Dying for work: the changing face of work-related injuries

Work is an important determinant of health. Satisfying, safe work contributes to positive health, financial security and greater engagement in society. It can even enhance recovery from injury. These effects are inter-generational; the children of happy workers also experience social, emotional and educational benefits.

But there’s a flip side. Under some conditions, work is a major risk factor for poor health, disability and even death.

So far this year, for instance, 48 Australians have been killed while at work. In 2014, there were 185 workplace deaths from traumatic injury. And the latest Australian Bureau of Statistics (ABS) data show there were over half a million workplace injuries in 2013/14. That’s one person hurt while working every minute.

Globally, the International Labour Organisation estimates that one worker dies and a further 153 have accidents at work every 15 minutes. That equates to 2.3 million deaths and 313 million accidents every year.

The economic costs of this are enormous, equalling about 4% of global gross domestic product (GDP). The human costs are even higher, especially when you take into account the impact that death or serious injury can have on family, friends and work colleagues.

All kinds of hurt

Some common work-related conditions are among the top five leading causes of disability in Australia. These include low back pain, musculoskeletal disorders and neck pain. Among working-aged people, these conditions are associated with the greatest burden of disability, higher than levels of other common health conditions such as cancer, diabetes, mental health conditions, cardiovascular or respiratory diseases.

As you can see, the data are compelling. And this is only in Australia, where we enjoy very safe working conditions compared to many other countries.

The global impact of unsafe working conditions is highlighted when we see reports of factory collapses in Bangladesh and hundreds of workers dying in Qatar building stadiums for the 2022 Football World Cup. Closer to home, multiple workplace-related deaths in a short period may capture our attention.

Official estimates dramatically underestimate the true burden of work-related injury. Many workers fail to report their injury or seek workers' compensation, particularly if they have a work-related mental health condition.

It can also be difficult to count instances of work-related diseases, such as some cancers and respiratory conditions, because they’re often captured in other health datasets and may not be identified as relating to work or working conditions.

Ripple effect

One way of measuring the impact of a health condition on an individual and on society is to determine the “burden” of disability associated with that condition. Such estimates include changes in health following injury, and the extent to which this limits our ability to participate in activities we usually take for granted, such as housework, driving a car and caring duties.

But work-related injury can also impact workers' mental health; studies show higher rates of anxiety and depression among injured workers. There’s also a ripple effect created by injury that extends well beyond the injured person – to their family, workmates and employers.

We need to adapt current systems of workplace injury prevention and compensation to reflect the change in how we work.Chris Ballard/Flickr, CC BY-NC

Studies report that work injury is associated with divorce and marital separation, for instance. And family members of people injured at work are 30% more likely to be hospitalised in the three months after the injury than before.

Work injury can also result in economic deprivation and income inequality. One recent US study showed people receiving workers’ compensation earned 15% less in the ten years after their injury than a matched group of non-injured workers. Presumably those who are injured but not receiving such compensation are even worse off.

Some workers with severe or complex injuries may remain unemployed in the long term, which can have negative effects on their children and grandchildren.

Studies like these illustrate the profound impact work-related injury can have on the lives of those injured, their families and the broader community.

Shouldering the cost

The cost of work-related injury and illness in Australia for 2008-09 was estimated at A$60.6 billion – that’s the equivalent of 4.8% of GDP. The figure includes direct costs, such as payments for health care and income replacement, and indirect costs, such as lost productivity and reduced quality of life.

Just over half of the total cost (51%) was due to injury, with the remainder due to work-related disease.

As you can see from the graphic above, the vast majority of these costs are borne by workers. The average cost per case of injury or illness is A$99,100, and A$73,300 of this is paid for by the injured worker.

The latest ABS data shed some more light on sources of financial assistance for injured workers. Many injured Australian workers receive no financial assistance. About one third access workers' compensation and about a quarter receive support from their employer, such as paid sick leave or other entitlements.

New challenges

Current systems of injury prevention and compensation were established in the 1970s and 1980s to address the problems of the time. But the world of work is changing.

Musculoskeletal conditions, traditionally the major type of workplace injury, are becoming less prevalent, whereas work-related mental health conditions are becoming more common. We have more workers with insecure jobs, we work longer hours on average, and workplace stress has been growing.

But while we have been effective at reducing workplace risk for physical injuries in Australia, we have not paid the same attention to risk factors for mental health conditions.

This change represents a big new challenge for employers as well as government prevention and compensation agencies. It must be coupled with changing workplace culture to address the discrimination and stigma that many workers with mental health conditions experience.

Some government-led and employer-focused initiatives are now tackling these issues, but much more needs to be done.

Only time will tell whether the changes governments make to create better workplaces and safety nets for workers will be effective for addressing the new ways we work.

Alex Collie receives funding from the National Health and Medical Research Council, the Australian Research Council, the Canadian Institutes of Health Research, Worksafe Victoria, the Transport Accident Commission and Comcare.