Health Law & Policy Institute

OCCUPATIONAL INJURY AND ILLNESS IN TEXAS EXECUTIVE SUMMARY

In 1991, the Legislature of the State of Texas funded the study, "Occupational Injury and Illness in Texas." The study was conducted by the University of Houston Health Law & Policy Institute and involved collaboration with the University of Houston Department of Economics, and The University of Texas School of Public Health (the Southwest Center for Occupational and Environmental Health). It also involved consultation with numerous state and national occupational safety and health professionals, and a sixty-two member advisory board.

The major study objectives included:

 Magnitude and Economic Costs of Occupational Injury and Illness

Occupational injuries and illnesses exact a large human and economic toll from Texans. The rate of occupational fatalities has fallen over the past decade in Texas and the U.S., and available data for Texas do not indicate an excess rate of nonfatal injuries and illnesses compared to the U.S. However, Texas continues to experience an occupational traumatic fatality rate sixty percent higher than the U.S. (private sector). Each year in Texas, over 500 workers are killed and one-half million workers are injured on the job. Although less precise estimates are available on illnesses, approximately 4,000 persons die from and over 20,000 workers develop an occupational illness each year. Total economic losses related to medical costs and lost productivity for these occupational injuries and illnesses amount to $3.8 billion, of which over sixty-two percent are medical costs. The tragic aspect of these data is that the majority of these injuries and illnesses are preventable. Therefore, these adverse events must not be considered an acceptable risk to our Texas work force.

Texas lacks comprehensive, quality information needed to make sound policy decisions in occupational safety and health. Accurate information can help policy makers identify and prioritize problem areas so that resources can be allocated in the most effective and efficient manner. Surveillance systems for occupational injury, illness, hazard exposure, and medical costs for Texas, as well as for the nation as a whole, are incomplete and fragmented, and its availability to researchers is limited by confidentiality concerns. Promising new federal/state efforts for injury surveillance are being implemented, but these efforts have yet to be evaluated. Data collection systems are more developed for fatal occupational injuries than for nonfatal injuries; data on occupational illnesses are the most severely lacking.

Approximately one million state, county, and municipal workers in Texas are not covered under the Occupational Safety and Health Act. Adequate data are not available on their injury and illness rates, despite the fact that many occupations in the public sector are known to be at high risk for injuries and illnesses.

Based on available data sources, the following highlights of the study should help direct the identification of policy options:

STUDY HIGHLIGHTS

I. Injury and Illness

A. Leading causes of fatal occupational injuries

• Motor-vehicle and homicide deaths on the job account for forty percent of all work-related injury deaths in Texas. Homicide became the leading cause of occupational injury fatalities in 1991; however, the rate has always been high and was overshadowed by a high rate of occupational motor vehicle-related fatalities, which is declining.

• In 1989, over one-third of all workers' compensation compensable injuries were back-related.
 
• Of the illnesses reported to the Bureau of Labor Statistics, cumulative trauma disorders accounted for fifty-five percent of all occupational illnesses in Texas.

• Texas rural counties experience occupational injury fatalities at a rate eighty-two percent greater than urban counties.
 
• Construction remains the industry division in Texas with the highest fatality rate and the only industry not demonstrating declining rates since 1980. Data were not available by firm size or other company characteristics.
 
• Meat packing plant workers in Texas experience an extraordinarily high injury rate (37.4 per 100 full-time workers per year), which exceeds the already high U.S. rate by thirty-five percent.

• Based on Texas death certificates from 1980-1990, each year on average, eleven children were killed on the job in Texas. Further, in 1991, over 1,000 injuries and illnesses among children less than 18 years of age were reported to the Texas Workers' Compensation Commission.
 
• Several special studies of occupational injury and illness in Texas indicated a disproportionate representation of Hispanic workers.

• Economic projections suggest that workers' compensation payments in 1990 would have been over 41.2 percent below actual workers' compensation payments, implying that the enormous growth in the program in the 1980s was primarily due to factors other than changes in the work force size, industrial structure, national trends in injury and illness incidence rates, or wage rates.

• An estimated fourteen percent of Texas private sector workers are potentially exposed to upper extremity cumulative trauma, six percent to crystalline silica, and five percent to noise (shown to be related to cumulative trauma disorders, silicosis, and noise-induced hearing loss, respectively).
 
• The service industries of various types also had risks of potential exposures in addition to traditionally hazardous industries.
 
• Direct data for measuring agricultural worker exposure to pesticides within Texas are not available.
 
• A large percentage of the Texas work force is estimated to work in indoor non-industrial environments in Texas at risk of health effects from indoor air pollution. However, no information on the prevalence of indoor air pollution is available in Texas.
 
• Even after several years of the Occupational Safety and Health Administration (OSHA) hazard communication standard being in place, the largest category for OSHA serious citations is hazard communication.

• In Texas, there is a shortage of comprehensively trained core occupational health professionals (physicians, nurses, industrial hygienists, and safety professionals).
 
• More than 150 additional occupational medicine physicians, 100 primary care practitioners with occupational medicine training, and 1,600 occupational health nurses are needed to meet current occupational health service demands in Texas. Although not quantifiable, there is a shortage of professionals in nearly all areas of industrial hygiene practice.
 
• Certain geographic areas, such as the Rio Grande Valley, are particularly affected by these shortages. This may be partially attributed to the minimal number of programs in Texas providing specialized training in occupational health.
 
• Fewer than half of the nurses who work for business and industry in Texas possess a baccalaureate degree. This degree is the minimum requirement for 1995 applications for professional certification.
 
• There is a lack of occupational health content in curricula in medical and nursing schools, as well as in training programs for other occupational health-related professional disciplines (occupational therapy, physical therapy, vocational rehabilitation specialists, and chiropractors).

OCCUPATIONAL SAFETY AND HEALTH SURVEILLANCE

Study Objectives

The University of Houston Health Law & Policy Institute was awarded a special line item from the Texas legislature to direct and implement the study, "Occupational Injury and Illness in Texas." This study was an interdepartmental and interinstitutional collaboration between the University of Houston Health Law & Policy Institute, the University of Houston Department of Economics, and The University of Texas School of Public Health at Houston (Southwest Center for Occupational and Environmental Health). The major objectives of the study were to document the magnitude and economic costs of occupational injury and illness in Texas, to describe occupational exposures, to evaluate human resources in occupational health and safety in Texas, to identify policy options for prevention of injury and illness, and to make recommendations for future study.

Organization of the Report

Chapter 1 of the report presents a history of general occupational safety and health activity in Texas, along with a brief history of surveillance of occupational injuries and illnesses in Texas. Chapter 2 presents estimates of the burden of occupational injury and illness for Texas. Chapter 3 describes the magnitude of specific injury and illness conditions and specific worker populations. Chapter 4 describes the population of workers in Texas, reviews the potential hazardous occupational exposures in Texas, and estimates the number of workers likely to be exposed to these hazards. Chapter 5 presents estimates of the economic consequences of occupational injuries and illnesses. Chapter 6 documents Texas resources available for the prevention and treatment of occupational injuries and illnesses. Chapter 7 discusses policy options and recommends areas for research.