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7 2020 JANUARY/FEBRUARY 'Strikingly high' cancer rates found in 5 Ontario cities F ive industrial cities in Ontario have been identified as having rates of acute myeloid leukemia (AML), a cancer of the blood and bone marrow, that are significantly higher than the national average, accord- ing to a recent study. The cities with "strikingly high" incidence rates are Sarnia, Sault Ste. Marie, Thunder Bay, St. Catharines and Hamilton, according to the study, recently published in the journal Cancer. "Studying exposures in detail in these cities may hold the key to understanding risk factors for AML overall," the researchers from McGill University and the University of Ottawa say in the report. In particular, Sarnia had an incidence rate that was more than three times the national average. "The pollution from local oil refineries and chemical plants in Sarnia may be implicated as a risk factor for AML in that city," the researchers say. The study also analyzed mortality rates from AML and, again, rates in Sarnia were more than three times the national average. Sarnia and its surrounding region is known as Chemical Valley due to its more than 60 refineries and chemical plants. In 2011, the World Health Organization named Sarnia the worst city for air qual- ity in Canada with the highest level of air pollution particulates. The researchers for the Cancer report say exposure to materials or pollu- tion from these plants could potentially be an important risk factor for developing AML. They also made the point to say that environmental activists in Sarnia "argued through popular media for years against the oil refinery/petrochemical plants and accused them of polluting their environment." High mortality rates "approaching statistical significance" were also found in the following Ontario cities: St. Catharines, Kingston, Peterborough, Newmarket, Kitchener, Toronto, Windsor, Oshawa and London. These cities have a notable proximity to the high-incidence communities in southern Ontario. The report issued a call to action to "limit exposure to certain chemi- cals through the ubiquitous installation of high-efficiency particulate air filters" in cities with a high incidence of AML. Researchers analyzed data from 1992 to 2010 using three independent population-based cancer registries. A total of 18,085 patients were identified, and AML incidence was documented to be 30.61 cases per million individuals per year. Age, a known risk factor for developing AML, was taken into consideration and research- ers conducted age distribution analyses for various provinces and territories. Of note, Prince Edward Island was identi- fied as also having significantly higher AML incidence rates than the national average, while Nova Scotia and Manitoba had higher mortality rates. Saskatchewan experiencing fatalities, injuries crisis: Union T he Saskatchewan Federation of Labour (SFL) says the province is in the midst of a "workplace fatalities and injuries crisis," and it is calling on the government to take action. "We owe it to the 48 workers who lost their lives in Saskatche- wan last year, and the many more that were injured at work, to keep fighting for safer workplaces," says SFL president Lori Johb. "We are in the middle of a crisis, and there are a number of things the provincial government can do immediately to help protect workers and save lives." The Saskatchewan Workers' Compensation Board (WCB) confirmed that workplace fatalities increased in 2018. One of the leading causes of workplace fatalities continues to be occupational diseases, responsible for more than 40 per cent of cases. And while injury rates have been declining since 2008 when the rate was 10.21 per cent, there was a year-over-year increase in 2018 with the injury rate increasing to 5.44 per cent from 5.25 per cent. "It was concerning to see the injury rate go up in 2018 after several years of improve- ment," says Jen Toews, communications consultant for the Government of Saskatchewan. "Any workplace injury, illness or fatality is unacceptable." The SFL has issued several recommendations to the government to improve workplace safety. The first is requiring all safety committees in the province to file minutes with the government's OHS division, a practice that was previously in place up until 2014. But Toews says government inspectors look at safety committee minutes when they conduct site inspections, adding that work site visits have more than doubled since 2014. The SFL is also recommending that the government update and expand the Young Worker Readiness Certificate course and move it from online to delivered and tested in-person. Toews says the course content is reviewed regularly and it is delivered online to ensure young workers have "equal and easy access" to the materials, regardless of their location. "They can review the materials at their own pace and access it from home, school, a library or anywhere else they have internet access," she says. The SFL is also recommending that the government expand fundamental workplace rights to include the right to refuse unsafe work on behalf of someone else. But Toews says this should remain an individual right — similar to all other Canadian jurisdictions — as work that can safely be performed by one person may not be safely performed by another. This variability is based on training, experience or physical capabilities of the worker, she explains. "It is important that each employee understand their individual right to refuse unusually dangerous work and that they are able to exercise that right and not face repercussions," says Toews. The SFL initially launched its campaign against injuries and fatalities last December, and while Johb says "much more needs to be done," she did acknowledge that some posi- tive steps had been taken. For example, the SFL called for the publishing of all incident reports in an accessible online format, as is done in British Columbia, and Toews says the government is reviewing the possibility of publishing fatality investigation reports online. The SFL had also called for the development of a comprehensive Worker Fatalities Crisis Strategy, including a roundtable with workers, unions, the WCB and other stakeholders. Toews says that WorkSafe Saskatchewan, a partnership between the Ministry of Labour Relations and Workplace Safety and the WCB, has been working with stakeholders to develop a fatalities and serious injuries strategy. The strategy is expected to be publicly available by the end of this year. Compensation Board's prevention arm, Safe Work Manitoba. It also praises the agency's young worker injury prevention strategy as well as its Safe Work Certified prevention rebate program, although it would like the program to be expanded to other sec- tors, such as health care. Workers' compensation received a grade of D. A major reason for this is that the report says no changes have been made since the 10-year legislative review of the Workers Compensation Act in 2016-17. However, the WCB disagrees. "It is unfortunate that, in this case, the MFL appears to be misinformed about some of the key changes that have taken place at the WCB," said Darlene Muise, communications manager at the WCB. The report says that claim sup- pression is inherently built into the structure of the WCB's rate model because of the way in which the WCB directly ties employer premiums to the number and duration of injury claims that are filed. However, the WCB com- missioned a third-party company to study this issue in 2013 and it found that six per cent of work injuries in the province are not reported to the WCB, due to claim suppression. Since 2014, there have been 18 cases in which claim suppression was proved, and in 11 of those cases, administrative penal- ties were applied, Muise says. "The MFL's report card fails to acknowledge the WCB's efforts since 2014 to address the issue of claim suppression including educational campaigns and increased enforcement through the creation of a compliance services division," she adds. The report also says that the WCB rate model causes dangerous return- to-work practices with an aim to reduce the cost of claims and keep employer premiums low. "We agree with others that a return-to-work program can be a very beneficial program — can be — not always in all cases and not at the expense of convalescence when it's needed," Rebeck says. "There are instances where 'Yeah, I could prob- ably return to work right away but I'm on T3s for the next three days and I am in pain.' So, I'm either impaired or I just need a couple of days to rest before I come back to heal." Rebeck is also deeply concerned about something he calls "medical claims suppression," occurring when the opinion of a worker's doctor is being over-ruled or disregarded by WCB medical advisors. But the WCB says its practice is for internal doctors to reach out and con- sult with the family doctor when there is a disagreement, not to "override" the family doctor. However, Rebeck says this is not working in reality. "We all know the medical system is pretty busy. I don't know when they are not seeing a patient… but they are certainly not waiting and taking calls from other doctors to talk through and justify why their finding was this and someone else's was that."