Publication Date: 
Monday, February 23, 2015

The Problem: Workplace injuries remain a significant public health problem. In the U.S. there were 4,383 fatal workplace injuries in 2012, and an estimated 3.8 million nonfatal injuries. Approximately 49,000 deaths each year are attributed to workplace-related illnesses. A 2011 economic analysis found that workplace injuries and illnesses cost the United States $192 billion annually.  Leigh, J. Paul. "Economic Burden of Occupational Injury and Illness in the United States." Milbank Quarterly 89, no. 4 (2011): 728-72.

The Law: Many countries have instituted Occupational Health and Safety (OSH) regulations. In the United States, the Occupational Health and Safety Administration (OSHA) and agencies in many states cooperatively enforce compliance with OSH legislation, which it accomplishes through workplace inspections, fines and other penalties for violations. OSHA was created as part of the 1970 Occupational Health and Safety Act. See 29 US Code ch. 15. Many states have passed similar legislation. See NMSA 1978 § 50-9-1.

The Evidence: A 2013 Cochrane review found uncertain evidence that workplace inspections are effective in improving worker safety. While there was some evidence of a long-term impact, the generally low quality and inconsistent results of the studies reviewed made firm conclusions impossible. See Mischke C, Verbeek JH, Job J et al. Occupational safety and health enforcement tools for preventing occupational diseases and injuries. Cochrane Database Syst Rev. 2013 (8). The reviewers defined OSH regulation enforcement interventions as having at least one of these components: (1) inspections and audits, either random or scheduled; (2) warnings or orders meant to change workplace conditions; (3) fines; (4) prosecution and (5) temporary or permanent closure of the workplace. The reviewers included studies that measured how workplaces either complied with OSH regulations or changed their policies following enforcement interventions. The reviewers also included studies that measured the incidence rates of injuries or occupational diseases, as well as workers’ and employers’ attitudes towards enforcement activities for qualitative studies. The reviewers identified 23 studies that fit these criteria. Of these studies, 2 were randomized controlled trials that analyzed 1,414 workplaces, 2 used controlled before-and-after designs and analyzed 9,903 workplaces, 1 was an interrupted time series with 6 outcome measurements, and 6 were qualitative studies with 310 total participants. The remaining 12 were econometric panel studies.  Of the 17 quantitative studies, 14 examined workplaces in the U.S., while 2 were conducted in Canada and 1 in Sweden. Of the 6 qualitative studies, 2 were from Canada, 2 were from the U.S., 1 was from Australia, and the remaining study was from South Africa. The quantitative studies found that OSH regulation enforcement results in a long-term, but not short-term, decrease in occupational injuries with no corresponding drop in productivity. The qualitative studies found strong support among workers for OSH regulation enforcement. Based on research design, methods and various sources of potential bias, the reviewers judged the body of evidence to be of low or very low quality.

The Bottom Line: According to the authors of a 2013 Cochrane systematic review, there is uncertain evidence that workplace inspections, when combined with fines and penalties, decrease the risk of occupational injuries and illnesses. Because the existing body of evidence is flawed, further research is needed on this topic.

Impact: Uncertain