Extent Of Problem – Why Workplace Violence Is A Public Health Issue

  

WPV is a significant public health issue due to the large number of workplace physical assaults, homicides, and lost work time. Millions of workers are injured each year during workplace assaults. The U.S. Bureau of Labor Statistics reported that in the United States in 2002 there were 18 104 lost work days due to work-related assaults and violent acts by persons. This is likely to be a substantial underestimate and in most settings, especially in less well-resourced countries, few if any data are reported and/or recorded. Workplace violence has been associated with stress and consequences leading to fatigue, absenteeism, and job turnover. Work-related homicide rates are highest among public safety and corrections, the retail industry, and taxicab drivers. Work-related nonfatal WPV injury rates are highest among health-care workers such as nurses in psychiatric hospitals and nursing homes, social service workers, elementary and secondary school teachers, retail workers, bus drivers, and in public safety and corrections.

In the United States, the vast majority (85%) of workplace homicides are type I violence (criminal intent), while only 3% of workplace homicides are type II violence (customer/client), 7% are type III violence (worker-on-worker), which continues to be emphasized by the media, and 5% are type IV violence (Peek-Asa et al., 2001).
Role Of Surveillance
The role of WPV surveillance is to provide data on the number and rate of workplace violence with respect to time, place, occupation, industry, and circumstances. Surveillance helps identify high-risk workers and their risk factors in order to focus resources for prevention. Surveillance also provides data to evaluate the success of prevention efforts by estimating the change in the number and rate of WPV incidents over time among high-risk occupations. Surveillance data systems have traditionally come from law enforcement crime reports, labor statistics, workers’ compensation records, hospital emergency records, and vital statistics records (coroner reports, death certificates, and other sources).

Challenges persist in surveillance of both work-related violent deaths and injuries caused by definitions of work relatedness for work-related homicides, and the absence of central reporting systems for nonfatal violent injuries (Peek-Asa et al., 2001). Traditional sources for nonfatal assaults such as workers’ compensation records, physicians’ records, or employees’ reports often fail to capture events related to violent crime that are not necessarily linked to criminal activity. Police records may fail to identify victims who are employees and therefore work relatedness is difficult to ascertain. Additionally, nonfatal events may be significantly underreported to authorities.
Risk Factors
Risk factors vary depending on the occupation and type of violence. Two examples are discussed below, retail workers who have a high type I homicide risk, and health-care and social service workers who have high type II and III nonfatal violence risk.
Late-Night Retail
The risk of robbery-related assaults is a problem in occupations requiring the handling of cash such as among retail workers. Additionally, female retail employees are at risk of sexual assault, which occurs more often in business establishments with a history of robbery and frequently involves a female clerk alone in a store at night.

Risk factors for late-night retail robbery (OSHA, 1998) include:

 	
Contact with the public;
 	
Exchange of money;
 	
Delivery of passengers, goods, or services;
 	
Working alone or in small numbers (pertains to taxicab drivers but not small grocery stores);
 	
Location of a store in high-crime areas or in close proximity of an expressway;
 	
Lack of natural surveillance due to poor environmental design (e.g., poor visibility into the store from the outside, and outside the store from inside, high shelf height providing places to hide and block visibility within the store, no mirrors, noncentralized placement of cash register, and easy access to escape routes);
 	
Lack of administrative or work-practice controls (e.g., no training of employees in crime prevention, no cash handling procedure to minimize amount of cash on hand, no use of a drop safe to deposit cash, an employee providing resistance, or use of weapons during a robbery;
 	
Lack of security equipment (e.g., no bullet-proof enclosures or closed circuit TV surveillance equipment).

Health Care And Social Service
Lanza (2006) noted that violence in health-care settings, particularly to nurses, is a problem internationally. Violence against nurses has been documented in the United States, Europe, China, Japan, India, Africa, Mexico, South America, New Zealand, and Canada. Risk factors that predispose health-care and social service workers to increased risk of assault (OSHA, 2004) include:

 	
The prevalence of handguns and other weapons among patients, their families, or friends;
 	
The increasing use of hospitals by police and the criminal justice system for criminal holds and the care of acutely disturbed, violent individuals;