Protect Construction Employees from Hazardous Exposures

Need for safety vigilance as three trends converge

Protecting construction employees from hazardous exposures is especially important now as three critical trends continue in the construction industry. 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 June 2024 signaled renewed confidence as all three indices were above 50, indicating growth expectations (sales, 59.4; profit margins, 53.6; and staffing, 61.3). Although overall construction backlog increased in June 2025, builders still have more than nearly eight and a half months of projects under contract to support their near-term financial outlook, based on the latest ABC Construction Backlog Indicator (overall, 8.4; commercial and institutional, 8.5; heavy industrial, 9.6; and infrastructure, 8.2).¹

ABC Chief Economist Anirban Basu says that nonresidential construction spending remains just 0.2% below the all-time high achieved in March 2024, with progress attributable to ongoing infrastructure investments.²

Concerns: Material costs and skilled labor

Construction continues to wrestle 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 2024, labor demands an estimated 501,000 new workers in addition to normal hiring to meet demands, according to the Associated Builders and Contractors.³

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 2020-2021 was $41,757, but this figure can be much higher in high-risk industries.⁴ 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.⁵

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.⁶

Researchers studied the disability patterns of more than 14,000 construction employees.⁷ 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 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. As many as 21 percent of asthma deaths are attributed to exposures at work.⁸ Workplace practices have improved but still the highest number of occupational asthma deaths among men occurred in the construction industry. For women, asthma deaths were highest in health care.”⁹

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.¹⁰ 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. 

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.¹¹

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.¹²

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.¹³

“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.”

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 2019.¹⁴ Also in 2019, Dr. McCarthy testified on Capitol Hill about occupational heat-related illness.¹⁵ 

Conclusion

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.

NOTES:

1. ABC’s Construction Backlog Indicator Inched Higher in June, Contractors Remain Confident. July 9, 2024. Associated Builders and Contractors.
2. ABC: Nonresidential Construction Spending Slips 0.1% in May But Remains Elevated. July 1, 2024. Associated Builders and Contractors.
3. ABC: 2024 Construction Workforce Shortage Tops Half a Million. January 31, 2024. Associated Builders and Contractors. 
4. Workers’ Compensation Costs. Injury Facts. National Safety Council.
5. Workers’ Compensation Insurance. Insureon.
6. Occupational Hazards and Social Disability Insurance. Research Division of the Federal Reserve Bank of St. Louis. Working Paper Series. 2014.
7. 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.
8. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. Accessed August 12, 2024.
9. Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. Accessed August 12, 2024.
10. About Work-related Asthma. The National Institute for Occupational Safety and Health. Centers for Disease Control and Prevention. January 2, 2024.
11. Occupational asthma. Mayo Clinic. Accessed August 12, 2024.
12. Overview: Working in Outdoor and Indoor Heat Environments. Occupational Safety and Health Administration.
13. Overview: Working in Outdoor and Indoor Heat Environments. Occupational Safety and Health Administration.
14. Heat Stress and Employer Readiness. Concentra webinar. May 27, 2020.
15. Occupational Heat Stress Illness Gets a Hearing on Capitol Hill. Concentra.com. August 16, 2019.