The Health Impact of Urban Mass Transportation Work in New York City Steven Markowitz MD Center for the Biology of Natural Systems Queens College City University of New York Dave Newman, M.A., M.S. New York Committee for Occupational Safety and Health Michael Frumin Robin Gillespie, M.A., M.P.H. Mount Sinai School of Medicine July 2005 This report was funded through a grant from the New York State Legislature through the New York State Department of Health to the Transport Workers Union Local 100, President Roger Toussaint. Table of Contents Chapters Page Executive Summary i Preface iii 1. Introduction Steven Markowitz 1 2. Illnesses and Injuries among Transit Workers 6 Steven Markowitz 3. Safety and Health Hazards in Urban Mass Transit 22 Dave Newman 4. Musculoskeletal Risk Factors and Disorders 58 Robin Gillespie 5. Transit Worker Data Sources 80 Michael Frumin 6. Current and Planned Transit Research 96 Steven Markowitz 7. Conclusion Steven Markowitz 112 Executive Summary The mass public transportation system in New York City is of critical importance and astonishing magnitude. The economy, the environment and the overall welfare of New York and its businesses and residents depend upon the subways and buses. These subways and buses carry over 7,000,000 passengers per day. To do so, New York City Transit operates nearly 6,500 subway cars, which travel 685 track miles, and 4,500 buses, which traverse over 2,000 route miles. In 2003, New York City Transit had an operating budget of $4.9 billion and employed 48,110 workers. These many workers are essential to the efficiency and safety of the public transit system, which, in turn, relies upon the safety and well-being of transit workers in the performance of their jobs. These concerns have special poignancy in view of the heightened emphasis on the security of public transport. Transit workers develop important, common diseases and injuries to which their work is likely to be a causal or contributing factor. Such injuries and diseases have been identified by a substantial body of scientific research, including epidemiologic and mechanism-based studies. The major health outcomes of concern are cardiovascular diseases, which include hypertension, heart disease, and stroke; lung and bladder cancer and possibly other cancers; emphysema and asthma; post-traumatic stress disorder and other stress-related psychological disturbances; and low back pain and other musculoskeletal disorders. Most available studies address the risk of disease among bus drivers; comparable studies among subway, maintenance and other transit workers are few. Occupational hazards of New York City transit workers are uncommonly diverse and encompass much of the spectrum of occupational health. They include chemical, safety, ergonomic, physical, psychological, and biologic hazards. These exposures are matched to important, sometimes life-threatening, outcomes, such as asbestos exposure and lung cancer; hypertension and heart disease; traumatic death and post-traumatic stress disorder; live electricity and electrocution; and vibration and disabling back injuries. Such diversity of hazards and associated diseases and injuries in a single industry is highly unusual in occupational health and presents an extraordinary opportunity for synergy in causing ill health. The bus driver experiences both job-related hypertension and exposure to air pollutants such as fine particulates and carbon monoxide, which work in concert to damage the heart. Similarly, the subway worker has the stress of keeping to tight time schedules, serving a demanding public, and suffering frequent loud noise, all of which contribute to high blood pressure. This diversity also presents a considerable challenge to develop and apply appropriate policies and practices of prevention and control. Indeed, few other single industries encompass as large a part of the National Occupational Research Agenda established the National Institute for Occupational Safety and Health as does the urban mass transit industry in New York City and other metropolitan areas. Current knowledge about the nature and extent of occupational disease, disability and injury experienced by New York City transit workers is limited, principally due to the lack of a coherent, comprehensive, integrated system to capture that information. Sufficient information exists at present i to warrant a re-examination of health and welfare policies and practices to maximize the health protection of transit workers and to alleviate the deleterious impacts of transit work on health. At the same time, development of a research and surveillance program that better measures the impact of transit work on health is critically needed. Such a program would be vital to assess the effectiveness of future interventions to limit the negative impact of transit worker on health. Creation of a university-based Center of Excellence of Occupational Health and Safety of Transit Workers in New York City would provide an excellent mechanism for overcoming the current knowledge deficit and for ensuring the development of a program of research and surveillance that is responsive to labor and management of the New York City transit industry. The goals of such a Center will be to assemble a multi-disciplinary research team; to develop a unified research database; to create a hazard, illness and injury surveillance system; to conduct epidemiologic analyses of transit worker health; to support pilot research studies; and to develop and provide appropriate methods of participation of labor and management in Center direction and activities. Such a Center would give direction and coherence to future transit research. It would serve as an incubator for new inquiries into the nature and extent of health and safety problems of transit work and would provide a mechanism for the rapid translation of new scientific advances into practice in the transit industry. It is a propitious moment to make progress in transit worker safety and health. The threat of terrorism to public transport systems has prompted the general public to have an acute understanding of the importance of a healthy and vigilant transit workforce to help prevent and respond to emergencies. Both union and management have a mutual interest and show evidence of recent cooperation (i.e. – development of safety dispute resolution process; joint walk-around inspection policy). Ready sources of data, especially health and job title data, exist, providing the research community with a rich and accessible resource. New York City has an active, highly regarded occupational health and safety research community located among its universities to assist in this endeavor. There are a large number of transit workers in New York City, which will enhance the scientific validity of relevant research and make the impact of that research meaningful to many people. Finally, the transit industry has enormous economic and environmental importance to New York City. It is, thus, an excellent window of time to intensify current efforts to protect the health of New York City transit workers and to acquire additional knowledge about relevant hazards in order to improve strategies to prevent avoidable death and disability among transit workers. ii Preface This report was written by several researchers and practitioners of occupational safety and health in the New York metropolitan area. Funding was provided through a grant from the New York State Legislature administered by the New York State Department of Health to the Transport Workers Union Local 100. We benefited greatly from comments and advice provided by an external review committee of nationally-renowned occupational health scientists and professionals working principally in New York. The members are listed on the following page. While all reviewers were positive in their comments on a draft version of this report, the listing of their names as members of the External Review Committee in this document does not constitute their endorsement of every statement in this report. The authors made diligent efforts to modify the report in response to the comments provided by this Committee. Indeed, the report was greatly strengthened by the reviews. The authors are grateful for their comments and suggestions. iii External Review Committee William S. Beckett, MD Professor Departments of Environmental Medicine and of Medicine University of Rochester School of Medicine and Dentistry Paul W. Brandt-Rauf, M.D., Sc.D., Dr.P.H., Professor and Chairman,, Department of Environmental Health Sciences Mailman School of Public Health Columbia University John Dement, Ph.D. CIH Professor Division of Occupational and Environment Department of Community and Family Medicine Duke University Medical Center Wajdy Hailoo, MD, DsC Professor Director, Division of Environmental and Occupational Medicine Department of Preventive Medicine School of Medicine, Stonybrook University Philip J. Landrigan MD, DsC Ethyl Wise Professor of Community Medicine Chairman, Department of Community and Preventive Medicine Mount Sinai Medical Center and School of Medicine Frank Mirer PhD Director, Occupational Safety and Health United Auto Workers Detroit, Michigan William N. Rom, MD, MPH Sol and Judith Bergstein Professor of Medicine and Environmental Medicine Director, Division of Pulmonary and Critical Care Medicine, Director, Chest Service at Bellevue Hospital Center. Bellevue Hospital NYU School of Medicine Dominick Tuminaro, JD Workers’ Compensation Attorney Brecher, Fishman,