Year
Fatalities
Employment
(× 103)
Fatality rate
(fatalities per 100,000 workers)
1970
13,800
77,000
18.0
1975
13,000
85,200
15.0
1980
13,200
98,800
13.0
1985
11,500
106,400
11.0
1990
10,500
117,400
9.0
1995
6,275
126,200
5.0
2000
5,920
136,377
4.3
2005
5,734
142,894
4.0
A Pandora’s box opens itself when the conditions in less developed countries are considered: Mine workers in insufficiently equipped mines, farm workers exposed to hazardous pesticides, factory workers (e.g. textiles) in dangerous factories, etc. are of concern. Countermeasures are evident.
The situation with respect to sports-related impairment which is likewise associated with enormous health cost (Table 9.2), is however quite different. Public awareness is mostly related to the health condition of star players in prominent teams rather than to health impairment resulting from sports activities of the general population. In professional sports, safety issues are primarily reflected in game rules, referee work and trainer education, while in general sports, countermeasures are often of an ad hoc nature, little systematic, limited to general recommendations or promoted by manufacturers of sports accessories. The reason might derive from the fact that most sports activities are of a recreational and voluntary nature. Again quite different, finally, are circumstances regarding health problems due to continued strenuous household work: This area is virtually unexplored from a scientific point of view.
Table 9.2
Number of accidents/injuries and illnesses along with cost due to sports, estimated for Switzerland in 2001 by the Swiss Federal Health Office
Number of accidents/injuries | Number of diseases | Direct cost (CHF) | Indirect cost (CHF) | |
|---|---|---|---|---|
Accidents/injuries and cost caused by sports | 300,000 | – | 1.1 109 | 2.3 109 |
Benefit from sports-related physical activity | – | 2.3 106 | 2.7 109 | 1.4 109 |
Illnesses due to lack of physical activity | – | 1.4 106 | 1.6 109 | 0.8 109 |
Medical disciplines mostly involved in chronic diseases are rheumatology, orthopaedics, neurology, sports medicine, radiology, pain management. Due to the significant involvement of psychic and social factors, psychiatry is likewise of importance. While diseases considered here such as bursitis (inflammation of a bursa, a friction-reducing layer between skin, ligament or tendons and bony structures) are mostly due to external mechanical overloading over extended periods of time, mechanical overload can also be caused by the body itself, in that obesity, hypertension or muscular dysbalance represent long-term risks in view of health impairment and premature death. Functional misuse, e.g. continued work in a bent position, is a further source for health impairment. The application of biomechanics in the quantitative sense treated in this book is difficult under circumstances exhibiting such a variety. “Simple” statistics, i.e., collection of numbers and monitoring of data over years prevail. This is not surprising since realistic experiments on long-term mechanical exposure can hardly be performed, analytical procedures suffer from missing basic knowledge and physiological and psychical reactions under conditions of continued pain exhibit enormous individual variations which cannot be disregarded. Accordingly, workplace safety issues are to a large extent limited to the prevention of acute injury.
Rehabilitation is an important issue likewise in cases of acute and chronic illnesses. Biomechanics are of important in this context insofar as physiotherapy, physical therapy, orthopaedic aids, wheelchairs, training devices etc. rely on the application of methods and on the design of apparatus where biomechanics have to be taken into account mostly on a quite basic, albeit important level. Since this is not directly related with trauma biomechanics, however, these subjects are not further considered here.
9.1 Occupational Health
Professions and working conditions which are associated with heavy and strenuous mechanical exposure are numerous and cover a wide variety of forms ranging from as different activities as underground mining to ballet dancing. The problem of long-term impairment appears in all of these professions, but it has to be treated differently in each case. Moreover, working conditions and standards to be maintained differ considerably from country to country. Activities of labour unions and NGOs as well as legal procedures with respect to early retirement, inability to work and workman’s compensation are furthermore quite influential and subjected to different local political conditions. Gender differences have furthermore been observed. In an extensive report prepared by the WHO (Kane 1999), the particular risks that women are exposed to are discussed.
A large number of regulations and status of health reporting plans in connection with strenuous and hazardous work is maintained by the Occupational Safety and Health Administration of the US Department of Labor (http://www.osha.gov/). In other countries, similar organizations exist. In Switzerland, e.g., it is the partly government-controlled Accident Insurance Company (suva) with mandatory coverage of all “blue collar” employees (i.e., including also low-risk professions) whose tasks includes workplace as well as leisure accident issues. From the many professions, a few exemplary remarks are made in the following:
Construction work, mining, lumber and woodwork: These are the professions that come to mind first when a hard and strenuous work environment is addressed. Early retirement due to health problems and health-related absenteeism are in fact well known (Brenner and Ahern 2000) and have been recognized as such for a long time. While the risk of acute injury is approached by numerous regulations (helmets, ear protection, gloves, etc.) long-range impairment is difficult to control. For practical reasons, e.g., weights to be lifted cannot be limited because these are given by the materials to be used. Accordingly, lower back pain is widespread (Latza et al. 2002). Cost associated with health problems along with the need for a continued increase in efficiency causes therefore a growing application of machinery.
Nursing: Nursing is known as a profession which is partly associated with strenuous work and impairment. The situation was analysed comprehensively in the EU sponsored NEXT study (Nurses Early Exit Study). The physical environment, i.e., lifting, bending or work with non-cooperative and aggressive patients was thereby recognized as a major problem.
Professional dancing (classical ballet, break dance): Amenorrhea is a well-known complication in females who are exposed to continued strenuous or irregular work environments such as professional ballet dancing or long-haul airline work. Associated loss of bone mineral content cannot systematically be compensated by physical training (Warren et al. 2002). Not surprisingly, the ankle joint is mostly prone to chronic impairment in ballet dancers (Rand et al. 1999). A comprehensive overview over risks associated with professional dancing is given in (Dance Medicine–The Dancer’s Workplace, Unfallkasse Berlin).The particular risks associated with break dancing were investigated by Kauther et al. (2009).Related posts:
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