion of safety, health, and well-being at work.
Occupational injuries and work-related diseases and disorders are a bigger problem than estimated earlier. Longer-term risks are gradually increasing in importance at workplaces. A toolbox comprising (i) legal measures; (ii) enforcement; (iii) knowledge and solutions; (iv) incentives; (v) awareness raising and campaigns; (vi) services available to enterprises and organizations, such as occupational health services; and (vii) networking for best exchange of good practice is vital for any successful strategy for safety, health, and well-being at work.
A comprehensive toolbox model is the ILO Convention no. 187 on the Promotional Framework for Occupational Safety and Health. Furthermore, ILO Code of Practice on Recording and Notification of Occupational Accidents and Diseases provide further guidance in a compact form.
Safe work is about decent work, good work, for life. In the words of the former Secretary General of the United Nations, Mr. Kofi Annan: “Health and safety at work is not just sound economic policy – it is a basic human right.”
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