CAISSE REGIONALE D'ASSURANCE MALADIE D'ILE-DE-FRANCE
(CRAM Ile-de-France) www.cramif.fr

Learning from the past to develop improvement strategies for the future.

Construction work involves a vast variety of objects and tasks. More than half of all construction involves modification of structures that are already in place: renovation, repair, maintenance and demolition. In addition to the construction of buildings - small scale villas, large apartment houses, office buildings and factory facilities - there are also major civil engineering structures. Some of the buildings might be in remote areas requiring extraordinary transport facilities like on the top of Aigie de Midi in the French Alpes. Some of the civil engineering structures might go deep beneath the surface of sea water like the Channel between France and England. Others might consist as well of a channel part as a bridge with both low and high elements like the one between Sweden and Denmark.

In all types of construction work and above all when including the affiliated trades like, insulation, plumbing etc there are three problem areas to face when considering health hazards. The first concerns safety precautions manifesting themselves as rates of injuries and fatalities due to accidents. The second is to establish ergonomically optimal working conditions to prevent musculo-sceletal injuries leading to disability and absence from work. The third involves the control of hazards from toxic material to which the construction workers might be exposed.

Let us first start with what the concept "learning from the past" implies. This learning might be seen either as a learning process on the individual level that makes the tradesman or architect or the engineer ever more competent as future objects are being built. In fact it rather implies that the organizations to which they belong become more competent to make the right choices and decisions - they mature to "to act a step ahead". That acting "a step ahead", which was a slogan for Bygghälsan, the Swedish Construction Industry Organization for Safety and Health that operated during the quarter of a century between 1968 and 1993, is relevant for all the three problem areas mentioned. In many countries the construction trades have for different reasons established specialized organizations to enhance preventive measures. Society at large has also got mechanisms to detect and discover, the failures of the past and present the consolidated data in ways that are accessible and understandable to both the contractors and the government regulators.

• Accidents/injuries
  • Accident prevention is highly relevant to the construction industry as indicated both by the perception among EU member states and pure EU statistics. Performance in this field is monitored by injury reporting and the consolidated statistics is based upon such reporting.
    Comparisons between trades over time and between countries is the mode of "benchmarking" that shall guide the utilization of such data. To judge from improvements over time in most countries lessons have been learn from the past failures. However, such comparisons are often difficult due to varying definitions, varying reporting mechanisms and varying processes to counteract the release of such data from the local employer source. A recent report from the US shows that while reported injury rates had declined by 60% since 1992 fatality rates had not declined at all. The report indicates that inappropriate or at least incomplete reporting might be an important factor behind the more rapidly declining rates for non-fatal accidents. Personal information received from a Safety manager in a major Construction company in India indicates that a multitude of internal company behaviors tend to hide the true picture such as a competition to show the most favorable figures or "results" between the safety specialists in the different departments/units. Fluctuations in rules for workers´compensation insurances is frequently also manifesting itself as upward or downward trends in reporting. For such reasons the statistics on fatal accidents might be more stable for comparisons than reported days off work. However, a statement by Prof Madhumota Dobe in Calcutta India suggests that there is a severe underreporting even of fatal accidents in countries with a developing economy. Two weeks ago at a conference in Quito, Equador it became quite obvious that as the major part of construction belongs to the informal sector the statistics is as unreliable as in India. I suppose many countries in Latin America share that problem.
  • Those major weaknesses in the national reporting statistics makes a company oriented "in-house" follow-up of the experiences even more important. In particular when performed as an active "benchmarking" between different units or perhaps between parallel contractors on a large object. The major bridge undertaking between Denmark and Sweden shown initially had such "benchmarking" which showed one of the contracting groups performing substantially better than the others in spite of mainly similar task. Moreover this construction was completed with very few lives lost. Another similar structure although with shorter span in the north of Sweden over-bridging a large river was completed with zero fatal accidents a few years earlier.The pattern of causes of fatal accidents are very similar worldwide with falling down, being hit by falling objects and electrocutions as three major causes of accidents in all countries. Comparisons between countries - even within the EU - definitely suggests that not enough lessons have been learnt in those countries with high injury rates from experiences in the past in countries that have been able to cope better with the prevention of such accidents. In conclusion, an important message is in my view that the lessons shall not only be learnt from the "domestic past" but also across boarders for which bodies like ISSA and its Sub-committees should be the ideal fora.
  • It is of interest to observe that the vast majority of papers at this Symposium fall in the category of prevention of accidental injuries. I recall in this connection an interesting similarity between comments made by Safety Inspectors of the Government here in Brazil at a visit 8 years ago about injuries at civil engineering sites around Fortaleza and preventive arrangements undertaken by the previously quoted Indian friend in his company. Some form of vocational training is essential when you extensively recruit local people from the area - often ex farmers - to technologically sophisticated tasks in modern construction work- sites. The negative experience in India of a modern false wall/form for concrete work produced in Austria in contrast to the good European experiences of the same could very well be explained by insufficient skills for the specific task among the construction workers in India. Accordingly the "strategy" must include both the "a step ahead" and the worker training approaches. This Seminar includes a session on Training!

• Ergonomics
  • In the consolidated EU-statistics ("State of OSH in EU") quoted previously on accidents the construction industry and labourers in construction are perceived as the groups with the highest risks for musculosceletal disorders. There are different ways to collect relevant data with regard to illness and incapacity for work due to musculosceletal disorders caused by inappropriate working postures, work loads and work organization. In case employees are to an increasing extent in certain professions or work-sites within the company recorded for sick-leave in the HR-department that should serve as a signal to look for cause. However, assessment of the etiological factors behind will need expert judgment based on more global statistics and on research carried out on a national and/or a research center basis. Several comprehensive reports have been presented over the years on this issue by Arbouw, BauBG and Ontario Construction Safety Association as well as by Bygghalsan of Sweden. A couple of examples presented by Bygghalsan, will be given and I do apologize for the inadequate use of personal protective safety equipment in some of the pictures but they were taken in the late 60-ies/early 70-ies. Unfortunately similar shortcomings in addition to others like lack of fall protection rales can be seen in many countries on this continent.
  • The early years of examination results of the construction workers in Sweden revealed that brick layers were the most suffering from low back pain. As a consequence prevention thinking was introduced to the companies in order to eliminate the working postures that caused the suffering. The vast difference in load on the lower back depending on what posture one handling level compared to another constituted lead to the adoption of new devices and equipment. Drilling operations performed with robot assistance and without hand holding eliminates not only back problems but also the effects of vibration. However, it doesn´t prevent the emission of noise and of mineral dust. Additional preventive measures had to be applied although with regard to hearing protection basically PPEs.
  • On another level the government regulators are able to introduce standards and rules related to ergonomics. In Sweden the legislation on ergonomics introduced in the late 90-ies in line with EU-Directives included all economic sectors including construction. There has not been any major complication for the industry due to these rules. On the contrary changes involving and requiring early design considerations like introducing less wide wall units require such national frameworks to become effective. It is worth mentioning that the Ergonomics standard introduced in the US (by President Clinton towards the end of his mandate) excluded the construction industry due to successful lobbying against by that industry in the US.
  • Another perspective was brought up in an article in the leading Swedish daily newspaper some two months ago by the previous CEO (more than a decade ago) of the car manufacturer Volvo. He described the various production changes introduced during his period in charge. They were based on all kinds of available scientific knowledge in ergonomics, work psychology etc and the manufacturing plants built during his time were really the best available in terms of optimal working conditions. I remember very well how proud we were in the Swedish occupational health society over his management in this respect. At the same time workforce turnover, absence from work etc improved substantially - "learning from the past" had created marvelous "improvement strategies for the future". Yes, but the "future" lasted only as long as he was in charge. As soon as he had disappeared his successors gradually broke down the most "modern" production layout and reintroduced the old principle of the "production belt line" based on economic performance arguments. His disappointment was great and the experience introduces another element into the title of this address: How to prevent that pure short-sited economic arguments destroy once achieved improvements?

• Hazardous substances
  • In the already mentioned "State of OSH in the EU" the construction industry was perceived as having the highest rate of occupational diseases. I have chosen to focus upon two specific hazardous materials widely used in the construction sector which contribute to that record - cement causing allergic skin reactions for concrete workers due to the content of 6-value chromium and the widespread use and handling of asbestos containing products.
  • The occupationally caused allergic skin reactions due to contact with cement is well-known. The two ways to combat the disease is to either prevent the direct contact using gloves or having a mechanical pumping device. The other option is to change the properties of the concrete itself. Addition of ferrosulfate to the cement in order to reduce the highly biologically active 6-value chromium to the inactive 3-values was successively and successfully introduced in Denmark, Sweden and Finland already in the late 70-ies/early 80-ies with a sharp decline in the cement induced allergic skin disorders in concrete workers in all those countries. In the beginning of the 90-ies the same approach was introduced in Germany and the effects were equally successful from a health point of view. A fairly recent EU Directive spreading this highly efficient prevention measure across all 25 member states.
  • I remember with a certain sense of achievement the day two years ago when in a little mountain village on the Spanish island of Mallorca in the Mediteranian Sea I met with a cement loaded truck with the typical revolving bulb and you could read a large poster telling that this was cement/concrete free from chromium 6 because cement containing such 6-value chromium would cause harm to the hands of the workers and to this was added a photo of a hand with severe allergic skin detriment.
  • In spite of this vast "world wide" or at least "European wide" experience of what is technically feasible and from a prevention point of view sensible such change has not been possible to introduce in the US. The opportunity to implement change by learning from the past in other countries has been blocked by the successful lobbying against such change by the cement producing industry in the US. The lesson to be learnt is in this case that available information is not automatically made positive use of.
  • A similar experience can be found with regard to another major hazard - asbestos - in many countries. Rather than listening to warnings from medical experts - "learning from the past although from other countries" the warnings have been neglected by the construction trade and even worse by the national regulators and no implementation measures have been taken. This is still the case in many Asian countries with the exception of Japan since recently. Countries like Thailand, India and China as well as several in Latin America still refuses to acknowledge the terrible prognoses for respiratory cancer death tolls due to asbestos exposure in the past from European and US assessments. The rapidly fatal mesothelioma of the pleura (and peritoneum) was reported by Selikoff and co-workers in the US insulators already 1964. In the UK, early preventive steps were introduced in the manufacturing industry including textile at an early stage while the construction industry was not recognized as a hazardous industry until much later.
  • The process of "learning from the past" meets with two problems as regards the control of carcinogenic substances in the workplace. The organisation of construction work and employment worldwide makes both steps critical. Both are related to the long latency period between exposure and detectable effect - the deadly cancer diagnose. This long latency means that the likelihood of relating such a diagnose (if ever performed on a poor rural construction worker in a Latin American or Asian country) to work decades earlier is low Accordingly these illnesses will not show up in domestic statistics; not because there are no cases but because there are no cases related to the true cause. Such methodological difficulties and the negligence to apply experiences made in other countries lie behind the French failure to recognize and act with prevention during the late 70-ies and the 80-ies. But this long latency also implies that the time from the moment you implement change, in this case stop the use and exposure, until your excess disease and death rates are declining will be further prolonged.
  • This shortcoming is further accentuated by the fact that all asbestos already installed in buildings worldwide constitute a potential exposure to construction workers in repair and demolition worldwide. A guide for the contractors on where to suspect asbestos in existing buildings was produced in Sweden already 20 years ago. However, a good example of applying the lessons from the past in actual preventive measures for future benefit is found in the recent EU Directive on asbestos, which recognizes that appropriate precaution and control of such exposures must be the focus for the future. A conference in Dresden in 2003 based on case studies in France, Spain, Sweden and the UK on behalf of the Commission has suggested the ways forward.
  • This spring of 2006 it is 30 years since construction industry in Sweden decided to abandon new use of asbestos and implemented that decision within a couple of months long before the effect of new legislation. Still, today the annual number of the fatal asbestos caused cancer called mesothelioma is twice as high as the number of fatal accidents in Swedish construction workers. In fact the annual number of mesotheliomas today is equal to the annual number of fatal accidents 25 years ago at the time of cessation of use.
  • The reality behind the Swedish success story with very early and complete preventive actions was that the construction industry players - unions and employers alike - had been made aware of the severity of the hazard thanks to the surveillance mechanisms created by Bygghalsan. Attempts to prohibit necessary preventive actions by the asbestos industry was thus not met by success as the user simply stopped buying their products and switched to other products. Within a few months during the spring of 1976 the import of asbestos dropped to almost nil because no one would buy asbestos products in the country. The market powers had acted and a well informed and unified consumer sector had given their say; that was a far quicker response than any regulatory actions by the government could achieve. The lesson here is that in order to achieve change, the "lessons from the past failures" have to be shared widely and as much between employers and unions as between producers and contractors/buyers.
  • The real problem has in many cases been that there is no preparedness to use "lessons from the past" in other countries where the true risk pattern could be detected to "develop strategies for future improvement" in their own countries. Of course there is no reason to believe that the real hazard, the excess risk, from asbestos should be any different for construction workers in France or Belgium nor in Equador, Colombia or Brazil than in Sweden. In fact comparisons between Sweden and the Netherlands have shown a good resemblance and even a higher incidence in the Netherlands. Nor is there any reason to believe that American cement producers and users should have other difficulties to apply chromium reduction than all their European counterparts. Almost without exception the reason for lack of national action has been a lobbying activity from the producing industry upon the rule-makers which has overridden the attempts to apply the lessons from the past across boarders.

Conclusion

In summary, modern information technology offers ample opportunities to collect, analyse and display data relevant to construction health and safety improvements. It is essential that learning from the past involves such experiences from other countries - in particular when the infrastructural conditions for detection of potential hazards are lower in your own country. Another lesson learnt from the past is that the attempt to improve a situation is very likely to be met with opposition by those who will be affected by decline of sales of a product or a machine. Finally we need to watch carefully and be prepared to act when good improvements that have been achieved are vulnerable to cancellation due to short-sighted financial concerns by new-comers in the industry. !
Never forget that this industry is a consumer industry and that neutral consumer advisors are the bestsupporters to achieve a safe working situation!
ISSA and its Sub-committee for Construction has a great role to play in enhancing these learning opportunities for the construction industry and its employees