Lena works in a turkey processing plant in Iowa. She’s up by 5:30 am, eats sensibly, is not overweight and has never smoked tobacco. Lena should be the picture of health, but her job makes her feel much older than her 32 years. Over her 10-hour work shift, she makes about 20,000 cuts on the turkey carcasses that move in front of her at a rate of 30 per minute. Lena has chronic pain in her wrist, arms and shoulders. Her physical pain is exacerbated by other work-related stress. Lena earns several dollars per hour over minimum wage, but she has to work another job part-time to help pay the bills. Her story is like that of the thousands of other workers employed in US meatpacking plants.

I was recalling my interview with Lena (not her real name) when I reviewed a draft document prepared by the National Prevention, Health Promotion and Public Health Council (Council). The Council was established by Section 4001 of the Patient Protection and Affordable Care Act of 2010 (PPACA) to coordinate and provide federal leadership on prevention, wellness and health promotion practices. The Council is chaired by the Surgeon General and its 15 members include the Secretaries of HHS, Transportation, Agriculture, and Labor, and the top official at EPA, Office of National Drug Control Policy, and Domestic Policy Council. The group released in late December its draft vision, goals and recommendations. I was disappointed to see how little the document mentioned working conditions as a target for injury and illness prevention. It’s not too late, however, to influence its content. Comments can be submitted until January 13.

The document’s Strategic Direction #1 “Healthy Physical, Social and Economic Environments” reads:

Create healthy physical, social and economic environments that encompass safe and healthy neighborhoods, worksites, schools, homes and public and green space. These environments should address physical (air, water, land, buildings and other structures) and economic (availably, affordability, fair market, opportunity) factors and social norms that promote health.

It is an open invitation to examine employment practices that degrade health, yet none of the draft recommendations target directly these practices. The six current recommendations include:

*Plan and develop community structures and environments that promote safety, community connectedness and health.

*Foster cross-sector collaboration and community involvement in municipal planning, including zoning, design standards, transportation investments and building rehabilitation standards.

*Promote a marketplace free from false and misleading health claims.

My comments to the Council include rephrasing the following recommendation with the underlined phrase:

Reduce physical, chemical, biological and radiological contamination of water, land and air (indoor and outdoor, including work environments).

Exposures to toxins in the ambient environment are typically a fraction of what individuals encounter in their work environment. Eliminating or reducing exposures at their source—in the workplace—would go a long toward preventing contamination of water, land and air and their potential effects on community health. I also suggested a new recommendations under the heading “Healthy Physical, Social and Economic Environments”:

Eliminate employment practices that force individuals to choose between their health and their livelihood, such as no practical right to refuse unsafe work, mandatory overtime, and extended work shifts.

For a worker like Lena at a non-union meatpacking plant, raising complaints to management about the line speed or other safety problems would be unwise. It wouldn’t be long and you’d be out of a job. (And, unemployment in its own way can be detrimental to one’s health.) You wouldn’t be fired for complaining about safety—that would be illegal—-but you’d be let go for some other reason like “poor work performance,” a “bad attitude,” or “not being a team player.”

The Council should look seriously at both the employment practices that deter workers from speaking openly about workplace conditions that cause harm, and the interventions needed to eliminate the unhealthy conditions themselves.

The Council’s Stragetic Direction #9 “Injury-Free Living” identifies workplaces, as well as homes, schools and neighborhoods, as environments on which to focus. Their recommendations include preventing falls, violence, and abuse, but could go much further. In my comments, I suggested:

“Strengthen workplace policies to prevent injuries related to repetitive motion, lifting, awkward postures, and forceful exertions, as well as those related to hazardous chemicals, unguarded machinery and very long work hours.”

These workplace factors alone cause tens of thousands of injuries every year.

The work of the Council will be complemented by a 25-person advisory committee of non-federal employees with expertise in preventative medicine, public health education, health, community services, geriatrics, rehabilitative medicine, and worksite health promotion. Members of the advisory committee will be appointed by the President and will be announced in the coming months. I hope that the individuals making recommendations to the President about these advisors take a broad view of the phrase “worksite health promotion.” An appropriate expert would recognize that worksite health promotion means much more than providing an exercise room and offering fresh vegetables in the cafeteria. A comprehensive worksite health promotion program would, for example, ask Lena and her co-workers how their jobs in the meatpacking plant could be modified to improve their physical and mental health. They’d likely respond with ideas for redesigning the line to prevent them from suffering upper extremity disorders, or increasing their pay so they earn a living wage at 40 hours per week.

I’m eager to see the line-up for the 25-person Advisory Committee and the final version of the National Prevention Strategy and its recommendations. It’s due by July 1, 2011.