Health in the Construction Industry

From OSHWiki
Jump to: navigation, search



Karen Oude Hengel, Linda Drupsteen,TNO, the Netherlands

Content

Introduction

Prolonging working careers is a major challenge for industries where physical work demands are high, such as in the construction industry. Compared with other industries, those with high physical work demands show higher ageing and higher shrinking rates of the working population [1]. The early retirement age among construction workers can mainly be explained by the fact that these workers run an increased risk for a lower work ability as well as a lower health status. Insights into health problems at the worksite, and effective measures regarding these problems, are helpful for prolonging the working careers of construction workers.

Health in the construction industry – facts

Construction is not only one of Europe’s largest, it is also one of the most industries dangerous industries and one involving the most physically demanding work [2] [3] . According to EU-OSHA, “More construction workers are killed, injured or suffer ill-health than in any other industry” [4]. Altogether in Europe, every year more than 1,000 workers are killed and over 800,000 workers are injured; others suffer ill-health, such as musculoskeletal disorders, dermatitis or asbestosis [5] .

The main health problems in the construction industry are:

  • Musculoskeletal disorders: the construction industry has one of the highest rates of musculoskeletal disorders (MSD). 75% of the health problems reported by construction workers were musculoskeletal [6]. Construction workers mostly reported complaints in their back and in lower extremities ] [7] [8] [9]. The workers who suffer from MSDs have a reduced ability to perform tasks and in the most serious cases they could even become permanently disabled.
  • Hearing loss: 35% of the construction workers experience significant noise levels for more than half of their working time [10] [11]. Exposure to high levels or long duration of noise can cause permanent hearing loss. Construction worksites are often temporary, mobile and located outside; noise is therefore likely to vary considerably in intensity throughout the working day [12] [13].
  • Vibration: 63% of construction workers are regularly exposed to vibrations at work [14]. Hand-arm vibration diseases normally result from the use of powered hand-tools, which could damage the nerves and blood vessels in the hand and arm. Operating heavy machinery and vehicles can cause whole-body vibration.
  • Skin Diseases: More than 15% of the construction workers are handling or touching dangerous substances during working hours, including rough materials. This can cause occupational skin problems such as dryness, redness and itching of the skin [15]. The skin may become swollen, cracked, scaly and thickened, and blisters and occupational dermatitis may develop.
  • Respiratory diseases such as silicosis, asbestosis and cancer: 32% of the construction workers reported in 2005 that they are exposed to vapours and fumes at least half of their working time [9]. Prolonged occupational exposure may cause considerable damage to the lungs [16] and may even lead to the development of other respiratory diseases such as silicosis, asbestosis and cancer [11] [17] [18].
  • Psychosocial health problems: The construction industry has one of the highest incident rates of psychosocial health problems such as stress, fatigue and burnout [19]. A study among bricklayers showed the following prevalence of self-reported mental health effects: high need for recovery after work (14%), distress (5%), depression (18%) and post-traumatic stress disorder (11%)[20].

Key issues

Work-related risk factors

The high levels of ill-health, accidents and injuries among construction workers could be explained by a high variety of risk factors on the job. Exposure differs from trade to trade, from job to job and between worksites and work tasks.

Physical risk factors

Physically demanding work is present in every construction project and at every construction site [21]. High physical work demands are the most important risk factor for a decrease in work ability among construction workers [22]. In particular, manual handling (e.g., lifting, lowering, pushing and carrying), repetitive tasks and static postures are activities within the construction industry that can cause injuries [23]. Because of the high physical demands, the construction industry has one of the highest rates of musculoskeletal disorders (MSD). Other physical hazards in the construction industry include noise, heat, cold, radiation and vibration. Construction work often must be done in extreme heat or cold, in windy, rainy, snowy, or foggy weather or at night.

Chemical risk factors

Chemical risk factors are often airborne and can appear as dust, fumes, mist, vapours and gases; thus, exposure usually occurs by inhalation, although some airborne hazards may settle on and be absorbed through the intact skin (e.g., pesticides and some organic solvents) [21]’ Expert forecast on emerging chemical risks related to occupational safety and health’ ISSN 1830-5946, EU-OSHA, 2010. </ref>. As occupational exposure to these substances seems inevitable in construction work, construction workers face potential health risks owing to chronic occupational exposure [24]. Several illnesses have been linked to the construction trades, among them: silicosis, asbestosis, bronchitis, skin allergies, neurologic disorders and cancer (e.g. lung or colon) [12].

Psychosocial risk factors

Because of tight planning in budget and time of construction projects, construction workers face more and more work-related stress at the worksite [20]. Time pressure, low social support from the supervisor, low job autonomy and skill discretion are important risk factors for work-related stress and lower work ability. In addition, psychosocial risk factors might be associated with musculoskeletal symptoms [25] [26] and (non-)fatal accidents at worksites [27] .

Biological risk factors

Although a variety of biological hazards exist that may be present on a construction site, not all sites will contain biological hazards. Biological hazards are presented by exposure to infectious micro-organisms, to toxic substances of biological origin or to animal attacks [21].

Context

The construction industry should be characterised as dynamic and complex. The complexity and dynamics of this sector may lead to large differences within and between individuals in their exposure to work-related risk factors and accompanying health problems. The complexity needs to be explained at individual, worksite and organisational level.

Individual level

Four issues with respect to individual risk-factors are identified. First, the exposure to work-related risk factors varied between and within the different professions within the construction industry. For instance, bricklayers reported MSDs most often whereas truck pointers more often reported respiratory problems [28] [8]. Second, a large variation also exists between individual construction workers, and this depends on work tasks, colleagues working at the same worksite and weather conditions. Third, a higher proportion of unskilled workers are performing construction work. Because of their lack of education, they generally have a lower knowledge and awareness of healthy and safe working practices. Fourth, night and shift work is not uncommon in the construction industry and these construction workers run an increased risk to an impaired health status.

Worksite level

Worksites are temporary, mobile and differ enormously in size. Construction workers are move from one worksite to another, depending on the stage of the project and the required competences. Therefore, the exposure to work-related factors and health problems may vary across worksites and during working days. Working at worksites often means working outdoors, which means weather conditions are a critical factor in construction workers’ working environment. Outdoor workers are exposed to many types of hazards, depending on their type of work, geographic region, season and duration of time spent outside. For instance, during summer - especially in southern Europe –ultraviolet radiation is a significant hazard for the skin.

Organisational level

Construction work is often organised in a complex and dynamic way, meaning that workers, (sub)contractors, flex-workers and self-employed workers are simultaneously working at the worksite. Subcontracting is an efficient solution for short-term projects where employees are only needed temporarily, and also when specialised work is required [29]. However, subcontracting also creates risks such as diffuse and/or unclear overall management control and responsibilities, differences in culture and language, lower levels of supervision and training for sub-contracted workers than for directly employed workers, and high work intensity [29].

Vulnerable groups in the construction industry

Several vulnerable groups are at a higher risk either of exposure to work-related risk factors or of developing health problems.

Older construction workers

As in all industries, the baby boom cohort moves towards retirement age and, at the same time, fewer young workers are entering the construction industry. As a result, the average age of construction workers increases and will continue to do so. Owing to their long exposure to high physical workloads and other risk factors and lower physical functioning, older construction workers (45 years and older) run an increased risk of developing health problems such as MSDs and chronic diseases [30] [31] [32].

Migrant workers

Construction work is more and more left to migrant workers who are hired for specific work tasks and for unskilled work by (sub)contractors. For many migrant workers, construction work is the entrance to paid labour, whereas migrant workers are important for employers from an economic point of view. Because of differences in culture, language barriers and knowledge about national policies, these workers have a higher potential to be exposed to work-related risk factors [33].

Construction workers in small and medium enterprises (SMEs) and self-employed workers

More than 99% of construction companies in Europe are SMEs. Additionally, construction workers are more often self-employed and are hired by the companies [control of contractors]. Because of time constraints and lower budgets, employers of small and medium enterprises, as well as self-employed construction workers, have less knowledge of existing health problems in the construction industry and are less willing to invest in effective preventive measures [34]. Therefore, both construction workers within SMEs and self-employed workers may run an increased risk of having health problems since fewer preventive measures are taken.

Green jobs

Although green buildings are often sustainable for the environment and final occupants, they do not always benefit construction workers’ safety and health [35]. New technologies and working processes (such as installing a solar water heater) require new skills from current construction workers [36]. Moreover, there could be increased potential for the release of novel, difficult to identify hazardous materials. The rapidly evolving technologies, new construction materials, and new materials such as biomaterials and nanomaterials will need to be closely monitored for potential (unknown) health and safety risks [37] . However, it should also be noticed that high levels of innovation and increased automation may improve OSH by removing workers from some hazardous tasks.

Legal aspects

Legislation, collective agreements, and guidelines at national or sector level, pay attention to the health and safety of construction workers at the phases of project preparation and construction [38].

Legislation

Directive 89/391 – the OSH "Framework Directive" – is the main piece of EU law governing occupational safety and health at work. Under this directive, several so-called daughter directives were adopted . Most of them are relevant for the construction industry because of diverse risk factors in this sector. Table 1 lists some important daughter directives.

Table 1: Directives related to safe and healthy working in the construction industry

TabelDirectives.PNG

Source: [39]

Directive 92/57/EEC – temporary or mobile construction sites of 24 June 1992 on the implementation of minimum safety and health requirements at temporary or mobile construction sites (eighth individual Directive within the meaning of Article 16 (1) of Directive 89/391/EEC).

Guidelines

Measures to reduce risk factors is determined in a variety of national guidelines, which could be obligatory. For instance, occupational exposure levels for quartz and asbestos or maximum lifting weights are determined in guidelines. Additionally, project supervisors have to appoint a (at least one) co-ordinator for safety and health matters, and checklists such as ‘last-minute risk analysis’ have to be carried out. Regarding collective agreements, the Dutch collective agreement offers construction workers the opportunity to participate in health examinations.

Preventive measures for health in the construction industry

During the past decades, several preventive measures were developed to improve the health of construction workers. This paragraph presents a short overview with some examples for technical, behavioural and organisational measures.

Technical measures

Technical measures are mainly aimed at reduction of the physical workload and the exposure of workers to noise, vibrations and substances [40]. Different types of technical measures are available, depending on the job tasks and professions. Several devices were introduced to minimise lifting and repetitive handling among construction workers [40]. For instance, devices for raised bricklaying ][41] [42] and mechanised equipment for floor laying [43]. The positive technological development, which has reduced the lifting of heavy loads, did not bring about the expected decrease in the number of back disorder incidents. In an article published in 2009, Hartmann and Spallek argue that physical work can have a clear positive effect on physical health (salutogenic effect). They recommend that extreme demands (both high and low) be avoided, and that an individual optimum between extreme demands (both high and low) should be aimed for. This means that general preventive measures are not enough; individual measures for each workplace are needed. Regarding occupational dust exposure, the most common measures used are local exhaust ventilation (LEV) or wet suppression, to minimise exposure to respirable dust [44] [45] [46]. Besides the technical measures, personal protective equipment such as masks and hearing protection are necessary in the construction industry to reduce risks.

Organisational measures

Toolbox sessions (obligatory, and organised at worksites to obtain a health and safety certificate) are organised in many construction companies in Europe. Topics during these toolbox sessions are ergonomics, introduction of new materials or new techniques, and safety. Toolbox sessions on risk factors such as psychosocial work demands with involvement of workers and management are less common [47] [40]. Besides the toolbox sessions, campaigns are organised for the construction industry to be better able to reduce accidents and ill health among this group [40].

Behavioural measures

Several behavioural measures have been introduced at construction worksites to improve health. These training sessions were mainly focused on ergonomics [40] (e.g., using devices correctly and learning working techniques properly [48] [49] [50] and on preventing injuries [51]. Other individual behavioural programmes for construction workers were focused on improving lifestyle behaviour (e.g., an energy balance intervention and a smoking cessation intervention) [52] [53] [54] [55].

Health surveillance is a health methodology that aims to detect undesired health effects in a given population in order to eliminate the source of the problem. Its tools range from medical screening tests to follow-up and register analysis. Health screening in the work setting such as the construction industry serves as an early warning system and to monitor and clarify the epidemiology of health problems in order to allow priorities to be set and to inform public health policy and strategies. Being subject to European and national laws, health surveillance of workers varies substantially between EU member states. For the construction industry, in several countries a health examination is periodically offered to all construction workers. These health checks focus on both chronic diseases and on physical and mental limitations at work. An innovative Dutch study even presents a new protocol in which the health examination was added with job specific questions [56].

Conclusions

Construction workers can be exposed to many risk factors during their working life and they therefore face an increased risk of developing health problems. The variety of exposure differs enormously between and within construction workers as this depends, for instance, on the worksite, work tasks and weather conditions. To prevent ill health among construction workers, it is important that effective measures are taken by both employers and workers.

References

  1. ’Labour market’. In: Europe in Figures; Eurostat yearbook 2011’, Piirto, J., Johansson, A., Lang, V. (eds) Eurostat European Commission, Luxembourg, 2011, pp. 227-268.
  2. ‘Construction in Europe – key figures’, European Construction Industry Federation (FIEC), Bruxelles, 2012. Available at:[1]
  3. ‘Building in Safety – European Week 18–22 October 2004’. European Agency for Safety and Health at Work, Available at: [2]
  4. ‘Actions to improve safety and health in construction>‘, Magazine of the European Agency for Safety and Health at Work magazine. (7), 2004. Available at: [3]
  5. Stocks, S.J., McNamee, R., Carder, M., Agius, R.M., The incidence of medically reported work-related ill health in the UK construction industry. Occup Environ Med. 2010, Vol. 67, Nr. 8, pp. 574-6.
  6. ’Health and safety at work in Europe (1999-2007) A statistical portrait’ , European Union, Luxembourg, 2010. Available at: [4]
  7. ’OSH in figures: Work-related musculoskeletal disorders in the EU — Facts and figures 2010’, European Agency for Safety and Health at Work, 2010
  8. 8.0 8.1 van der Molen, H.F., Kuijer, P.P., Smits, P.B., Schop, A., Moeijes, F., Spreeuwers, D., Frings-Dresen, M.H., ’Annual incidence of occupational diseases in economic sectors in The Netherlands’, Occup Environ Med, 2012, Vol. 60, Nr. 7, pp. 519-21.
  9. 9.0 9.1 ’Musculoskeletal disorders in construction’, E-fact 1, European Agency for Safety and Health at Work, 2004. Available at: [5] Cite error: Invalid <ref> tag; name "Msd" defined multiple times with different content
  10. ’Health and safety at work in Europe (1999-2007) A statistical portrait’ , European Union, Luxembourg, 2010. Available at: [6]
  11. 11.0 11.1 ’Hearing problems, EU 15 figures. In: Work and health in the EU: a statistical portrait’. European Communities, 2004, pp.62-63. Available at: [7] Cite error: Invalid <ref> tag; name "Hearing" defined multiple times with different content
  12. 12.0 12.1 ’Protecting yourself from noise in construction’, Occupational Safety and Health Administration, Washington, 2011. Available at: [8] Cite error: Invalid <ref> tag; name "protecting" defined multiple times with different content
  13. Noise BPG Intro, Controlling Noise on Construction Sites, ’Laborers' Health & Safety Fund of North America, Washington. Available at: [9]
  14. Donatl, P., Schust, M., Szopa, J., Starck, J., Iglesias, E.G., Senovilla, L., Fisher, S., Flaspoler, E., Relnert, D., Op de Beeck, R., ’Workplace exposure to vibration in Europe: an expert review’, European Agency for Safety and Health at Work, Luxembourg, 2008. Available at: [10]
  15. ’Skin sensitisers. Factsheet 55’, European Agency for Safety and Health at Work, Bilbao, 2003. Available at:[11]
  16. Tjoe-Nij, E., De Meer , G., Smit, J., Heederik, D., ’ Lung function decrease in relation to pneumoconiosis and exposure to quartz-containing dust in construction workers’. Am J Ind Med 2003, Vol 43, Nr. 6, pp. 574-583.
  17. Tjoe-Nij, E., Heederik, D., ’Risk assessment of silicosis and lung cancer among construction workers exposed to respirable quartz’. Scand J Work Environ Health 2005, Vol. 31, Suppl 2, pp. 49-56.
  18. Mohner, M. , Kersten, N., Gellissen, J., ’Chronic obstructive pulmonary disease and longitudinal changes in pulmonary function due to occupational exposure to respirable quartz’. Occup Environ Med 2013, Vol. 70, Nr. 1, pp. 9-14.
  19. Rushton, L., ’Chronic obstructive pulmonary disease and occupational exposure to silica’. Rev Environ Health 2007, Vol. 22, Nr. 4, pp. 255-272.
  20. 20.0 20.1 Boschman, J.S., van der Molen, H.F., Sluiter, J.K., Frings-Dresen, M.H., ’Psychosocial work environment and mental health among construction workers’. Applied Ergonomics. 2013, Vol. 44, Nr. 5, pp. 748-55.
  21. 21.0 21.1 21.2 Weeks, J.L., ’Health and safety Hazards in the Construction Industry’. In: Health, Prevention and Management, Ringen, Knut, Seegal, Jane L., Weeks, James L., Editor, Encyclopedia of Occupational Health and Safety, Jeanne Mager Stellman, Editor-in-Chief. International Labor Organization, Geneva, 2011. Available at: [12] Cite error: Invalid <ref> tag; name "Weeks" defined multiple times with different content Cite error: Invalid <ref> tag; name "Weeks" defined multiple times with different content
  22. Alavinia, S.M., van Duivenbooden, C., Burdorf, A., ’Influence of work-related factors and individual characteristics on work ability among Dutch construction workers’. Scandinavian journal of work, environment & health. 2007, Vol. 33, Nr. 5, pp. 351-7.
  23. ’Health topics in construction’., Health and safety Executive, London. Available at: [13]
  24. Brun, E., ’Expert forecast on emerging chemical risks related to occupational safety and health’. European Agency for Safety and Health at Work, Bilbao, 2009
  25. Bongers, P.M., de Winter, C.R., Kompier, M.A., Hildebrandt, V.H., ’ Psychosocial factors at work and musculoskeletal disease’ , Scandinavian journal of work, environment & health . 1993, Vol. 19, Nr. 5, pp. 297-312.
  26. Holmström, E.B., Lindell. J., Moritz, U., ’Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 1: Relationship to low back pain’. Spine 1992, Vol. 17, Nr. 6, pp. 663-71.
  27. Milczarek, M., Schneider, E., Gonzalez, E.R., ’OSH in figures: stress at work- facts and figures’, European Communities , Luxembourg, 2009. Available at: [14]
  28. ’Bedrijfstakatlas ’., Arbouw, Harderwijk, 2013
  29. 29.0 29.1 Ustailieva, E. , Starren, A., Eeckelaert, L., Lopes Nunes, I., Hauke, A., ’Promoting occupational safety and health through the supply chain’., European Agency for Safety and health at Work, Bilbao, 2012. Cite error: Invalid <ref> tag; name "Ustailieva" defined multiple times with different content
  30. De Zwart, B.C.H., Frings-Dresen, M.H., Van Duivenbooden, J.C. , ’Senior workers in the Dutch construction industry: a search for age-related work and health issues’, Exp Aging Res 1999, Vol. 25, Nr. 4, pp. 385-91.
  31. Peterson, J.S., Zwerling, C. , ’Comparison of health outcomes among older construction and blue-collar employees in the United States’, Am J Ind Med 1998, Vol. 34, Nr. 3, pp. 280-7.
  32. Holmström E, Engholm G. , ’ Musculoskeletal disorders in relation to age and occupation in Swedish construction workers’, Am J Ind Med, 2003, Vol . 44, Nr. 4, pp. 377-84.
  33. ’Diverse cultures at work: ensuring safety and health through leadership and participation’., Starren, A., Luijters, K., Drupsteen, L., Vilkevicius,G., Eeckelaert, L., European Agency for Safety and Health at Work, Luxembourg, 2013.
  34. Houtman, I., Kok, L., Klauw, M. van der, Lammers, M., Jansen, Y. & Ginkel, W. van., ’Waarom werkgevers bewezen effectieve maatregelen wel of niet nemen: eerste resultaten van een kwalitatief onderzoek’, Hoofddorp: TNO, 2012. Available at: [15]
  35. Gambatese, J. A., Rajendran, S. and Behm, M. G., ‘Green design & construction: Understanding the effects on construction worker safety and health’, Professional Safety, 2007, Vol. 52, Nr. 5, pp. 28–35.
  36. Bradbrook, S., Duckworth, M., Ellwood, P., Miedzinski, M., Ravetz, J., Reynolds, J., ’Green jobs and occupational safety and health foresight on new and emerging risks associated with new technologies’., European Agency for Safety and health at Work, Luxembourg, 2013. Available at: [16]
  37. Occupational safety and health issues associated with green building. E-facts 70., European Agency for Safety and Health at Work, 2013. Available at: [17]
  38. ’Achieving better safety and health in construction. Managing construction projects — Summary of an Agency report, factsheet 55’., European Agency for Safety and Health at Work, Bilbao, 2004. Available at: [18]
  39. European Agency for Safety and Health at Work European Directives Available at: [19]
  40. 40.0 40.1 40.2 40.3 40.4 Elsler, D. ’Innovative solutions to safety and health risks in the construction, healthcare and HORECA sectors’. European Agency for Safety and Health at Work, Luxembourg, 2011. Available at: [20]
  41. Luijsterburg, P.A., Bongers, P.M., de Vroome, E.M., ’A new bricklayers' method for use in the construction industry’. Scandinavian journal of work, environment & health 2005, Vol. 31, Nr. 5, pp. 394-400.
  42. Boschman, J.S., van der Molen, H.F., Sluiter, J.K., Frings-Dresen, M.H., ’Occupational demands and health effects for bricklayers and construction supervisors: A systematic review’. Am J Ind Med. 2011, Vol. 54, Nr. 1, pp. 55-77. doi: 10.1002/ajim.20899.
  43. Burdof, A., Windhorst, J.,van der Beek, A.J., van der Molen, H., Swuste, P.H.J.J., ’The effects of mechanised equipment on physical load among road workers and floor layers in the construction industry’. International Journal of Industrial Ergonomics, 2007, Vol 37, Nr. 2, pp. 133-143.
  44. Middaugh, B., Hubbard, B., Zimmerman, N., McGlothlin, J., ’Evaluation of cut-off saw exposure control methods for respirable dust and crystalline silica in roadway construction’. J Occup Environ Hyg 2012, Vol. 9, Nr. 3, pp. 157-165.
  45. Akbar-Khanzadeh, F., Milz, S., Ames, A., Susi, P.P., Bisesi, M., Khuder, S.A., Akbar-Khanzadeh, M., ’Crystalline silica dust and respirable particulate matter during indoor concrete grinding - wet grinding and ventilated grinding compared with uncontrolled conventional grinding’. J Occup Environ Hyg 2007, Vol. 4, Nr. 10, pp 770-779.
  46. Tjoe Nij, E., Hilhorst, S., Spee, T., Spierings, J., Steffens, F., Lumens, M., Heederik, D., ’Dust control measures in the construction industry’. Ann Occup Hyg 2003, Vol. 47, Nr. 3, pp. 211-218.
  47. Oude Hengel, K.M., Joling, C.I., Proper, K.I., Blatter, B.M., Bongers, P.M., ’ A worksite prevention program for construction workers: design of a randomized controlled trial’. BMC Public Health. 2010, Vol. 10, Nr. 336. doi: 10.1186/1471-2458-10-336.
  48. Oude Hengel, K.M., Joling, C.I., Proper, K.I., van der Molen, H.F., Bongers, P.M., ’Intervention Mapping as a framework for developing an intervention at the worksite for older construction workers’,. Am J Health Promot. 2011, Vol. 26, Nr. 1, pp. e1-10. doi: 10.4278/ajhp.100326-QUAL-88.
  49. Oude Hengel, K.M., Joling, C.I., Proper, K.I., Blatter, B.M., Bongers, P.M., ’A worksite prevention program for construction workers: design of a randomized controlled trial’. BMC Public Health. 2010, Vol. 10, Nr. 336. doi: 10.1186/1471-2458-10-336.
  50. Jensen, L.K., Friche, C., ’Effects of training to implement new tools and working methods to reduce knee load in floor layers’., Applied Ergonomics, 2007, Vol. 38, Nr. 5, pp.655-665.
  51. Lehtola, M.M., van der Molen, H.F., Lappalainen, J., Hoonakker, P.L., Hsiao, H., Haslam, R.A., Hale, A.R., Verbeek, J.H., ’The effectiveness of interventions for preventing injuries in the construction industry: a systematic review’. Am J Prev Med. 2008, Vol. 35, Nr. 1, pp. 77-85. doi: 10.1016/j.amepre.2008.03.030.
  52. Groeneveld, I.F., Proper, K.I., van der Beek, A.J., Hildebrandt, V.H., van Mechelen, W., ‘Factors associated with non-participation and drop-out in a lifestyle intervention for workers with an elevated risk of cardiovascular disease’, International Journal of Behavioral Nutrition and Physical Activity, 2009, Vol. 6, pp. 80.
  53. Groeneveld, I.F., Proper, K.I., van der Beek, A., van Mechelen, W., ’Sustained body weight reduction by an individual-based lifestyle intervention for workers in the construction industry at risk for cardiovascular disease: Results of a randomized controlled trial, Preventive Medicine’., 2010, Vol. 51, Nr. 3-4, pp. 240-246.
  54. Groeneveld, I.F., Proper, K.I., van der Beek, A.J., van Duivenbooden, C., van Mechelen, W., ’Design of a RCT evaluating the (cost-) effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: the health under construction study’., BMC Public Health, 2008, Vol. 8, Nr. 1. Available at: [21]
  55. Lingard, H.C., Bradley, L.M., Brown, K.A., Bailey, C., Townsend, K. J., ’Organisational Health Management Interventions in the Australian Construction Industry: An Evaluation of One Case Study Project’. In: Global Unity for Safety and Health in Construction: CIB W99 International Conference, 28-30 June 2006, China. Available at: [22].
  56. Boschman, J.S. , van der Molen, H.F., van Duivenbooden, C. , Sluiter, J.K., Frings-Dresen, M.H., ’A trial of a job-specific workers' health surveillance program for construction workers: study protocol’. BMC Public Health. 2011, Vol. 11, Nr. 743. doi: 10.1186/1471-2458-11-743

Links for further reading

Eurostat – European Commission (April 2013) Construction Statistics – NACE Rev 2. Retrieved 4 February 2014 from: http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Construction_statistics_-_NACE_Rev._2

European Construction Industry Federation (June 2010) Construction activity in Europe. Retrieved 4 February 2014 from: http://www.ciccp.es/ImgWeb/Sede%20Nacional/folletos/fiec_2010.pdf

European Agency for Safety and Health at Work (no date) Construction. Retrieved 4 February 2014 from: https://osha.europa.eu/en/sector/construction

European Agency for Safety and Health at Work (no date) European Safety and Health legislation. Retrieved 4 February 2014 from: https://osha.europa.eu/en/legislation

European Agency for Safety and Health at Work (no date) Occupational safety and health in figures. Retrieved 4 February 2014 from: https://osha.europa.eu/en/safety-health-in-figures