What, if anything, does a “near miss” have to do with health and safety?

“Well, no one died, so what’s the problem?”  I have heard lines like this before and I heard it again yesterday.  What irks me is that the people saying (or reported to have said) these words are often in supervisory or managerial positions.  Some even have a title or function that includes “safety and health”.  The truth is, the absence of injury is not a true measure of workplace health and safety.   And how a “near miss” is reported and reviewed reveals much about the safety culture of a workplace.

I instruct classes and seminars with learners and talk about safety with a lot of workers.  When I ask about their health and safety experiences, they often relate incidents like the following—serious incidents but without injury: 

•  The ladder I was on began to slide sideways and I had to jump off.     
•  The patient suddenly lost balance and collapsed on top of me.
•   The student I was helping impulsively started the drill press while my eye was next the bit aligning the project.    
• As I pulled out the top drawer, the file cabinet began to fall forward… I was just able to step out of the way before it went crashing to the floor.        
• Someone had sprayed a lubricant in the hallway and I nearly slipped and fell when I stepped in it.
• The metal plate broke loose from the winch and missed my toes by a fraction of an inch.

The workplaces above are varied:  a paint job on a residential site, a clinic, an industrial education shop in a school, an office, a hallway in a public building, a fabrication shop.  From an outcome perspective, there were no injuries, no lost days due to accidents, no need for doctor’s visits or alternate duties.  Yet, most of us would recognize that what separated the worker from injury in each case was a matter of luck (or millimetres) and not safety. 

Regardless of the workplace, each of the above incidents is a wake-up call, an opportunity to review the “near miss” to see if there are improvements or changes that might prevent a repeat of the incident.  Each case is worthy of an incident report and an investigation by the site safety committee. 

Safety is a function of the safeguards, barriers and defenses that protect workers from harm due to the hazards inherent in all workplaces.  Every near miss reveals active or latent defects in the barriers, safeguards and defenses that protect workers from harm.  Design, supervision, training, safe work procedures are some of the safeguards, barriers and defenses I’m talking about; an effective investigation will reveal the possible defects that had to align in order for the near miss to occur. 

If you are looking for a leading indicator of your workplace health and safety program, focus on incident or “near miss” reports.  How many are we getting?  Are they being investigated and discussed at the Joint Health and Safety Committee?  Are means of preventing future incidents being considered?  If incidents are not being reported, don’t assume they aren’t occurring.  And if incident reports are met with a “no one died” or “that’s just part of the job” sort of response, you’ll know a true concern for health and safety is not part of the culture of your workplace.  

What percentage of the working-age population receives Disability Benefits in Canada and the US?

My post on the US Social Security Disability (SSD) issue generated a lot of email.  .  Most of the feedback I got expressed disbelief that 4.7% of the population aged 18 to 64 in the US are in receipt of SSD.  A few offered theories as to why certain states would have high or low percentages of working-age residents on SSD.  Others asked if the US average of 4.7% of the working age population is low or high compared to other countries, particularly Canada, which has a similar economy and social security system.  I thought that might be interesting to examine.

The closest comparable plan to US SSD is the Canada Pension Plan- Disability benefit (CPP-D).  There is a specific but very similar plan in Quebec so data from both CPPD and the Quebec Pension Plann (QPP) have to be considered in any comparison.

Primary recipients of SSD and CPP-D are workers unable to work because of a disability from injury or disease.  SSD and CPP-D  have differences that influence who qualifies for the benefit.    CPP-D benefits are payable to workers who meet the contribution requirement (contributions to CPP in four of the last six years, or three of the last six years if there are at least 25 years of contributions), are under 65 and have a condition that meets the test of being “severe and prolonged”.  SSD in the US is designed to pay disability benefits to workers who have worked long enough to qualify and have a medical condition that  “ has prevented you from working or is expected to prevent you from working for at least 12 months or end in death." 

The qualifying years are more generous under the US SSD. The following table appears in a publication by the Social Security Administration:

The averages and maximums payable under the plans also differ significantly.  SSD  pays an average of $1,148  with a maximum of $2,642 per month in 2014.  CPP-D  provides an average of $896.87 with a maximum of   $1,236.35 per month in 2014.  [Values in US$ and Canadian$ respectively]. 

So, what percentage of the population receives SSD or CPP-D?  In Canada in 2013, there were 22,851,645 people aged 18 to 6 and an average of 234,423 CPP-D recipients... but remember Quebec, which has a similar program, had 74,893 recipients in late 2012 for a total of 309,316 disabled workers in receipt of CPP-D or the Quebec equivalent.  For Canada,  1.35% of the working age population (18 to 64) is in receipt of either  CPP-D or disability under the QPP —a significant percentage but substantially lower than the 4.7% noted for the US SS-D.

Are the top causes of disability similar? Each system classified disorders in different ways so direct comparisons are difficult.   In the US, “Mood Disorders” account for 15.1% of the SSD cases and “Musculoskeletal and Connective Tissue” account for 29.8% of SSD cases.  In Canada, “Mental Disorders” total 30% of cases while “Diseases of the Musculoskeletal System” accounted for another 23%.

Both SSD and CPP-D have some interplay with other social insurance programs including workers’ compensation.  The rules vary by state and province but there is often some reduction in benefits paid to a worker under a workers’ compensation plan when there is a benefit payable from SSD or CPP-D. 

The human and financial cost of work injury and non-work injury that removes workers from the labour force is unacceptable.  Prevention remains the best approach to reducing these costs but building resiliency, fostering greater accommodation and return to safe, durable employment are the best way forward.  

Are disabled workers a significant proportion of the working-age population?

Our economy needs skilled and able workers to deliver the goods and services we need locally and provide internationally.  When a worker becomes disabled through work injury or other cause, there is one less member of the working age population capable of and able to participate in the labour force. 

At any given time, there are workers off work because of a work-related injury, illness or occupational disease; other workers are out of the labor force due to non-work related causes.  Whether the cause is work-related or not, in most cases, disabling conditions resolve to the point where a worker is again able to return to work.  The remaining individual must live with an impairment that may be a significant barrier to continuing in the labor force.  This is not just an issue of an individual and his or her family having to bear physical and mental suffering, society losses the skills, knowledge and abilities of a proven human resource—something that can impact local communities and national economy. 

For worker covered by workers’ compensation, work-related financial impacts can be offset in part by temporary and permanent income compensation.  For all workers, there may be access to other social insurance programs such as US Social Security – Disability benefits and Canada Pension Plan – Disability benefits.

In the US, Social Security Disability (SS-D) benefits are available to workers who become disabled.  Most people who receive disability benefits are workers.  Of the 10,088,739 recipients of SS-D in December 2012, about 87.5% of them were workers.  Nearly $10 billion a month gets paid out to workers who must now depend on SS-D. 

We normally think of the labor force as being drawn from the resident population aged 18 to 64.  Restricting SS-D recipients to that same age range means there are 9.3 million Americans or 4.7% of the population aged 18 to 64 were on SS-D in 2012.  The vast majority of these SS-D beneficiaries were workers who are unable to work and contribute to building a vibrant economy. 

That 4.7% is an average for the whole country.  The distribution of SS-D recipients varies by state. The following table is derived from the Annual Statistical Report on the Social Security Disability Insurance Program, 2012 [table 8]:

Number aged 18–64 as a percentage of the resident population aged 18–64,
by declining percentage by state, December 2012

	Resident population a	Beneficiaries
		Number	Percentage of resident population
West Virginia	1,159,423	104,406	9.0
Alabama	2,998,237	250,301	8.3
Arkansas	1,795,660	149,632	8.3
Kentucky	2,747,524	225,529	8.2
Mississippi	1,835,518	144,398	7.9
Maine	836,898	63,333	7.6
Tennessee	4,043,720	268,443	6.6
South Carolina	2,948,174	189,251	6.4
Missouri	3,735,332	235,374	6.3
Michigan	6,173,776	380,524	6.2
Louisiana	2,888,885	173,283	6.0
Vermont	403,616	24,198	6.0
New Hampshire	852,075	49,925	5.9
Rhode Island	675,189	39,715	5.9
Oklahoma	2,343,210	135,431	5.8
North Carolina	6,117,676	349,592	5.7
Indiana	4,056,709	221,264	5.5
Pennsylvania	7,981,289	438,294	5.5
Ohio	7,175,429	378,923	5.3
New Mexico	1,276,263	66,763	5.2
Delaware	571,568	28,909	5.1
Massachusetts	4,286,235	217,351	5.1
Florida	11,805,373	565,421	4.8
Montana	624,872	29,767	4.8
Wisconsin	3,584,341	173,441	4.8
United States	197,040,596	9,306,256	4.7
Georgia	6,290,121	295,892	4.7
Idaho	956,497	45,118	4.7
Kansas	1,767,332	80,876	4.6
Oregon	2,457,110	112,691	4.6
Iowa	1,880,928	84,657	4.5
New York	12,549,535	565,836	4.5
Virginia	5,266,625	227,060	4.3
Washington	4,403,628	185,482	4.2
Arizona	3,960,828	162,630	4.1
South Dakota	507,002	20,764	4.1
Illinois	8,116,753	321,189	4.0
Minnesota	3,373,224	135,566	4.0
Nebraska	1,134,766	45,737	4.0
Connecticut	2,264,077	89,371	3.9
New Jersey	5,587,651	215,599	3.9
Texas	16,234,269	610,238	3.8
Wyoming	365,414	13,556	3.7
Maryland	3,777,744	135,798	3.6
Nevada	1,734,434	62,961	3.6
North Dakota	444,354	15,680	3.5
District of Columbia	450,954	15,374	3.4
Colorado	3,342,983	108,554	3.2
California	24,201,126	762,133	3.1
Utah	1,695,896	50,916	3.0
Alaska	481,852	13,848	2.9
Hawaii	878,501	25,262	2.9

[Footnote to original table]  SOURCES: Social Security Administration, Master Beneficiary Record, 100 percent data; Census Bureau, 2012 resident population.

NOTE: Data exclude U.S. territories and other areas

Population estimates for the United States as of July 1, 2012, as reported by the Census Bureau.

CONTACT: (410) 965-0090 or statistics@ssa.gov

The profile of the average worker on SS-D in 2012 was a male (53%) average age was 53 receiving an average monthly benefit of $1,134.86. 

Not everyone on SS-D is there permanently, although many are.  You may have the image of a worker on SS-D as having catastrophic and permanent physical impairments.  Some recipients have disabilities that could be described that way but a third of them have a primary disability related to mental disorders.  Another 30% have a primary diagnosis related to “muskulo-skeletal and connective tissue”.   Some are expected to get better or for their medical disability to improve and allow a return to work; about 70,000 workers terminated their SS-D benefits for these reasons in 2012 [table 50 in the 2012 Annual Statistical Report]

Preventing injury that leads to permanent disability remains the number one priority but more needs to be done to prevent workers who develop or incur impairments from becoming permanently disabled.  Disability is largely a societal issue; the lack of accommodation, failure to foster resiliency and the inability (or resolve) to overcome systemic barriers are perhaps greater contributors to the mounting human and economic costs. 

I don’t know all the reasons for the wide disparity in SS-D recipient rates across states. Why, for example, does Virginia have an SS-D worker recipient rate that is less than half that of West Virginia?  No doubt some of the variation can be accounted for by the demographics of the state population.  Perhaps some states are more proactive in prevention and accommodation thus obviating the need for income support for SS-D.  If you have the answer, share it!  Post a comment or send me an email.   

Do California and Canada have a lot in common when it comes to workers’ compensation?

Do California and Canada have a lot in common when it comes to workers’ compensation?   In preparing my presentation to the annual meeting of the California Workers’ Compensation Institute (CWCI.org),  I updated some of the information from a very nice briefing comparing coverage in California and Canada published by the Institute for Work and Health (IWH.on.ca)in 2010.  The broad parameters of the workers’ compensation context are similar:

                                         Canada                     California                

Employed labour force (2013):   17,731,000     17,053,071  (June)

Estimated covered by WC:  14.8 million (2013)   14.7 million (2012)

Actual [weighted]Average
 Assessment Rate for Assessable 
employers  ($/$100):            1.96  (2011)         2.46 (June 2012)

The coverage in California is set by legislation and similar to what you might find in many US states:

• 2/3rds  Average Weekly Wage
• Three day waiting period (with two week retroactive period)
• Max insured 2014: $1,611.96 per week (about $84,000 per year)

Each Canadian province has its own limits.  Most do not have any waiting period; most cover 85 to 90% of Net average earnings to a maximum ($77,900 BC, $92,300 Alberta, $84,100 Ontario, no maximum in Manitoba). 

Administration costs are difficult to compare.  In Canada, each province has a workers’ compensation board or commission that is the equivalent of an exclusive state fund.  The Association of Workers’ Compensation Boards of Canada (AWCBC.org) reports Administration Costs for Assessable Employers was $1,474,841,000 in 2011.  The IWH study reports 2007 data for California that pegs  the insurer underwriting profit of  $1,976 million and Administration expense $5,323 million.   That makes the administrative cost in California about five times that of Canada. 

What accounts for this significant difference?  A lot of US commentators have suggested that Canada’s universal healthcare may account for some of the difference.  In fact, however, Canadian workers’ compensation boards are “first payers” for healthcare costs.  Payments by provincial workers’ compensation boards are excluded from the definition of “insured health services” under the Canada Health Act.  So the same healthcare costs paid for by US workers’ compensation insurers are also paid for by Canadian workers’ compensation boards. While the Canadian systems benefit from a population who all have health care coverage and certain economies of scale by building on systems, medical fee schedules negotiated by provincial agencies and lower prescription medicine costs. 

Another possible source for the difference between California and Canada is the number of insurers authorized to provide workers’ compensation coverage.  In Canada, there are a dozen workers’ compensation boards—each with its own exclusive jurisdiction (monopoly providers in their own jurisdictions); in California there are more than 200 authorized insurers writing at least $50,000.00 of premiums (the largest by market share is the STATE COMPENSATION INSURANCE FUND). 

There are, of course, many other differences between Canada and California.  The rate of disputes, the way disputes are settled, differences in self-insurance with and without self-administration, the risk associated with the mix of industry,  and the scope and involvement of workers’ compensation in occupational health and safety (prevention, education, enforcement and regulation) are just the beginning of areas to consider in comparison.   That said, both Canada and California continue to see substantial human and financial costs of work-related injury, disease and death.  Comparing approaches to workers’ compensation between jurisdictions may yield new insights into prevention, treatment and return to work—something valuable to everyone. 

Can a Childhood Illnesses be considered an "occupational disease"?

Key  “measles outbreak” into a news search engine (or ask Siri) and you will see stories from Canada, New Zealand, the US, Syria and many other countries about recent clusters of cases in schools and communities.  Other search terms reveal similar results.  The health concerns reported are often focused on kids but occasionally you see stories that include concerns for teachers, staff and  other community members. 

Every time there is a reported “outbreak” I  get a lot of questions about the compensability and prevention obligations of employer regarding infectious diseases. 

As every parent, caregiver, and early childhood educator knows, a child with a cold can easily pass on their illness to siblings, parents, nannies, caregivers and educators they come into contact.  Considering colds alone, young children may contract 8 to 10 each year before they turn 2 years old (NIH) while older children get an average of 6 to 8 colds per year (Worrall, Common Cold, Can Fam Phys, Nov 2011; 57(11): 1289–1290). Given that the average cold lasts about 10 days, young children can spend a third to a quarter of their pre-school lives with a runny nose.  Add to that other common childhood diseases like influenza, measles,  and chicken pox and you might be forgiven for concluding that “children” are nature’s most perfectly designed vectors of disease.

In reality, however, limiting the spread of infectious diseases can be achieved through frequent, effective hand-washing, routine site hygiene and “distance” during illness.  While inconvenient for parents, keeping kids home when they are infectious (in the case of colds, about five days after the cold symptoms begin) can be an effective strategy in preventing the spread of disease to other students, staff and the community.  There is no vaccine (yet) for the common cold or norovirus, but vaccination is another effective strategy for protecting both the person immunized and the unimmunized population they are in contact with from serious illnesses like many seasonal flu strains, measles, mumps, and chicken pox. 

Childcare centres, kindergartens and schools are obvious targets for preventing the spread of disease.  Sadly, budgetary pressures may lead to actions that actually increase the potential for the spread of disease. Washrooms that are cleaned less frequently, hot water being turned down or off,  and inadequate supplies for washing and drying hands may cost more in terms of work absences and the health of students, families and the community than any marginal savings that may be gained. 

Is any of this a workplace health issue?  Yes.  It is easy to overlook daycares, preschools, tutoring centres and regular schools when thinking about workplaces but for the teachers, teaching assistants,  early childhood educators, custodian and office staff, these locations are workplaces.  And the owners, operators and school boards responsible for them have a duty to provide for the health and safety of all workers and other persons (including children) in the workplace regardless of the compensability of any particular case. 

Many educators, other school-based staff, and cleaners contract illness in their workplace. Some file a claim with a workers’ compensation authority but many simply take two aspirin and a dose of personal sick leave.  For illnesses that are common and active in the community, this is reasonable—it is as likely as not the disease was contracted in the community rather than the school.  This does not remove or lessen the duty of the employer to provide a safe and healthy work environment.  In the case of specific illnesses such as measles, mumps, chickenpox, norovirus, Fifth’s disease, etc. the teachers and other staff infected in a localized outbreak may be maybe entitled to workers’ compensation. 

A few years ago, the British Columbia Teachers’ Federation circulated the accompanying poster to all schools.  It consolidated on a single page many of the illnesses law and policy have defined as occupational diseases that may be work-related for teachers.  The list of diseases that may be related is long but it is far from exhaustive. In practice, very few cases are reported to WorkSafeBC or local WCB agency.  This means that the lost wages and medical costs are being wrongly attributed and born to a greater degree by workers and taxpayers.

The direct message of the poster is simple:  Don’t use sick leave for a work-related illness.  The rationale for the message is even stronger and goes beyond considerations of who pays.  Every unreported work-related illness is a missed opportunity to review the circumstances and protect workers and others from harm.

Next time you attend an immunization clinic or have to stay home with sick child, have a thought for the health of educators, staff and caregivers deserving of protection. 

British Columbia Teachers, Federation (BCTF.ca) Occupational Disease Poster (used with permission).