NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy

The controversy over whether repeated head impact (RHI)—a feature of occupations including professional contact sports, military service, firefighting, and logging—can cause the neurodegenerative disease now known as CTE (chronic traumatic encephalopathy) has thrust many positive epidemiologic studies into the spotlight. Various skeptics who dispute that the relationship is strong and causal continue to raise objections to these studies and their interpretation. The arguments these skeptics use remind other observers of many past sagas of “manufactured doubt,” particularly the history of attempts to cast doubt on the propensity of tobacco products to cause lung cancer. A recent article in the Journal of Science and Medicine in Sport³ complained that drawing the parallel between RHI and cigarettes is unhelpful, concluding that “the time for politically motivated analogies has now passed.” This author disagrees, and explains in detail 2 scientific aspects of risk assessment and management that make the analogy apt and instructive for the future. In particular, I argue that the problem of “manufactured doubt” here is two-fold: it relies on various fallacies of reasoning discussed herein, but more importantly, it seeks to divert and delay the utilitarian imperative—while we grope toward the ever-elusive certainty, there are many low-regret actions we can and should take on the basis of persuasive signals of harm.

For public interest advocates engaged on issues of worker health and safety and environmental protections, regulatory cost–benefit analysis has long been seen as an obstacle to meaningful progress. In November 2023, the Biden administration overhauled Circular A-4, which provides guidance to agencies on how to perform cost–benefit analyses for their rules. The reforms seek to make cost–benefit analysis less biased against worker safety, public health, environmental, and other protective safeguards. As such, the new version of Circular A-4 offers important new levers to agencies to justify more stringent protections. By extension, those in the public interest community can use agency implementation of the new Circular A-4 as part of their advocacy efforts for specific rules they are tracking. This article seeks to support this tactic by providing a roadmap for advocates on how to incorporate into their comments critiques of agencies’ cost–benefit analyses based on the Circular A-4 revisions.

This paper describes the work-related information collected in several important U.S. national health and behavior surveys, to highlight data gaps that prevent identifying responses by vulnerable workers in the gig economy, with emphasis on the growing digital platform sector of the work force. The national information systems used to understand health status and health behaviors, including drug use, rely on outdated census categories for self-employed workers. This paper describes the importance of understanding the needs of this growing part of the labor sector and describes how some of the most well-known and utilized national surveys fail to meet this need. For the agencies conducting national health and behavior surveys, we propose revisions to the categories used to classify type of worker and recommend adoption of a new Worker-Employer Relationship Classification model.

The well-being of health care workers (HCWs) and the public in Ontario, Canada is at risk as the province's health care system is strained by neoliberal restructuring and an aging population. Deteriorating working conditions that preceded the COVID-19 pandemic further declined as the added challenges took their toll on the work force, physically and mentally. The pandemic-weary hospital staff, predominantly women, many racialized, are facing unprecedented challenges. They are experiencing stress, anxiety, and burnout from staffing shortages and the resulting increased workloads, long hours, and violence. Comprehensive telephone interviews were conducted with 26 HCWs from less highly paid occupations in a range of hospitals across the province. Thematic analysis reveals a critical need for policies and legislation ensuring increased funding, hospital capacity, and reduced wait times while providing HCWs with fair and equitable wages, increased staffing, mental health supports, greater respect and acknowledgment, and strong protections from violence and other workplace hazards.

Ethnic minority healthcare workers (EMHCW) are at high risk of COVID-19 infection and adverse health outcomes, but vaccine uptake is low among ethnic minority communities, including EMHCW. We explored the views of EMHCW towards COVID-19 Vaccine Education (CoVE), a digital training resource to improve knowledge and confidence for promoting the COVID-19 vaccine. Thirty EMHCW completed CoVE, then participated in a semi-structured qualitative interview. Principles of framework analysis were used to deductively analyse data using concepts from the Kirkpatrick New World Model of training evaluation. CoVE was viewed to be engaging, accessible and relevant to EMHCW. This training increased EMHCW perceived knowledge and confidence to provide evidence-based information to others, dispel myths, and reduce vaccine hesitancy. Participants reported changes in vaccine promotion behaviours and vaccine uptake. CoVE could be used to help improve vaccine literacy among EMHCW, enhance health communications about vaccines, and ultimately help facilitate uptake of occupational vaccination programs.

For many women, house cleaning is an important way to participate in the labor market. In Brazil, there are 2 types of domestic workers: housekeepers have relatively secure employment and house cleaners are day laborers. The aim of this hypothesis-generating study was to describe the sociodemographic, occupational and health profile of a sample of domestic workers in Brazil. House cleaners received lower wages, had longer daily working hours and worked in a larger number of homes each week in comparison to housekeepers. About 51% of the domestic workers in this sample reported the use of pain medication and 34% reported spinal problems. Musculoskeletal symptoms were frequent in the lower back and upper limbs. Forty-seven percent reported high blood pressure. This study highlights the vulnerability of domestic workers, especially house cleaners, regarding workload, salary, and health conditions. Level of education is a contributing factor to this vulnerability.

Ensuring the safety and health of workers in this country, who are employed at millions of workplaces presenting a dizzying array of hazards, is beyond daunting. And yet, it is exceptionally important, because the lives and well-being of countless workers, and their families, hang in the balance. Every day, workers are maimed or die of their workplace injuries or occupational illnesses. These outcomes are unacceptable. Agencies must use all the means at their disposal to keep workers safe and healthy in their workplaces. This paper addresses this challenge through the lens of strategic enforcement, with the goal of maximizing enforcement effectiveness to save lives and limbs.

First, we examine how, under the Occupational Safety and Health Act, federal and state enforcement schemes are designed to interact. Next, we dive into the impressive array of strategic enforcement tools that are available to federal, state, and local enforcers, and we observe that many of them are either unrecognized or underutilized. We emphasize that these are all significant, because, given our limited enforcement resources, we need to use every tool we can muster—from strategic targeting, to enterprise-wide enforcement, to heightening deterrence through more robust penalty assessments and publicity, to valuing and making the most of partnerships and coenforcement efforts with a wide range of organizations and agencies. And we need to engage in a process of continual evaluation and improvement of our tools and assets, always striving to maximize our enforcement leverage in aid of worker safety and health. Finally, we examine an impressive list of initiatives state and local governments have taken, beyond what the OSH Act mandates, in their efforts to go the extra mile for the safety of the workers in their states and cities. These examples are intended to inspire federal, state and local agencies to do the same, or, hopefully, even better. The stakes are high. Workers deserve to work in safe and healthy environments. This paper is intended to provide practical ways in which state and local agencies can better—and potentially far better—satisfy that obligation.