Introduction to Occupational Health in Public Health Practice

Bernard J. Healey, PhD, is director of the Graduate Program in Health Care Administration, King's College, Wilkes-Barre, Pennsylvania, and Professor of Health Care Administration. Formerly, he was a public health epidemiologist for the Commonwealth of Pennsylvania. Kenneth T. Walker, CSP, is president of Endless Mountains Safety Consulting, Inc., Tunkhannock, Pennsylvania and adjunct professor at the University of Scranton. Previously, he was Industrial Hygiene, Safety, Emergency Response, and Technical Equipment Safety Manager for Proctor and Gamble Corporation. In 2009 he was elected a regional director for the American Society of Safety Engineers.

Figures, Tables, and Exhibits xi

Introduction xv

Acknowledgments xix

The Authors xxi

The Contributors xxiii

Part One Public Health Prevention Focus 1

1 History and Importance of Public Health 3

A Brief History of U.S. Public Health 4

Healthy People 2010 8

Responsibilities of Public Health 11

Public Health Accomplishments 11

Emphasis on Prevention Not Control 14

Public Health and Occupational Health 16

Summary 25

Key Terms 25

Questions for Discussion 25

2 Epidemiology of Occupational Safety and Health 27

Introduction to Epidemiology 28

Surveillance Systems 31

Epidemiology Studies 33

Health Hazard Evaluations 35

Public Health Systems in the Workplace 37

Chronic Disease Epidemiology in the Workplace 38

Summary 39

Key Terms 39

Questions for Discussion 39

Part Two Occupational Safety and Health 41

3 History and Importance of Occupational Safety and Health 43

Health, Disease, and Prevention 48

The Role for Public Health 51

Summary 54

Key Terms 55

Questions for Discussion 55

4 Occupational Injuries 57

Epidemiology of Injuries 58

The Case for an Epidemiological Approach 59

Epidemiology of Accidents 66

Epidemiology of Violence 68

Surveillance Systems for Occupational Injuries 69

Surveillance Results 70

Injury Prevention Programs 73

Future Challenges 77

Summary 78

Key Terms 80

Questions for Discussion 80

5 Compliance versus Prevention 81

OSHA Standards Development 84

The Inspection Process 88

Compliance or Prevention 90

Prevention of Cumulative Problems 93

Summary 93

Key Terms 93

Questions for Discussion 93

Part Three Public Health Issues in Occupational Safety and Health 95

6 Toxicology 97

Application to Occupational Epidemiology 98

Subdisciplines in Toxicology 99

Classification of Toxic Agents 100

Environmental Tobacco Smoke 103

Risk Assessment 104

Toxicology Case Studies 105

Toxin Regulation and Research 105

Summary 108

Key Terms 109

Questions for Discussion 109

7 Stress 111

Stress Basics 112

Workplace Characteristics and Stress 116

Organizational Response to Stress 117

When to Get Help 122

Summary 122

Key Terms 122

Questions for Discussion 123

8 The Impaired Employee 125

Drug Use Frequency and Demographics 127

Epidemiology of Addiction 129

Substances Often Abused 134

Drug-Free Workplaces and EAPs 136

Summary 140

Key Terms 140

Questions for Discussion 141

9 Wellness Programs 143

Chronic Diseases in the Workplace 145

The Value of Wellness Programs 146

Addressing Obesity and Nutrition 147

Addressing Physical Inactivity 151

Addressing Tobacco Use 153

Developing Comprehensive Health Programs 155

The Role for Public Health 157

Summary 159

Key Terms 160

Questions for Discussion 160

10 Emergency Response Planning 161

Definitions 162

Emergency Management Planning Steps 162

Terrorism and Bioterrorism 164

Workplace Preparedness for Terrorism 167

CDC’s Strategic Workplace Plan 168

Applying Epidemiology to Preparedness 168

Applying an Information Model to Preparedness 174

Involving OSHA and NIOSH in Planning 175

Summary 176

Key Terms 177

Questions for Discussion 177

11 Ergonomics 179

Two Approaches: Broad and Narrow 181

Ergonomists’ Roles and Experience 187

Few Absolute Limits 188

Cumulative Trauma Disorders 189

The Industrial Athlete 195

Summary 198

Key Terms 198

Questions for Discussion 198

12 Communicable Diseases 199

Epidemiology of Communicable Diseases 200

Foodborne and Waterborne Diseases 202

Tuberculosis 203

Hepatitis 204

HIV and AIDS 207

Influenza 208

Emerging Infections 209

Summary 213

Key Terms 213

Questions for Discussion 214

13 Vision and Hearing Issues 215

Protecting Vision in the Workplace 216

Protecting Hearing in the Workplace 223

Summary 231

Key Terms 232

Questions for Discussion 232

14 Occupational Health Disparities 233

Disparate Populations 234

How Do Health Disparities Persist? 251

Future Trends in Health Disparities 256

Summary 257

Key Terms 258

Questions for Discussion 258

Part Four Evaluation and Leadership Issues in Prevention 259

15 Economic Impacts of Prevention 261

Premature Mortality 262

Employer Health Insurance Costs 262

The Purposes of Economic Evaluation 264

The Burden of Injury and Illness 264

Types of Economic Analysis 266

Target Areas for Evaluation 268

Summary 276

Key Terms 277

Questions for Discussion 277

16 Impacts of Leadership and Culture 279

Using Vision and Management Skills 282

Using Power Effectively 284

Exercising Transformational Leadership 286

Changing the Process of Work 287

Motivating Employees 287

Building a Culture 288

Empowering Workers 290

Improving Team Effectiveness 291

Summary 292

Key Terms 292

Questions for Discussion 292

References 293

Index 313