The U.S. is at or near rock bottom among peer countries (Box 1) in protecting the health and safety of its citizens, according to the National Research Council and Institute of Medicine (2013) report U.S. Health in International Perspective: Shorter Lives, Poorer Health.1

Among the findings: the U.S. is at the bottom among peer countries for infant mortality and low birth weight; “years of lost life” from unintentional injuries before age 50 is double that of peer countries; and, the mortality rate for females before age 50 is “forty years behind the average of its peers.” 

Although the report did not closely examine how the workplace contributes to the overall problem, it recommends that, “government agencies, employers, workers, and other stakeholders must recognize that improving the health and safety of workers is of critical importance and impacts both economic and national security.”

Where do U.S. workplace conditions stand among other countries and how do these conditions influence the health of our nation?  Let’s take a snapshot of conditions.

Chemical exposures

Evidence suggests that nearly ten times as many U.S. workers die annually from occupational disease, mostly from chemical exposure, than die from workplace injury. Within the last six years nearly every physician organization in the U.S. has called for lower chemical exposures for vulnerable workers. Last year OSHA built a web resource — “annotated PELs” — to suggest that employers use more protective exposure limits.  Still, the U.S. was one of the last rich countries to adopt GHS and most PELs are more than 40 years old with little to no chance of being updated. The EPA’s Toxic Substances Control Act of 1976 hasn’t been updated in nearly 40 years. If TSCA is ever updated it will be at least a decade, maybe two, behind the European Union’s REACH legislation in chemical management.

Noise exposure

The U.S. now stands alone in the world with allowable workplace noise exposure at 90 dBA TWA with a 5 dB exchange rate.  Nearly all other nations have moved to the more protective 85 dBA TWA and 3 dB exchange rate. The health disadvantage from the effect of noise for tens-of-thousands of U.S. workers compared to global peers is further jeopardized because OSHA generally allows an employee to reach about 94 dBA TWA before non-compliance can be proven.


All PPE sold in the EU must carry the conformity assessment mark CE. Similar mandates are not available for non-respirator PPE in the U.S. The importance of PPE conformity assessment for the protection of worker health and safety was analyzed in the National Research Council and Institute of Medicine (2010) report Certifying Personal Protective Technologies: Improving Worker Safety.2  


The direct biophysical effects and indirect health effects caused by electromagnetic fields have been known for many years. On June 29th, 2013, the European Commission (EC) published an EMF Directive3 (replacement of a 2004 Directive) that requires Member States to transpose the Directive into national law no later than July 1, 2016. 

Requirements include a risk assessment, conformance to exposure limit values and action levels, worker information and training, consultation and participation of workers, and health surveillance. When carrying out the risk assessment the employer shall give particular attention to workers who “wear active or passive implanted medical devices, such as cardiac pacemakers, workers with medical devices worn on the body, such as insulin pumps, and pregnant workers.” 

The U.S. has no proposals for regulatory control of EMF exposure to workers.

Vulnerable populations

Vulnerable populations, such as pregnant workers, are routinely addressed in EU regulations such as the EMF Directive above. The EC established a Pregnant Workers Directive in 1992 that requires employers in the EU to conduct risk assessments and control exposures.4 No comparable federal regulations exist in the U.S.

Papua New Guinea in Asia, Lesotho and Swaziland in Africa, and the U.S. are the only countries in the world without federal legislation for paid maternity leave for all workers. This “social issue” results in the majority of more than two million annual U.S. pregnant workers to work longer into their pregnancy and return to work sooner after giving birth than among any of its peer countries.

Workplace violence

The U.S. owns more guns per resident, a ratio at 0.89, than any other nation in the world. The next two highest nations, Serbia and Yemen, have a ratio at about 0.55. More than eight million concealed carry permits (CCP) for handguns are active in the U.S.

The gun culture and violence carries over into the U.S. workplace. According to NIOSH, “homicides accounted for 26% of work-related deaths for women in 2011 — the second leading cause of injury death for women in the workplace.” The Bureau of Justice Statistics’ National Crime Victimization Survey estimates there were 572,000 nonfatal violent crimes against U.S. workers in 2009.

Psychosocial stress

U.S. occupational safety and health pros generally look outside the U.S. for current recommendations to address workplace stress. The voluntary National Standard of Canada CAN/CSA-Z1003-13/BNQ 9700-803/2013 Psychological health and safety in the workplace —Prevention, promotion, and guidance to staged implementation, published in January 2013, is one example.


Recommendations that may reduce the health disadvantage are available, such as found in the American College of Occupational and Environmental Medicine 2011 Guidance Statement on Workplace Health Protection and Promotion: A New Pathway for a Healthier – and Safer – Workforce.5

An immediate recommendation: Use of best practices often means following non-U.S. derived guidance.

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