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Morbidity, Disability, Cost, Pain & Distress: Exposing the True Burden of Workers’ Compensation

July 30, 2017 (6 min read)

By Karen C. Yotis, Esq., Feature Resident Columnist, LexisNexis Workers’ Compensation eNewsletter

A resolute new analytic essay about the substantial impact that the underestimation of workers’ comp risk has on national welfare and public health examines the multi-dimensional aspects of the burden that workplace hazards impose on individuals, organizations, and society, and cuts straight to the heart of the economic and political strains that are weakening the Grand Bargain.  Burden is defined as “the health, economic, and social consequences of occupational and work-related diseases and injuries,” and the authors argue that decision-makers need to know more about it in order to make more accurate and comprehensive policy and investment choices.

The essay, “An Approach to Assess the Burden of Work-Related Injury, Disease, and Distress,” by Paul A. Schulte et al., published in the American Journal of Public Health (Vol. 107, No. 7, July 1, 2017, pp. 1051-1057), proposes an approach to gauge what we know about burden, understand its dimensions, and discern the changes that affect that burden over a working lifetime. Their approach includes these four parts:

  1. Utilization of Multiple Domains
  2. Taking a Broader View of Disease and Injury
  3. Assessing the Entire Working-Life Continuum
  4. Using ‘Well-Being’ as a Burden Indicator

Whose Gonna Be the Beast of Burden?

The essay lays the groundwork for its four-pronged approach by highlighting the findings and conclusions about the impact of under-estimation of reported burdens from other cited research studies. Spending of over $250 billion in 2007 on medical costs and productivity losses, annual costs of $340 billion resulting from reductions to the overall health of the employed population in the mining sector, and the death of an estimated 2.3 million workers globally from reasons attributed to work, are among the indicators the authors use to illustrate the significant nature of the work-related disease and injury burden. The authors also point out how burden is commonly estimated for narrowly defined conditions directly tied to specific workplace exposures. Studies pointing to the under-recognition, under-reporting, or under-counting of occupational disease and injury statistics and the failure to consider adverse health effects like musculoskeletal disorders, mental health, cardiovascular disease (and their economic and social impact) because of multi-year lag time or latency between exposure and disease also support the authors’ suggested burden assessment approach.  The essay also mentions missing data associated with hidden costs (like personal health expenses, wage losses, and Social Security disability benefit payments) as well as the myriad consequences suffered by workers, their families, employers, and society overall that are not currently assessed in a comprehensive way when decision makers measure and plan for risk.

The authors’ approach is accordingly “designed to encompass the many dimensions of burden on people and organizations, the resultant burden from different aspects of work and workplace hazards, and the changes that affect burden over a working lifetime.”  Regardless of whether or not you’re a workers’ rights advocate, I encourage you to read on. While the essay does take a somewhat idealistic approach to risk assessment, the authors may be on to something interesting here …

Backs are Broad, but they’re a-Hurtin’

Each of the four factors in the authors’ proposed approach to burden assessment is intended to contribute to a more accurate accounting of burden.

Utilization of Multiple Domains – this facet of the authors’ approach adds the subset groups of the worker’s family and community to the main worker/employer/society participants to the Grand Bargain to include a broader range of considerations to risk assessment. This approach is based on a recognition that while burden is generated in the worker’s domain, it spills over into each of the other groups across many different realms (such as physical, psychosocial, functional, economic and legal), with a growing impact on communities in the form of social welfare payments, medical and health scheme costs, and lost potential output and revenue. Future researchers and policymakers are accordingly challenged to go beyond the narrow view of burden that has heretofore been the norm towards a more accurate accounting of burden that includes a broader range of considerations.

A Broader View of Disease and Injury – this facet of the authors’ approach advocates consideration of the entire spectrum of diseases caused or exacerbated by work and a broader examination of the interaction of work and nonwork factors. Based upon an appreciation that many health conditions most prevalent in workers are not caused solely by workplace hazards, this approach calls out the separation of work and nonwork as artificial and argues for a more comprehensive accounting of health conditions that are substantially, but not exclusively, related to work (think obesity, hearing loss and arthritis) to ensure effective prevention and control.

Assessment of the Work-Life Continuum – this facet of the authors’ approach points to the rich literature describing the changing nature of work, the workforce, and the workplace to support the position that examination of an individual’s entire working life is necessary to accurately capture the components of occupational and work-related burden. This runs the continuum from pre-work to post-work and generally involves many jobs and periods of employment. Included in the assessment alongside traditional occupational safety and health hazards are: the “discontinuities and distresses” of working life; underemployment; income-based underemployment; employability; the diminished potential to succeed; and even the accurately depicted “precarious employment” involving today’s numerous nonstandard employment arrangements in which individuals are characterized by their “insecure relation to work.” Unemployment itself is also included as a source of ill health that has adverse physical and mental health effects.

Well-Being as a Burden Indicator – this facet of the authors’ approach is based on the idea that consideration of well-being (and the lack or absence of this nebulous concept) may be what is needed to identify the correct parameters related to workplace hazards and to individual risk factors that lead to burden for workers, their families, employers, communities, and society at large. The challenge (aside from the HUGE definitional questions) is “how to implement well-being determinations on an on-going basis and how to interpret differences in well-being among individuals and groups in relation to their work.”

Am I Rich Enough?

Further research on burden and enhanced surveillance is needed to develop these elements. The authors readily admit that developing a comprehensive approach to burden depends on achieving a more far-reaching and complete quantification of the concept and formulating ways to communicate it effectively. Indeed, the essay includes an entire section that delineates the important research and data needs in each of the four elements of their proposed burden analysis. Highlights include identifying: new sources of surveillance data to support burden determinations; mechanisms of interactions of occupational and personal risk factors; how to operationalize precariousness in employment studies; how well-being can be assessed across groups and times; and how to effectively communicate the burden of adverse effects in the working-life continuum to influence decision-makers.

Not Too Blind to See

There’s a lot to digest here, and to some of our readers, portions of what the essay authors say may sound unattainable or unrealistic. The authors argue that lack of awareness about the true burden of work-related injury, illness and distress is the reason decision-makers at both the enterprise and societal level have not heretofore supported the need to address these issues in a comprehensive way, despite the existing partial estimates related to burden, which are admittedly significant. The authors hope that increased use of their four-part approach will lead to a deeper understanding of burden. But the long-term goal is that a more comprehensive understanding of burden will “provide useful information for enterprise and national investment priorities.” See … I told you they were on to something interesting …

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