Perhaps most noticeable is the country’s growing ethnic diversity as a result of immigration and higher birthrates; this trend has prompted estimates that no ethnic or racial majority will exist in the U.S. by 2042 (Johnson & Lichter, 2010). Each group brings unique experiences, assets and challenges to the workplace in general and occupational safety and health in particular. Effectively responding to this diversity will be increasingly important for public- and private-sector institutions alike.
Occupational Health DisparitiesThe growth and expansion of the Latino immigrant population has been accompanied by increased occupational health disparities for Latino immigrant workers. These workers suffer significantly higher rates of workplace mortalities (5.0 per 100,000) than all workers (4.0), non-Latino white workers (4.0) or non-Latino black workers (3.7) (Cierpich, Styles, Harrison, et al., 2008) (Figure 1, p. 54).
Considered alone, Latino immigrants to the U.S. have a workplace fatality rate of 5.9 per 100,000 person-years, which is almost 50% higher than the rate for all workers (4.0) and even greater when compared to Latino workers born in the U.S. (3.5) (Figure 2, p. 55). During the same period, two-thirds of work-related deaths among Latinos were among foreign-born individuals, up from just more than half in 1992. These data suggest that immigrant workers may be the driving force behind the elevated rates of workplace injuries and illnesses among Latinos in the U.S.
The direct and indirect cost of occupational injury and illness in the U.S. increased from $146 billion (or $217 billion in inflation-adjusted dollars) in 1992 to $250 billion in 2007 (Leigh, 2011). This economic burden is similar to that of cancer and greater than that of diabetes, coronary heart disease or stroke. During 2007, workers’ compensation benefits covered less than 25% ($55 billion) of these costs, leaving injured workers and society as a whole to absorb these additional costs (Leigh, 2011). If OSH disparities are not reduced or eliminated for Latino immigrant workers, the cost to society will increase as their participation in the workforce grows over time.
To remain effective, competitive and safe, organizations must ensure that they have the internal capacity to successfully integrate employees from an increasingly diverse workforce. This article discusses the immigrant work experience based on recent NIOSH research with Latino immigrant workers across the U.S. It identifies challenges that OSH professionals and organizations face as they work to promote OSH among immigrant workers as well as some general strategies for solutions. While the primary focus is the Latino immigrant workforce, the general themes and approaches are broad enough to inform efforts with other workforce groups as well.
Promoting Occupational Health Among Immigrant WorkersAn essential first step in improving OSH among any group of workers is to understand the factors that contribute to their injuries. The noted demographic changes will not only require workers to integrate and adapt to the worksite, but will also require institutions to adapt and change. Therefore, it is important to focus on the diverse perspectives, backgrounds and experiences of all workers as well as those of the organization (Koonce, 2001).
Knowledge as a Barrier to SafetyUnderstanding how to work safely is crucial in avoiding occupational injuries and illnesses. Upon arrival to the U.S., immigrant workers often take jobs in industries in which they did not work previously (Eggerth, DeLaney, Flynn, et al., 2012). They are often unfamiliar with the machines, chemicals and materials present nor the hazards associated with them. Even immigrants who worked in the same industry often find different materials and procedures in the U.S.
For example, residential home construction in Mexico often relies on cinder blocks and cement, whereas materials such as wood and drywall are more common in many areas of the U.S. Finally, the regulatory structure and veracity of regulation enforcement in the U.S. may differ greatly from that of their home country (Flynn, Check, Eggerth, et al., 2013).
Therefore, even if workers are aware of the safety regulations governing their work, they may not know how to address an unsafe situation.
As a result, providing effective safety training is an essential practice. However, concerns have been raised about the quality of training that immigrant workers receive. Brown (2003) found that many Spanish-language safety materials were of poor quality. In addition, immigrant workers frequently report not receiving any safety training on the job in the U.S. (Gany, Dobslaw, Ramirez, et al., 2011; O’Connor, Loomis, Runyan, et al., 2005).
Therefore, determining effective ways to provide safety training to immigrant workers is an essential step in combating occupational health disparities (O’Connor, Flynn, Weinstock, et al., 2011). Such efforts must go beyond simple translations of existing English-language materials, and the format, content and messages should be customized for the target audience as well (Brunette, 2005). O’Connor, et al. (2005), provide a general overview of tailoring safety training along with an overview to approaches, techniques and best practices from the training literature.
Language as a Barrier to SafetyLanguage differences between immigrant workers and their supervisors and coworkers are one of the most frequently cited challenges companies face in promoting safety among immigrant workers (Gany, et al., 2011). This is particularly common in areas of the U.S. that have little to no bilingual infrastructure (Gouveia & Saenz, 2000; Pew Hispanic Center, 2005).
A common practice in companies with no bilingual staff is for the manager to identify the best English speaker among the immigrant workers and have him/her translate for the other workers. This can lead to miscommunication if the employee is not as competent in English as the supervisor believes. Additionally, it puts this employee in a position to mediate the relationship between the supervisor and the other workers, which could be exploited for personal gain by communicating one thing to the manager and another to coworkers (O’Connor, et al., 2011).
Developing a bilingual capacity within an organization, either through training or hiring, will become increasingly important in economic sectors with high immigrant participation such as the construction and service sectors. One way to address this is for companies to provide English classes to immigrant workers. While this is a laudable effort, anecdotal evidence suggests that U.S-born workers may perceive this as immigrants receiving special treatment.
An alternate model is to provide both English and Spanish classes so that all workers have the opportunity to improve their communication skills and even their economic situation if proficiency with a second language is rewarded by a salary increase or a promotion. The shared struggle of learning another language may also help break down barriers within the workforce as coworkers, both immigrant and U.S.-born, see each other tackle the challenges of learning another language. Indeed, classes could be structured in such a way that students could practice with each other, which could also foster increased contact between workers of different backgrounds.
Workers’ Culture as a Barrier to SafetyWhile the ability to communicate is essential, fixation on language can cause other important cultural differences to be overshadowed. In the context of OSH and immigration, culture can be generally understood as a system of shared beliefs and behaviors, either brought from home or that develop after arrival that impact how groups of workers perceive, understand, adapt to and address work-related safety concerns.
Cultural factors that may affect safety at work include how immigrants understand work and their relationship to their coworkers and employers; how these understandings compare to their native-country experiences; how they perceive the dangers at work relative to other risks they face each day; how they adapt to workplace dangers; and how these understandings are similar and different from other groups of workers.
A study of a small group of Latino immigrant workers in Chicago, IL, documents how these workers’ behaviors reflect a culture that placed a high value on hard work and being perceived as such by their employer (Gomberg-Munoz, 2010). These workers were observed making overt demonstrations of their productivity to curry favor with employers and cultivate a reputation as better employees, which led to a competitive edge in the labor market relative to U.S.-born workers. This study also describes the various tactics the group used to ensure that team members maintained a high productivity level. While this strategy may prove effective in securing employment, it can lead to an increased risk of injury over time.
Employers seeking to create a safe work environment must recognize these evolving value systems and adaptations so they can be addressed during training or in one-on-one interactions. A common mistake made by U.S.-born managers is to overlook the significant diversity that exists in the Latino immigrant community (Eggerth & Flynn, 2010). Differences such as one’s country of origin, ethnicity or race, primary language (Spanish or a pre-Columbian language), previous work experience, time in the U.S. and level of formal education are among the many factors that contribute to diversity in the Latino immigrant community and impact how immigrant workers relate to their coworkers (both immigrant and U.S.-born), their employers and work-place safety. These differences can play a critical role in how workers respond to hazards and must be accounted for in training content, format and messages (Brunette, 2005; O’Connor, et al., 2011).
It is also important to consider these factors in personnel decisions. Often, it is assumed that bilingual individuals hired as safety professionals or supervisors will easily relate to and be effective with the monolingual employees because they speak the same language. While language skills are essential for effective communication, it is important to account for factors such as social position, personality and experience when hiring supervisors or safety professionals (Eggerth & Flynn, 2010). The ability to speak a language does not mean that an individual has the people skills or technical knowledge necessary to be an effective leader. Finding qualified individuals can be difficult, especially in areas of the country with a limited number of bilingual individuals in the labor market. Companies must take care to not become overconfident that they have solved their language problem simply by hiring one bilingual individual.
Institutional Culture as a Barrier to SafetyAnother common mistake is focusing on an immigrant’s culture without examining or accounting for the organizational culture or that of workers from the dominant group. The scope of this article does not allow for a detailed discussion of areas such as organizational culture, diversity and safety culture. Suffice it to say that organizations must develop an understanding of their specific culture and the degree to which relying on “the way we do things here” may inadvertently exclude workers from different backgrounds.
Germane questions may include: What value does management place on safety? Is this consistently enforced in times of both high and low productivity? How is this communicated to employees? How might limited English proficiency affect this communication? What formal and informal channels are used to address safety concerns? Are these open to all workers? How might a cultural disposition to nonconfrontation with authority affect important safety information flowing from workers to supervisors and managers?
Understanding and overcoming cultural barriers to safety requires sensitivity to employees’ different cultural backgrounds, knowledge of the organizational culture, and an appreciation of where these may hinder or facilitate a common understanding and practice.
Structural Realities as a Barrier to SafetyEffective communication and improved cultural understanding are not the only factors involved in improving safety for a diverse workforce. Structural realities can contribute to occupational health disparities for immigrant workers as well. Structural realities often refer to laws, policies and practices, such as large macroeconomic trends like globalization (Siqueira, Gaydos, Monforton, et al., 2013); systemic discrimination such as racism (Krieger, 2010; Krieger, Waterman, Hartman, et al., 2006); and industry practices, such as a growing reliance on temporary workers (Landsbergis, Grzywacz & LaMontagne, 2014). These realities contextualize the work experience and affect the likelihood or ability of workers or specific groups of workers to raise safety concerns.
Likewise, macroeconomic trends and industry practices also contextualize and influence the safety practices and choices of individual companies (NIOSH, 2008). While it is beyond the scope of this article to discuss how specific trends, policies and social attitudes may contribute to or hinder OSH, safety professionals must understand how these structural realities contribute to individual and organizational behavior.
By definition, eliminating structural barriers often requires changes in policies and practices at levels (e.g., industry, federal government, international regulatory body) beyond that of the individual worker or organization. While individual workers or organizations can advocate over time for structural change to eliminate barriers to safety, they often can take short-term actions to mitigate the effects of structural barriers on safety.
One such example relates to proper-fitting safety equipment for diverse workers. Many PPE specifications in the U.S. are based on measurements taken from military male recruits in the U.S. during the 1950s to 1970s (Spahr, Kau, Hsiao, et al., 2003). These data do not account for the range of body shapes and sizes of the modern civilian workforce and, consequently, structurally exclude many workers in today’s economy. This decreases the ability to achieve good PPE fits for women, nonwhites and individuals with unique body sizes or shapes (Hsiao, Friess, Bradtmiller, et al., 2009). This is problematic because poor fit not only reduces the PPE’s ability to protect the worker as designed, it may also cause a worker to reduce or eliminate its use because the gear is perceived to be either ineffective or uncomfortable (Goldenhar & Sweeney, 1996).
Current initiatives are focused on developing better methods to collect anthropometric data and ensure that datasets used to design PPE are more inclusive. For example, researchers are involved in improving the fit of respirators and fall protection harnesses for a wider range of body shapes (Hsiao, 2013; Zhuang, Benson & Viscusi, 2010). While more must be done to update anthropometric data sets and PPE for the modern workforce, NIOSH’s formative research suggests that alternative-sized PPE (e.g., designed for women, unisex) may be more widely available than previously thought. However, poor advertising to those with purchasing authority and restrictive (e.g., bulk) purchasing policies within organizations often prevent these options from reaching workers (DeLaney, 2012).
Updating the anthropometric databases and creating better-fitting PPE for a wider range of workers is essential in improving safety among the diverse workforce. However, this will take time. In the meantime, a company can investigate available alternative-sized PPE and examine how it might adapt purchasing procedures to make such gear more accessible to the workforce.
Case StudyIn 2009, NIOSH researchers initiated a project to develop an ergonomic awareness and work-related musculoskeletal disorder (WMSD) prevention publication for residential building contractors and workers. Based on an extensive literature review and numerous visits to residential building sites, NIOSH researchers planned to develop a publication similar to “Simple Solutions: Ergonomics for Construction Workers” (NIOSH Publication No. 2007-122), which addresses WMSD risks related to multiple body regions and construction activities, including system installation, material component assembly and manual material handling. Focus groups were conducted in English and Spanish, respectively, with native born and immigrant residential building workers representing multiple trades to understand their perspectives on WMSD risks and prevention and their preference for communication materials.
Findings from the focus groups suggested that building workers in both groups were more likely to recognize the risk of low back injury during manual material handling than other potential WMSD risks. Participants in both groups described favoring publications with more illustrations and limited text and technical explanations (Albers & Cato, 2011). Differences between the two groups were apparent when describing potential interventions for WMSD risks, as immigrant workers were more likely to suggest worker training and work rules, rather than substituting tools and equipment for labor or utilizing different building materials.
Since the publication was intended to provide information about actionable interventions, the research team decided to limit the focus to the area that participants clearly recognized as problematic. The document published was “Simple Solutions for Home Building Workers: A Basic Guide for Preventing Manual Material Handling Injuries” [NIOSH Publication No. 2013-111 and 2013-111(Sp2013)].