Rosemary Sokas, M.D., M.O.H.

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Testimony
Before the Senate Subcommittee on Employment, Labor and Pensions, Committee on Health, Education, Labor, and Pensions
CDC Efforts to Address the Health and Safety Needs of Immigrant Workers
Statement of
Rosemary Sokas, M.D., M.O.H.
Associate Director for Science,
National Institute for Occupational Safety and Health,
Centers for Disease Control and Prevention,
HHS
For Release on Delivery
Expected at 2:00pm
on Wednesday, February 27, 2002

Mr. Chairman and members of the Subcommittee, on behalf of the National Institute for Occupational Safety and Health (NIOSH), I am pleased to provide this testimony addressing the health and safety of immigrant workers.

NIOSH is an institute within the Centers for Disease Control and Prevention (CDC), a part of the Department of Health and Human Services. CDC's mission is to promote health and quality of life by preventing and controlling disease, injury and disability. NIOSH is responsible for conducting research, providing technical assistance, and making recommendations for the prevention of work-related illness and injury.

Immigrant workers always have played a vital role in our nation's success story because of their important contributions to our institutions, our commerce, and our society. Today's immigrants continue to come to our shores with great hopes, ready to work hard to make better lives for themselves and their families. They will continue to be an important part of our country's future. NIOSH is working to address the needs of immigrant workers through targeted efforts to reduce illness and injury in high-hazard sectors of the workforce and increase appropriate language materials available to workers, employers, clinicians, occupational safety professionals, and faith-based and other non-profit institutions who work with immigrant populations. My testimony today will address the current state of our knowledge regarding the safety and health of immigrant workers and summarize the activities under way at NIOSH to learn more about immigrant worker safety and to reach out to workers and employers through prevention, intervention, and information dissemination.

Background

Occupational injuries and illnesses are tragic yet preventable occurrences. Sixteen workers will die today and every day from traumatic injury in the United States. Every locality with a working population of 100,000 will experience four work-related deaths each year, but these deaths will not be distributed evenly across the workforce. The risk of death for a farm worker is more than 31 times that of a clerical employee; the risk of death for a taxicab driver is 42 times as high; for a construction laborer, 47 times as high; and for a timber cutter, the risk is more than 240 times as high. Overall, the industries with the highest occupational mortality rates are mining, agriculture, and construction; the leading overall causes of death are highway incidents and falls. In addition to these fatalities, an estimated 136 Americans die daily from the chronic effects of occupational disease, and 9,000 sustain disabling injuries. Again, these outcomes are not evenly distributed across the workforce.

Immigrant Worker Demographics

To a great extent, the United States remains a nation of immigrants. According to the 2000 Current Population Survey (CPS) conducted by the U.S. Census Bureau for the Bureau of Labor Statistics, Department of Labor, one in every five Americans is an immigrant or the child of an immigrant. These figures include 16.5 million foreign-born workers. Latin America (Mexico, Caribbean, Central America, and South America) is the region of birth for over half of foreign-born workers, followed by Asia, Europe, Africa, and Canada.

Although foreign-born workers are diverse and include highly educated individuals with sought-after technical skills and strong family support, many foreign-born workers are from poorer, more disadvantaged societies, have recently endured disasters, or have arrived from war-torn countries.

As a group, foreign-born workers differ from U.S.-born workers in occupation and rates of injuries and fatalities. On the whole, foreign-born workers are less likely to be employed in managerial and professional specialty, technical, sales, and administrative support occupations (45.6% of foreign-born workers versus 61.5% of U.S.-born workers). At the same time, they are more likely to be employed in the higher-risk and lower-wage sectors of the workforce.

Nineteen percent of all foreign-born workers are employed in service occupations (private household, personal, cleaning and building protective service, food service, and health service), versus 13% of all U.S.-born workers. Of foreign-born workers in service occupations, 62% were born in Latin America.

Nineteen percent of all foreign-born workers are employed as operators, fabricators, and laborers (machine operators, assemblers, and inspectors; transportation and other material moving; handlers, equipment cleaners, helpers; construction laborers), versus 13% of all U.S.-born workers. These workers are also primarily from Latin America.

And foreign-born workers are twice as likely to be employed in farming, forestry, and fishing as U.S.-born workers. Of the foreign-born farm worker population, 90% are from Latin America.

According to the Bureau of Labor Statistics Census of Fatal Occupational Injuries (CFOI) surveillance system, between 1992 and 1998, 25% of work-related deaths of foreign-born workers occurred in retail operations (many resulting from crime-related homicides). The industry with the second highest number of foreign-born worker fatalities was construction (17%), followed by transportation and public utilities (15%).

The employment data we have may not provide a complete picture of the immigrant worker population. Recent or undocumented workers are likely to have been excluded from data collections since they may not have stable residences or may live in unofficial residences such as garages and backyard structures, or in shelters.

Furthermore, limited English proficiency may contribute directly to workplace fatalities. For example, the U.S. Chemical Safety and Hazard Investigation Board identified language barriers in worker training as a key factor in a January 7, 1998, explosion at a chemical company in Mustang, Nevada, that killed four immigrant workers and injured another six. In response to these findings, the State of Nevada revised the Nevada Occupational Safety and Health Act to include the following requirement: "The written safety program and all training programs required pursuant to this section must be conducted and made available in a language and format that is understandable to each employee."

Foreign-Born Agriculture Workers

There were 101 fatal injuries to foreign-born workers in the agriculture industry in the U.S. in 2000, comprising 16% of all occupational fatalities in agriculture. In 1990, with guidance from Congress, NIOSH established the National Program in Agricultural Safety and Health to address the severe health and safety hazards in agriculture and to protect and enhance the health and safety of farm operators, workers, and families. The program now includes funding for ten Centers across the country for agricultural disease and injury research, education, and prevention, as well as the National Children's Center for Rural and Agricultural Health and Safety.

In an effort to improve surveillance of farm worker safety and health, in 1995, NIOSH convened an expert work group consisting of public policy experts, farm worker representatives, and occupational health professionals. Although many of the findings and recommendations of the working group were specific to the occupational exposures of farm workers, they also addressed some issues generic to immigrant workers, especially recent immigrants. One of the key findings of the group was that many farm workers are employed in temporary, part-year employment and may feel intimidated about reporting health problems for fear of reprisals. These concerns are compounded when farm workers are undocumented immigrants. Also, immigrant farm workers may have different cultural beliefs that can influence their understanding of health risks, disease causation and treatment options. Another finding of the workgroup was that immigrants may be unfamiliar with their rights as workers including: health care coverage, lost work time payments available through workers' compensation, and their right to make complaints to OSHA or other government agencies when they encounter unsafe working conditions. The work group recommended forming research teams that include community members who are knowledgeable about local customs and concerns and have the trust of the community. For example, they recommended the use of "promotores" or lay community health workers to provide better outreach and communication with the worker community.

In 1997, based on the recommendations of the work group, NIOSH designed a pilot surveillance project which used lay health workers as advisors and as questionnaire administrators. The survey populations were in large part Mexican or Mexican-American so the obvious advantage was knowledge of language, especially local language variations. Other advantages included access to the community, knowledge of the local area, and a stake in the success of the project. The project raised awareness of the importance of occupational health and safety within the farm worker communities and documented the prevalence of musculoskeletal disorders, skin and eye irritation, field sanitation, and potential pesticide exposure. In addition, the results from this study have been disseminated to workers and other interested parties through collaborating organizations, at migrant health forums, at state meetings, and at general public health conferences.

To increase our understanding of the immigrant agricultural worker population, NIOSH began a collaboration with the Department of Labor in 1998 to collect large-scale data on the health and injury experience of hired crop farm workers through the National Agricultural Workers Survey (NAWS). NAWS data collected in fiscal 1999-2000 reveal that 85 percent of hired crop farm workers were foreign-born. The NAWS takes into account the seasonality and distribution of agricultural work done in the U.S. An employment-based survey, in which workers are found and sampled at their work sites, the NAWS is recognized for its ability to locate immigrant workers who may otherwise be missed in household surveys due to their mobility and/or non-standard housing arrangements. It is the only national study that has documented the living and working conditions of immigrant workers. About 7000 interviews have been completed on the health and injury sections, and data analysis is underway.

Current NIOSH-funded research and education projects targeted at immigrant farm workers include: 1) annual Migrant Farmworker Stream Forums which help researchers, workers, and advocates break down barriers to develop cooperation and trust; 2) teaching teen farm workers about workplace safety through school-based ESL (English as a Second Language) classes; 3) maintaining the National Agricultural Safety Database; 4) using peer educators to train high school students; 5) a health education project using theatre as a medium, thereby addressing literacy limitations; and 6) examining child farm labor in the Hmong population in Minnesota.

Construction Worker-Related Initiatives

According to the CFOI, in 2000, 23% of fatal occupational injuries to foreign-born workers occurred to construction laborers and workers in construction trades (i.e. brick masons, carpenters, drywall installers, electricians, painters, roofers, structural metal workers). While the number of Hispanics working in construction in the U.S. increased 19.8% between 1996 and 1997, the fatality rate among these workers increased 40.7% (CFOI, 1998).

NIOSH has a number of projects aimed at preventing injuries and fatalities to construction workers, a high-risk industry for immigrants. For example, NIOSH is doing a study on dry wall work, the construction occupation that has the highest percentage of Hispanic workers. NIOSH participated in 2000, along with other Federal agencies and the National Safety Council, in organizing and participating in the "Hispanic Forum on a Safe and Healthy Environment" which discussed a range of safety and health topics including issues relevant to construction safety. NIOSH also works with universities and key partners such as the Center to Protect Workers' Rights to coordinate research, evaluate the effectiveness of interventions, and disseminate those that emerge as best practices. Two current projects address: 1) evaluation of CPS data describing Hispanic construction workers with the objective of guiding development of initiatives targeting this group and very low-income construction workers in general, and 2) safety culture of Hispanic workers in construction.

NIOSH also targets the immigrant population for health education. For silicosis, a fatal disease which was identified in rock drillers and other construction workers, NIOSH developed a silicosis survey in Spanish and evaluated the effectiveness of targeting a silicosis prevention message to Hispanic construction workers. We have now developed a Spanish translation of silicosis education materials. Other construction-related education materials available in Spanish cover topics such as sandblasting, operation of wood chippers, electrocutions and falls during tree trimmings, working in hot environments, and work-related hearing loss. The Electronic Library for Construction Occupational Safety and Health (eLCOSH), funded by NIOSH, provides English and Spanish education materials relevant to construction. The materials are available on the internet for distribution by trainers and health educators.

Safety Promotion, Hazard Evaluation, and Workplace Violence Prevention

Many immigrant workers are employed in the service sector and small businesses. NIOSH is actively working to disseminate information to prevent injuries and workplace violence in these industries. In 2000, 24% of fatal occupational injuries to foreign-born workers were due to homicides. The majority of foreign-born homicide victims were tending a retail establishment; ten percent were in vehicular and transportation operations.

To address workplace violence, NIOSH is evaluating the effectiveness of various prevention strategies. NIOSH researchers are assessing crime prevention strategies for taxi cabs, such as bullet-resistant partitions, panic buttons, satellite-based tracking devices, and driver training, in reducing robbery-related injuries, assaults, and homicides to taxi-cab drivers. NIOSH is also assessing the effectiveness of various state-based approaches to workplace violence prevention, including state-specific occupational safety and health regulations, as well as other regulatory activities that might enhance workplace violence prevention.

The results of much of our research is communicated on our web site. For example, the new NIOSH Spanish-language web site, "NIOSH en Español," includes materials addressing topics such as workplace stress and prevention of homicide in the workplace.

For nonfatal injuries, NIOSH has also funded a range of projects relevant to immigrant workers, including research on home health care aides and poultry workers. We currently have a health hazard evaluation document available on dry cleaning chemical hazards translated into Korean for Korean operators and employees of dry cleaning establishments and hope to translate more materials into more languages in the future. The NIOSH Health Hazard Evaluation Program is available to employers and to workers and their representatives and provides safety and health evaluation and recommendations at no cost to the employer.

Through NIOSH's Fatality Assessment and Control Evaluation (FACE) Program, NIOSH, and state-based evaluators in 15 states funded by NIOSH, conduct evaluations of workplace fatalities using an epidemiologic model to identify potential risk factors and develop recommendations to reduce the risk of fatal injury. Since the FACE program was initiated, NIOSH and its state partners have conducted a number of evaluations of the deaths of immigrant workers. Examples include a machinist who was pinned between parts of metal materials handling equipment and a 22-year-old laborer who fell 41 feet to his death from a roof under construction. Language barriers were identified in each of these two instances. NIOSH-funded evaluators recommended that supervisors ensure that workers who do not understand English are offered safety instructions in a language they do understand.

Information Dissemination

NIOSH has developed many innovative methods of communicating occupational health and safety information to immigrant workers. Immigrant workers who have Limited English Proficiency (LEP) are susceptible to failures of communication with their employers and co-workers which can lead to work-related injuries and fatalities. NIOSH is working to accurately enumerate the number of LEP workers in the U.S. by occupation and high-risk industries, e.g., construction, agriculture, and mining. Using this information, NIOSH will be better able to develop new methods to communicate injury risk and prevention information to LEP workers.

NIOSH recently published a document entitled "Simple Solutions: Ergonomics For Farm Workers." Backaches and pain in the shoulders, arms, and hands are the most common symptoms that farm workers report. The "tip sheets" in this booklet show how to make or order inexpensive new tools or to modify existing ones to reduce the risk of pain.

Current efforts to address low-English-literate workers include development of graphic representation of hazards and the development, with the International Labor Organization, of an occupational safety and health curriculum which may benefit immigrant workers. Also, NIOSH is partnering with international organizations to fund a web site which provides International Chemical Safety Cards (ICSC) in 13 languages. The cards contain summaries of chemical safety information for use at the "shop floor" level in factories and other workplaces.

We are working with the National Academy of Sciences to host a workshop to develop a Spanish-language dissemination strategy. Currently, in addition to consulting our Spanish-language web site, Spanish-speaking workers can call the NIOSH 800-number (800-356-4674) and access Spanish speakers.

NIOSH Extramural Research

In 1996, NIOSH and hundreds of its stakeholders launched the National Occupational Research Agenda (NORA), a framework for setting priorities in occupational safety and health research. One of the priority research areas identified was Special Populations at Risk. One focus of the NORA Special Populations at Risk team is the contribution of occupational factors to health disparities in low-income populations, including the immigrant worker population.

Research into the immigrant worker population poses many challenges, including: language/cultural barriers, greater job mobility, over-representation in temporary work situations, over-representation in small industries, and employers less likely to want to participate in occupational health research. The goal of the NORA Special Populations team is to identify gaps in research and make recommendations for new types of survey instruments to be developed. Issues of concern include validating questionnaires for multi-cultural, low-literacy, non-English speaking populations and developing questions that have universal application across a wide range of occupations and exposure situations.

Additional NORA priority areas that address the specific needs of immigrant workers include the Organization of Work Team, which has focused attention on contingent and part-time work; the Traumatic Injuries Team, focused on fatal injuries, and the Intervention Effectiveness Team, which has developed guidelines for taking off-the-shelf materials and evaluating their efficacy in workplaces. Alone as well as in partnership with the National Institutes of Health, the Environmental Protection Agency and others, NIOSH has funded research projects to evaluate teen farm worker education and specific health and safety interventions, state-based pesticide illness tracking, the use of community health centers to track minority occupational health outcomes, control technologies to reduce electrocutions, and a variety of innovative programs to track and prevent injury and illness among high-risk, low-wage and LEP workers.

Opportunities for Improving Immigrant Worker Health and Safety

There are many opportunities for research and health education activities that target the immigrant worker population.

Data collections involving immigrant workers can be improved. Researchers should take into account not only cultural and language barriers, but also factors such as job insecurity, high job mobility, temporary employment, and informal employment such as day labor and domestic and childcare work. Interventions must better address needs and concerns of small employers, and workplace health and safety recommendations should be appropriate to small businesses where immigrant workers are often employed. In general, occupational health research should incorporate multi-disciplinary approaches that include disciplines such as engineering, economics, sociology, anthropology, and political science.

Community-based programs for immigrant workers could include an occupational safety and health component which would address the social/political challenges low-wage immigrant workers face, including lack of transportation and access to social services, inadequate housing, and exploitation due to their unfamiliarity with US. culture and institutions. Special efforts should be made to educate immigrant workers about U.S. regulations and compensation programs and take into account concerns of undocumented immigrants.

Conclusion

In summary, NIOSH is making progress in working to address the needs of immigrant workers. The activities mentioned herein are only the beginning of our efforts to conduct research into immigrant worker safety and health, track injuries and illnesses, and communicate workplace health and safety issues to immigrant workers. Many challenges specific to immigrant workers have been identified and innovative prevention strategies have been developed. Increased understanding of the experience and concerns of immigrant workers will help us better tailor education and intervention programs to the needs of this diverse population. NIOSH is dedicated to continuing this work to further protect the health and safety of the immigrant worker population.

I will be glad to answer any questions you may have.

Last revised: March 7, 2002