OTI Online
Winter 1998

Stop the Pain
by Penney Kome


All day long she twists and flexes her wrist to scan products, lifts bags that can total thousands of pounds per shift, pushes items along a counter and hoists produce onto scales. like many women, she is in a job where the pay is low, and the benefits paltry or even nonexistent. She is also in a job with a surprisingly high risk of hand, arm, shoulder, and back injuries.

Sitting at a desk five days a week isn't much safer. Pink collar workers, from secretaries to nurses to computer programmers, also report high rates of musculoskeletal injury (MSI). Workstations - as well as cars, bus seats, and the rest of our built environments - are generally designed for the generic 510" man.

Thus, most women sit at desks that are too tall for them, or in chairs wrongly proportioned to be supportive. The contortions we go through in order to fit ourselves to these environments often lead to the crippling pain that is a symptom of MSI.

Statistics on MSIs are sketchy and controversial. One source estimates that one worker in eight has an MSI. What's clear is that women file twice as many workers' compensation claims for upper-extremity MSIs as men do, and only one-third as many claims for everything else. Repetition, force and and awkward body postures are key job factors contributing to an MSI. Low temperatures, vibration, and long working hours without breaks are other risk factors. While truckers and construction workers report high rates of MSIs, the jobs where women predominate - such as needlework, electronic assembly, poultry packing, cashiering, data entry, and patient care - seem virtually tailored to induce MSIs.

Compromising Women's Health

Often called "the number one occupational health hazard of the 1990s," MSIs include a variety of soft tissue conditions ranging from aches and pains to epicondylitis (tennis elbow), tendinitis, bursitis, and frozen shoulder, as well as the infamous and potentially devastating carpal tunnel syndrome. MSIs "account for one-third of all serious workplace injuries," according to Peg Seminario, director of Safety and Health for the AFL-CIO - an estimated 700,000 upper extremity and back injuries a year. And affected women are doubly disabled, as MSIs interfere not only with their paid labor but also their household responsibilities.

"Musculoskeletal disorders represent a very significant, serious, and largely preventable occupational health problem," says Dr. Linda Rosenstock, M.D., M.P.H., director of the National Institute for Occupational Safety and Health (NIOSH) in Cincinnati, Ohio. NIOSH takes the position that "Through effective programs the pain and disability of musculoskeletal disorders can be reduced, workers' compensation costs can be cut, and productivity and employee satisfaction can be improved."

Workers pay the price when employers ignore NIOSH reports. Take single mother Shirley Mack: after several years splitting chicken breasts in the high-risk poultry packing industry, she developed carpal tunnel syndrome so severe that she can't hang laundry or push a shopping cart. Her employer took the easy way out, and fired her. Her story is all too common in poor, rural areas, where such work often offers the best-paid jobs available to African American and immigrant women.

Health-care workers who specialize in occupational safety say that once a worker reports pain, treatment should be swift - and appropriate. Occupational-health nurse (OHN) Pat Bertsche, manager of the Institute for Ergonomics at Ohio State University, suggests in the American Association of Occupational Health Nurses Journal that "conservative therapy deserves an adequate trial [at least six months] before surgical intervention is contemplated."

As with so many conditions that affect mainly women, surgery is often offered as a first resort, not a last resort. Gary Franklin, M.D., medical director for the Washington State Department of Labor & Industries in Olympia, Washington, says that the Workers' Compensation Board there now refuses to pay for surgery for certain injuries unless the surgeon meets strict guidelines, because otherwise, "surgeons march up and down patients' arms and leave them disabled."

"Medical management should ideally include vigilance, rehabilitation, and familiarity with Occupational Safety and Health Administration [OSHA] record-keeping requirements," writes Bertsche. "One reason MSIs are systematically underreported is that many administrators don't realize that all actual MSI cases are reportable, regardless of whether the worker has to take time off"

Epidemiologist Barbara Silverstein, Ph.D., director of research for Washington State Department of Labor & Industries was originally a registered nurse who hurt her back lifting patients. She returned to school and in 1987 produced a groundbreaking thesis on upper-extremity MSIs. Subsequently, Dr. Silverstein headed the OSHA committee that proposed a set of ergonomic regulations, as well as the American National Standards Institute (ANSI) committee currently working on a voluntary standard. The purpose of both policies is to help employers and workers identify MSI hazards in order to redesign jobs and work stations that would protect workers.

Both OSHA and ANSI ergonomic standards have been fiercely opposed by coalitions of employers and blocked from publication, or in OSHA's case, enforcement. Since OSHA is supposed to be an independent agency, Congress is forbidden to intervene directly in any regulations the agency passes or enforces. Congress has instead put riders on OSHA's funding appropriations, stating that no monies may be spent to publish or promulgate an ergonomics standard. Rep. Henry Bonilla (R-Texas) has even tried, unsuccessfully, to forbid OSHA from collecting MSI data - eliminating a category of "reportable injuries" that has been on the OSHA 200 log (the form on which employers must report workplace injuries and illnesses) since Richard Nixon signed OSHA into existence in 1970.

The 1998 budget allows OSHA and NIOSH to research and to teach ergonomics, but not to enforce ergonomics regulations. In fact, there are no regulations for these agencies to enforce. OSHA has discarded the draft regulations developed by Dr. Silverstein's committee and is looking for other ways to promulgate ergonomic standards. 'This is a policy decision," Dr. Silverstein says of the deep-sixing of her committee's regulations, "not necessarily a scientific decision."

Ergonomics checklists are widely available, she says. OSHA's checklist drew from generally accepted principles. To opponents' charges that the proposed standards were too strict, she points out that "there are 6.2 million workplaces and not enough ergonomists to go around." OSHA's standard was meant to provide a means for triage. It had to be sensitive, rapid and easy to use. NIOSH has picked up the torch and is producing volume after volume of ergonomics information.

Up Against the System

The relatively new field of ergonomics is concerned with redesigning jobs in order to fit workers, so workers don't have to strain themselves to fit job demands. One of the first steps in an ergonomics program is to encourage workers to report any arm pains that last more than a few minutes. This not only protects workers, it also helps identify problem jobs.

Typically, an OHN is the first person in the workplace to spot those problem jobs. "Early intervention is the key," says OHN Kathleen Buckheit of the North Carolina Ergonomics Resource Center, a consulting and education service in Raleigh, North Carolina. "When you're in the plant every day, talking with the workers and watching the workers, you can get them to come in at the early stages, when it's just sore wrists," she adds. "We can ice their wrists, give them NSAIDs [non-steroidal anti-inflammatory drugs], and put them on light duties. Then we go out and we look at that job and try to find out what's hurting people."

Unions have encouraged OSHA to pursue ergonomics complaints and enforce workplace safety by using its General Duty Clause, which requires employers to protect workers from workplace hazards. OSHA enforcement is particularly important to the jobs that are at highest risk for MSIs (i.e. women's jobs) because those jobs usually don't have the protection of collective agreements or joint health and safety committees.

MSI-inspired national boycotts of meat-packing plants occurred in the mid-1980s, when the United Food and Commercial Workers International made carpal tunnel syndrome a central strike issue. In 1990, then Labor Secretary Elizabeth Dole announced OSHA ergonomics guidelines for meat-packing - an industry where, annually, some plants average one injury per fulltime job and Bureau of Labor Statistics (BLS) figures show an overall annual injury rate of about 25 percent. Since the installation of those guidelines, MSI rates in the industry have not increased; the 1996 BLS figures actually showed a slight decrease. This year, the AFL-CIO launched a national "Stop the Pain" campaign in favor of ergonomic regulations.

Many employers and their insurers, lawyers, and doctors dispute the very existence of MSIs. Anti-regulatory lobbyists, doctors, lawyers and insurers presented their perspectives at a "Science and Policy Issues" conference on "Managing Ergonomics" last June. Their arguments: "Pain may not be disability, depending on personal and workplace factors"; "An increase in MSIs reported in the workplace does not necessarily mean that they're work-related"; "These conditions are common in the general population"; "Doctors are encouraged to blame work so that workers' compensation will pay."

Opponents of OSHA's standard argue that both the incidence and severity of MSIs are overstated. Their argument is that much of what are called MSIs actually result from outside activities or aging; that workers either deliberately malinger or else unconsciously exaggerate their pain for what's called "secondary gain" (e.g., workers' compensation); that "the scientific proof is lacking" to link MSIs with workplace conditions (remember Agent Orange, Love Canal, and, most recently, the smokescreen of the tobacco industry?); and that the proposed standard is both too sensitive to potential hazards and not specific enough about which body parts might be affected. And of course, they complain about their cost estimates for retooling.

The American Trucking Associations estimate that compliance with OSHA's ergonomic regulations would cost its members $6 billion, including $2.5 billion in extra personnel costs. What's really peculiar is that its cost/benefit chart shows that this $6 billion would barely exceed current "unspecified" costs. Costs usually associated with not fixing ergonomic problems include workers' compensation, fines, disability claims, and litigation.

Looking Ahead

Although OSHA inspections and workers' compensation fines may provide impetus for employers to implement ergonomics programs, many employers become converts when they realize that ergonomics programs improve efficiency and productivity as well as safety. Ford Motor Company, for instance, responded to a 1989 OSHA fine of $1.9 million by incorporating a new documentation program into their ergonomics program. From data collection to line design to monitoring and review, Ford's program is outstanding in the automotive or any other industry.

"We didn't achieve the kind of two-for one dollar return you hear about with ergonomics," says Hank Lick, Ford's Manager of Industrial Hygiene, "but we got a return in other ways. All of our health and safety programs help our relations with our union. It's sort of a jewel in management's crown."

Ergonomic approaches are even more beneficial to small businesses. Gail Sater credited ergonomics programs with helping her employer, Red Wing Shoe Company, in Red Wing, Minnesota, survive in competition with overseas (Asian) manufacturers. This manufacturer enlisted workers' analyses and suggestions to revamp old plants into ergonomic showpieces. Ingenious low-cost, low-tech solutions for potentially crippling tasks included tiltable sewing machines, adjustable tables, and home-sewn forearm supports, strung from plant ceilings. By 1995, their workers' compensation costs had dropped to $800,000 per year, down from $4 million in 1988.

Yet for every company willing to think ahead and prevent injury, there are others who blame the victim. Joseph D'Avanzo, attorney for IBM and other defendants in harmful-products lawsuits, raises one of the most contentious questions in determining culpability: non-occupational factors. "How come nobody integrates into their models what people do outside of work?" he asks. 'Two people work side by side...doesn't mean that both of them are going to complain of pain or injury. So what is the difference between the two?"

"It's the same with tobacco," Dr. Silverstein replies. "Some people can smoke for twenty years and not get lung cancer. That doesn't mean tobacco has no impact on the development of cancer."

While lawyers haggle and lobbyists wrangle, women in and out of unions insist that jobs should not require them to do work that hurts. "When I do something at home that hurts, I can stop doing it," says Tashlyn Chase, CAW National Ergonomics Coordinator for Ford Canada. "When it hurts at work, I don't have that option. When workers go home at night, we go home tired. We can't pick up our children because our arms hurt too much. The onus has been placed on us for far too long."


Penney Kome is an award-winning feminist author and journalist. Her sixth book on women's issues, Working Wounded: The Politics ofMusculoskeletal Injuries, is due to be published next spring by the University of Toronto Press.


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