In 2011, the National Institute for Occupational Safety and Health along with the National Institute of Environmental Health Sciences and in partnership with the Occupational Safety and Health Administration and the Environmental Protection Agency convened a national conference on Eliminating Health and Safety Disparities at Work (www.aoecdata.org/conferences/healthdisparities/). In this issue Steege et al. [2014] present new analyses of the Bureau of Labor Statistics data on occupational injuries and illnesses and work-related fatalities, which indicate that workers who are African American, Hispanic, immigrant, who earn low wages and who have lower levels of educational attainment are at greater risk of working in occupations where occupational injuries and illnesses occur at more than twice the national rate. These data clearly demonstrate the need for more targeted and comprehensive occupational safety and health prevention programs aimed at reducing these disparities.

BACKGROUND: Occupational status, a core component of socioeconomic status, plays a critical role in the well-being of U.S. workers. Identifying work-related disparities can help target prevention efforts. METHODS: Bureau of Labor Statistics workplace data were used to characterize high-risk occupations and examine relationships between demographic and work-related variables and fatality. RESULTS: Employment in high-injury/illness occupations was independently associated with being male, Black, ≤high school degree, foreign-birth, and low-wages. Adjusted fatal occupational injury rate ratios for 2005-2009 were elevated for males, older workers, and several industries and occupations. Agriculture/forestry/fishing and mining industries and transportation and materials moving occupations had the highest rate ratios. Homicide rate ratios were elevated for Black, American Indian/Alaska Native/Asian/Pacific Islanders, and foreign-born workers. CONCLUSIONS: These findings highlight the importance of understanding patterns of disparities of workplace injuries, illnesses and fatalities. Results can improve intervention efforts by developing programs that better meet the needs of the increasingly diverse U.S. workforce.

In 2012, the U.S. civilian labor force comprised an estimated 155 million workers. Although employment can contribute positively to a worker's physical and psychological health, each year, many U.S. workers experience a work-related injury or illness. In 2011, approximately 3 million workers in private industry and 821,000 workers in state and local government experienced a nonfatal occupational injury or illness. Nonfatal workplace injuries and illnesses are estimated to cost the U.S. economy approximately $200 billion annually. Identifying disparities in work-related injury and illness rates can help public health authorities focus prevention efforts. Because work-related health disparities also are associated with social disadvantage, a comprehensive program to improve health equity can include improving workplace safety and health.

In 2012, the U.S. civilian labor force comprised an estimated 155 million workers. Although employment can contribute positively to a worker's physical and psychological health, each year, many U.S. workers are fatally injured at work. In 2011, a total of 4,700 U.S. workers died from occupational injuries. Workplace deaths are estimated to cost the U.S. economy approximately $6 billion annually. Identifying disparities in work-related fatality rates can help public health authorities focus prevention efforts. Because work-related health disparities also are associated with social disadvantage, a comprehensive program to improve health equity should include improving workplace safety and health.

OBJECTIVE: To examine trends in the proportion of work-related emergency department visits not expected to be paid by workers' compensation during 2003-2006, and to identify demographic and clinical correlates of such visits. DATA SOURCE: A total of 3,881 work-related emergency department visit records drawn from the 2003-2006 National Hospital Ambulatory Medical Care Surveys. STUDY DESIGN: Secondary, cross-sectional analyses of work-related emergency department visit data were performed. Odds ratios and 95 percent confidence intervals were modeled using logistic regression. PRINCIPAL FINDINGS: A substantial and increasing proportion of work-related emergency department visits in the United States were not expected to be paid by workers' compensation. Private insurance, Medicaid, Medicare, and workers themselves were expected to pay for 40 percent of the work-related emergency department visits with this percentage increasing annually. Work-related visits by blacks, in the South, to for-profit hospitals and for work-related illnesses were all more likely not to be paid by workers' compensation. CONCLUSIONS: Emergency department-based surveillance and research that determine work-relatedness on the basis of expected payment by workers' compensation systematically underestimate the occurrence of occupational illness and injury. This has important methodological and policy implications.

BACKGROUND: Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity. METHODS: We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations. RESULTS: Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work-related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers. CONCLUSIONS: Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed. (Am. J. Ind. Med. (c) 2013 Wiley Periodicals, Inc.)

OBJECTIVE: To analyze neurodegenerative causes of death, specifically Alzheimer disease (AD), Parkinson disease, and amyotrophic lateral sclerosis (ALS), among a cohort of professional football players. METHODS: This was a cohort mortality study of 3,439 National Football League players with at least 5 pension-credited playing seasons from 1959 to 1988. Vital status was ascertained through 2007. For analysis purposes, players were placed into 2 strata based on characteristics of position played: nonspeed players (linemen) and speed players (all other positions except punter/kicker). External comparisons with the US population used standardized mortality ratios (SMRs); internal comparisons between speed and nonspeed player positions used standardized rate ratios (SRRs). RESULTS: Overall player mortality compared with that of the US population was reduced (SMR 0.53, 95% confidence interval [CI] 0.48-0.59). Neurodegenerative mortality was increased using both underlying cause of death rate files (SMR 2.83, 95% CI 1.36-5.21) and multiple cause of death (MCOD) rate files (SMR 3.26, 95% CI 1.90-5.22). Of the neurodegenerative causes, results were elevated (using MCOD rates) for both ALS (SMR 4.31, 95% CI 1.73-8.87) and AD (SMR 3.86, 95% CI 1.55-7.95). In internal analysis (using MCOD rates), higher neurodegenerative mortality was observed among players in speed positions compared with players in nonspeed positions (SRR 3.29, 95% CI 0.92-11.7). CONCLUSIONS: The neurodegenerative mortality of this cohort is 3 times higher than that of the general US population; that for 2 of the major neurodegenerative subcategories, AD and ALS, is 4 times higher. These results are consistent with recent studies that suggest an increased risk of neurodegenerative disease among football players. (Neurology 2012;79:1-1)

Concern exists about cardiovascular disease (CVD) in professional football players. We examined whether playing position and size influence CVD mortality in 3,439 National Football League players with ≥5 pension-credited playing seasons from 1959 to 1988. Standardized mortality ratios (SMRs) compared player mortality through 2007 to the United States population of men stratified by age, race, and calendar year. Cox proportional hazards models evaluated associations of playing-time body mass index (BMI), race, and position with CVD mortality. Overall player mortality was significantly decreased (SMR 0.53, 95% confidence interval [CI] 0.48 to 0.59) as was mortality from cancer (SMR 0.58, 95% CI 0.46 to 0.72), and CVD (SMR 0.68, 95% CI 0.56 to 0.81). CVD mortality was increased for defensive linemen (SMR 1.42, 95% CI 1.02 to 1.92) but not for offensive linemen (SMR 0.70, 95% CI 0.45 to 1.05). Defensive linemen's cardiomyopathy mortality was also increased (SMR 5.34, 95% CI 2.30 to 10.5). Internal analyses found that CVD mortality was increased for players of nonwhite race (hazard ratio 1.69, 95% CI 1.13 to 2.51). After adjusting for age, race, and calendar year, CVD mortality was increased for those with a playing-time BMI ≥30 kg/m(2) (hazard ratio 2.02, 95% CI 1.06 to 3.85) and for defensive linemen compared to offensive linemen (hazard ratio 2.07, 95% CI 1.24 to 3.46). In conclusion, National Football League players from the 1959 through 1988 seasons had decreased overall mortality but those with a playing-time BMI ≥30 kg/m(2) had 2 times the risk of CVD mortality compared to other players and African-American players and defensive linemen had higher CVD mortality compared to other players even after adjusting for playing-time BMI.

Increasingly, the occupational health community is turning its attention to the effects of work on previously underserved populations, and researchers have identified many examples of disparities in occupational health outcomes. However, the occupational health status of some underserved worker populations is not described due to limitations in existing surveillance systems. As such, the occupational health community has identified the need to enhance and improve occupational health surveillance to describe the nature and extent of disparities in occupational illnesses and injuries (including fatalities), identify priorities for research and intervention, and evaluate trends. This report summarizes the data sources and methods discussed at an April 2008 workshop organized by NIOSH on the topic of improving surveillance for occupational health disparities. We discuss the capability of existing occupational health surveillance systems to document occupational health disparities and to provide surveillance data on minority and other underserved communities. Use of administrative data, secondary data analysis, and the development of targeted surveillance systems for occupational health surveillance are also discussed. Identifying and reducing occupational health disparities is one of NIOSH's priority areas under the National Occupational Research Agenda (NORA).

ONLY A FEW YEARS AGO, we were most of us under the impression that our country was practically free from occupational poisoning, that American match factories never were troubled by cases of phossy jaw, and that our lead works were so much better built and managed, our lead workers so much better paid, and therefore better fed, than the European, that lead poisoning was not a problem here as it is in all other countries. | The investigation made by John Andrews for the United States Bureau of Labor disillusioned us about our freedom from phosphorus necrosis, and the studies published by the New York State Factory Investigating Commission and by the United States Bureau of Labor Statistics are teaching us that, far from being superior to Europe in the matter of industrial plumbism, we have a higher rate in many of the lead industries than have England and Germany. As a matter of fact, the supposed advantages of the American lead worker, good wages, short hours, a high standard of living, obtain only in a few of the lead trades, such as house painting, plumbing (hardly a lead trade now), printing, and white ware pottery work. Art potteries, tile factories, white and red lead works, storage battery plants, and lead smelters and refineries pay the rate of wages given to unskilled laborers in that particular section and the work day is ten hours, while the standard of living is often very low, the men employed being for the most part foreigners with no permanent relation to the community in which they are working. When to these factors are added the almost universal absence of sanitary control of the work places and of personal care of the working force, it is easy to understand why we have much lead poisoning in industries which in Great Britain and Germany are comparatively safe.

ALICE HAMILTON, OFTEN referred to as the mother of US occupational medicine, was also one of a pioneering group of young women who formed part of Jane Addam's Hull House at the turn of the 20th century. Born in New York City and raised in Fort Wayne, Indiana, Hamilton earned her medical degree at the University of Michigan in 1893. Following internships in Minneapolis, Minnesota, and Boston, Massachusetts, she studied bacteriology and pathology in Germany and then at Johns Hopkins University in Baltimore, Maryland. She moved to Chicago in 1897 where she was appointed professor of pathology at the Women's Medical School of Northwestern University.1(p1–10) | While happy to find a professional position in her field, she was most excited about the opportunity to become part of Jane Addam's new settlement movement. Her life at Hull House exposed her to many of the leading progressive era activists and social reformers including Florence Kelley, the socialist, who fought against child labor and for the 8-hour workday. In her autobiography, Hamilton wrote, “In settlement life it is impossible not to see how deep and fundamental are the inequalities in our democratic country.”2(p75) While living among the working class immigrant communities of Chicago, Illinois, she heard about their deplorable working conditions and she began reading studies by European occupational medicine researchers. When she asked US authorities about the existence of industrial poisoning she was assured that the European findings could not apply to American workers who “were so much better paid, their standard of living was so much higher, and the factories they worked in so much finer than the Europeans.”2(p115) Alice Hamilton's training in pathology, combined with her intimate knowledge of working class life, and her ideals of social reform made her the spearhead of the occupational safety and health movement in the United States.3