The uphill struggle for workplace health.

As Congress changes OSHA's direction, states are taking charge of protecting workers' health and safety.

Today's typical Americans - busy and health conscious - demand that their local grocery store be well stocked with lean, easy-to-cook meat. As a result, the number of poultry processors in this country has almost doubled since 1980, while workers now clean and gut chickens - a numbingly repetitive task - at nearly twice the pace they once did.

Repetitive-stress injuries - flaring pain in the fingers and wrist - are now a near epidemic on the chicken assembly line.

Congress, however, barred the federal Occupational Safety and Health Administration (OSHA) last year from creating rules designed to prevent such injuries, even though they account for one of every three workers' compensation dollars, for $2.7 million a year in workers' compensation claims and for an annual $20 billion in costs to employers.

This April, California was expected to become the first state in the country to adopt regulations requiring businesses to reduce these injuries. The so-called "ergonomics standard" involved much toil and debate, but it demonstrates how the states - in the absence of federal laws or guidelines - have taken charge of protecting workers' health and safety. States are tackling everything from ergonomics to on-the-job violence, from getting tobacco out. of the office to encouraging workers to eat better, exercise more, drink less and unwind oftener.

WHY OSHA HAS FAILED

There are some safety and health professionals who say the role of aggressively protecting the nation's workers can best be filled by the federal government. David Hunnicutt, president of the Wellness Councils of America, a nonprofit organization of 3,000 companies trying to encourage healthy workers, says the move to improve working conditions has come a remarkable distance in a very, very short time. "I think the federal government has played a tremendous role in assisting American work sites."

But recent budgetary pressures on OSHA, it can be argued, have left the agency far less effective than it once was. Concerned that the agency was choking businesses with too many laws and fines, Congress cut its budget from $312 million in FY 1995 to $304 million in FY 1996. And while the agency is now recovering with a FY 1997 budget of $326 million, supporters say the $8 million loss was critical to the agency's already small budget.

Since 1994, OSHA has had an 8 percent drop in staff. Inspections have fallen 43 percent and serious citations 64 percent, a development that came about not just because of budget cuts, but because of a push to help businesses correct workplace hazards before fining them. Nearly one-third fewer American workers are now covered by the agency's inspections and other actions, leading critics to call the agency a "toothless tiger" that is moving, in the words of the Chicago Tribune, "from beat cop to social worker."

OSHA spokeswoman Susan Fleming says her agency does the best it can with the resources it has. "We have a tiny budget and a huge mission," she says. "We didn't hire anyone when anybody left and didn't do any inspections," she said. "We sort of held the line."

Congress continues this year to steer OSHA away from rulemaking and enforcement toward collaborating with businesses to help them comply with federal requirements.

Joseph Kinney, a founder of the National Workplace Safety Institute, notes that while the U.S. Environmental Protection Agency has blossomed in its staffing levels and budget since being created, OSHA has fared less well - largely, he believes, because the environmental protection movement gained popular support that the workplace safety movement hasn't. In addition, research money from private foundations also tends to go, Kinney says, to the issues that make the evening news.

"We can get funding out the wazoo to deal with the maquiladoras on the Mexican border, but never any serious funding to look at [domestic] work practices," says Kinney, noting that his institute operates on $150,000 a year, has only three staffers and no longer promotes legislation as it did just a few years ago. "I think these foundations are reluctant to strike at the way people do business in this country."

LIGHT YEARS AHEAD

"States are light years ahead of the federal government," says Peg Seminario, the AFL-CIO health and safety director who remains frustrated by the lack of - or impotence of - federal laws governing the work site.

Getting federal regulations for workplace chemicals, for instance, can take up to a decade from the time the chemical is first recognized as potentially harmful, Seminario says. Even when federal regulations exist, she says, they are sometimes either too weak or too weakly enforced to satisfy the nation's labor and medical communities.

Lead in the workplace, for instance, remains a frustration to medical professionals who believe that the existing thresholds - the levels of lead in the blood that the federal government deems acceptable - are still too high. Too much lead in the blood can lead to fatigue, high blood pressure, and, in extreme cases, seizures and kidney damage. As a result, some states and even some businesses that use lead in their manufacturing have taken it on themselves to create their own stricter standards.

MODEL GUIDELINES

When the National Institute for Occupational Safety and Health last year produced a report on workplace violence - concluding that some 1 million people a year are assaulted and 1,000 murdered on the job - it wasn't news to Patti Pearce, a human resource professional with the Kansas Department of Administration. In Topeka four years ago, a gunman walked into a federal building, firing and lobbing pipe bombs, killing a security guard and seriously injuring three others before explosives strapped to his body detonated and killed him. Pearce and colleagues created a model set of guidelines to prevent the same thing from ever happening in a state office.

Though workplace violence costs an estimated 1.8 million lost workdays and more than $55 million in lost wages each year, and even though homicide has surpassed machines as the second most prevalent cause of on-the-job deaths after motor vehicle accidents, "there weren't as many guidelines or programs in place as I thought there might be," says Pearce.

Thousands of organizations, often with the help of state guidelines and resources, have developed programs before violence happens - hiring consultants, adopting policies, installing alarm systems and publicizing the availability of counseling.

State authorities, sometimes working alone and sometimes with insurers and health care professionals, are moving ahead themselves.

California Senator Steve Peace, who was instrumental in crafting the 1993 workers' compensation reforms that included the requirement for an ergonomics standard, says it can be easier for states to tackle worker safety issues.

"This is a huge country, and just to get the players together is very difficult," he says. "I don't criticize Washington for not being able to reconcile these kinds of things. It was hard enough here. Every time you multiply the number of participants, you multiply the complexity of solving the problem.

"It's a learning process, and what we're going through now in this state and other states is figuring out how to develop these standards without being rigid or irrational," Peace says.

About 20 states, Seminario says, have created their own programs to identify workplace hazards before injuries or illnesses become pronounced. By adopting this "whole systems" approach, as she calls it, businesses take proactive steps when anything appears amiss, rather than reacting with a plan only after an injury or death.

The New Jersey State Industrial Safety Committee offers free monthly safety seminars for businesses, and free visits from state specialists who identify and suggest corrections for problems such as noise, air contaminants, poor ventilation, inadequate machine guards or electrical hazards. A Texas alliance of government, universities and health groups will soon give small businesses a directory of places they can turn to for advice on different health topics. In Georgia, employees do not get workers' compensation benefits if they were injured while intoxicated or if they were under the influence of marijuana or other illegal drugs.

Fifteen years ago, Utah launched what is now one of the most innovative and replicated work site health programs in the nation. "Healthy Utah" reaches about 16,000 state workers, offering cash rebates for losing weight and quitting smoking, and up to $60 a year for regular exercise. At a cost of about $400,000 a year, paid by the state's main insurance carrier, the state hosts brown bag lunch seminars on low-fat diets and stress management, sets up free screenings for fat, cholesterol and blood-pressure, offers a library of books and audiotapes on healthy living, and gives its workers three hours of leave a year to participate.

GOOD HEALTH ON THE JOB

Since most of us spend the bulk of our waking hours at work, promoting healthy living on the job is, in the opinion of many professionals, perhaps the smartest way to keep health care and workers' compensation costs down. Many larger companies have been promoting preventive health programs for some time, as have state governments for their employees. The challenge, says Sandra Wendel of the Wellness Councils of America, is to convince smaller companies that the expense is not prohibitive and that it is worth the payoff in productivity and morale, lower absenteeism and stabilized health care costs.

"They think, 'Oh gosh, we gotta build a locker room and showers and a gym,' and we say, 'No, no. Let's just write a smoking policy or give people the opportunity to walk at lunchtime or make Fridays fruit day or negotiate with the health club down the street for a corporate rate,'" Wendel says.

To many, letting states do the job of protecting workers has practical and political advantages.

"Employers want healthy employees because they are more productive and less likely to drive up heath care costs or workers' comp costs - also serious concerns of state legislators," says Brenda Trolin, director of employment issues for the National Conference of State Legislatures. "For so long, we depended on the federal government to be responsible for worker safety and health, but federal programs haven't been doing the job because they lack coordination and adequate funding."

And because the needs of businesses around the country [TABULAR DATA OMITTED] vary, there tends to be disagreement among states about which issues to make a federal priority: In Iowa, the top concern may be farm safety; in North Carolina, it's clothing mills; in California, pesticide use. Even when specialists can agree on priorities - that railroad workers are being exposed to solvents, for instance - there is sometimes disagreement on whether the problem is serious enough to warrant research.

"You won't find anybody in this organization who says OSHA is doing too much, because there definitely is still a need for regulatory reform to make the existing laws work better and to provide new protections," says Katherine Kirkland, executive director of the Association of Occupational and Environmental Clinics, a 55-member group promoting safe and healthy workplaces here and in Canada. "But within that general opinion are the varying opinions of 55 clinics with different concerns about workplace safety and health."

And business groups themselves, long pestered by safety officer visits and fines, prefer that states, rather than the federal government, do the rulemaking. Although national safety standards can provide uniformity that makes it easier for businesses working across state lines, there are advantages to leaving these issues at the state or local level and, in some instances, to companies themselves.

"The states tend to be more aware of what can and can't be done," says Peter Eide, manager of labor law policies for the U.S. Chamber of Commerce. "They're closer to the workplace."

Whether states can create programs to combat violence or prevent health problems depends, very often, on budgetary constraints, support from state lawmakers and whether state health employees can be cut loose to develop something. Some states have tapped into federal block grants, though they often compete with private companies that want the same limited money. Often, state health officers seeking money for worker safety programs find that unless they are zeroing in on funds tagged for a specific issue - smoking, breast cancer, diabetes, for example - the money is hard to come by.

The job of protecting workers, however, need not always be an "either/or" proposition, since the federal government has demonstrated that it can work closely with state governments and businesses to cut workplace illnesses and injuries. Witness the Maine 200 program, which many safety and health professionals point to when asked for an example of a federal program that's been proactive and successful. Many states are now replicating the 4-year-old program, which identified 200 employers in Maine with the highest injury and illness rates, and gave them the opportunity to work with OSHA to remedy work site problems. More than half who participated have reduced injuries and illnesses.

NCSL's Trolin says the Maine 200 program is a good example of a state and the federal government working together. She predicts more experimenting at the state level with federal support. "It's clear that as we move into the 21st century, there will continue to be emphasis on worker safety and health, and that state lawmakers will have a role to play. Employers want to keep down health care costs and workers' comp costs and increase their productivity. Workers want a better and healthier quality of life."

RELATED ARTICLE: A SWEETER FACE FOR THE OSHA OGRE

In New Hampshire, state safety inspectors pore over workers' compensation records to locate the 50 manufacturing companies in the state with the most injuries and illnesses. They could descend on the businesses armed with clipboards and questions. Instead, they come bearing literature - pamphlets that explain what causes injuries and ways to prevent them.

States across the country like New Hampshire are replicating a highly successful federal program called Maine 200. Launched in that state four years ago by the Occupational Safety and Health Administration (OSHA), the experimental project identified the 200 businesses in Maine with the highest number of injuries, then let employers collaborate with federal inspectors to turn things around. The Maine companies identified nearly 96,000 hazards, more than double the number that OSHA inspectors discovered during the previous eight years combined. So far, the companies have corrected more than half the problems.

The state-created replicas of Maine 200 - there are at least a dozen of them and another 14 in the works - have names such as "Dakota First," "North Carolina 248," "Safe Mississippi" and "Alabama Four."

Typically in these new programs, safety inspectors sift through workers' compensation claims to pinpoint those businesses that have an unusual number of injuries and sicknesses. Inspectors give managers the opportunity to work with them to fix the hazards, usually by creating safety and health programs. Because declining the help would likely make the company a top inspection target, managers often sign on. The new programs usually include some type of enforcement for failure to follow through, and some way to measure whether the program is, in fact, preventing future problems.

"OSHA should not be a police organization," says Peter Eide, manager of labor laws policy for the U.S. Chamber of Commerce. "It should be an educational, consulting organization. Too often, OSHA is a four-letter word to small businesses that don't have a full-time person to do nothing but find OSHA regs, read them and try to understand them."

But there are measurable successes. Before one Wisconsin inspector, for instance, descended on any of the 200 employers in the state with the worst safety records, OSHA in mid-1994 mailed letters explaining that each company could take advantage of the so-called Wisconsin 200 program. When inspectors did come around during the next two years, they discovered the letter had served its purpose: Many employers had taken advantage of OSHA's free safety and health training. Most had beefed up their health and safety programs and were enjoying a corresponding reduction in injuries and illnesses. Eight out of 10 companies on the target list experienced an average 30 percent drop in lost workdays during that two years. Nine out of 10 voluntarily adopted ergonomics plans to cut back on repetitive stress injuries.

The approach has its critics, especially labor advocates who fear enforcement will suffer if too much state money is funneled into government-business partnerships.

They note that the number of enforcement actions that federal OSHA now takes is nearly half of what it was three years ago.

But OSHA officials operate on this premise: If businesses learn to work with safety officers, rather than be frightened or angered by them, not only will state governments save money by cutting back on enforcement, business managers may be more amenable to fixing workplace hazards if given the chance to do so before, not after, they are punished.

Dana Wilkie is a state capital correspondent for the San Diego Union-Tribune.