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Beyond basic costs, occupational illness and disease impose a substantial burden

By Bernard L. Fontaine, Jr., CIH, CSP, FAIHA

Economic Impact
    Total Costs: In the United States, the combined cost of occupational injuries and illnesses was estimated at approximately $250 billion (2007) for both direct and indirect costs. This figure surpasses the costs associated with diseases like cancer, diabetes, and chronic obstructive pulmonary disease (COPD) for the same year.¹ Some of the direct costs associated with workplace illness and disease are obvious and easily quantifiable. Medical bills are one of the primary sources of direct costs concerning work-related illness. The organization’s health insurance pays these bills, including doctor’s visits, hospitalization, surgeries, prescription medications, physical therapy, and necessary medical equipment. Direct medical costs for 14 occupational diseases totaled $14.5 billion (1999). These costs include circulatory diseases: ~$4.7B; cancer: ~$4.3B; COPD: ~$2.2B; and asthma: ~$1.5B.²
    Cost Breakdown: Medical expenses accounted for $67 billion (27% of the total), while indirect costs such as lost productivity and home production losses amounted to $183 billion (73%) in 2007.
    Workers' Compensation Coverage: Workers' compensation covers less than 25% of these costs, shifting the financial burden to workers, their families, and taxpayers.³ The average cost of a workers’ compensation claim is over $41,000, not including the administrative and legal costs of processing these claims. Additionally, occupational health programs can include return-to-work programs for less disabled workers. This helps employees transition back to the workplace, reducing wage replacement costs. As part of the risk assessment, occupational health and industrial hygiene professionals can audit workers’ compensation claims and conduct exposure risk assessments to identify common workplace hazards and evaluate risk.
    Hidden Indirect Costs: Beyond direct medical expenses, occupational diseases lead to several indirect costs.
    Lost Productivity: Injured or ill employees often require time off, leading to decreased productivity. The average number of days lost due to injury is 11 days per person each year.
    Administrative Expenses: Managing injury-related paperwork, investigations, and legal issues consume resources.
    Employee Morale: Workplace injuries can negatively impact overall employee morale, leading to further productivity losses

Legal and Regulatory Issues
    OSHA General Duty Clause: Employers are legally obligated to provide a workplace “free from recognized hazards that are causing or are likely to cause death or serious physical harm.” But the burden of proof is high. Stakeholders argue that OSHA’s enforcement can bypass proper rulemaking, applying regulatory burdens informally through citations.
    Challenge in Standard-Setting: OSHA’s rule-making process is notoriously slow, constrained by political, procedural, and industrial lobbyist pushback—often delaying protections against major hazards for years.
    Emerging Federal Regulations: Heat Stress – A proposed the first-ever federal rule to protect workers from extreme heat, with mandates for training, hydration, and rest aimed at safeguarding about 35 million workers is now on hold. Some U.S. states have issued their own rules regarding outdoor and indoor heat stress.

Global Overview: Occupational Illnesses at a Glance⁴
In 2019, workplace-related deaths totaled around 2.9 million, with:
    • Circulatory diseases accounting for 31%
    • Cancers: 29%
    • Respiratory diseases: 17%

WHO and ILO estimates3 show occupational risk factors caused nearly 1.1 million deaths in 2015, including:
    • 489,000 cancer deaths
    • 357,000 from particulate matter, gases, and fumes (mainly COPD)
    • 42,000 from asthma-inducing agents

Leading Occupational Diseases by Category
    Musculoskeletal Disorders (MSDs): Chronic back and neck pain, repetitive strain injuries—like carpal tunnel—top the list of work-related health burdens. In terms of disability-adjusted life years (DALYs). Low back pain accounts for 18,400 DALYs globally. In the United States, MSDs are a leading cause of workplace illnesses. Direct costs per case: $15,000–$85,000 whereas undirect costs can double or triple the direct costs.
    Fatigue: OSHA links extended shifts to fatigue, which in turn increases injury and illness risk. Estimated annual employer cost from fatigue-related lost productivity: $136.4 billion. Fatigue also impacts accident rates: 18% higher during evening shifts and 30% higher during night shifts. Example: 12-hour shifts increased commuter crash risk for medical residents by 16.2% per shift. Overwork erodes sleep, exercise, social time, and pushes unhealthy behaviors like poor diet and stress—factors that amplify long-term health deterioration.
    Respiratory Illnesses: Pneumoconiosis, including silicosis and coal workers’ pneumoconiosis (black lung), remains a significant cause of occupational death and disability. Over 21,000 annual deaths from pneumoconiosis globally. Black lung disease alone caused 25,000 deaths in 2013. Silicosis killed more than 24,000 people annually in China (1990s); up to 2 million U.S. workers are exposed to silica.
    Lead poisoning: Costs (2014 U.S.) show that direct medical costs: ~$141 million/year. The total (direct + indirect): ~$392 million/year for high-exposure workers. The ratio of costs showed indirect expenses at similar or even higher levels than direct costs
    Asthma and COPD: Asthma is the most prevalent occupational lung disease in several regions around the world, tied to hundreds of chemical exposures. COPD deaths—commonly due to air pollution, gases, particulate matter—account for hundreds of thousands globally.
    Dermatitis and Skin Diseases: Contact dermatitis (irritant or allergic) makes up 15–20% of occupational diseases in some countries.⁵ Skin issues are prominent but often underreported. A recent WHO resolution emphasized their large-scale impact and need for better integration into health systems.
    Occupational Cancer: Occupational cancers—due to exposure to asbestos, diesel exhaust, silica, and second-hand smoke—caused around 489,000 deaths in 2015.⁶ Examples include mesothelioma, lung cancers, leukemia, and others tied to carcinogen exposure.
    Emerging Hazard: Heat Stress: Affects over 2.4 billion workers globally—71% of the workforce. Leads to nearly 23 million injuries and 19,000 deaths annually. Linked to chronic kidney disease for more than 26 million people.
    Byssinosis: Also known as "brown lung," caused by cotton/jute dust exposure in textile mill workers. Still present in low- and middle-income countries due to a lack of modern textile industry engineering and administrative controls.
    Noise-Induced Hearing Loss (NIHL): Recognized as the most common occupational health problem globally. Affects 16–24% of workers worldwide, with construction and mining being particularly affected sectors.⁷
    Long Working Hours: According to a WHO–ILO study, in 2016, working 55+ hours per week was tied to an estimated 745,000 deaths worldwide from stroke (398,000) and ischemic heart disease (347,000) — a 29% increase since 2000. Those working these excessive hours faced a 35% higher stroke risk and 17% higher heart disease mortality, compared to those working 35–40 hours weekly.
    On the cognitive front, a South Korean study showed that working 52+ hours per week can alter brain structure—affecting attention, memory, emotional regulation, and decision-making.⁸ The hidden cost goes well beyond medical bills: it includes reduced life quality, fatal and chronic disease burden, diminished cognitive capability, and immense economic loss from reduced productivity and increased health service needs.
    Long working hours now represent the largest occupational disease burden globally, accounting for about one-third of work-related disease deaths. Occupational stress from long hours also contributes to elevated cortisol levels, impacting cardiovascular health. It also increased healthcare utilization—workers with high stress levels saw healthcare costs rise nearly 50%, and 200% in those with concurrent depression.

Hidden Indirect Costs
    The hidden costs of workplace illness and diseases are often overlooked but can be far more significant over time. Lost productivity, absenteeism, training, and reduced employee morale create significant expenses for an organization. When employees become sick while on the job, productivity is often lost. The average number of days lost due to injury is 11 days per person each year but the number of days lost from illness or disease can be far greater. Beyond direct medical expenses, occupational diseases lead to several indirect costs:
    Lost Productivity: This interrupts the workflow and productivity, leading to reduced output for the organization as a whole. Additionally, workplace illness can lead to extended periods of absenteeism. Employees took time off for medical appointments, physical therapy, and rehabilitation. This extra time off beyond the initial recovery period from surgical interventions can lead to project delays and increased work for other employees.
    Training and Replacement: Hiring and training replacement workers incurs additional costs and time. Depending on the labour market, human resources may be lean requiring more resources to acquire the needed talent.
    Administrative Expenses: Managing injury-related paperwork, investigations, and legal issues consumes resources. Time and resources spent on hiring consultants; investigative teams; reconfiguring programs, policies and procedures; management change and legal counsel can be expensive.
    Employee Morale: Workplace illness and disease can negatively impact overall employee morale, leading to further productivity losses from labor shortages and strikes by unions. Amid COVID-19, United Auto Workers (UAW) members in Detroit refused to enter plants after coronavirus cases among employees.
    Sanitation crews in Pittsburgh walked off the job because of the lack of protective gear, hazard pay, better gloves and boots.⁹ In the Sub-Sahara in Africa Health worker strikes—mostly by nurses and doctors—were driven by chronic shortages, unsafe work environments, and systemic infrastructure issues, leading to disrupted services and elevated mortality in some cases.¹⁰
    More recently in Montevideo, Uruguay (2025) a non-teaching hospital staff at Hospital de Clínicas struck for 36 hours, protesting long workloads, lack of supplies, and management neglect. A strike by 2,500 health workers is affecting seven hospitals and over 160 clinics in the Pacific Coast state of Oaxaca, southeast of Mexico City. At issue was the lack of medications, tools and equipment.¹¹ A three-day walkout by 7,000 healthcare workers at two New York hospitals was a result of over staffing, personal protective equipment, and unmanageable workloads.
    In short, the hidden cost goes well beyond medical bills: it includes reduced life quality, fatal and chronic disease burden, diminished cognitive capability, and immense economic loss from reduced productivity and increased health service needs.

Specific Disease Costs
    Musculoskeletal Disorders (MSDs): Work-related MSDs cost between $13 billion and $54 billion annually in the U.S. Direct costs per case range from $15,000 to $85,000, with indirect costs potentially doubling or tripling this amount.
    Occupational Asthma: In 1996, the U.S. estimated the total cost of occupational asthma at $1.6 billion, combining direct and indirect expenses.

Landmark Cases in Occupational Health
    Radium Girls (1920s, U.S.): Five dial painters sued the U.S. Radium Corporation over radium exposure, jaw necrosis, and cancer. Though the case settled in 1928 and offered modest compensation, it was pivotal in igniting public awareness and advancing labor protections.
    McGhee v. National Coal Board (UK, 1972): The House of Lords ruled that an employer’s failure to provide washing facilities—which materially increased the risk of dermatitis—could be treated as causation in negligence claims.
    Mankayi v. AngloGold Ashanti (South Africa, 2011): The Constitutional Court recognized that statutory compensation under the Occupational Injuries and Diseases Act does not bar common-law claims. This allowed miners suffering from silicosis or tuberculosis to sue for damages—leading to a major 5 billion settlements.
    Paraquat Litigation (U.S.): Thousands allege that pesticide paraquat caused Parkinson’s disease. Judges in both Illinois (federal MDL) and California have rejected plaintiffs’ expert testimony on causation—highlighting stringent scientific standards for expert evidence.¹²
    Amazon Ergonomic Settlement (U.S.): OSHA settled ergonomic injury complaints against Amazon, retaining one citation in Illinois and dropping nine across other facilities. Amazon agreed to corporate-wide ergonomics improvements and regular OSHA monitoring, without admitting wrongdoing.¹³

Global Perspective
    Globally, work-related diseases and injuries resulted in 2.9 million deaths in 2019, a 26% increase from 2014. The associated economic loss was estimated at 5.8% of the global GDP, highlighting the substantial global burden of occupational health issues. Drawing from recent global data (WHO, ILO, and other authoritative sources), here are the top occupational diseases by impact—both in terms of mortality and long-term burden:
    Occupational Cancers and Noncommunicable Diseases (NCDs): Account for a large share of work-related deaths—work-related cancers (~29%) and circulatory diseases (~33%) dominate globally. An estimated occupationally related cancer deaths reached about 489,000 annually, driven largely by exposure to asbestos (~180,000), diesel exhaust (~120,000), silica (~86,000), and second-hand smoke (~96,000).

Mitigation Strategies
    Implementing comprehensive occupational health programs can significantly reduce both direct and indirect costs:
    Employee Training: Educating employees on industrial hygiene work practices reduces the risk of illness, which may result in occupational disease. Workers need to review the information provided on the Safety Data Sheets (SDS) to understand the occupational health hazards and controls to prevent illness and disease. OSHA mandated training is required for workers who are exposed or potentially exposed to elevated air and surface concentrations to hazardous materials like inorganic lead and arsenic, cadmium, benzene, asbestos, respirable crystalline silica and other regulated contaminants. The use of respirators and personal protective equipment are essential if engineering and/or administrative controls cannot reduce worker exposure to a safe level.
    Health Monitoring: Regular health assessments can detect early signs of occupational illness and diseases, allowing for prompt intervention. OSHA requires medical screening and surveillance requirements for a number of vertical health standards such as noise, lead, asbestos, acrylonitrile, benzene, cadmium, methylene chloride, vinyl chloride, cotton dust, coke oven emissions, ethylene oxide, arsenic, and formaldehyde. Hazardous waste workers and those workers wearing respirators also require medical surveillance. Medical surveillance includes pre-assignment, annual, and incident-triggered exams.
    Programs, Policy, and Procedures: Occupational health professionals can develop health procedures, programs and policies designed specifically for individual workplaces. These policies help prevent work-related illness, thus reducing costs like lost productivity and training replacements. Additionally, occupational health and industrial hygiene consultants can use illness and Workers’ Compensation data analytics to identify the root causes of illness and potential for occupational disease by implementing measures to prevent similar incidents. This proactive approach minimizes the likelihood of recurring illness and associated costs.
    Organizational Culture: One of the greatest benefits of implementing occupational health programs in any organization is developing a proactive workplace culture. Health programs encourage employee participation in the identification of occupational hazards and the creation of hazard-preventing policies. Employees will experience fewer health-related incidents and create a better work environment by playing an active role in the health at work.
    By prioritizing workplace health, organizations can protect their employees and reduce the substantial hidden costs associated with occupational illness and disease. The cost savings can be used to hire more workers, incentivize productivity, purchase new equipment and machinery, and expand business operations or acquire new enterprises. Governments can also mitigate these risks by adopting standards—capping weekly hours, enforcing rest periods, and promoting work-life balance—backed by WHO, ILO, and occupational health guidance. Together, these changes in mitigation strategies can also benefit society in every country.