Male grocer chain worker smiling at his job.

An Essential Business Need: Keeping Food Supply Chain Employees Safe and Healthy

By Michelle Hopkins | 05/08/2020

The COVID-19 pandemic has emphasized the importance of 22 million full-time and part-time employees in agriculture and food-related industries, as every component of the food supply chain – growers, food processors, food transport and warehouse employees, and retailers – works long hours to ensure a steady flow of food to American households. Agriculture, food, and related sectors that depend on agriculture represent a $1 trillion contribution to U.S. gross domestic product (GDP).1 Keeping these employees healthy and safe may seem like a no-brainer; however, at every point in the food supply chain, employees confront a myriad of occupational health and safety hazards that can be best addressed by the expertise of an occupational health provider like Concentra®.

Going above and beyond

The farm-to-table food supply chain not only delivers the goods while families shelter in place but has also taken extra steps outside of normal business to serve the public. These steps include millions of dollars in donations and food relief for low-income families, seniors, and children.2, 3, 4 Members of the food supply chain supported research into COVID-19 treatment, grant programs to help their smaller industry brethren, revamped programs to onboard new suppliers faster, accelerated hiring of furloughed employees from hospitality and recreation, and developed creative business alliances to redirect food to retail shelves from shutdown restaurants and large institutions.5, 6, 7, 8, 9 And, like other industries designated by the government as essential, employees in the food supply chain continue working even though it meant putting their own health at risk.10, 11

A mere expression of “thanks” can never be enough for the many ways food supply chain employees have stepped up to serve in a time of national emergency. Gratitude can be expressed in a more long-lasting way by addressing the day-to-day occupational safety and health hazards these vital employees face in normal times.

In the food supply chain, even ‘normal times’ are tough

Working in food system industries is dangerous business. Both the morbidity and mortality rates are significantly higher than for non-food system industries, according to a three-year analysis of data from the US Bureau of Labor Statistics. Researchers reported that food system industries had higher rates of more severe injuries requiring days away from work. “Based on non-food industry, sector-specific mean morbidity and mortality, food industries had an estimated 57,975 excess injuries and illnesses and 439 excess deaths annually, “ they said.12

As we’ll see, a robust farm-to-table food supply chain is encumbered with an equally robust cascade of potential occupational hazards, ranging from slips and falls, hazardous machinery, and traffic accidents to zoonotic infectious disease, hazardous chemicals, musculoskeletal injuries, and exposure to noise and extremes in ambient temperatures.

Occupational health and injury pitfalls for food growers

Based on industry surveys in 2018 and 2019, 15 states represent a majority of the nation’s farms or the largest livestock (cattle) operations. Five states appear on both lists: Texas, Missouri, Iowa, Oklahoma, and California. California and Texas were among the states hardest hit by COVID-19, while the other three were clustered more near the middle.13, 14

The National Institute for Occupational Safety and Health (NIOSH) acknowledges that agriculture is among the most hazardous industries, and that fact is further complicated by farming being “one of the few industries in which family members (who often share the work and live on the premises) are also at risk for fatal and nonfatal injuries.”15

While the largest grain and soybean operations are mostly automated, harvesting produce requires a more delicate touch and makes spatial distancing among employees virtually impossible, according to a supply chain and operations management expert at Purdue University.16 COVID-19 puts these employees at the start of the food supply chain at risk.

Respiratory disease is a threat to growers (farmers and ranchers) beyond COVID-19. Chemical exposures are one of the most common causes of work-related asthma.17 Chronic bronchitis is also becoming more common. In addition to chemicals, agricultural employees are exposed to organic dust, which can contain dangerous microorganisms called endotoxins, and inorganic dust, which may contain mineral dust, including crystalline silica, as well as a variety of gases related to fertilizer and animal waste. A 2017 study of agriculture-related lung diseases (asthma, hypersensitivity pneumonitis, chronic obstructive pulmonary disease or COPD, and lung cancer) led researchers to conclude that more needs to be done to develop safe work practices, identify hazardous exposure levels and define appropriate exposure limits.18 (The Occupational Safety and Health Administration, or OSHA, does have standards in place for limited aspects involving agriculture.19)

When there are hazardous exposures, surveillance exams, both baseline and periodic, can help detect lung conditions earlier. Concentra provides surveillance exams for many chemical exposures, as well as respirator clearance and fit tests for employees who wear personal protective equipment (PPE) against such hazards.

A serious and preventable environmental hazard – and one for which there is no federal OSHA standard – involves exposure to temperature extremes (hot and cold). Concentra’s National Director of Medical Surveillance Services Ronda McCarthy, MD, MPH, FACOEM, is a national expert on heat- and cold-stress, as well as other exposures. In 2019, she testified on Capitol Hill about a successful heat-stress program she spearheaded in central Texas to achieve major cost reductions in these workers’ compensation injuries.20

Growers confront numerous other occupational hazards, such as injuries due to equipment and machinery, slips and falls, and hearing loss.21 One more that will be discussed in this article is musculoskeletal injury of farm employees, which was addressed in the National Occupational Research Agenda (NORA) final report on the agricultural, forestry, and fishing sectors, released in May 2018. NORA is a NIOSH partnership program to unite business, education, and government in recommending better approaches for the most serious occupational hazards that affect the most employees.

The NORA report said growers “face a wide range of musculoskeletal injury risk from force, repetition, duration, posture, and metabolic factors. Several studies have shown increased risk of developing work-related musculoskeletal disorders among agricultural workers compared to other occupational groups. Annual prevalence of musculoskeletal symptoms among agricultural workers in the US has been estimated between 40 and 73 percent.”22

NIOSH says about half the musculoskeletal injuries to crop employees during one period were sprains and strains.23 This is a common injury treated by Concentra physical therapists. Through pre-offer testing Concentra provides, prospective employees who lack the capacity to perform essential job functions can be identified. By not hiring employees who lack the needed physical capacity, some risk of injury can be avoided. Concentra athletic trainers can also make recommendations for safe on-the-job performance.

In addition, Concentra Telemed® and Concentra Telerehab® are ideal solutions for treating and preventing musculoskeletal and other injuries when traveling to a medical center is not convenient.

Food processors brave severe injury risk

Most employees in food processing work in manufacturing facilities mixing, cooking, and preparing ingredients used in food manufacturing. States with the highest employment in food processing are California, Arkansas, Texas, Ohio, and Louisiana.24 Although the setting is different, employees in food processing brave many of the same types of occupational hazards as growers and also have high morbidity and mortality rates.12

A Cal/OSHA study identified the major types of costly injuries in food processing plants.25, 26 They are:

  • Cuts and amputations from improper use of knives, cutters, grinders, and choppers
  • Burns and scalding from contact with open flames, hot oils, steam ovens, and appliances
  • Electrical shock and electrocution from improperly grounded or malfunctioning equipment
  • Slips, trips, and falls from slippery and cluttered floors and improper lighting
  • Musculoskeletal injuries from awkward movements and extended time in one position
  • Skin itching, swelling, and redness from temperature extremes and chemical exposures
  • Coughing, wheezing, and shortness of breath from exposure to grain dust, spices and food additives

Concentra injury care and physical therapy provide dynamic, hands-on treatment to restore function and accelerate return to work, reducing disability duration and workers’ compensation costs. An important aspect of these outcomes is the ability of Concentra clinicians to set positive expectations for functional restoration to help elicit strong employee adherence to treatment plans for faster recovery.

But there is no need to wait until injury happens. Many employers have discovered that a range of injuries can be prevented through consultation with an on-site Concentra ergonomics expert or a Concentra athletic trainer. In addition, Concentra’s standard early intervention approach to care can help mitigate injury severity and help get employees back to work sooner.

Safety of employees in food transport and storage

While appreciation for locally grown produce is on the rise, much of the nation’s food continues to be transported long distances because not all regions have equivalent ability to grow the food they need. Food distributors serve as the bridge between growers and retailers by buying from farmers and food processors and storing these products in warehouses for transport to retail and wholesale markets.27

In 2018, transportation and warehouse employees generally were fifth in total cases of nonfatal occupational injuries and illness, behind health care and social assistance, manufacturing, retail trade, and accommodations and food service. The transportation and warehouse segment has 213,100 injury cases and 8,300 illness cases. The incidence rate of 4.5 (injuries and illness per 100 workers) was second highest, trailing only agriculture, forestry, fishing, and hunting (5.3).28

The most common injuries for truckers are sprains and strains (50 percent), bruises, fractures, cuts and lacerations, soreness and pain, multiple traumatic injuries, overexertion, contact with an object, falling on the same level, and vehicular accidents.29 For warehouse employees, the most common injuries involve loading docks, forklifts, conveyor belts, material storage, manual handling, and lifting.30

An occupational health expert understands the rigors of transportation and warehousing functions and how these highly physical jobs can lead to injury. Concentra is well-equipped to provide injury care for transportation and warehouse employees, with medical centers in 44 states and telemedicine provided via Concentra Telemed, which enables injured employees to receive injury care and physical therapy anywhere Wi-Fi is available for use on a mobile device or computer equipped with a camera and microphone.

Concentra certified medical examiners are available at all center locations to provide Department of Transportation (DOT) physicals and drug testing. These compliant activities help ensure the safety of commercial motor vehicle drivers and proactively identify any DOT disqualifying medical conditions.

Food retailers, a microcosm of injury risk

Unsurprisingly to anyone who has ever reached for an item on a high grocery store shelf, musculoskeletal injuries are a dominant concern and, according to OSHA, represent about one-third of the work-related injuries and illnesses experienced by grocery store employees. In a US Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses, grocery stores were one of nine industries with 100,000 or more injury and illness cases annually; taken together, these nine industries represent nearly one-third of all injury and illness cases for private industry.31

While the association with musculoskeletal injuries may first come to mind for stockers, there are many other employees in food retail who experience these and other work-related injuries, including managers, cashiers, baggers, kitchen employees, and meat cutters. Food retail is a microcosm of occupational injury risk. Injuries occur when moving containers, twisting, bending and stretching, crossing the floor, and working with machinery.

Some of the predominant factors in food retail that present risk of musculoskeletal injury include:

  • Force, or the amount of physical effort required to lift, push or pull, handle merchandise or maintain control of equipment or tools
  • Repetition, or performing the same motion or series of motions over an extended period of time
  • Awkward and static postures, such as prolonged or repetitive reaching, kneeling, squatting or twisting

Whether these actions lead to musculoskeletal injury can depend on the individual, as well as duration, frequency, and intensity of the activity.

OSHA reports that grocery stores have successfully reduced work-related injuries and workers’ compensation costs by implementing injury prevention efforts.32 Concentra offers a cornucopia of injury prevention efforts, and one exciting approach that can be ideal in the food retail setting is the athletic trainer.

On-site athletic trainers can help reduce musculoskeletal injury through task analysis and functional screening, prehabilitation regimens, and one-on-one movement analysis. An athletic trainer can identify factors that may lead to an injury and signs of impaired mobility early, before they become full-blown injuries.

Concentra occupational health care is vital for the food supply chain

Protecting the health and safety of employees in the nation’s food supply chain – growers, processors, transporters and warehouse employees, and retailers – has never been more important. Only an occupational health provider, like Concentra with more than 40 years of service, can completely understand the challenges these employees confront in their daily work and provide the type of injury prevention and injury care they need.

Concentra’s more than 520 medical centers nationwide, Concentra Telemed and Concentra Telerehab, onsite centers, surveillance exams and other testing and screening, and athletic trainers are leading options to help ensure the food supply chain remains strong and unbreakable for years to come.


NOTES
1 Ag and Food Sectors of the Economy, United States Department of Agriculture, Economic Research Service. https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/ag-and-food-sectors-and-the-economy/ 
2 “PepsiCo pledges funds for COVID-19 response: ‘Bringing food to our neighbors who need it most,” Food Navigator, April 3, 2020. https://www.foodnavigator.com/Article/2020/04/03/PepsiCo-pledges-funds-for-COVID-19-response-Bringing-food-to-our-neighbours-who-need-it-most 
3 “Tyson Foods Commits $13 Million in COVID-19 Hunger Relief and Community Support,” Refrigerated & Frozen Foods, March 27, 2020. https://www.refrigeratedfrozenfood.com/articles/99167-tyson-foods-commits-13-million-in-covid-19-hunger-relief-and-community-support 
4 “H-E-B Feeds the Frontlines Tackling COVID-19,” Progressive Grocer, April 10, 2020. https://progressivegrocer.com/h-e-b-feeds-frontlines-tackling-covid-19 
5 “H-E-B Feeds the Frontlines Tackling COVID-19,” Progressive Grocer, April 10, 2020. https://progressivegrocer.com/h-e-b-feeds-frontlines-tackling-covid-19
6 “The Giant Co. Helping Small Food Businesses in PA,” Progressive Grocer, April 10, 2020. https://progressivegrocer.com/giant-co-helping-small-food-businesses-pa 
7 “How Walmart Is Helping Suppliers During the Pandemic,” Progressive Grocer, March 26, 2020. https://progressivegrocer.com/how-walmart-helping-suppliers-during-pandemic 
8 “Kroger Offering Free COVID-19 Testing in Ky., Progressive Grocer, April 13, 2020. https://progressivegrocer.com/kroger-offering-free-covid-19-testing-ky 
9 “Food goes to waste amid coronavirus crisis,” Politico, April 5, 2020. https://www.politico.com/news/2020/04/05/food-waste-coronavirus-pandemic-164557 
10 “Driver Health Becomes Paramount During Coronavirus Outbreak,” Transport Topics, April 8, 2020. https://www.ttnews.com/articles/driver-health-becomes-paramount-during-coronavirus-outbreak 
11 “Truckers Work to Overcome Difficulties in Food Supply Chain,” Transport Topics, April 3, 2020. https://www.ttnews.com/articles/truckers-work-overcome-difficulties-food-supply-chain 
12 Newman KL, Leon JS, Newman LS. Estimating occupational illness, injury, and mortality in food production in the United States: A farm-to-table analysis. Journal of Occupational and Environmental Medicine. July 2015; 57(7): 718-725. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494896/ 
13 “Ranking of States with the Most Farms,” Beef2Live, April 21, 2020. https://beef2live.com/story-states-farms-ranking-1-50-154-113143 
14 “Top 10 States with the Most Cattle,” Beef2Live, April 14, 2020. https://www.beef2live.com/story-top-10-states-cattle-0-110713 
15 Agricultural Safety, Centers for Disease Control and Prevention, The National Institute for Occupational Safety and Health (NIOSH). https://www.cdc.gov/niosh/topics/aginjury/ 
16 “Covid-19 is about to reach US farms in a major test for food supply chains,” Quartz.com, April 1, 2020. https://qz.com/1829558/covid-19-is-about-to-reach-us-farms/ 
17 “Do You Have Work-Related Asthma,” OSHA Fact Sheet. https://www.osha.gov/Publications/OSHA3707.pdf 
18 Nordgren TM, Bailey KL. Pulmonary Health Effects of Agriculture. Current Opinion in Pulmonary Medicine. March 2017; 22(2): 144-149. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764055/  
19 Standards in Agricultural Operations, Occupational Safety and Health Administration, US Department of Labor. https://www.osha.gov/dsg/topics/agriculturaloperations/standards.html 
20 “Occupational Heat Stress Illness Gets Hearing on Capitol Hill,” Concentra.com, August 16, 2019. https://www.concentra.com/resource-center/articles/occupational-heat-stress-illness-gets-hearing-on-capitol-hill/ 
21 Von Essen SG, McCurdy SA. Health and safety risks in production agriculture. Western Journal of Medicine, October 1998; 169(4): 214-220. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305289/ 
22 National Occupational Research Agenda (NORA) for Agriculture, Forestry, and Fishing Sector, May 2018. https://www.cdc.gov/nora/councils/agff/pdf/National_Occupational_Research_Agenda_for_AgFF_May_2018.pdf 
23 Agricultural Safety, Centers for Disease Control and Prevention, The National Institute for Occupational Safety and Health (NIOSH). https://www.cdc.gov/niosh/topics/aginjury/
24 Occupational Employment Statistics for Food Processing Workers, May 2018. US Bureau of Labor Statistics. https://www.bls.gov/oes/2018/may/oes513099.htm 
25 “8 Causes of Costly Injuries in Food Processing Plants,” Fusion Tech Inc., May 25, 2015. https://ftiinc.org/8-causes-of-costly-injuries-in-food-processing-plants/ 
26 “Ergonomics in Action: A Guide to Best Practices for the Food Processing Industry,” Department of Industrial Relations, Cal/OSHA, May 2003. https://www.dir.ca.gov/dosh/dosh_publications/Erg_Food_Processing.pdf 
27 Food Distribution, Johns Hopkins, Center for a Livable Future. http://www.foodsystemprimer.org/food-distribution/ 
28 2018 Survey of Occupational Injuries and Illnesses, Charts Package, US Bureau of Labor Statistics, November 7, 2019. https://www.bls.gov/iif/soii-charts-2018.pdf 
29 Trucking Industry, Occupational Safety and Health Administration, United States Department of Labor. https://www.osha.gov/SLTC/trucking_industry/safetyinfo.html 
30 “Most Common Warehouse Injuries,” Frommer Damico. https://mycomplawyers.com/common-warehouse-injuries-compensation/ 
31 Gagne R. Workplace Injuries Associated with Grocery Store Workers. Fit2Wrk. 2011. https://fit2wrk.com/wp-content/uploads/2015/08/ARTICLE_Fit2wrk_ClinicalEd_vol1-18.pdf
32 Guidelines for Retail Grocery Stores, “Ergonomics for the Prevention of Musculoskeletal Disorders,” US Department of Labor, Occupational Health and Safety Administration, 2004. https://www.osha.gov/ergonomics/guidelines/retailgrocery/retailgrocery.html