Workplace Violence: Examining Interpersonal and Impersonal Violence among Truck Drivers

Employees who work alone are at greater risk of workplace violence. One of the higher‐risk lone worker occupations in North America is truck driving. Drawing on interviews with 158 truck drivers across the United States and Canada, this article examines how truck drivers interpret and experience both interpersonal and impersonal forms of workplace violence. Rather than rely on police enforcement and safety regulations, the truck drivers in this study believed that they were primarily on their own with regard to workplace violence. As a result, truck drivers described how they continually engage in informal personal safety strategies in order to decrease their chances of being victimized. These findings reveal how neoliberal responsibilization approaches to health and safety serve to conceal structural patterns of power and risk by containing individual responsibility for safety at the frontline. Overall, this study points to the need for law and policy to better incorporate the frontline experiences of workers when attempting to decrease the risk of workplace violence.     

Labor union involvement in occupational safety and health, 1957-1987

Right-to-know policies and related market-oriented occupational health policies require an institutionalized means through which workers can interpret and act on information about quality differences among jobs. In principle, labor unions could play this role. However, union coverage has been declining since the 1950s, and the decline has accelerated in recent years. This paper documents the growth in occupational health and safety activities in unionized workplaces from 1957 to 1987 and the decline in union representation in hazardous workplaces from 1971 to 1986. It also analyzes the relationship between right-to-know and right-to-refuse-hazardous-work guarantees under industrial relations and occupational health law.     

Publicsector worker safety and legal remedies

While much is known about the affirmative responsibilities private employers must undertake in order to protect workers on the job, the responsibilities of public-sector employers have not been heretofore addressed. This article analyzes federal laws that pertain to worker safety. These laws will be discussed in light of legal responsibilities placed on public-sector agencies to provide a safe work environment for employees.     

Organisational restructuring/downsizing, OHS regulation and worker health and wellbeing

A growing body of international evidence indicates that downsizing and related forms of organisational restructuring are having profound adverse effects on worker safety, health and wellbeing. In particular, evidence links downsizing to poorer mental health outcomes, including bullying and other forms of occupational violence. In Australia federal, state and territory occupational health and safety (OHS) legislation imposes obligations on employers who make changes to the workplace or work processes to identify hazards, undertake risk assessment, consult with employee representatives and take appropriate steps to manage any significant hazards that are identified, including psychosocial hazards. This study shows that while Australian regulators are aware of the problems posed by downsizing they have made only modest efforts to pursue compliance with legislative duties, producing some guidance material that refers to restructuring and workloads and launching a small number of prosecutions. At the same time, there is an increased willingness to address staffing levels and other impacts of downsizing (like working in isolation). Employer and union responses were also examined. The article concludes by identifying a number of initiatives that would enable regulators, unions and employers to address the problems posed by downsizing more effectively.     

AIDS-related risks in the health care setting: HIV testing of health care workers and patients

Do patients and health care workers have the legal right to know each other's HIV status? Professor Flanagan argues that they do not. Given that with appropriate precautions the risk of transmitting HIV in the health care setting is extremely small and that the discriminatory consequences of HIV disclosure can be extremely high, it is suggested that the right of a patient or a health care worker not to disclose their HIV status must outweigh the other's "right to know."     

National Institute for Occupational Safety and Health; occupational exposure to inorganic lead: request for comments and information; republication--NIOSH. Request for comments and information relevant to occupational exposure to inorganic lead

NIOSH is reviewing its recommendations contained in the document Criteria for a Recommended Standard.... Occupational Exposure to Inorganic Lead, Revised Criteria--1978 [NIOSH 1978]. The evaluation of recent literature indicates that the NIOSH recommended exposure limit [REL] of 100 micrograms/m3 as an 8-hour time-weighted average [TWA] in that document does not sufficiently protect workers from the adverse effects of exposure to inorganic lead. NIOSH is requesting comments and information relevant to the evaluation of the potential health risks associated with occupational exposure to inorganic lead, as well as case reports or other data that demonstrate adverse health effects in workers exposed to inorganic lead at or below the OSHA permissible exposure limit [PEL] of 50 micrograms/m3 as an 8-hour TWA and any information pertinent to evaluating the technical feasibility of establishing a more protective REL for inorganic lead. NIOSH is also soliciting information on worker blood lead levels [BLLs] including data on methodologies used in measuring BLLs in the workplace and information that can be used for comparing airborne inorganic lead concentrations to observed BLLs. NIOSH intends to analyze the feasibility of developing preventive measures including an REL that would provide better protection for workers. In the interim, NIOSH plans to adopt the more protective current OSHA PEL as its REL.     

Workers describe the effect of the workers' compensation process on their health: a Québec study

This article reports on a Canadian qualitative study designed to examine the workers' experience of the workers' compensation process and to look at the effects of the process on the physical and mental health of claimants. Eighty five in depth individual interviews of injured workers in Québec and six group interviews with workers and worker advocates from Québec, Ontario and British Columbia were analysed to determine the positive and negative impact on claimant health of various steps of the workers' compensation process and of behaviours of significant actors in that process. While superior access to health care and access to economic support both contributed to claimant well-being, various facets of the process undermined the mental health of workers, and in some cases, also had a negative impact on physical health. Primary characteristics of the process that influenced outcomes included stigmatization of injured workers and the significant power imbalance between the claimants and the other actors in the system; the effect of both these mechanisms was tempered by social support. The article describes how caseworkers, physicians, appeal tribunals, employers and compensation boards contribute to the positive or negative impacts on worker health and concludes with recommendations designed to promote the therapeutic aspects of workers' compensation and to curtail those facets that are harmful to worker health. It also has implications for researchers who wish to consider the role of lawyers or compensation in the development or prevention of disability.     

Work and mental health: learning from return-to-work rehabilitation programs designed for workers with musculoskeletal disorders

Despite the high costs associated with mental health problems in the workplace, few studies have yet been published on the design and evaluation of return-to-work rehabilitation programs for workers with mental health problems. In fact, the best-documented return-to-work rehabilitation programs concern workers with musculoskeletal disorders (MSKD). For this clientele, a disability paradigm has been adopted which explains the multicausality of work disability. Long-term work disability is no longer seen simply as the consequence of impairment, but rather as the result of interactions between the worker and three main systems: the health care, work environment and financial compensation systems. A return to work is thus influenced by a complex set of interrelated factors that must be taken into account in any intervention. Parallels can inevitably be drawn in the field of mental health in the workplace, where individual and organizational factors are involved and must be taken into account in the return-to-work process. This paper presents the first results of an exploratory study aimed at determining the possible links between work rehabilitation programs for workers with MSKD and those for workers with mental health problems. To this end, the components of a work rehabilitation program for workers with MSKD, the Therapeutic Return to Work (TRW) program which addresses psychological factors, work environmental factors and factors related to the involvement of the various stakeholders in the rehabilitation process, are described through a multiple-case analysis and mapping of interventions. The results support the relevance of adopting the disability paradigm and considering the return-to-work clinical activities conducted with workers with MSKD (and their mechanisms of action) in the design of work rehabilitation programs for workers with mental health problems.     

The resistible rise of preventive medicine

The politics of preventive health care have changed dramatically in the last fifteen years. In the late 1960s and early 1970s, prevention was the motherhood issue of health care reform. With only the slightest glimmer of controversy, vaccination, promotion of lifestyle changes, mass screening, and safety regulation all became widely accepted strategies for improving health and reducing medical expenditures. By the mid-1980s, the dark side of each strategy became visible. Vaccinations can cause serious and permanent injuries; lifestyle factors are being used to raise insurance premiums, to deny eligibility for disability insurance benefits, and to deny employment. Screening is similarly used to deny employment, and new technologies for prenatal screening have raised fears of stigma and selective abortion among racial, handicapped, and antiabortion groups. Occupational safety regulation is increasingly focused on excluding the "high-risk" individual from jobs. In the absence of social protections from these economic and social harms, citizens have used tort and civil rights litigation to resist preventive health measures.     

Healthy ageing--a patients' rights perspective

The demographic development is a challenge for the European healthcare systems, and to meet these challenges it is crucial to develop efficient health preventive strategies to ensure that the population is, and stays fit as long as possible. However, along with demographic development, Europe is also facing a boom in lifestyle diseases which constitute an impediment for healthy ageing. Smoking and obesity are considered to be the major causes in this regard. Both internationally and nationally there has been a strong commitment to reduce smoking, and it seems that a combination of information, economic incentives and legal regulation have been successful. The article explores whether the same public health strategy could be useful fighting obesity, and discusses whether such public health measures are compliant from a human and patients' rights perspective. Special questions regarding public health initiatives targeting elderly patients will also be addressed.     

The Deserving Worker: Decisions about Workplace Accommodation by Judges and Laypeople

Employment civil rights laws require employers to make reasonable accommodations for certain workers so that they can perform their jobs. The “reasonableness” of an accommodation request should be based largely on the cost of the accommodation relative to the company's resources, but how do people really evaluate such requests? This study examines determinations of the reasonableness of workplace accommodation requests made by trial judges and ordinary people. Using a 2 × 3 × 3 between‐subjects factorial design, we test the effect of worker identity (nursing‐mother worker, transgender worker, and Muslim worker) and cost on determinations of reasonableness. We find that (1) the identity category of the requesting worker impacts determinations of reasonableness by both judges and laypeople, (2) the cost of the accommodation impacts determinations of reasonableness, (3) judges are more likely to think that accommodation requests are reasonable than are laypeople, (4) there is a complicated relationship between accommodation cost and employee identity, and (5) the cost of the requested accommodation mitigates the effect of identity significantly for judges but less so for ordinary citizens. While judges are less influenced by the identity category of the employee‐requestor than are their lay‐counterparts, social status plays a role in determining what constitutes “reasonable accommodation.”     

The use of medical examinations for employment purposes

This article examines a number of legal issues which arise where medical examinations or tests are used in the employment context, either to test the suitability of a prospective employee in pre-employment situations or to ascertain the fitness of existing employees. Employer justifications for seeking medical information usually relate to attempts to comply with health and safety legislation and to reduce workers compensation costs. This article discusses the legal obligations involved in pre-employment medical testing and, in particular, employee obligations to provide correct information in relation to their health to a prospective employer. It also notes the consequences for employees of providing false information in relation to workers compensation claims and dismissal cases. The article notes the growing trend of requiring drug and alcohol testing for existing employees, particularly in the mining industry. The article concludes by noting that employers need to take care in seeking medical information, and that it should not simply be done as a mechanical, matter-of-course exercise. Failure to observe anti-discrimination laws may result in the employer facing allegations of misuse of medical information and claims for damages for discrimination.     

The impact of vendorship legislation and interprofessional competition in the market for social workers' services.

The results of this article suggest that, in the short run, vendorship legislation will not result in a large shift of social workers from organized settings into private practice. However, vendorship legislation appears to increase the number of social workers in private practice in areas that have not attracted as many psychiatrists. Thus, vendorship may have a favorable impact on the geographic distribution of mental health providers. Vendorship legislation may result in increases in private practice social workers in underserved areas. The results also suggest that social workers and psychiatrists compete in the market for mental health services. In counties with higher psychiatrist-to-population ratios, fees for social workers' services are lower. Further, in counties with higher psychiatrist-to-population ratios, the number of social workers in private practice decreased after vendorship. Finally, there is a large range of optimal practice size for social workers. Social workers with 20 or more clients per month can provide mental health services at the lowest average cost per client. Thus social workers operating either full-time or part-time practices with more than 20 clients per month can provide mental health services efficiently.     

重视和培育良好的农民工就业环境，提高农民工就业能力——以重庆市为例

培育良好的农民工就业环境,提高其就业能力,保证农民工充分高品质就业是当前我国顺利转移农村劳动力和城镇化建设关键所在,也是增加农民收入,缩小城乡差距的,解决"三农"问题的重要环节.本文以重庆为例,通过对就业环境和就业能力的分析并提出相关若干建议.     

Regulating Supply Chains to Improve Health and Safety

The fragmentation of previously integrated systems of productionand service delivery has been an important feature of organisationalrestructuring over the last three decades. This article highlightsthe adverse implications of this development for the healthand safety of workers, examines the extent to which currentBritish health and safety law provides an adequate frameworkfor addressing these outcomes and explores whether its capacityto do so could be enhanced through the introduction of new statutoryprovisions on the regulation of supply chains. It concludesthat, in terms of both structure and operation, the presentframework of law is problematic. It further argues that recentinternational initiatives show that it is feasible to developsuch statutory provisions and that existing evidence suggeststhat provisions of this type could usefully be introduced inrespect of a number of areas of activity where the implicationsof the externalisation of production and service delivery seemparticularly problematic.     

Accidental Ligature Strangulation by an Ironing Machine: An Unusual Case*

Abstract: In this paper, we present a case of a 53‐year‐old woman who had her headscarf catch on the cylinder ironing machine in the laundry of the hospital where she worked. The hospital workers found the woman dead with her head stuck to the ironing machine. After the death scene investigation and autopsy were completed, it was determined that the death occurred as a result of accidental ligature strangulation. Accidental ligature strangulation in which an article of clothing is caught in such an electrical machine and strangles the wearer is very rare. This case highlights the fact that these kinds of machines can be hazardous to work around and that increased safety measures should be taken to insure worker safety; additionally, the people who use these machines should be educated on the potential hazards.     

Constructive cigarette regulation

Professor W. Kip Viscusi argues for a move away from the adversarial approach to tobacco regulation, an approach that is currently embodied in class action lawsuits and the proposed broadening of FDA regulatory power over cigarettes. In this Article, he suggests that the FDA should take a constructive role in fostering technological innovations to promote cigarette safety, in much the same way that the government currently fosters safety improvements in motor vehicles and jobs. Professor Viscusi claims that the objective of government policy should be to promote informed consumer risk taking--an approach which recognizes that adult consumers have a right to smoke and to incur the associated risks. He provides survey data demonstrating that although consumers know that smoking is a risky decision, they have little exposure to information regarding the comparative riskiness of various cigarette brands. According to Professor Viscusi, the government should assist in compiling and disseminating information regarding the comparative risks of different smoking options and the effects of certain innovative safety features for cigarettes. Making this information available would enable consumers to make more informed smoking decisions and potentially minimize the health hazards that smoking poses.     

A Case Example of Asphyxia Due to Occupational Exposure to Airborne Chemicals and Review of Workplace Fatalities

Although worker injury and fatalities have decreased since adoption of the Occupational Safety and Health Act in 1970, it remains an important safety issue. This article describes a 27‐year‐old white male who died from occupational exposure to airborne chemicals. Several trends in the last several decades, both in the types of injuries and the occupations associated with fatalities, are noted. Additionally, individual risk factors such as age, gender, chronic disease, smoking, and alcohol and drug use are implicated in worker health and safety. The role of the forensic pathologist in the investigation of workplace deaths is highlighted, in addition to the future of occupational safety and current improvements brought about by such incidents.     

Mass screening in low-income populations: the challenges of securing diagnostic and treatment services in a national cancer screening program

Funding for many mass screening programs for low-income and uninsured populations provides resources for screening tests, yet only rarely does it provide coverage for necessary follow-up diagnostic and treatment services. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a federally funded initiative that provides cancer screening to low-income uninsured and underinsured women, covers some diagnostic follow-up tests and no treatment services. We conducted in-depth case studies of seven state programs participating in the NBCCEDP to investigate the strategies and approaches being used to secure diagnostic and treatment services. The results suggest that the program relies on a patchwork of resources--at state and local levels--to provide diagnostic and treatment services. This includes a number of components of local safety nets, all of which are unstable and have uncertain futures. Public health disease-screening initiatives need to reconsider the feasibility of continued reliance on case-by-case appeals to the local safety net for diagnostic follow-up and treatment services.