Hypertension and cardiovascular issues are common outcomes of job-related stressors. Frequent urination is one side effect of taking medication to reduce blood pressure. It also is a symptom of other conditions typically found in older workers (e.g., Type 2 diabetes, enlarged prostate). Yet access to bathrooms and adequate bathroom breaks are not common in a variety of jobs. This presentation will focus on the health inequities that arise forolder bus drivers. Their job stressors lead to the highest rates ofobesity and hypertension compared to those in other jobs in the US. Urban bus drivers’ outcomes include high rates of heart attacks, cardiovascular disease, and diabetes. One result is thatrequired medical exams now include blood pressure control. Blood pressure and other medications lead to frequent urination;other health issues common in older workers require bathroom access. Yet bathroom access often is made so difficult that many bus drivers stop taking prescribed medications. For example, they don’t want to be blamed for drinking on the job or taking an unscheduled break when they are seen walking into a bar or coffee shop to use its washroom because that is the only place on their route to do so. This inequity persists as transit employers expect workers to take blood pressure or other medication and fail to accommodate needs associated with that treatment and other health conditions. Health care practitioners try to coax patients to take medications and have healthy lifestyles, without understanding the work environment makes adherence difficult, if not impossible. Bus drivers (and other workers in similar positions) find themselves being blamed for their health issues and taking extraordinary measures to keep their job. The Transportation Research Board has recognized that lack of bathroom breaks and/or access is a hazard that needs investigation. What else can be done?

The 1970 Occupational Safety and Health Act clearly declared that employers are responsible to provide and maintain safe and healthful working conditions. On the other hand, worker blaming persists in many ways. For example, OSHA “accident” investigations, workers’ compensation apportionment laws, and employer “health promotion” programs often attribute injuries or disabilities to worker inattention or ways in which the individual worker differs from an ideal “fit” worker. Similarly, the OSH Act mandates that regulation of toxic substances or harmful physical agents ensure “that no employee will suffer material impairment of health or functional capacity even if such employee has regular exposure to the hazard dealt with by such standard for the period of his working life.” But studies used in standard setting often disregard effects on vulnerable sub-populations. What effect should differences in susceptibility or outcome have on exposure limits? What does it mean that over 25 years after the Johnson Controls decision, OSHA PELs, including specifically the PEL for lead, do not protect reproductive health? What is the overall effect on health equity when individual workers are left to fend for themselves against hazards? This presentation will analyze when and how regulatory agencies’ policies, practices, laws and regulations blame, rather than protect, workers, and will discuss ways in which agencies can support meaningful worker involvement.

This presentation will discuss the negative impacts of employer policies in the healthcare industry, focused on those that shift blame to nurses and other healthcare workers. These policies take many forms, including injury investigations that blame nurses and discipline for violations of policies and practices that are impossible to follow due to under-staffing. The presentation will show how employers use these policies and practices to cut costs and minimize their risks by depending on nurses (and others) to perform their jobs, sometimes at the cost of their own health and safety. This undue burden is directly related to high rates of stress, burnout, and ultimately turnover. As a result, nurses, whose profession is to do the best for their patients, are discarded by a system that depends on that very cycle to function. Gendered expectations that nurses will do whatever it takes to fulfill their caretaking role are used to justify chronic under-staffing and ultimately blame nurses for employers’ lack of resources and the failure of prevention measures. In response to this health inequity, National Nurses United (NNU) is building a strong union, centered around nurses’ dedication to their jobs and advocacy for their patients, winning protective legislation and regulation, strong collective bargaining contract language, and increasing nurses’ say in how their workplaces are organized. Nurse health and safety is central to NNU’s work of increasing nurses’ self-determination, their collective power, and democracy in the workplace, all of which are essential to end dangerous blame-the-worker policies and practices.

The National Institute for Occupational Safety and Health’s (NIOSH) Total Worker Health (TWH) program defines TWH as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. The TWH approach prioritizes changes to improve physical, organizational, and psychosocial factors that present possible risks in the work environment. This approach is markedly distinct from interventions that only address or place sole responsibility on the worker to manage the risks. Programs that “blame the worker” or with a primary motivation of cost savings are not aligned with the TWH framework. This presentation will first define and clarify the TWH paradigm, including providing a brief history of its origin and evolution. It will then describe examples of workplace policies, programs and practices that have the potential to improve worker safety and health and advance overall worker well-being, across occupations and industries. This session will also explore scientific evidence-based interventions and opportunities to improve safety and health outcomes across the working lifespan. An emphasis on vulnerable populations of higher risk for poor work-related safety and health outcomes, such as older, low-income, and contingent workers will also be included.