NIOSH Officials See Need for Research on Contingent Workers' Safety

Noting the big changes in U.S. workforces and types of work since 1970, two NIOSH officials posted an entry on the agency's Science Blog ( commenting that more research is needed on the safety of contingent workers. The Canadian Centre for Occupational Health and Safety has similar ideas; it has invited the nation to take a Web survey about issues emerging from changing Canadian workplaces. Visit to read the CCOHS survey. CCOHS will present its results this spring.

Kristin J. Cummings, M.D., M.P.H., a medical officer in the NIOSH Field Studies Branch, Division of Respiratory Disease Studies, and Kathleen Kreiss, M.D., chief of the division, wrote in a Feb. 19 post on the blog that contingent workers are nearly one-third of the U.S. workforce, or 43 million workers in 2005, and they range from well-compensated independent financial consultants to low-skilled construction workers. Cummings and Kreiss wrote about the issues facing contingent workers in the Jan. 30, 2008, issue of JAMA in "Contingent Workers and Contingent Health: Risks of a Modern Economy."

Most U.S. contingent workers are white and 25 years old or older. "However, compared to workers in traditional arrangements, contingent workers are more likely to be young, female, black or Hispanic, and to have lower incomes and fewer benefits," according to the blog post. "One analysis of 2005 federal data found that 16 percent of contingent workers have family incomes less than $20,000, a proportion twice as high as that of noncontingent workers. Only 13 percent of contingent workers had health insurance provided by their employer, compared with 72 percent of noncontingent workers. In addition, there is growing evidence that contingent workers are at higher risk for work-related injury, illness, and death. While much of the evidence comes from Europe, several studies in the United States have demonstrated higher risk," it says, citing BLS data, a rate of needlestick injuries among temporary nurses caring for AIDS patients in 11 U.S. hospitals that was 1.65 times higher than the rate for staff nurses working in the same units, and a 2004 survey of day laborers that found 19 percent of them reported work-related injuries that required medical attention in the previous year, compared with less than 5 percent of workers in all private industries and 6 percent of all workers in construction.

"Possible explanations for the higher risk of work-related injury, illness, and death among contingent workers include: the outsourcing of more hazardous jobs, lack of experience and familiarity with operations in a dangerous workplace, inadequate safety training and protective equipment, and limited access to preventive measures such as medical screening programs," Cummings and Kreiss noted in their post. "Components of current health and safety regulations and the workers' compensation system, which were designed during a different economic era, also play a role. For example, millions of contingent workers are not covered by workers' compensation insurance for medical benefits for work-related injury and illness. The limited research conducted on the health of contingent workers in the U.S. is due in part to the challenges of studying this unaffiliated, transient and dynamic workforce. More research is needed to accurately estimate the extent of the problem, understand its causes, and find effective ways to prevent injury and illness and promote health among contingent workers."

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