The construction industry is a very large part of the economies of nations, accounting for approximately 7-12% of GDP and employment.  It is also a very dangerous industry to work in.  In all countries, the construction industry accounts for approximately 20-30% of all occupational fatalities, injuries and most likely occupational illnesses.  In other words, the industry's contribution to occupational risks is about three times as great as its contribution to the economy.

In both the US and in the greater Eurozone, an approximately three-four workers are killed each day on construction sites, hundreds more are seriously injured, and all workers are exposed to musculo-skeletal and toxic risks.  In developing countries the risks are even greater.  Construction continues to take a terrible human toll.

Even so, historically, there has been little interest in the construction industry among occupational safety and health professionals.  The proportion of scientific publications in occupational safety and health with an emphasis on construction has been miniscule. 

This presentation focuses on three periods in the evolution of construction safety and health (origin in Europe; Advancement in the North America; Adoption in India), and explores three historical questions:

• Why have societies allowed the high risks in construction?
• Why has there been so little interest in the occupational safety and health community?
• What has been done to remedy this terrible problem?

ORIGIN IN EUROPE

Starting in Europe in the twelfth century, workers in different trades began to form Guilds, beginning with pile drivers, carpenters, painters, stone masons, forgers, etc.  The guilds established requirements of the trade, and began to issue journeymen letters to qualified tradesmen.  This recognized the reality that in construction work, employment and places of employment are temporary.  As Europe colonized the rest of the world, they brought with them this structure of work, with all its specialized skills, but also all its management problems.

From this tradition emerged a highly fractured industry with worksites being multi-employer and multi-trade, and growing problems with coordination and management.  The problem only grew as new technologies were invented, and new trades created to handle them, such as mill-wrights, boilermakers, plumbers, electricians, etc. 

When public welfare systems were created for workers, first in Germany and northern Europe, then in France and in Southern Europe, the emphasis was on compensation for occupational injuries and fatalities.  With growing awareness of costs of compensation,  more emphasis on safety and fitness for work began to be recognized.  The transformation of what had been guilds into trade unions in the 20th century sparked demands for better working conditions.

In 1927, the International Social Security Association was created.  Forty years later, it formed a Construction Section to focus on prevention of occupational injuries and illnesses.  Over the years it has held a total of 29 International Symposia on Occupational Safety and Health in the Construction Industry.  The 30th Symposium will be held in Boston, USA, 16-18 October 2012.

Gradually, a statutory and regulatory framework for construction safety and health also emerged, most extensively in the United Kingdom.  Following the establishment of the European Union, a directive governing this field was issued in 1992, which has led to a more unified approach among member nations.

 However, until 1968 there was little in the way of systematic evidence-based safety and health work.  Then the trade unions and the employers in Sweden's construction industry agreed to create Bygghalsan as an industry-wide organization.  IT was dedicated to collecting epidemiological data the health of workers, identifying workplace risks, developing and testing interventions to lower those risks, and disseminating those interventions that were effective.  Based on Bygghalsan's effectiveness, other countries adopted similar models throughout Western Europe and parts of Canada. 

In 1983 ICOH's Scientific Committee on Occupational Health in the Construction Industry was established.   It has focused on defining best practices in occupational medicine and increasingly on the evaluation of evidence on best practices to prevent injuries and illnesses.

This general model gradually spread to other parts of the world, including Japan, Korea and Brazil.

ADVANCEMENT IN THE US

In 1990, the building and construction trades unions approached the National Institute for Occupational Safety and Health (NIOSH) and proposed a public-private partnership to dramatically reduce safety and health risks in the construction industry.  Up until then NIOSH had not had a meaningful focus on the construction industry, even though it was well known that construction was a very high risk industry.

The unions made a deal with NIOSH in which if NIOSH would engage itself in this partnership, the unions would work to secure the necessary public funding.  The funding was used to establish a program with three parts: internal research at NIOSH, external research at universities, and a national construction center which would serve as the link between researchers and industry decision-makers and assure that research findings would be translated into prevention practices.   Further, to jump-start the program, help was sought from members of ISSA's Construction Section and the ICOH Scientific Committee.  CPWR, the Center for Construction Research and Training, was selected to serve as the National Construction Center. 

From the start the focus was on four objectives at the same time: identify benchmarks for best practices worldwide and compare the US to them; conduct surveillance research to define the main safety and health needs/risks in the US; begin targeted research to validate interventions to reduce risks; and develop campaigns, networks etc to disseminate research findings as effectively as possible.  The program was designed to address three types of risks that required very different approaches: safety/traumatic injuries (including fatal injuries); ergonomics/musculo-skeletal disorders; and health hazards/chronic diseases.  In the early 1990s several large national and regional conferences of industry leaders were held to reach consensus on a national strategy for change.

Over time, the program built a national research community, developed an extensive surveillance system and data base on both numerators and denominators, and produces a growing body of research and a large inventory of evidence-based best practices.  Within the Occupational Safety and Health Administration a Directorate on Construction was created to bring policy and enforcement focus on the needs of this industry.

In time these changes began to be reflected in significantly reduced risks.  Fatality rates began to decline about ten years after the program was started.  Compared to 1990, by 2006, fatality rates had declined 16%, and by 2010, 34%.  Even more impressive results were found for risks where the program had developed special emphasis, such as falls, electrocutions, and residential home construction.

In 20 years, the US had gone from nothing to being a world leader in construction safety and health, both in terms of research and in terms of impact.   In 2008, when NIOSH asked the National Academies of the U.S. to perform an individual evaluation of its programs, the Construction Research program was given the highest ratings of all the programs evaluated.

ADOPTION IN INDIA

Since the opening up of the economy in the 1990s, India has seen massive economic growth with the result that by 2010 construction was its largest economic sector with employment of more than 31 million workers.  Of these workers 82.5 were considered unskilled, and combined with a weak industry organization, extensive reliance on migrant workers --including women and children-- and a low level of mechanization, leaders of the industry have recognized that it is not sustainable.

To respond to this development, India adopted a comprehensive construction safety and health law in 1996.  Then, building on the experience in the US, in 2010 a symposium was convened in New Delhi to develop an action plan to change the industry.    It resulted in a White Paper that was presented to the national government and the states of India.   Since then a number of actions have taken place.  First, the national government's Factory Inspectorate created a dedicated office focused on construction.  It is located in Chennai.  Second, another national symposium was held in 2011, which further clarified and strengthened priorities for the development of better safety and health.  It is hoped that these developments will continue and that as a result the high rate of fatalities, injuries and illnesses arising from construction work will decline.  Judging from experience, first in Europe, then in North America, there is good reason to think that the strategy adopted by India will be effective.

CONCLUSIONS

Most of the safety and health problems of the construction industry can be tied to its structure.  Clients want to build for least cost.  Because most construction is based on short-term contracts that are bid competitively, there is tremendous pressure to cut costs.  The high fragmentation of the industry, with mostly very small employers, transient employment and a large presence of self employed tradesmen/women, exacerbates the problem.  Because workplaces are temporary and ever changing, it is hard for authorities to regulate them.  We know from construction in the nuclear power industry that where clients are willing to pay for safety and takes care to assure that best practices are followed, construction safety and health can be as good as in any other industry, such as IT or finance...