Theorizing the State of Health Practices and Climate in Construction via Fourfold Structuration

Regulatory agencies, such as the Occupational Safety and Health Administration (OSHA), and the National Institute of Occupational Safety and Health (NIOSH), recognize that decisions regarding occupational health are often economically driven, with worker health only a secondary concern (Ruttenberg, 2014). To investigate the four National Occupational Research Agenda (NORA) long-standing health concerns—welding fumes, crystalline silica, noise, and musculoskeletal disorders—a mixed methods research is conducted. Fourfold structuration, a holistic communication process with roots in indigenous/ancient knowledge, is used to organize data and facilitate making tangible relationships of health to productivity and profits that are abstract and often stated by industries, such as construction, as difficult to quantify. From both construction trade worker and occupational health and safety expert interviews data/codes are developed. For the qualitative method, the codes are organized into a constructivist grounded theory depicting the construction industry with regard to its foundation – profits. A theoretical exercise translating the qualitative codes into potential productivity losses is presented as a way for quantifying the abstract relationships of health to productivity. For the quantitative study, the data/codes are used to develop a comprehensive list of practices, barriers to, and catalysts for addressing health in construction. A significant quantitative finding is that occupational health and safety (OSH) experts are not traditionally involved at the highest levels of the OSHA Hierarchy of Controls, where the greatest opportunity to prevent exposure to health hazards is possible. Organized via a holistic framework, this research emphasizes our primary responsibility to each other as highlighted in recent NIOSH worker health agendas.