Comments on Occupational Health Standards for Preventing Musculoskeletal Disorders

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2003.06.17

No.01

1. Background and Focus of the Amendment

Musculoskeletal disorders, which have recently become a subject of controversy in industrial workplaces, have been increasing every year due to the mechanization and automation of work processes, the spread of computers, and especially changes in labor and working conditions since the IMF foreign exchange crisis. Here, “musculoskeletal disorders” (WMSD: Work-related Musculoskeletal Disorders) refer to diseases affecting the nerves, muscles, and surrounding bodily tissues in the neck, shoulders, back, arms, elbows, wrists, hands, and other areas, caused by simple repetitive work or awkward postures that place excessive strain on the human body. In the past, they were also called VDT syndrome or cervicobrachial syndrome.

Musculoskeletal disorders accounted for only about 6.7% of all occupational diseases within industrial accidents in 1998, but surged to 33.7% (1,827 cases) in 2002. The number of sufferers also rose from 1,634 in 2001 to 1,827 in 2002, an increase of 11.8%. By industry, more than 40% of all musculoskeletal disorder patients are concentrated in the shipbuilding and automobile industries. As a result, enormous economic losses are expected, including workers’ compensation payments and indirect costs, making it an urgent task to prepare countermeasures. In May 2002, the government (Ministry of Labor) announced that in 2000 there were a total of 1,009 musculoskeletal disorder cases, resulting in direct losses of about 29 million won per person, or a total of 30 billion won. In addition, according to data released by the Korean Ergonomics Society in October 2002, the direct and indirect costs resulting from musculoskeletal disorders are estimated to reach 1.4 trillion won to 4 trillion won by around 2014, when the number of patients is expected to be about 27,000.

At the end of last December, the government (Ministry of Labor) amended the Occupational Safety and Health Act (to take effect in July 2003), newly codifying “employers’ duty to prevent musculoskeletal disorders,” among other provisions. Specifically, Article 24(1)5 of the Occupational Safety and Health Act, concerning health measures, requires employers to take necessary steps to prevent “health hazards caused by simple repetitive work or work that places excessive strain on the human body.” It also established a severe penalty for violations: “imprisonment for not more than 5 years or a fine of not more than 50 million won.” In addition, the specific health measures employers must take were to be prescribed by Ordinance of the Ministry of Labor (Article 24(2) of the Act).

On this basis, the Ministry of Labor recently gave legislative notice of a “Draft Amendment to the Rules on Occupational Health Standards” (hereinafter the “Health Rules”) specifying employers’ duty of prevention in order to reduce workers’ musculoskeletal disorders (Ministry of Labor Notice No. 2003-42, April 2, 2003). To “specify employers’ duty to prevent musculoskeletal disorders under the Occupational Safety and Health Act,” the draft Health Rules established Part XIII, “Prevention of Health Hazards Caused by Musculoskeletal Burdening Work,” consisting of Chapter 3 and 11 articles (Articles 288 to 298). The purpose of this new part was to impose duties on employers regarding musculoskeletal disorders and to supplement standards for preventing occupational diseases caused by chemical substances and the like. Its main contents can be summarized as follows: (i) establishing new employer obligations concerning hazard factor investigations, medical management, education, and the operation of musculoskeletal disorder prevention programs when workers engage in “musculoskeletal burdening work”; (ii) presenting weight limits for manual material handling; (iii) expanding hazardous chemical substances subject to management (from 107 to 168 types) and establishing new measures to prevent infectious diseases caused by biological agents; (iv) establishing standards for office ventilation facilities; and (v) expanding the scope of pesticide work, abnormal-temperature work, and confined-space work beyond oxygen-deficient spaces to include spaces with risks of fire and explosion, while strengthening the management of poisoning and other hazards caused by harmful gases.

2. Problems and Proposed Improvements

However, the above-mentioned draft amendment to the Health Rules has several problems. I would like to point these out and briefly mention possible improvements.

First, it is necessary to expressly define the concept of “musculoskeletal burdening work” in the Health Rules.

Under the Occupational Safety and Health Act, “musculoskeletal burdening work” refers to “simple repetitive work or work that places excessive strain on the human body,” but this wording itself is unclear. The draft Health Rules somewhat supplements this by defining it as “work designated by the Minister of Labor as work that places a burden on the musculoskeletal system in light of workload, work speed, work intensity, workplace structure, etc.” Yet this too remains unclear, making it difficult to apply to the scope of employers’ preventive obligations. Furthermore, by re-delegating the matter to “work designated by the Minister of Labor,” it makes the application of the law less predictable for both labor and management, potentially causing conflict between the two sides and confusion in workplaces. In fact, musculoskeletal disorders arise from a complex interaction with “non-work-related factors” such as degenerative factors, poor postural habits, personal factors including household labor, and psycho-psychological factors. As a result, “work-relatedness” itself—such as harmful factors and working conditions—is unclear, and there is a serious lack of reliable objective evidence regarding the causes. There is still ongoing controversy over the connection or causation between musculoskeletal disorders and work. Therefore, since employers’ preventive obligations will take effect from this July, the Health Rules should expressly provide a rational and objective definition of burdening work and its scope of application in order to prevent confusion in enforcement, and detailed standards should be subdivided by industry and occupation.

Second, institutional mechanisms should be 마련ed to establish criteria for determining musculoskeletal disorders and to ensure consistency in such determinations.

At present, “musculoskeletal disorders” are mostly determined based on workers’ own complaints of pain, and the criteria are broad and abstract. As a result, there are considerable differences in rates of positive findings and diagnostic names depending on the subjective judgment of the examining institution or physician, and consistency in determinations is lacking. In this situation, if employers’ legal obligations are codified ambiguously, there is a high likelihood that various social problems will arise, including unnecessary labor-management conflicts and a decline in firms’ international competitiveness. Because unclear judgment standards and inadequate evaluations of work-relatedness are not being properly carried out, many industries are now in an ambiguous situation in which such disorders cannot clearly be distinguished from non-occupational illnesses, yet workers are strongly demanding that they be recognized as occupational diseases. Labor unions, too, are raising this issue collectively, further intensifying labor-management conflict. Moreover, this disease is producing a considerable number of industrial accident patients, and firms are suffering not only disruptions in production due to employees’ absence from work but also enormous economic costs. Therefore, when assessing musculoskeletal disorders, it is necessary to subdivide the classification system for occupational diseases by body part and disease name, and to establish institutional devices such as objective measurement tools and standardized diagnostic criteria to ensure consistent determinations. In addition, the specific meaning of “excessive work” should be defined, and decisions on whether to recognize an occupational disease should be made through a comprehensive evaluation of the duration of engagement in the work and the content of the work. Further, when deliberating occupational diseases, review by specialists in clinical medicine, occupational medicine, and ergonomics should be included, and radiological examination results should always be interpreted by a radiology specialist. Of course, it would also be worth considering a method of determining whether a disease is occupational by comprehensively reviewing and deliberating the relationship between the work and the musculoskeletal disorder, together with the attending physician’s medical opinion. In addition, treatment methods for workers with musculoskeletal disorders should be diversified and made more specific according to the severity of the condition—including inpatient treatment, outpatient treatment, and treatment while working (within the workplace)—so as to prevent moral hazard among workers, rather than centering only on hospitalization.

Third, not only employers but also workers and labor unions should be required to participate in preventive efforts.

Even if the “employer” takes necessary measures regarding the work environment or prepares and implements a musculoskeletal disorder prevention and management program, the effect of such efforts may be greatly reduced if the relevant “workers and labor union” do not cooperate in implementing the employer’s prevention program. Therefore, it is necessary to newly establish a provision requiring not only the “employer” but also “workers and labor unions” to participate in implementing the employer’s prevention program.

Fourth, medical measures should be carried out according to the severity of symptoms, not for every symptom.

If medical management, job transfer, or other measures must be taken for workers complaining of every symptom caused by “musculoskeletal burdening work,” there is a risk that the number of such patients will grow enormously, leading to unnecessary personnel and administrative burdens for firms and creating potential labor-management conflict. Therefore, medical management should be provided not for all workers who complain of symptoms, but according to the severity of symptoms caused by musculoskeletal burdening work, and appropriate measures such as improvements in the work environment should be taken where necessary.

Fifth, the standard of “10 or more workers with musculoskeletal disorders” should be revised to “workplaces with an incidence rate at or above the average for the same industry,” and the order to prepare and implement a prevention and management program in cases of labor-management disagreement over occurrence should be deleted.

The Minister of Labor may order an employer to prepare and implement a “musculoskeletal disorder prevention and management program” (that is, a comprehensive plan concerning hazard factor investigations related to musculoskeletal disorders, improvement of the work environment, medical management, education and training, etc.) for: (i) “workplaces where 10 or more workers with work-related musculoskeletal disorders occur in one year,” and (ii) “workplaces where there is disagreement between labor and management regarding the occurrence of musculoskeletal disorders.” As for the former, it may raise issues of fairness between large firms and small and micro enterprises. As for the latter, because it invites government intervention, there is a high risk that it may be abused for labor unions’ purposive policy goals and cause friction between labor and management. Therefore, the former should be revised to “workplaces where the incidence of musculoskeletal disorders is at or above the average for the same industry,” and the latter provision should be deleted.

3. Summary and Conclusion

As discussed above, the issues related to musculoskeletal disorders established through the amendment of the Occupational Safety and Health Act have become a major point of contention for both labor and management. It is therefore necessary to accurately understand the current status and realities of musculoskeletal disorders and to resolve the pending issues appropriately. Moreover, by legislating provisions that go beyond those of advanced countries such as the United States and Japan in terms of economic and technological conditions, there is a risk of imposing management difficulties and cost burdens on firms and of reducing their international competitiveness through unnecessary labor-management friction. For this reason, the relevant regulations need to be relaxed.

In industrial workplaces, because the medical criteria for judging musculoskeletal disorders are ambiguous, collective applications for workers’ compensation treatment for conditions such as frozen shoulder have recently continued, especially led by labor unions in the shipbuilding and automobile industries. The Korea Workers’ Compensation and Welfare Service has generally approved even personal illnesses as occupational diseases, and as a result, even patients who do not require hospitalization are being hospitalized, while even those who could receive treatment while employed are undergoing long-term outpatient treatment. In addition, once workers’ compensation treatment begins for musculoskeletal disorders, the treatment period tends to be longer than for ordinary accidental industrial injuries. Some workers with musculoskeletal disorders employed by large companies receive not only “temporary disability benefits” under the Industrial Accident Compensation Insurance Act (70% or more of average wages) but also “subsidies in the name of livelihood assistance” under collective agreements (20–30%), creating the contradiction that they may receive 10% to 50% more than their own pre-treatment wages or the wages of workers performing normal duties at the workplace. As a result, some workers, in collusion with their attending physicians, remain on long-term workers’ compensation treatment, and this has become an important factor preventing “early return to work.”

Accordingly, defining the scope of application and the criteria for judgment for musculoskeletal disorders is a matter of great importance and must be approached with extreme caution. Of course, the issue of musculoskeletal disorders is one to which both labor and management should pay close attention, with continuous management focused on preventive activities. In this regard, I would like to emphasize that the government, taking into account the realities faced by our companies, needs to carefully establish business-friendly, rational, objective, and finely differentiated judgment standards (recognition standards) and evaluation standards (review standards) so as to prevent workers’ moral hazard and labor-management conflicts related to these disorders.

Seunggil Lee (Head of the Labor Law and Institutions Office, Labor and Economic Research Institute, Korea Employers Federation; Ph.D. in Law)

Wiki:

https://www.cfe.org/w/bbsDetail.php?idx=62

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Original title: 근골격계 질환 예방을 위한 산업보건기준에 관한 의견

Author: Seung-gil Lee

Date: 2003-06-17

Source: https://www.cfe.org/bbs/bbsDetail.php?cid=bill&pn=4&idx=25819