Employment conditions as social determinants of health. Part I: the external domain.
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Chronic Disease↗
Biomedical subjects
Supriya Lahiri
Publications and source records attributed to Supriya Lahiri.
Estimation of net-costs for prevention of occupational low back pain: three case studies from the US.
BACKGROUND: Occupational low back pain (OLBP) is widespread in industrialized societies. We present a model to estimate the net economic costs of investments in ergonomic interventions at the company level to reduce work-related low back pain. METHODS: Costs of interventions are defined by incorporating not only the costs of investment of equipment and labor, but also by taking into account the avoided costs of lost work time, medical care costs, and productivity improvements. In the net-cost model, all costs are annualized and are calculated at the level of an individual organization. Three case studies have been performed based on data from three companies in the manufacturing sector of the United States using the above approach. RESULTS: The net-cost estimates for the three case studies consistently show that ergonomic interventions applied appropriately can result in substantial cost savings for the companies. CONCLUSIONS: Although generalizing on the basis of three case studies is not ideal, our analyses show that it might be in the economic interest of management to play a more active role to prevent back pain. Gathering useful retrospective cost data, even on interventions deemed effective by corporate innovators, proved to be extremely difficult. We conclude that it is essential to incorporate a protocol for collecting cost and effectiveness data in the standard operating procedures of ergonomists and companies introducing such innovation. We intend to validate the net-cost model for the monitoring and reporting of such data through prospective studies in a variety of industrial settings and in countries at various stages of economic development.
Cost-Benefit Analysis↗
The cost effectiveness of occupational health interventions: preventing occupational back pain.
BACKGROUND: Occupational back pain exacts a toll on society with concomitant economic losses; it is imperative to evaluate the cost-effectiveness of interventions to reduce the relevant ergonomic stressors at work. This study estimates and evaluates the average and incremental cost-effectiveness ratios (CERs) of specific interventions for the prevention of occupationally induced back pain for the World Health Organization (WHO) defined subregions of the world. METHODS: Four back-pain interventions were selected from the literature: training (T), engineering controls (EC), engineering controls and training (EC&T), and a comprehensive full ergonomics program (EP) for evaluation. A simulation model for a 100-year time horizon, developed by the WHO CHOICE initiative project was used to estimate the effectiveness of the interventions in healthy year equivalents. The intervention costs were adjusted for all WHO subregions. RESULTS: In all of the subregions, training was the most cost-effective with CERs varying from 74 dollars per healthy life years gained in the subregion comprising of Egypt, Iraq, Morocco, Yemen (EMROD) to approximately 567 dollars in the subregion covering Canada and the United States (AMROA). Training is considered to be very cost-effective and would be the first choice option where resources are scarce. However, the overall effectiveness of training is low. Although other interventions such as engineering controls and total ergonomic interventions are relatively more expensive, the addition to health outcome through these interventions is much higher. The difference in the CERs for training and other engineering controls and full ergonomic interventions is relatively small for most of the industrialized regions of the world. It is clear from the ranked CERs and incremental CERs over the different subregions that in most of the industrialized regions of the world additional resources, if they become available, should go straight to the full ergonomics program. CONCLUSIONS: The model results based on CERs show that worker training is a low cost, feasible first step toward reducing back pain/injury incidence. However, all of the average CERs for the different interventions, for each of the regions, fall well within their GDP per capita estimates [World Bank, 2001]. According to the WHO Commission on Macroeconomics and Health any intervention that costs less than three times GDP per capita for saving a healthy year equivalent should be considered worthwhile and good value for money [WHO, 2002]. Given this criterion, the engineering controls interventions as well as the full ergonomics program look very cost effective for all of the WHO subregions.
Back Pain↗
The cost effectiveness of occupational health interventions: prevention of silicosis.
BACKGROUND: The failure to recognize occupational health as an economic phenomenon limits the effectiveness of interventions ostensibly designed to prevent disease and injury. Hence, consideration of economic efficiency is essential in the evaluations of interventions to reduce hazardous working conditions. In this paper, we present an analysis of the cost effectiveness of alternative means of preventing silicosis. METHODS: To evaluate the cost effectiveness of specific interventions for the prevention of occupationally induced silicosis, we have used the simulation models based on the generalized cost-effectiveness analysis (GCEA) developed by the WHO-CHOICE initiative for two representative subregions namely AMROA (Canada, United States of America), and WPROB1 (China, Korea, Mongolia). RESULTS: In both of the two subregions, engineering controls are the most cost effective with ratios varying from 105.89 dollars per healthy year or disability adjusted life year saved in AMROA to approximately 109 dollars in WPROB1. In the two subregions, the incremental cost-effectiveness ratio of engineering controls (EC) looks most attractive. Although dust masks (DM) look attractive in terms of cost, the total efficacy is extremely limited. CONCLUSIONS: To the extent that this analysis can be generalized across other subregions, it suggests that engineering control programs would be cost effective in both developed and developing countries for reducing silica exposure to save lives. Note that this analysis understates health benefits since only silicosis and not all silica-related diseases are considered.
Adolescent↗
Net-cost model for workplace interventions.
PROBLEM: Few methods exist for comprehensively examining the costs and benefits of ergonomic interventions applicable to a variety of economic sectors and settings. METHODS: An instrument for data collection and data analysis at the facility level is presented. In this net-cost model intervention costs are defined by equipment and labor costs for the interventions as well as the avoided costs of lost work time, medical care, and productivity improvements. RESULTS: Net-cost estimates for three case studies show that ergonomic interventions applied appropriately can result in substantial cost savings for the companies. DISCUSSION: It would be prudent to incorporate a protocol for collecting cost and effectiveness data in the standard operating procedures of companies introducing ergonomic interventions. Validation of the net-cost model through prospective studies is necessary. IMPACT ON INDUSTRY: This model may be used to determine the net-cost of implemented or proposed ergonomic interventions in industrial facilities.
Ergonomics↗
The burden of emissions restrictions.
Models with time horizons of 100 years are customarily used to predict anthropogenic greenhouse gas emissions. Historical evidence indicates that over this time span the current consumption patterns in developing countries are likely to change and converge to the present patterns in developed countries. This study deals with modeling this type of convergence in consumption patterns within the MIT Emission Prediction and Policy Analysis Model (EPPA) framework. We find that the differences in the model with static consumption-function coefficients from that in the model with dynamic coefficients have significant implications for the costs of emissions restrictions in developing countries, even though the regional emissions profiles are virtually the same. Our results suggest that the costs of emissions restrictions in developing countries would be higher if the changes in consumption patterns are taken account of than if they are ignored in the simulation model.
Journal Article↗