Min Choi, MD, Activist and occupational and environmental medicine specialist

Korean Institute of Labor Safety and Health

2023

Everyone has experienced musculoskeletal pain related to work at least once or twice. More than half of compensated illnesses are musculoskeletal disorders (MSDs). Musculoskeletal hazard assessment (MSHA) is a legal requirement for employers to prevent MSDs. If there is any task corresponding to one of the eleven musculoskeletal burdens that the Ministry of Employment and Labor defines, the employer must carry out regular investigations of the workplace, working conditions, and workers’ symptoms once every three years and improve the working environment depending on the outcome of the investigation.

Musculoskeletal hazard assessment was made by workers’ struggles 

In 2003, the hazard assessment and prevention of work-related MSDs were included in the South Korean Occupational Safety and Health Act. Workers’ struggles on MSDs in the early 2000s formed the background to this change. Those struggles were quite different in nature from previous ones involving a struggle of women telephone operators in Korea Telecom (currently known as KT Corporation) on occupational MSDs in the late 1990s. The reason is that many workers in the manufacturing industry suffered from more serious MSDs than before due to increased labor intensity after the International Monetary Fund-related restructuring. Workers intuitively realized that MSDs, which were thought to be the norm, were not only ‘work-related’ but also closely related to factors that seemed far from ‘worker health’ such as restructuring, layoffs, and labor intensity.

Led by the Korean Metalworkers’ Union, 70 to 80 percent of workers at each workplace applied for workers’ compensation at once and fought to have it recognized as an occupational disease. In addition to the right to treatment for their illnesses, workers demanded improvements in their current labor that would make it impossible to stay healthy if the work continued unchanged. “Slow down the conveyor belt, reduce the output per hour, reduce the intensity of labor, hire more people” were demands that the rhythm and pace of the workplace be determined by the bodies and minds of the workers.

This collective struggle for workers’ compensation benefits demonstrated to the workers that having control over the work process is the most important requirement for working healthily. The struggle exploded from 100-200 workers’ compensation claims per year until 1999 to more than 1,500 in 2001 alone. As the struggle to strengthen workers’ control over their workplaces spread through MSDs, the government came up with the Musculoskeletal Hazard Assessment (MSHA). The MSHA is unprecedented globally, as South Korea is the only country in the world that requires all workplaces to conduct such assessments on a regular basis.

The double-edged sword of institutionalization

In response to the MSHA requirement, the Coalition for the Elimination of Occupational Injuries in Masan Geoje Changwon created a best practice exercise at nine worksites in the area, where workers themselves conduct MSHAs of their sites, saying that ‘the experts in the field are the workers’. The union of Doowon Precision, an auto parts manufacturer, also achieved results in reducing labor intensity by straightening U- and O-shaped lines that had previously aggravated work intensity and lowered production.

But institutionalization was also a double-edged sword. Employers tried to deflect workers’ demands by making them do stretching exercises before and after work, providing them with work aids. Some large companies even built fancy fitness centers on site. As occupational disease approval rates for MSDs increased, workers sought treatment and time off alone instead of uniting to fight the pace of work.

This fossilized the MSHA that was introduced as a result of workers’ struggles. In many workplaces, an outside agency or expert visits the workplace once or twice, without the participation of the workers, to check if the work falls under the eleven burdensome tasks listed in the Ministry of Employment and Labor’s notice, and proposes similar improvement measures every year. There is no monitoring of the implementation of the recommendations, and the same recommendations from three years ago appear in the next report. Even where trade unions are present, their role is limited to participating in the selection of the surveyor or accompanying them on site. In some cases, ergonomic improvements have been implemented to improve the workplace after the assessment, but it is rare to see improvements that address the issues that led to the need for a MSHA in the first place, such as workload and staffing. It is worth asking if the remaining MSHA programs are just a shell of their former selves after being institutionalized.

Why are we doing MSHAs?

The reason we are looking back at the history of musculoskeletal surveillance, which is already more than 20 years old, is that in order to talk about how to make MSHA a health-saving, workplace-changing program, we need to look at the context in which it was first introduced.

The system that workers fought to introduce, using their sick bodies as evidence that the speed and intensity of capital’s demands were damaging to workers’ bodies and minds, was not simply a MSHA that looked at ergonomic risks. The goal was to identify and change how our work is affecting our bodies and minds, whether the pace of our work is adequate to maintain our health, and to reveal the pain and discomfort of the people we work with.

This should be the goal for unions participating in MSHAs now. “We’re doing it because we have to do it every three years” may be an employer’s answer, but it is not a union’s answer. The goal can be anything from taking a closer look at the work we do and finding the root causes of what makes workers sick and uncomfortable, to sharing with workers what the union already knows about the problems, to growing activists through the process of surveying and building consensus, to negotiating with companies with a specific agenda beyond wages, to making sure that the standards that govern the workplace include workers’ bodies, minds, and safety. This is not about instrumentalizing MSHAs. It is about getting back to the original idea that workers’ control of their workplaces can prevent MSDs.

Beyond fossilized MSHAs

Despite the criticism that it is an ” empty shell,” there have been ongoing attempts by workers themselves to become inspectors, to inspect their work, to communicate with their union members, and to implement improvements that the workers themselves think should be made. In fact, the kind of “checking for eleven musculoskeletal burden tasks” done by “experts” in many workplaces is so simple that workers can do it themselves. By giving workers the opportunity to conduct their own intuitive MSHAs, greater worker participation can be encouraged in a variety of labor and health issues, including subsequent risk assessments. This can also ensure that workers’ perspectives are included in problem identification and problem solving.

A “direct survey” Is not the only best practice. As part of a MSHA, a labor union at one workplace conducted a survey of all workers who had received worker’’ compensation for musculoskeletal disorders. The goal was to find out how they evaluated the treatment process and what their current status was. All the participants were interviewed and provided a docto’’s examination of their current condition. The results showed that even in a workplace with a very high number of musculoskeletal injury cases, the stigma and isolation of being an injured worker was causing as much distress as the physical pain. They also found that the lack of a return to work rehabilitation program and principles for work placement upon return made the end of treatment and return to work unsafe and uncertain. After confirming this, the union introduced a musculoskeletal advisory doctor to the workplace, established programs such as fitness-for-duty assessment and gradual return when returning to work, and improved the system to reflect the opinions of the workers in the placement decision process after returning to work. In addition, the union educated its members about the results.

There is another approach. The labor union at a plant that has been conducting MSHAs every three years since 2003 conducted a survey to see how many of the proposed improvements had actually been implemented. Since the workplace environment has not changed much, they saw no point in repeating the same assessment every time. They reviewed the previous hazard investigation reports by department and listed all the proposed improvements, and checked whether they had been implemented, whether they were well maintained, and whether there were any additional improvement requests. It was a much simpler and more practical survey than repeatedly measuring work postures and weights. The findings were then put on the agenda for the following year’s departmental improvement tasks and the Occupational Safety and Health committee. This helped to reduce the “survey is survey” attitude toward MSHAs in the workplace and increased the worker’’ interest in the day-to-day activities of the Occupational Safety and Health Committee.

Hopefully, where there are unions, they would ask why are we doing this MSHA every three years, are we really raising the issues that need to be raised, and what are we going to do to make sure that we are not just doing it to fulfill a legal obligation. That is the first step to making it a MSHA that saves worker’’ health and changes workplaces. Of course, it is difficult to intervene in MSHAs in places where there are no labor unions. However, even if it is a company-led MSHA, we can start by talking to people around us about where and how they are sick and whether this is properly reflected in the survey process. Hopefully, the fossilized MSHAs will serve as an opportunity to shine a light on occupational health and safety activities at workplaces.