Safety vs. Health

This is Part 4 of a series called Clash of the Protocols. See Part 3 here.

On Tuesday afternoon, I was speaking with the Summer of Protocols program director about my summer research plan. I pointed out the difference between Safety and Health. It’s a critical distinction:

Heath and safety can be effectively defined as:

• Health: the absence of diseases that negatively affect the quality or length of life.

• Safety: the absence of hazards that pose a risk of injury or death.

I say “effectively” because Occupational Health and Safety (OHS) nitpickers get hung up on the definition of safety. That’s because, despite being immersed in the field, they don’t understand that safety is the absence of something, not a thing itself. The same goes for health. Most of us are born with an absence of disease. We lose that absence over time. There is a good quote from Herbert K. Abrams:

“...work-related disease is socially produced and is, therefore, preventable; and work can be the source of good health and happiness rather than disease and misery.”

To be more precise, we should say that work can be a means of restoring or maintaining health. Our goal is to keep health, not create it. 

Now that we know what Health and Safety are (or rather, aren’t), we can look at their opposites:

More diseases, less health. More hazards, less safety. This is a good time to mention that Safety is the favorite sibling of H&S. Because it takes a longer time for Diseases to cause harm, Health is easier to ignore. And it takes longer to restore. It’s simpler to find cause-and-effect with acute injuries and fatalities caused by hazards, like explosives. 

However, the acute, immediate nature of hazards poses its own problems. Because it’s easier to find cause-and-effect in general, it’s easier to find WRONG causes. In other words, it’s easier to be fooled by randomness. Sticky, incorrect narratives catch on with pernicious effects.

In the early days of occupational safety (then known as industrial hygiene), accidents were always the worker’s fault. Workers’ poor judgment was always the cause. Today, it’s better understood that accidents have more to do with a cascade of small failures (this is known as the Swiss Cheese model of safety), rather than the fault of a single worker’s actions. They might be the proximate cause – “the last one to touch it” – but there were other events that, if it weren’t for them, the accident wouldn’t have happened. So the worker is rarely to blame. 

However, this tendency to blame the worker closest to the scene persists. We have a strong inclination to create a narrative to explain something (See Clash of the Protocols Part 1). We quickly forget that the accident was a surprise. With the knowledge that the accident occurred, we assume that it could have been avoided. 

This narrative problem is less of an issue with problems of occupational health. Because issues take longer to surface, and they are more systemic, it becomes more difficult to blame a single worker. However, the whole working class could be blamed. In the 19th century, workers were almost viewed as a different race. Issues with health were (wrongly) blamed on the inferior biological constitution, or the inevitable destiny, of workers. 

Class issues also come into play in another way. Herbert K. Abrams suggested that the scientific community has a history of being captured by industrialist interests. Universities are funded by corporations, scientists hang out with entrepreneurs. The interests of the two groups integrate without much care for the working class.

In Gang Safety, I touched on two different types of groups: Safety Gangs and Safety Armies. Safety Gangs are informally organized groups of coworkers. They operate using an organic network of communication channels. Safety Armies are groups of coworkers with a strictly defined hierarchy. They operate using designed channels of communication.

There are some major differences between the two types of groups. There are pros and cons to each:

There are two key points here. First, Safety Gangs are not the result of a plan – they arise to meet a need that multiple individuals share. Second, Safety Gangs come before Safety Armies. The initial reaction to a workplace hazard is NOT government regulation or corporate policy. The initial response is always bottom-up. 

This sequence of action is the same in public and private spaces. In public spaces, such as on state highways or in the broader setting of a town, initial responses are bottom-up. In the early days of Covid-19 people isolated, quarantined, distanced, and wore masks long before any formal guidance was issued. 

In workplaces, employees respond to hazards before formal interventions are made. Photos of dockworkers in the early 20th-century show workers using bandanas as masks to protect themselves from asbestos. Coworkers advise each other on dangerous terrains, persons, or pieces of equipment. 

This might make it sound like we don’t need Safety Armies. But Safety Gangs, those informal networks, aren’t equipped to correct systemic issues. Using Covid-19 again as an example, bottom-up efforts alone could not have created a vaccine (which saved millions of lives). 

In the staggeringly exciting world of OHS administration, there is a framework called The Hierarchy of Controls: 

Controls are ways of preventing a hazard from causing injury or death. The most effective controls do require organized efforts and sufficient resources. This is where Safety Armies come in. However, Safety Gangs can do a lot before that happens, even if it’s not as effective. Behavioral protocols, like shift rotations, sign-in sheets, verbal signals, and tutoring can all emerge in a bottom-up fashion. According to the Hierarchy of Controls, protocols are not as effective as simply eliminating a hazard. The advantage is protocols emerge sooner, require fewer resources, and are less fragile than controls requiring Safety Armies. 

The reliable sequence of bottom-up preceding top-down is explained well by a theory known as Pace Layering:

As discussed in Dirty Work, codification comes after implementation. Safety protocols are first created as a bottom-up reaction to a hazard. The different layers of the Pace Layering diagram operate at different paces. Where individuals have high agency, things change faster. Things change slower where big things are being built, where regulation is written, or where committees make decisions.

Big, cultural changes take a long time. In the 1800s, workers were always at fault for accidents. In the early 1900s, people began to recognize that sometimes it’s not the worker’s fault. But companies were rarely held liable. In 1916 Pennsylvania, mining accident records show that nearly all accidents that were not the fault of workers were unavoidable. So, no one was held accountable. 

As time went on, those same records show shared responsibility between the employee and employer. The culture around safety has changed dramatically over the last 100 years. Today, it’s frowned upon to blame workers for accidents.

We’ve even changed the nature of our workplaces. More and more people work “white collar” jobs. Many dangerous jobs have been automated away. But there are still threats to health and safety. They are new, and still largely overlooked. Diseases of abundance plague laborers and sedentary office workers alike. Atherosclerosis (heart disease) is the #1 cause of death in the world. Abundances of physical safety, food safety, and enabling technology have most likely contributed to this. Musculoskeletal injuries and diseases are also common among modern workers. High rates of depression, too.

The existence of these new occupational diseases doesn’t mean that we’ve solved basic safety problems everywhere. Large corporations, with high concentrations of power, can put a lot of pressure on smaller suppliers. Smaller suppliers, with small “Safety Gangs” and an inability to unionize, cut corners on safety to stay competitive. Transnational corporations can source materials from countries with less OHS oversight. The night shifts that our 24/7 economy requires have been linked to coronary heart disease and peptic ulcers. Workers from all of these groups lack a necessary component to safe work: agency. They don’t have alternatives.

Improvements in occupational health and safety follow a tragedy-fueled step function. When something big and terrible happens, and everyone sees it and cares, things change. There are three components to this function. Terribleness x Visibility x Importance = Likelihood of Change. 

Fortunately, with the amazing cost decreases in audiovisual technology, it’s becoming easier to establish transparency in global supply chains. This is a good thing for workplace safety.

The issue of health is more complex, due to its longer timescale. But technological and cultural shifts are also underfoot there. Overall, the world of OHS continues to trend in a positive direction. But the system doesn’t work for everyone; people still get hurt on the job and contract occupational diseases. So there is work to be done.

For those interested in my summer project, here is a summary of my research plan.

Summary:

A study protocol evolution, using workplace safety reporting protocols as a case study. Worker and employer reports on near misses, injuries, inspections, and fatalities have created a rich historical record. Informal and formal protocols determine what data is communicated, when it’s communicated, and to whom it’s communicated. Workplace safety is a good area to explore why some protocols succeed, and others fail. By better understanding the process of natural (and artificial) selection of protocols, workers and leaders can make better decisions.

Outputs:

1. A long-form essay on protocol evolution, and

2. An open-source whitepaper on safety reporting principles.

Methods:

• Literature review,

• Public OHS databases,

• One or two case studies of corporations, and

• A survey of OHS professionals.

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Thanks for reading The Thursday Edition! This was the last part of a series. Here are Part 1, Part 2, and Part 3. Subscribe to stay tuned on my summer research.

[1] Herbert K. Abrams theorized that the scientific community has a history of being captured by the industrialist upper class. For example, researchers could not disprove that materials like silica dust were causing “consumption”, i.e. tuberculosis. These findings were systematically suppressed. Scientists were on the payroll of large employers, whose profit-driven incentive structure provided them little reason to make the information public – let alone do anything about it.

He cited Rosner and Markowitz, who said “...What is so pernicious about labor’s dependence on the good will of the scientist is that close economic and class links tie the university to industry.”