Tuesday, January 17, 2017

Mandatory flu shots for health-care workers?

A perennial OHS issue is whether or not health-care workers (HCWs) should be compelled to get an annual flu shot. Paula Simons tackled this issue last week for the Edmonton Journal. Her arguments (implicit or explicit) for the government mandating vaccinations among HCWs are basically three:
  1. We require HCWs to be vaccinated for many diseases (such as mumps, measles and rhubella) and should do so for influenza as well.
  2. Immunization of HCWs can reduce the incidence and effects of influenza among patients. 
  3. Failing to get vaccinated is unethical behaviour for HCWs.
I spent some time looking through the research related to this issue. Before talking about that, I want to be clear that (1) I get a flu shot, (2) I have no time for anti-vaccer arguments, and (3) I’m not an expert in the efficacy of flu shots or influenza transmission.

From what I can tell, vaccination seems to prevent influenza some of time (overall, it is about 60% effective), including among HCWs. This finding seems pretty widely accepted; if you are interested, here is a study.

This is a significantly lower rate of effectiveness than MMR vaccinations (which are about 90% effective).  Opponents of mandatory influenza vaccination note the much lower effectiveness of the influenza vaccine undermines the argument for mandatory flu shots.

The evidence on whether vaccinating HCWs affects patient outcomes (since HCWs are not the only source of patient infection) is mixed. Some research supports this position, particularly when looking at elderly patients in geriatric facilities (example and example). Yet, every study has limitations. A systematic review of the literature (which controls for the quality of studies) concludes:
Our review findings have not identified conclusive evidence of benefit of HCW vaccination programmes on specific outcomes of laboratory-proven influenza, its complications (lower respiratory tract infection, hospitalisation or death due to lower respiratory tract illness), or all cause mortality in people over the age of 60 who live in care institutions. … This review does not provide reasonable evidence to support the vaccination of healthcare workers to prevent influenza in those aged 60 years or older resident in LTCIs.
This systematic review is not without controversy (it sets a high bar, for one). That said, it stands for the proposition that there is (as yet) no conclusive proof that vaccination programs reduce the incidence of influenza or its effects among older patients in long-term care facilities. I didn’t see any similar studies on effects among other patient groups or other kinds of helath-care facilities. Such studies may exist, I just didn’t find any in my search. Given this data, I think we can conclude the jury is out on the effectiveness of HCW vaccination on patients.

The final argument is essentially a moral one: if vaccination may reduce transmission to patients, then health care workers should be compelled to be vaccinated. As Simons puts it:
In a time of anti-vaccine hysteria, we need health-care workers to set an ethical example. We need them to demonstrate respect for science and for logic.
Setting aside that HCWs are not responsible for refuting anti-vaccer non-sense (that would be journalists’ jobs…), as we’ve seen above, the science on the effectiveness of mandatory flu shots for HCWs is not settled. Rather than engage with this nuanced issue, Simons opts for an ad hominem attack on HCWs:
But it’s time to stop making excuses for health workers who just can’t be bothered, or who think they’re invincible, or who just have some vague prejudice against vaccines.
As Jason Foster and I note in Chapter 5 of our new OHS textbook, the other side of this argument is that mandatory vaccinations interferes with the rights of HCWs to control their own health. Simons largely dismisses this concern, briefly noting “Forcing people to be vaccinated does sound coercive” and moving on to propose just that.

Health-care employers frequently advocate mandatory immunization. Presumably, they do so in pursuit of patient safety. Yet, this position is hard to square with the lack of evidence that vaccination affects patient outcomes. Some workers note that health-care employers have many motives for policies, including reducing sick leave claims.

Some employers (including the province of British Columbia) have attempted to manage this issue by giving workers a choice: get immunized or wear a mask when interacting with patients. This may be a more reasonable approach than the mandatory vaccinations that Simons advocates. An interesting question for those who like evidence-driven policy is what evidence of reduced rates of influenza has the BC experiment yielded?

-- Bob Barnetson

Friday, January 13, 2017

Labour & Pop Culture: Dirty Hands

This week’s installment of Labour & Pop Culture is the Battlestar Galactica episode “Dirty Hands”. I recently coauthored a paper on the absence of unions in science fiction with Mark McCutcheon and this was one of the few examples we found of unions in the (huge) canon of SF. I never really watched the new BSG (I prefer my Cylons robotic and my flight suits corduroy—see right) but this was a good episode.

The crux of the plot is declining fuel quality and quantity endanger the fleet’s ability to evade the Cylons. Responding to Dickensian working conditions aboard the fleet’s refinery ship, the refinery workers sabotage its operation by hiding crucial parts, a tactic thwarted via imprisonment and psychological torture. A replacement director of the refinery is converted to the worker’s cause and calls a general strike, which is averted first by threats of killing supporters and then by accommodation of some of the workers’ demands by the authorities.

In this episode, we see fleet Admiral Adama use the coercive powers of the state—including imprisonment, threats, and torture—to contain illegal strike action. Yet, having achieved his goal, Adama then sees the need for a political solution, wherein workers’ consent to their conditions of work is necessary to maintain long–term stability.

This portrayals of state activity may reflect the pluralist view of labour relations (i.e., workers and employers have legitimately conflicting interests and the state referees to preserve social stability) or the radical (i.e., the state colludes—or is one and the same as—with the employer to contain worker dissatisfaction).

This radical interpretation of “Dirty Hands” might be preferable given that the union’s leader, after abandoning a strike and securing minor improvements in working conditions, is wined and dined by the president in her luxurious cabin. This scene implies that the union leadership has been coopted by the political elite.

It is notable that the episode uses a strike as a plot device: strikes and corrupt union officials are pretty much the only two instances where unions are mentioned in contemporary books, TV series, or movies. I couldn’t find any related video of “Dirty Hands” so, instead, I leave you with the opening sequence from the 1978 Battlestar Galactica television series.

-- Bob Barnetson

Tuesday, January 10, 2017

News round-up: Farm WCB, child labour, and dead workers

A few interesting things went down last week in Alberta labour issues. The government announced the results of the first full year of mandatory WCB coverage for paid farm workers. The short version is that the number of operations covered jumped from 1756 in 2015 (when coverage was optional) to 3629 in 2016. There was no estimate of what percentage of operations have taken out the mandatory coverage.

In 2016, 793 farm injuries were accepted. The most number of accepted injuries came from feedlots (192), then hay/grain/crop farming (131) and beef producers (106). In 2015, there were 339 claims accepted.

Looking at the these numbers, it is important to be mindful that (1) these injuries represent only the most serious injuries (where there was wage loss or medical aid beyond first aid required)—most injuries do not have to be reported to the WCB—and (2) even among injuries that should be reported, there are going to be unreported injuries (40% non-reporting is the best estimate I have seen).

Add in farms that haven’t taken out WCB coverage and we can be confident that the true level of injury to paid farm workers is appreciably higher than these numbers indicate. Looking at the type of injury, the Calgary Herald reports:
Nearly a quarter of the claims, 199, were strains or sprains, with 153 superficial wounds, 165 open wounds and 106 cases of fractures, dislocation or nerve damage. There were 170 other injury claims, as well as three accepted farm fatality claims.
The most notable response was from the Wildrose that seemed to walk back promises to repeal Bill 6 by saying the Wildrose would provide replacement legislation, perhaps allowing farmers to choose between WCB or some sort of private alternative.

Staying with agriculture, the Parkland Institute posted a piece I wrote about proposed exemptions around hours of work and child labour for farms. The most interesting reaction to this was that report that triggered the blog post disappeared from the employer lobby group website it had been posted on!

The union-positive website rankandfile.ca also posted a two-part interview they did with me (part 1 and part 2 here). This interview canvasses a wide variety of labour issues in Alberta and (I hope) heralds new attention to labour issues in Alberta.

Finally, APEGA levied a $10,000 fine and a $150,000 contribution on Canadian Natural Resources Ltd as a result of engineering problems that lead to the deaths of two foreign workers in 2007. This fine is trivia (CNRL's revenue in 2015 was $13 billion) and likely is less than the cost of proper engineering work would have been.

This announcement likely concludes the various investigations into this incident where an unqualified employee did the engineering work on tanks that fell apart while being assembled due to high winds. This incident also revealed that one of the other companies involved in this project was stealing the wages of the foreign workers that had been brought in to do the work. Good work, "job creators"... .

-- Bob Barnetson

Friday, January 6, 2017

Labour & Pop Culture: How to have an Accident at Work

This week’s installment of Labour & Pop Culture is a 1959 safety video featuring Donald Duck that my colleague Jason Foster ran across while revising IDRL 308. The video subscribes to the careless worker myth: essentially that worker inattention and irresponsibility are the main cause of workplace injury. Apologies in advance for the sexism and racism in the six-minute film.

Donald’s behaviour is clearly ridiculous and the movie ignores the insanely unsafe conditions in the factory he works in! It isn’t clear to me who funded this cartoon or who the intended audience was (all I could find was that it was a theatrical short). You can see more modern version of this theme in this 2008 Alberta video from the Bloody Lucky series.

An interesting question is why is the myth of the careless worker so persistent (it dates back about 100 years)? As I note in my book The Political Economy of Workplace Injury in Canada, American companies used the careless worker myth in the 1920s to counter opposition to the introduction of leaded gasoline. Lead poisoning among workers making the tetraethyl lead additive made people leery of leaded gasoline. General Motors, DuPoint and Standard Oil responded to critics, in part, by blaming injuries on workers not following safety precautions.

In this case, carelessness was not root cause of worker injuries and death—exposing workers to a toxin at work was. Indeed, analysis of injury causation suggests unsafe conditions, not carelessness, are the cause of most accidents. Injury mechanisms are well known to employers, as are many ways to prevent injuries. The problem is that eliminating or containing hazards is expensive. It is cheaper and much easier to blame the victim

Focusing attention on the victim protects cherished beliefs or powerful actors. We do this all the time. Victims of sexual assault were (and are) often blamed for their injury. Blaming rape victims is easier than grappling with seemingly intractable issues like the objectification and victimization of women by social and legal forces. Similarly, it is easier to blame workers than grapple with the idea that injuries are the byproduct of employer decisions.

-- Bob Barnetson

Tuesday, January 3, 2017

Research: Safety crimes in Alberta's O&G industry

Last week I had a chance to re-read an MA thesis I have been saving for awhile. “Bloody Oil: A Critical Discourse Analysis of Safety Crimes in the Alberta Oil and Gas Industry” comes from the Department of Criminology at UOttawa.

This study is notable in two ways. First, it conceptualizes safety violations as crimes (rather than regulatory offences). Framing the injury of workers as a crime sits uneasily with the mainstream view of occupational injuries as uncommon, unpreventable, and (regrettably) economically necessary.

The idea that workplace injuries are caused by so-called accidents reflects that the “perps” are upstanding members of the community (corporations) doing legitimate work where responsibility for the injury is often diffuse and hard to see. Shooting someone in the head is murder. But decapitating someone on the job because of a decision to delay cable replacement is an accident. Added to this is the widely accepted notion that “workers accepted the risk” when they took the job and responsibility for injury is subtly shifted to the worker.

Second, it applies this framing to Alberta’s oil-and-gas industry, the upstream portion of which (basically dinosaurs to the refinery gate) has a real cowboy culture. You can see an analysis of that culture in the book chapter “Working hard and staying safe: Drilling rig hands in Alberta”.

The economic importance of the oil-and-gas industry in Alberta meant that the conservative government largely turned a blind eye to workplace safety (to be fair, the Tories did a poor job on workplace safety in general). The study examines court documents, fatality reports, and safety awareness campaigns to tease out how serious injury and death are officially conceptualized.

The upshot of the study is that injuries are typically framed as the fault of the worker. Blaming the worker has a long pedigree (as we’ll see in Friday’s post) and the careless worker myth has been evident in many Alberta safety campaigns over the years. If the worker is to blame, then the employer must be (mostly) innocent and there is little reason to identify root causes of injury found in the structure of work. Where remediation is possible, it is focused on worker behaviour.
In a way, workers face a catch-22 in comparison to employers who are described in more general or descriptive terms: if a worker is well-trained and experienced, they have no excuse for not being able to avoid harm; if they are un-trained or inexperienced, then their carelessness is simply and quickly used as an explanation for what occurred. (p.61).
Injuries are also represented as non-serious and non-violent offenses. Investigations generally don’t look for root causes (found in the structure of work), instead focusing on proximate causes of injury. Where employers are found to have violated the law, they often receive creative sentences, whereby they make a socially beneficial donation (which is tax deductable) and then look to be good corporate citizens. The level of the fine and that it is levied on the corporation (rather than an individual) may also attenuate the impact of the fine on future behaviour. This, in turn, reinforces treating injury events as regulatory offences, rather than as crimes. Injuries are caused by accidents, rather than a chain of decisions leading to an unsafe workplace.

Overall, this is a very useful piece of research. It examines in depth how serious injuries and fatalities in the oil-and-gas industry are dismissed as unavoidable accidents that are likely the fault of the worker anyhow. We see a similar framing in newspaper reports of workplace injury, which dial down public concern by noting that injuries are under investigation or before the courts or are simply human tragedies (for which no one is really at fault).

The question going forward is whether Alberta’s New Democratic government will adequately resource and politically empower OHS inspectors to raise the cost of injury to employers to the point where employers make structural changes in their workplace.

-- Bob Barnetson

Friday, December 30, 2016

Labour & Pop Culture: Absolute Rage

Over time, I've grown increasingly fascinated by how unions are portrayed in popular culture. Mostly, unions are just absent. But I was wandering through the library with my daughter and picked Absolute Rage (2002) almost at random.

The book is a crime thriller wherein a trade unionist is killed to help another (corrupt) trade unionist steal a union election in the West Virginia coal fields.

The "good" trade unionist is not really good, except in the sense that he actually cares about the workers. Otherwise, he's an abusive drunk blinded by ideology who gets his family killed in the cross fire.

The "bad" trade unionist is evil, corrupt (e.g., in the boss' pocket), greedy, and kind of stupid. He surrounds himself with various dumb and corrupt stooges who do his bidding. These character flaws are his undoing.

The strengths of the book are a good understanding of US labour politics and a realistic portrayal of the  company towns in the coal field. The plot and characterization are consistent with the tendency of all US fiction to represent unions as corrupt or, alternately, a source of disruption (via strikes).

I certainly understand the need for a source of dramatic tension in a novel. What is so striking is how union are almost never framed a force for good and, indeed, are rarely mentioned at all.

-- Bob Barnetson

Tuesday, December 27, 2016

Occupational violence in health care

Violence against health-care workers is a profound problem in Canada. A recent article in The Bulletin (co-authored by AU tutor James Brophy) identifies how the victims of this violence are more likely to be women (due to occupational segregation) and this contributes to the lack of action on the issue.

A number of other actors contribute to the occurrence of violence. These include high patient loads and limited access to security for workers. Workers are also reluctant to report violence, perhaps because they know little will be done and that they will be singled out as complainers.

Overall, this is an excellent summary of how workplace violence has been normalize in health-care settings

-- Bob Barnetson