Occupational accidents in the construction industry of Israel

Journal of Occupational

Accidents,

Elsevier Science Publishers

9 (1987)

B.V., Amsterdam

225-243

-

Printed

225

in The Netherlands

Occupational Accidents in the Construction Industry of Israel* A. PINES**,

S.-T. HALFON

The Hebrew

University,

Jerusalem

(Israel)

Institute,

Jerusalem

and R. PRIOR The National Insurance

(Received

1 October 1986; accepted

(Israel)

15 June 1987)

ABSTRACT Pines, A., Halfon, S.-T. and Prior, R., 1987. Occupational accidents of Israel. Journal of Occupational Accidents, 9: 225-243.

in the construction

industry

The long-term trends and current occupational accident statistics in the Israeli construction industry have been analysed. It has been found that occupational accident incidence and severity rates decreased little, if at all, during the last decades, and at present head the list of enonomic branches ranked by the degree of work accident risk. Almost all those injured were males; the proportion of older workers was higher than in other economic branches. The proportion of commuting accidents to total occupational accidents was half the national average. The most prevalent accident causes were falls, falling objects and collisions with foreign bodies. Most injuries were contusions and wounds damaging mainly upper limbs, although less often than in other economy branches; whereas foot, trunk, head and neck injuries were more frequent in construction workers. Among recommended preventive actions, such as implementation of safety measures, professional and safety education of workers, etc., increasing insurance premiums for building contractors with unsatisfactory safety ratings seems to be a promising incentive for the improvement in work safety. The main areas of further research are outlined.

INTRODUCTION

The construction industry may be defined as the building and civil engineering sector which includes activities such as construction, upkeep, repair or demolition of permanent or temporary buildings erected for different purposes, using various materials and techniques ( Andreoni, 1983). *Based in part on a presentation at the International Congress for Occupational Health in the Building Industry, 13-16 October 1985, Haifa, Israel. **All correspondence should be addressed to: Dr. Anatol Pines, Department of Occupational Health and Medical Ecology, School of Public Health and Community Medicine, The Hebrew University - Hadassah Medical School, P.O. Box 1172, Jerusalem, Israel.

0376-6349/87/$03.50

0 1987 Elsevier Science Publishers

B.V.

226

Five to ten percent of the total workforce in European countries are employed in some aspects of the construction industry (Year Book of Labour Statistics, 1979). One may assume that the statistics are similar in other parts of the world. Workers employed in the construction industry may be exposed to a variety of occupational health hazards, such as noise, vibration, ultraviolet radiation, heat, could, asbestos, cement, silica-containing dusts, diversity of toxic chemicals ( lead, solvents, etc. ) , electric welding aerosols, ergonomic problems (carrying and lifting heavy loads and uncomfortable body working positions) ( Andreoni, 1983; Grandjean, 1983). That these hazards can cause various occupational and work-related diseases, ranging from reversible dermatitis and nuisance to lung cancer and mesothelioma, is generally recognized. Nevertheless, in the construction industry, the above hazards should be considered of secondary significance to accident hazard, as the health risk associated with exposure to these factors is outweighed many-fold by the latter. As early as 1941, Heinrich reported that in Pennsylvania accidents of the construction and contracting industries accounted for 10.8% of all occupational accidents and 9.0% of all fatal occupational accidents. The accident frequency rates including separately those resulting in death or total permanent disability, as well as the accident severity rate in these industries, were 2.5-3 time higher than average rates for overall industry in this state. The above rates in construction and contracting, were ranked as 3rd and 4th respectively, among 30 industry branches, being lower only than those in mining, quarrying and logging ( Heinrich, 1941) . Results of recent surveys give additional support to these conclusions. Guralnic (1963 ) reported that in 1950 the rate of the fatal on-the-job incidence for the construction industry as a whole was 81% greater than the national average, and for such occupations as crane-men, hoistmen and construction machinery operators, 173% greater. For a relatively narrow occupational group of construction workers defined as operators of earth-moving and other construction machinery, British statistics reported a four-fold risk of dying from non-traffic accidents occurring outside the home (The Registrar-General’s Decennial Supplement, 1971) . Decoufle et al. (1977)) analysing causes of death among construction machinery operators, observed a statistically significant increase in the proportionate mortality rate (PMR) of this occupational group from such causes as all accidents (PMR= 1.78)) motor vehicle accidents (PMR= 1.41)) non-transport accidents (PMR = 2.37) and accidents “except for those occurring at home or residential institutions” ( PMR = 3.01) . The last studies on fatal occupational accidents ranked the construction industry 4th in Maryland, among other economic branches (Baker et al., 1982)) and 3rd in the United States at large (CDC, 1984). According to the statistical data reported by Waller (1980)) the construction industry accounted for 19.2% fatal accidents and 10.4% disabling occupational

227

accidents, of the total for “all industries” in the United States in 1977. The highest level of occupational accident mortality in construction works in comparison with other occupations has been indicated by Rivera Ferreira and Mendes (1981) and Parkinson et al. (1986). Much less attention has been given to the study of non-fatal occupational accident statistics in the construction industry. In one study, Schaffer (1964) found that frequency and severity rates of occupational accidents in the Israeli construction industry was 4050% greater than that for the country as a whole. In the Swedish construction industry, the frequency of occupational accidents was reported as almost double that of the entire industrial sector (Ahlgren et al., 1984). Similar increase in work accident incidence in building construction was observed in England (Buck and Coleman, 1985). To summarize, the studies performed in various countries for almost a half century show that construction work involves excessive risk, in terms of both frequency and severity, of occupational accidents. Notwithstanding, no comprehensive study on the epidemiology of occupational accidents in the construction industry, has been made, to the best of our knowledge, apart from that of Schaffer (1964) pertaining to the late 1950s-early 1960s. No attempt has been done to evaluate factors contributing to the development of permanent incapacity to work resulting from occupational accidents in construction works. The aims of this study were: - To assess trends in occupational accidents in the Israeli construction industry over a long period (mainly 1970-1980)) as well as their current rates, and to compare them with those in other economic branches. - To ascertain the distribution of selected variables, such as place of accident occurrence, major accident causes, types of injuries and affected organs, in construction ’ workers receiving injury benefits or permanent disability allowances. - To outline acceptable preventive strategies and major directions for further research. POPULATION

AND METHODS

Population

The study population was considered as all workers, permanent or temporary, employed in building construction and civil engineering in Israel. In the years 1970-1982, the number of these workers ranged from 78,500 to 99,500, averaging 85,800 (Statistical Abstracts of Israel, 1977, 1981, 1985). This study population can be characterized as follows: _ a strong preponderance of male workers accounting for 94% of the total employed, vs. 63.9% in this country at large;

228

_ a clear increase in the proportion of female employees in this economic during the last decade from 2.1% in 1970 to 8.1% in 1980;

branch

_ three-quarters of the total workforce employed in building construction are employees; the rest are self-employed workers. This conforms well to the figures in the total national economy; _ about two thirds of the construction industry employees are paid daily; - the proportion on non-Jews employed in the building/construction industry is three times higher than that in the economy at large. Sources of data

The information analyzed below was obtained from the computerized files of the National Insurance Institute (NII) and was based on data included in primary claims for injury benefits. Part of this information has been published in several NII surveys (NII, 1978,1980, 1984). It should be taken into account that according to the existing legislation in Israel, as well as in most other countries, only work accidents resulting in three or more (3 + ) workdays lost due to injury are recorded and subsequently reported. Workers suffering from such injuries are eligible to receive injury benefits. The following rates for evaluation of frequency and severity of occupational accidents, experienced by ‘recipients of injury benefits’, were used: (a 1 annual injury incidence rate ( AIIR) : number of workers involved in 3 + occupational accidents per 1,000 employed; (b ) number of workdays lost due to accidents as above, per worker employed in the industry; (c ) number of workdays lost due to occupational accidents per injury. Attention was also given to distribution of the injured by sex, age, employment status, place of accident occurrence, cause of accident, nature of injury and affected organ. In Israel, as in most other developed countries, occupational accidents include not only those which occurred at work, but also those occurring while proceeding to or from work, and known as commuting accidents (ANPAT, 1983). These were included in accideht statistics, unless otherwise specified. To clear up the trends in occupational accidents in building construction, the last available dat,a (mainly for the years 1979-1980) were compared with the findings of the preceding years. To enable the correct inferences to be drawn the statistical data obtained for the building industry were compared with those for other branches of the economy. The analysis of occupational accident rates and accident distributions by cause, nature of injury, and affected organ, was complemented by a brief analysis of the above distributions of permanently disabled construction workers (the last available data refer to the year 1976). This was done in order to

TABLE I Occupational branches

accident

rates in the construction

Rate

Annual injury incidence rate Average number of workdays lost due to accident per: worker injury

Construction

industry

in comparison

industry

with other economic

Other economic branches

1970

1980

1970

1980

126.6

113.7

79.2

55.7

1.7 14.1

1.7 14.6

1.1 14.6

0.8 14.4

estimate the prognostic significance of these factors as determinants of the development of permanent disability due to occupational accidents. Statistical assessment of the significance of the difference between accident distributions, was performed by the application of X2-test (Blalock, 1979). RESULTS

Trends in occupational

accidents in the construction

industry

Frequency and severity rates of occupational accidents occurring to Israeli construction workers in 1980, compared with 1970, as well as with respective rates in other economic branches (pooled) are presented in Table 1. It is obvious that both injury incidence rate and mean number of workdays lost per employed in the construction industry in 1980 were double that of other economic branches. A similar, though not so pronounced difference, was also observed in 1970, AIIR being 60.0% higher than that in other economic branches, and mean number of workdays lost per employed 54.5%. No time trend and no differences between building construction and other economic branches were observed with respect to average number of workdays lost per injured. It should be noted here that during this decade (1970-1980)) the proportion of workers engaged in building construction decreased from 8.3% to 6.3% of the respective total numbers of the employed in this country. No such trend was observed with regard either the number of occupational accidents or the total number of workdays lost, due to these accidents in this industry, as a percentage of the national totals (12.7% vs. 12.3%, and 12.8% vs. 12.1%, respectively) . Similarly, 12.8% of the total number of workers permanently disabled due to occupational accidents, are construction workers (NH, 1984). AIIR trends for a longer period (19551980) appeared alike (Fig. 1) . Overall increase in AIIRs between 1955 and 1960 was followed by a decline, steeper in the manufacturing industry (by 31.3% in 1980, as compared with 1960) and

230

Q

-<

Goj11 I 11. Ai

11 I1

1960

1,

1965

1 11 I1

I I,

1970

1915

i , I I 1980

economy

branches

Years Fig. 1. Annual injury incidence only).

rate, by selected

in 1955-1980

(employees

7.00

I m-m-4 \ I’ ,’ ,A, ‘\\ k 1.15 : :/ “*\ ‘, ,’ ‘Y’ % \ ‘c j--a._ FJ \d -.t,*’ y 1.50 z 3 z :.75 I d---L ‘6 9

ALL branches Manufacturing A Construction

A

/AA

‘,

\

____-a,, ,r---

‘A ‘\

‘\

‘\

‘\ ‘\.

l

----\

n

11 1970

I

I

1972

/

11

1974

i

1976

L

1‘1

1978

1980

Years Fig. 2. Mean number of workdays lost per worker, by selected economy branches in national

(1970-1980).

total (by 36.8% ) , than in the construction industry (only by 17.0% ) . It should be noted that AIIR in manufacturing industry in 1960 was 26.4% greater than that in construction; in the late 1970s the former appeared to be lower than the latter. Similar trends may be observed concerning changes in mean number of workdays lost due to occupational accidents per employed person (Fig. 2) : after 1972, the severity rate in the manufacturing industry became noticeably lower than in the construction branch. Distribution of absence from work by their duration also changed in due

231

course: in 1975, 6.0% of spells of absence were shorter than 12 workdays; by 1979, this proportion had decreased to 58.7% (x2*=57.06, p< 0.001)) while the proportion of longer absences increased. Employment status of the injured appeared to be significant determinant of absence duration: the proportion of employees with short-term absences (less than 12 days) was higher than that of self-employed: whereas the opposite was true for long-term absences (x2 = 105.4, p < 0.001; Fig. 3 ) . Special attention should be given to the fatal occupational accident rates (Fig. 4; only 1955-1975 data are available). It may clearly be seen that while national total economy and manufacturing industry rates during this period of time remained relatively constant, the construction industry exhibited an approximate two-fold rise in the fatality rate. Distributions of construction workers injured in occupational accidents by sex and age differed significantly from those injured in other economic branches (x2 = 1484.0, p < 0.001, and x2 = 1673.1 d.f. = 3, p < 0.001) . These differences were as follows: an especially low proportion of injured women employed in building construction, and an increased proportion of workers older than 65 among the injured (9.1% vs. 1.9% in other economic branches) (Fig. 5). The 35 r

t 30;

25 L

OL

m

self-employed

c 3

4-

Number Fig. 3. Percentage accident.

7-

12-

26-

42-

56-

91+

of work days Lost due to accident distribution

*Number degrees of freedom

of employees and self-employed

(d.f.

by number

) for x2 = 1, unless otherwise specified.

ofworkdays

lost due to

232 7J 0.4 E 9

ALI branches Manufacturing A Construction l

b

n

EO, : 202 5 n ‘E 0.1 m z $00 Years

Fig. 4. Fatal occupational

accident rates, by selected economy branches

(1955-1975).

proportion of commuting accidents in construction workers appeared unexpectedly to be half that in the total economy ( 2.9% and 6.2% of all occupational accidents, respectively). Ratio between AIIRs for ‘at work’ accidents in building construction and other economy branches was four times greater than the similar ratio for commuting accidents (Fig. 6). The most prevalent cauSe of accidents in construction, as well as in other economic branches were falls (21.1% and 20.7% respectively), followed by collisions with foreign bodies (11.7% vs. 10.8%, x2=6.34, p< 0.05).Significantly greater proportions of occupational accidents in the construction industry than in other branches of the economy were caused by falling objects (8.5% vs. 6.0%, x2 = 77.35,~ < 0.001) . On the other hand, the following causes of acciSex

Age Years

n 0

p65

accidents

+

c

women l)$j 46-65

men

0

accidents

q 26-45 H 525

A

commuting

at work

A

Fig. 5. Percentage distribution other economy branches.

B

L

0

of injured persons by sex and age. A - construction

Fig. 6. Accident incidence ratios for accidents industry/AIIR for other economic branches.

at work and commuting:

industry;

B -

AIIR for construction

233

dents appeared to be less prevalent in construction than in other branches: materials and objects, other than falling, 9.3 vs. ll.O%, x2= 22.96, p
distribution

of occupational

Cause of accidents

accidents

by cause

Recipients benefits”

of injury

Construction industry

Power and pressure transmission apparatus, freezing, electrocution Conveyor systems Falling objects Other materials and objects Machinery Moving tools and instruments Falls Collision with foreign bodies Caught in or between objects Overexertion and strenuous movements Other and unspecified causes Total: % abs

Permanently personsb

Other economic branches

Construction industry

disabled

Other economic branches

1.4 6.9

2.3 17.8

2.5 24.0

6.0 11.0

9.5 4.4

11.7

9.0 5.7 20.7 10.8

2.1

2.3

9.0 2.9 28.2 6.7 3.1

5.3 4.2 15.2

1.4 5.6 8.5 9.3 3.6 6.2 21.1

8.5 22.0 100.0 8,550

“All employed, accidents at work only, 1979. hAll employed, all occupational accidents, 1976.

7.9

18.3 100.0 64,475

16.1 100.0 869

2.6 23.2 4.5 3.0

_ 15.5 100.0 5,919

234

tion industry vs. 36.4% in other economy branches, x2 = 5.36, p < 0.05 ) and burns (3.8% and 5.0%, respectively, x2 = 24.38, p < 0.001) . Fractures and amputations, being somewhat infrequent, obviously represented the most disabling injuries. These accounted for almost half (47.6% ) the permanent disability cases among construction workers. On the other hand, wounds and contusions together resulted in only 30.2% of such cases. Injuries of internal organs resulting from occupational accidents in construction workers were very rare (0.3% ) but were obviously the most severe regarding consequences: this type of injury was recorded in 4.5% of all permanently disabled construction workers (Table 3 ) . Accident distribution by affected organ was significantly different in construction than in other industries (x” = 221.6, d.f. = 5*, P-C 0.001) with head and neck, foot, and trunk injuries clearly more prevalent, whereas wrist, palm and fingers, and ‘other than foot’ lower limb injuries less prevalent among construction workers (Table 4). Comparison of distribution ofpermanent disability cases in the construction industry with other economy branches by affected organ showed that trunk and lower limb injuries were somewhat over-represented among construction workers (15.9% vs. 12.7%, x2=6.79,p<0.01; and 22.3% vs. 19.9%,x2=13.94, p < 0.001, respectively). On the other hand, the share of upper limb injuries associated with permanent disability was significantly lower in the construction industry (37.5% vs. 43.8%, x2=13.11,p~0.001). Proportions of head and neck injuries as well as of foot injuries were lower among permanently than temporarily disabled construction workers; the reverse was true for trunk injuries (Table 4 ) . Epidemiological analysis of fatal occupational accidents was based on the last available data for 1973-1974. A total of 66 fatal occupational accidents in construction workers have been analysed in comparison with 354 fatal occupational accidents during this period in all other local economic branches. All fatalities due to occupational accidents in the building industry were among men, mainly younger than 40 years old (54.5% ) . Fatalities in other economic branches included ten women (x2 = 0.88, p > 0.1) and a significant number of victims older than 40 (63.2%, x2=6.67, ~~0.01). Preretirement age group was particularly underrepresented among construction accident fatalities (4.5% vs. 17.2% among other, x2 = 5.98, p< 0.05). Similarly underrepresented in this group were self-employed persons (3.0% vs. 17.5%,x2 = 7.95, p < 0.01) . Medium wage earners slightly predominated among construction workers deceased from occupational accidents ( 59.1% ) as compared with the extremes of wage earners prevailing in other economic branches (57.1%, x2=5.88, d.f.=2,p
in Table 4 was excluded from x’ calculation.

235 TABLE 3 Percentage

distribution

of occupational

Nature of injury

accidents

Recipients

injury benefits”

Construction industry

Contusions Wounds Dislocations, strains and sprains of muscle/joint Fractures and amputations Burns Other and unspecified Total: % abs

by nature of injury

Other economic branches

Permanently personsb Construction industry

disabled

Other economic branches

37.7 28.1

36.4 28.2

15.8 14.6

16.0 13.3

10.0 11.0 3.8 9.4 100.0 8,550

10.2 10.7 5.0 9.5 100.0 64,475

7.6 47.6 2.8 11.0 100.0 869

46.3 2.6 12.3 100.0 5,919

9.5

“All employed, accidents at work only, 1979. bAll employed, all occupational accidents, 1976.

as in other economic branches and accounted for about half of the total mortality. With respect to accident causes, more than half, in both construction indusTABLE 4 Percentage

distribution

of occupational

Affected organ

Head and neck (eyes included) Wrist, palm and fingers Other upper limbs Foot Other lower limbs Trunk Multiple and unspecified Total: % abs

accidents

Recipients

by affected organs

injury benefits”

Permanently personsb

disabled

Construction industry

Other economic branches

Construction industry

Other economic branches

15.6 29.7 7.7 10.7 15.1 13.1 8.1 100.0 8,550

13.0 36.2 7.2 8.0 16.4 11.4 7.8 100.0 64,475

11.9 28.4 9.1 5.7 16.6 15.9 12.4 100.0 869

10.5 34.1 9.7 4.5 15.4 12.7 13.1 100.0 5,919

“All employed, accidents at work only, 1979. bAll employed, all occupational accidents, 1976.

236

TABLE 5 Percentage distribution of fatal occupational injury, and affected organ” Accident characteristics

accidents

Construction

by place of occurrence,

industry

cause, nature of

Other economic branches

Place of occurence

Accidents at work Commuting accidents Cause of accident Power and pressure transmission apparatus, freezing, electrocution Conveyor systems Falls Falling objects Other

54.5 45.5

49.1 50.9

7.6

4.2 59.0

51.5 13.6

12.1 15.2

4.8 3.7 24.9

40.9 42.4 16.7

46.0 31.1 22.9

36.4 13.6 50.0

21.5 28.0 50.5

Nature of injury

Fractures Internal organ involvement Other and not known Affected

organ (part of the body)

Head Trunk Other, multiple, and not known “All employed,

1973-1974.

try and in other economic branches, resulted from conveyor systems. Casualties due to falls and falling objects were three times more prevalent in construction workers than in the rest of economically active population (x2 = 15.03, p < 0.001) . No significant differences were uncovered between the distribution of injuries by their nature among accident victims employed in the construction industry and those in other economic branches. Half of all fatal occupational injuries in construction industry and in other economic branches were accounted for by multiple or poorly specified injuries, with several cases of limb injuries included in this category. It should be noted than one third of isolated fatal injuries in construction workers affected the head, while isolated trunk injuries were three times less prevalent. On the contrary, among subjects employed in other economic branches the latter predominated (x2 = 8.41, p < 0.01) . This difference is attributable to a high proportion ( 65 of 99) of myocardial infarction cases among those reported as trunk injuries in other economic branches, whereas in construction workers these com-

237

prised two out of nine. After excluding myocardial infarction cases, no significant difference between trunk and head injury prevalence was observed in either group (x2 = 0.45, p > 0.1) . DISCUSSION

The major finding of this study was that the construction industry in Israel exhibited the highest occupational accident rates (in terms both of frequency and severity) in comparison with other branches of the economy. The fact is not astonishing if we take into account that industries such as mining and forestry, which in other countries usually head the list of high risk industries (Heinrich, 1941; Baker et al., 1982; CDC, 1984)) are practically absent in Israel. Attention should be given to the fact that unlike other economy branches, there was only a slight decrease in accident incidence rate in construction while the severity rate actually remained unchanged for a decade, whereas the incidence of fatal accidents increased. The probable reasons for the elevated occupational accident rates in building construction in Israel resemble those throughout the world and are associated with: (a) peculiarities of the working process, such as no permanent working place, part of jobs performed at high altitude, low level of mechanization and high physical workload, wide use of heavy transport vehicles, workers and equipment belonging to different contractors working at the same site, etc., and (b) peculiarities of the labor force such as the high proportion of unskilled and semi-skilled workers, preponderance of the temporary (i.e. daily paid) workers, expanded employment of migrant workers, resulting, inter alia, in their unsatisfactory understanding of safety rules and precautions, often issued in an alien language, etc. ( Andreoni, 1983; Grandjean, 1983 ) . The higher proportion of longer spans of absence due to accidents (12 + workdays) among self-employed in comparison with employees, may easily be explained by the fact that the self-employed place voluntary restrictions on absences from work for economic reasons: injury benefits do not compensate real money losses when they are absent. Only in cases of severe injuries they are forced to make use of rights to benefits. Female under-representation among the injured in comparison with their proportion in the total workforce in construction industry finds its explanation in women’s employment in relatively safe, light, generally office, works. No such explanation can be found for the differences in age distribution between those injured in construction industry and those in other economy branches. The over-representation of the older workers in the former group may be a result of a higher proportion of elderlies in the construction workforce or of their accident proneness. Since the data on construction work-force

238

distribution by age are not available, the correct explanation remains to be found. Special comments are required to explain an extremely low proportion of commuting accidents among construction workers. It is well known that most construction workers are rural and suburban; therefore their commuting is usually longer than that of other occupational groups, so their accident risk is expected to be higher. A plausible explanation is that unskilled migrant workers, with a low level of general education are simply unaware of their rights to receive injury benefits for commuting accidents as for occupational ones. The administered territory residents, mainly employed in construction trades and, generally, far from the place of their residence, reported commuting accidents as only 2.4% of the total number of occupational accidents experienced by them vs. 6.1% for this country at large. The residents used to utilize their rights to injury benefits mostly in the cases of severe commuting accidents, which is indicated by the fact that the mean number of days lost per injured in such accidents is almost twice the national average ( 38.8 vs. 20.3 days) (NH, 1984 ) . With respect to accident causes, the most prevalent appeared to be falls on the same level, or from higher to lower level. This was true for the construction industry as well as for other economy branches. Approximately the same proportion of falls was reported for the construction industry in Sweden ( Ahlgren et al., 1984). As indicated in a number of epidemiological studies, falls represent the first or second most frequent cause of both non-industrial and occupational accidents; although lack of uniformity of accident-cause classifications should be considered (Mann et al., 1964; Evans, 1983; Manning, 1983; Fife et al., 1984; Pines et al., 1985). In the construction industry, falls accounted for a higher proportion of permanent disability than in the total economy. Although direct data are unavailable, it can be suggested that this is due to an increase in the proportion of falls from higher to lower level which are the most injurious to the human body. Heinrich’s (1941) data lend some support to this hypothesis: 25.4% of all occupational accidents in the construction industry were falls, about two thirds of this number were falls to different levels. Additional indirect evidence can be found in statistical data reported by Manning (1983) : falls in the construction industry accounted for 14.7% of all occupational accidents of this type, and fatal falls accounted for 47.1%. It should be noted that figures for reported accidents due to falling, usually underestimate the extent of the problem. Falls often result in a person’s collision with, or blow from, foreign (moving) bodies, entrapment between objects and other types of accident which, as a matter of fact, are recorded as immediate cause, whereas the fall role remains undiscovered. Significantly increased proportion of accidents caused by falling objects

should be considered an obvious indication of lack of safety precautions in construction settings and represent an area where preventive measures are urgent. On the other hand, a low proportion of occupational accidents caused by conveyor systems or machinery, merely reflects a low level of work mechanization in building construction in this country, although the latter accidents usually result in severe injuries and account for an increasing share of permanent disability cases, although not as great as in other economy branches. Accident distribution by nature of injury does not show particular differences between the construction industry and other branches of Israeli economy. It also does not differ essentially from that reported for building construction in this country in 1960-1962 (Schaffer, 1964). On the other hand, comparison with Finnish data (Niskanen and Saarsalmi, 1983) was striking: strains and sprains in their study were proportionally four times higher than in our investigation, but wounds and contusions were rarer. Some possible causes for such a discrepancy should be considered: - small sample size analyzed in the study cited above (215 accidents only) may easily result in chance clustering of a specific type of injury (sample bias ) ; - only two occupational groups (labores and carpenters) have been investigated by Niscanen and Saarsalmi, whereas various occupational groups employed in construction work were included in our study; - other publications of this group of Finnish researchers (Niskanen, 1985; Riihimaki, 1985; Wiikstrom et al., 1985) reveal a particular interest in the investigation of musculoskeletal, especially of the back, disorders in construction workers. Therefore, the level of the correct diagnosing of such disorders is as complete as possible. Our study is based on routinely recorded medical data and there is sufficent evidence to suggest that musculoskeletal disorders, requiring particular physician’s attention, remained undiscovered in many cases, or, alternatively, that their occupational etiology was overlooked. Fractures and amputations were at first place among the injury types responsible for the development of permanent disability, which well confirms findings in other economy branches. The differences described above in injury distribution by affected organ in construction industries and other economy branches, can most plausibly be explained by differences in prevalence of causative agents. As was reported for the Israeli economy at large ( NII, 1984)) only 6.1% of injuries caused by falling objects affected wrist, palm and fingers, whereas such injuries were observed in 82.2% of machinery-caused and 16.0% of conveyor system-caused accidents (x2= 7983.07, d.f. = 2, p< 0.001). From these calculations, it can easily be inferred that increased prevalence of falling objects as an accident cause in the construction industry, and the under-representation of accidents caused by machinery and conveyor systems, resulted in described peculiarities in injury distribution by affected organ. No clear explanation could be found for the

240

diminished proportion of ‘other then foot’ lower limb injuries among construction workers. The elevated proportion of permanent disability cases resulting from lower limb and trunk injuries, is self explanatory. A few remarks with respect to the epidemiology of fatal occupational accidents are in order. Fatal injury rates observed in Israeli construction industry appeared to be of approximately the same order of magnitude as it was recently reported for Washington State, U.S. (Buskin and Paulozzi, 1987). No plausible explanation can be found for the observed discrepancy between the relatively high proportion of older construction workers suffering from occupational accidents and lower mortality in this category. It should be taken into account that the respective findings refer to different periods, and that, due to unavailable denominator data, calculation of age-standardized injury rates is not possible. The decreased representation of self-employed among fatal accident victims may be explained by the advantage of members of this group in being able to choose less laborious and less risky jobs. The similarity of proportions of fatal commuting accidents among construction and other workers conforms well with the above consideration on general underreporting of mild to moderate commuting accidents by construction workers. A very high proportion of fatal accidents caused by ‘conveyor systems’ reflects the fact that according to the definition accepted by the National Insurance Institute this category includes all accidents caused by motor transport, i.e., at least 27 of 30 fatal commuting accidents which occurred while the victims traveled to or from work by vehicle, are classified in this category. Good compliance exists between increased proportions of all and fatal occupational accidents caused by falls and falling objects in construction industry. As it was reported by Buskin and Paulozzi (1987) falls were the most frequent cause of accident mortality in Washington State. No special comments are required by the distribution of fatal occupational accidents by nature of injury and affected part of the body. The only appropriate remark at this point is that labeling of myocardial infarctions occurred at work as occupational accidents, although completely justified and socially advantageous, may seriously distort the accident statistic as shown in this study. It is our opinion that occupational diseases and cases of myocardial infarction and viral hepatitis currently classified as occupational accidents should not be included in occupational accident statistics, but treated separately. The evidence of this study is that the construction industry bears an elevated risk of occupational accidents and resulting permanent disability. Long term trends show a minimal amelioration in the situation, as compared with other economy branches. To diminish the accident risk and to provide the workers with healthy and

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safe work environments, the strict implementation of safety measures according to requirements of IL0 (1972) at all stages of construction work, and related jobs, appears to be the first necessary provision. The building contractors should be urged to meet safety measures, both by administrative and economic measures. Compulsory increases in insurance premiums paid by contractors whose safety rating is considered unsatisfactory (e.g. where injury incidence rate in the preceding year was above average for this industry) may appear appropriate incentive for safety measures enforcement. Similar measures have recently been suggested for implementation in England (Henderson, 1983). On the other hand, improvement in health and safety education of the workers, as well as in their vocational training, providing them with clear explanation of safety requirements in their own language, does not seem, taking into account their generally low educational level, to be less important. Concerted efforts of governmental supervisory authorities, employers, labor unions and occupational health services are expected to result in substantial reduction of occupational accident incidence and severity. The present study, while shedding light on some important aspects of epidemiology of occupational accidents in construction industries, still leaves much room for strongly needed further research. These should be made as large scale, cross-sectional and short-term (two-three years) prospective studies and should elucidate, inter alia, the following questions: - correct injury incidence rates, including minor accidents (with no work days lost, or with one to two days’ work incapacity) and those 3f days accidents which remain unreported for various reasons; - effect of workers’ age and seniority on occupational accident frequency and severity; _ accident rates among daily-paid as opposed to monthly-paid construction workers; - which construction occupations are associated with higher accident risk; - the effect of general educational level, vocational training and safety education on accident proneness; - the effect of company dimensions, employees’ salary level, degree of workers’ unionisation, availability of occupational health programs on accident incidence and severity. The clarification of the above problems is expected to provide the competent authorities or those occupational health services responsible for the construction industry, with effective tools for the planning and implementation of preventive actions. ACKNOWLEDGEMENTS

The authors thank the manuscript.

M. G. Coblentz

for her assistance

in editing and typing

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