Protect Construction Employees from Hazardous Exposures

Michelle Hopkins

Need for safety vigilance as three trends converge

Protecting construction employees from hazardous exposures is especially important now as three critical trends come together in the construction industry.1,2 They are:

  • An upturn in construction starts, particularly nonresidential
  • Escalating costs for building materials
  • A persistent shortage of skilled labor

Later, we’ll see how taking steps to protect current construction employees and new hires from hazardous exposures will benefit employers who want to build on newly emerging industry optimism.

Construction confidence, construction starts rise

The Associated Builders and Contractors’ (ABC) Construction Confidence Index in March signaled renewed confidence as all three indices were above 50, indicating growth expectations (sales, 65.8; profit margins, 53.7; and staffing, 63.7). Although overall construction backlog declined from February 2021 to March 2021, builders  still have more than seven months of projects under contract to support their near-term financial outlook, based on the latest ABC Construction Backlog Indicator (overall, 7.8; commercial and institutional, 7.7; heavy industrial, 8.5; and infrastructure, 8.3).3

Nonresidential construction starts that were down 26.6 percent in February 2020 compared to February 2015 are beginning to show improvement. In January 2021, year-over-year nonresidential construction was still down, but only by 5 percent. In a Construction Executive webinar in March 2021, ABC’s Chief Economist Anirban Basu projected that total nonresidential construction spending will increase by 2.3 percent in 2021 with the strongest growth in public safety (11.2 percent), water supply projects (7.3 percent), manufacturing (6.5 percent), highway and street (6.1 percent), and power projects (4.6 percent).4

Basu says construction investment currently is strong in data centers, fulfillment centers, health care and industrial centers that support manufacturers. But the key will be bringing more people back into the labor force, he says.

Concerns: Material costs and skilled labor

While reporting a 13 percent rise in nonresidential building starts in March 2021, Dodge Data and Analytics cautioned that this activity must be balanced against looming concerns. “Just as the pandemic is beginning to loosen its grip on the economy, logistical problems and the rapid escalation in material prices have stepped in as the primary risk to the construction sector,” the construction analytics firm said in mid-April 2021.5 For example, the price of steel – one of the most common commercial building materials – is climbing. Some steel producers increased their price for wide-flange steel shapes, which are used for beams and columns, from $300 to $400 per ton in March.6 Due to rising material costs, current projects may need to be reassessed. “What might have cost $100,000 if they started last June is now probably closer to $160,000,” Diane Mills, a contractor officer, said.7

That’s not all. Construction is wrestling with a skilled labor shortage. “Due to the global pandemic, the construction industry lost 975,000 jobs in April 2020 as a result of lower demand,” or 13 percent of the nationwide construction workforce.  Even before the pandemic, construction had a shortage of skilled labor. Many skilled craft employees dropped out after the 2009 recession and did not return. In the six months after April 2020, there was a 60 percent recovery but the skilled labor shortage persists.8

Workers’ compensation costs in construction

Amid the pressures of higher prices for materials and an uncertain skilled labor pipeline, builders who want to participate as fully as possible in reinvigorated construction activity will need to keep their current employees healthy and productive and, as much as possible, avoid lost work days, higher workers’ compensation and health care costs, and employee disability.

The National Safety Council reported the average cost of a workers’ compensation claim in 2017-2018 was $41,000, but this figure can be much higher in high-risk industries.9 In fact, construction is listed by Insureon, an independent market for small business insurance, as having the highest workers’ compensation premiums – a reflection of higher workers’ compensation costs – among 15 industries.10

Construction and a high risk of disability

Also in terms of occupational disability, construction is a high-risk occupation. Construction and mineral extraction, representing a large portion of high-risk occupations, specifically machine operators and transport operators, have a mean occupational disability rate twice that of low-risk occupations, according to a Federal Reserve Board working paper.11

Researchers studied the disability patterns of more than 14,000 construction employees.12 They concluded that the risk of disability is higher for construction employees than the general workforce in relation to:

  • Cancer
  • Respiratory diseases
  • Musculoskeletal conditions
  • Injuries/poisonings
  • All causes combined

So, with workers’ compensation costs that are already high and occupational disability a perennial risk, construction employers who are struggling to hire enough skilled employees don’t need the additional burden of the two types of hazardous occupational exposures we’ll discuss next.

Avoidable risks: Occupational asthma and heat-related illness

As construction employers address multiple economic aspects of their businesses, they also must remain aware of an important requirement of the Occupational Safety and Health Administration (OSHA). That is, construction employers must conduct medical surveillance, in conjunction with other employer workplace practices and engineering controls, if hazardous exposures are present at sites where employees are working. Medical surveillance is a program that involves medical examinations and tests to detect and monitor potential health effects from hazardous exposures, including chemicals, certain materials, heat, and noise.

“Based on inquiries I have received from employers generally, there is growing interest in occupational asthma and heat-related illness and their effects on employees,” says Ronda McCarthy, MD, MPH, FACOEM, national director of medical surveillance services for Concentra. “This interest in mitigating the risk of occupational asthma and heat-related illness is encouraging because they share two common threads. First, both types of exposure can be fatal. Second, both are completely preventable.”

Managing occupational asthma in construction

In late 2020, in response to employer interest, Concentra standardized and expanded occupational asthma and allergy services, both to raise the visibility of these services to all employers and to ensure all Concentra customers received best-in-class service. Best-in-class service, as defined by Concentra, focuses on achieving results through five channels:

  • Employer engagement and clinician identification of worksite risks before problems occur
  • Employee engagement that includes respectful care with access to multiple clinicians or specialists at a single location
  • Clear communication among employers, employees, clinicians, and payors
  • Quality medical outcomes with employer access to clinicians, a focus on outcomes, and occupational expertise
  • Workforce health care that helps to contain and/or reduce workers’ compensation and health care costs

In addition, Concentra is seeking to raise awareness of occupational asthma in the construction industry. An article by Dr. McCarthy appeared in Construction Executive on April 14, in which she highlighted the seriousness of occupational asthma: “In 2019, 3,524 people died with asthma in the United States.13 As many as 21 percent of those deaths are attributed to exposures at work.14 Workplace practices have improved but still the highest number of occupational asthma deaths among men, based on a 1999-to-2016 study, occurred in the construction industry. For women, asthma deaths were highest in health care.”15

Nationwide and across all industries, more than 300 substances have known or suspected associations with work-related asthma, which can occur in acute form shortly after an exposure or in chronic form after weeks or months of exposure.16 Asthma-related exposures can occur at virtually any phase of construction – during excavation and foundation work, in wall construction, roofing, sheet metal work, and in finishing work.

Dr. McCarthy and Dr. Deepa Rajakrishnan will speak more about how occupational asthma can be managed and the services available to support construction employers in meeting state and federal requirements in the May 12 Concentra webinar, “Managing the Hidden Risk of Work-related Asthma.”

Asthma that is not properly managed can worsen as a result of workplace exposures, leading to permanent lung damage, resulting in disability and possibly death.17

Preventing heat-related illness

OSHA regularly communicates the importance of preventing work-related heat illnesses – ranging from heat rash to heat stroke, which can be fatal. However, there continues to be no national OSHA standard for heat-related illness. Most outdoor heat-related fatalities occur within a few days of first exposure because a person’s body has not had time to gradually build up a tolerance to conditions, OSHA says.18

Construction is one of the most vulnerable industries due to time spent outdoors, along with agriculture, mail and package delivery, and oil and gas extraction.19

“To create a site-specific program for the prevention of heat-related illness or injury, you must first understand specific risk factors. These risk factors can be grouped in three main categories: environmental, job-specific, and personal,” Dr. McCarthy said in the Concentra webinar, “Heat Stress and Employer Readiness,” in May 2020.

Dr. McCarthy is a leading expert in how to design heat stress prevention programs, heat acclimatization, and employer/employee training programs to dispel persistent misunderstanding and myths about heat-related illness. She implemented a successful employer-based occupational heat-related illness prevention program that was published in the Journal of Occupational and Environmental Medicine in 2019.20 Also in 2019, Dr. McCarthy testified on Capitol Hill about occupational heat-related illness.21

An additional resource to learn about heat-related illness prevention is the Concentra article, “Employers and Employees Can Work Together to Prevent Heat-related Illness.”


Construction activity is reemerging from the pandemic and gaining strength. Builders can find ready support from occupational medicine experts to protect current construction employees and new hires from exposure risks like occupational asthma and heat-related illness. Put concerns about hazardous exposures to rest by contacting an occupational health expert today.

1   Construction Starts Increase in March, but Rising Material Prices Could Hamper Recovery. Dodge Data and Analytics. April 16, 2021.     
2   The Construction Labor Shortage: Where Did All the Skilled Labor Go? Tradesmen International. October 25, 2020.
3   ABC’s Construction Backlog Slips in March; Contractor Optimism Continues to Improve. Associated Builders and Contractors news release. April 13, 2021.    
4   Anirban Basu, chief economist for Associated Builders and Contractors. Construction Executive webinar. Construction Economic Forecast for 2021, updated for changes in the first quarter. March 31, 2021.  
5   Construction Starts Increase in March, but Rising Material Prices Could Hamper Recovery. Dodge Data and Analytics. April 16, 2021. 
6   Rising Material Prices Impact Construction Industry and Economic Progress. Georgia-Pacific Building Products blog.     
7   Soaring material prices, supply chain delays spook owners and developers. ConstructionDive. April 12, 2021.  
8   The Construction Labor Shortage: Where Did All the Skilled Labor Go? Tradesmen International. October 25, 2020.  
9   Workers’ Compensation Costs. Injury Facts. National Safety Council.  
10  Workers’ Compensation Insurance. Insureon.  
11  Occupational Hazards and Social Disability Insurance. Research Division of the Federal Reserve Bank of St. Louis. Working Paper Series. 2014.  
12  Arndt V, Daniel U, Zschenderlein B, Schuberth S, Brenner H. Construction work and risk of occupational disability: a ten year follow up of 14,474 male workers. Occupational and Environmental Medicine. 2005; 62(8): 559-566.  
13  About Underlying Cause of Death, 1999-2019. Centers for Disease Control and Prevention.  
14  Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. January 19, 2018.  
15  IMorbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. January 19, 2018.
16 Work-related Asthma. The National Institute for Occupational Safety and Health. Centers for Disease Control and Prevention. May 11, 2017.
17  Occupational asthma. Mayo Clinic. March 20, 2020. 
18  Overview: Working in Outdoor and Indoor Heat Environments. Occupational Safety and Health Administration.  
19  Overview: Working in Outdoor and Indoor Heat Environments. Occupational Safety and Health Administration.
20  Heat Stress and Employer Readiness. Concentra webinar. May 27, 2020.  
21  Occupational Heat Stress Illness Gets a Hearing on Capitol Hill. August 16, 2019.