The reduction in the incidence of work-related accidents and ill-health in Brazil in recent years may be related to public policies designed to protect workers’ health and safety [13, 14, 15]. However, the reduction was not homogeneous across all the main causes of accidents and ill-health. A larger reduction can be seen in the groups related to injury, poisoning or certain other consequences of external causes; diseases of the musculoskeletal system and connective tissue; mental and behavioral disorders; and diseases of the nervous system.
The causes of accidents with the highest incidence rates over the period in question are injury, poisoning or certain other consequences of external causes. These include traffic accidents involving people engaged in work activities, as well as assaults and attacks, reflecting the overall upsurge in urban violence .
Back pain was the most common item in the group of work-related accidents/illness associated to diseases of the musculoskeletal system and connective tissue. This indicates the existence of a serious public health issue caused by this kind of ill-health, which can impair the well-being of the economically active population at some time in their lives . Meanwhile, work-related synovitis and tenosynovitis was found to be common. Although its incidence dropped in the period under study, this could be associated with underreporting .
The results for work-related mental disorders were found to diverge from the numbers reported in the literature, where an upward trend has been found [19, 20]. Brazilian legislation already addresses the subjectivity of workplace analyses, but the findings cannot yet be seen in the analysis of the incidence of cases of mental health issues . This situation could contribute to the higher rates of reactions to severe stress and adjustment disorders encountered in this study.
As for the incidence of work-related ill-health affecting the nervous system, the most common are mononeuropathies of an upper limb. This finding is consistent with the literature . Interestingly, the increased incidence of nerve root and plexus compressions in diseases classified elsewhere could be related to the introduction of a new method in 2007 by the social security system designed to identify which diseases and accidents are related to which kinds of occupations, thereby helping to improve the identification and notification of such cases .
An increase was observed in the incidence rates of external causes of morbidity and mortality and factors influencing health status or contact with health services.
Among the external causes of morbidity and mortality, the biggest cause of work-related accidents was being bitten or struck by a dog. This kind of accident is common amongst workers who work in public places, such as mail carriers, community health agents, etc., demonstrating the need for preventive measures for these kinds of activities [24, 25].
Work-related accidents relating to factors influencing health status or contact with health services saw the highest growth. This was found for all the specific causes contained in this group. Constant exposure to biological risks due to contact with bodily secretions and the handling of potentially contaminated material could play a part in this trend. Increasingly inadequate work environments associated with the fear of contamination arising from accidents mean that the reporting of this kind of accident is more consistent . The increased incidence of accidents taking place during outpatient medical and dental care seems to be related to this. Another question observed in this group was the increased incidence of problems related to other psychosocial circumstances. Failure to observe standard procedures to prevent psychosocial risks in the workplace could have contributed to the increased incidence .
The results demonstrate a higher frequency of accidents in manufacturing and production, corroborating the findings of other authors [27, 28]. Financial incentives offered to workers to increase their productivity run directly counter to accident prevention policies. This is borne out in the high rates of accidents in industrial activities . However, manufacturing and production were also the group with the greatest reduction in work-related accidents/ill-health.
In manufacturing and production, one of the workplaces where most accidents occur is at abattoirs. This could have to do with the working conditions and work relations in this sector, indicating the need to make consistent improvements to workers’ health and safety .
Jobs in human health and social services were the ones that had the second highest rate of occupational accidents and ill-health, topped by hospital care. High levels of stress are common in such activities, related to emotional ties to patients and their relatives, working night shifts, working more than one job, and working excessively long hours [31, 32, 33]. These factors not only increase the likelihood of accidents, but also impair workers’ quality of life [34, 35, 36]. Jobs involving the provision of human health care could be improved if actions included more effective standard practices for accident/disease prevention and if these were designed with the active participation of the workers in question .
In transportation, storage, and mail services, mail services were the activity with the highest rates and an upward trend in the period under study. Adequate preventive policies and measures are needed to deal with this kind of activity, which is often undertaken in unfavorable social and environmental conditions and involves repetitive solitary actions over long periods of time, increasing the likelihood of accidents .
In the area of civil construction, the high and growing incidence of accidents in the areas of power generation and distribution and telecommunications indicate a reality that needs to be addressed. The outsourcing of construction work for big projects of this kind has contributed to a rationale whereby the employer gains financially, while worker safety issues are underplayed . Also, construction work in power generation and distribution and telecommunications is associated with the most serious accidents, resulting in death, pointing to the need for greater attention on the part of government inspectors in these areas .
In the trade in and repair of motor vehicles, the highest accident/ill-health rates were found in workers engaged in the wholesale of beverages. According to the literature, this is an activity that involves the transportation of goods. The high rates call not just for preventive actions for workers’ health, but also inter-sectoral policies to help prevent traffic accidents .
In view of the limitations of the method used in this study, it would be worthwhile doing new research to ascertain what the most frequent causes of the work-related accidents in each economic activity are. This information could be used by policymakers to improve occupational accident prevention policies in a more targeted manner.
If we compare the rates of work-related accidents before and after the introduction of the Accident Prevention Factor, the only significant difference can be found in manufacturing and production. This suggests investments are still required to reduce work-related accidents in most sectors of the economy.
Brazil does not seem to be keeping pace with the trends in health and safety in developed countries, where occupational ill-health is on the rise, but accidents are on the decline – a situation that is typical of structural change and preventive actions targeting the workplace . One way accident rates could be improved, as reported in the literature, would be to bring about increased integration between the stakeholders, including employers, workers, and government institutions .
It should be pointed out that the Accident Prevention Factor targets the frequency and severity of accidents, but does not discuss issues intrinsically related to occupational health and safety, which could lead to the underreporting of accidents and limitations in tackling specific preventive measures in certain occupations [14, 42]. Furthermore, investigations of work-related accidents in Brazil are conducted using a variety of methods. The quality of these investigations needs to be improved, with the adoption of standard forms and procedures for recording accidents so as to build up a better picture of how they happen and thus to plan more effective prevention measures, resulting in reduced incidence rates [43, 44].
As for the severity of the accidents and illnesses, an overall reduction was observed. In the figures on accidents that require medical attention, underreporting could be at play, with employers choosing not to report minor injuries. Furthermore, since the Accident Prevention Factors means they are liable to pay higher taxes if a workplace injury occurs, this may reinforce their inclination not to report .
When it comes to more serious accidents, including those resulting in death, underreporting is less likely given the broader repercussions and the investigations triggered in such cases [16, 31, 32]. We would therefore suggest that the Accident Prevention Factor has had the effect of reducing cases of more serious accidents because of the financial implications for employers. The decline observed in the incidence of accidents resulting in death is also supported by the literature .
The falling rates of work-related accidents/ill-health resulting in time off work and permanent disability are indicative of measures being taken to improve working conditions. However, more studies are needed to identify more precisely which components are responsible for bringing about this change .
The limitations of this study include the potential for underreporting of accidents given the composition of the database. Also, the time series was limited to 2008–2014. Data from before 2008 were not included because of the way work-related accidents/ill-health are reported, which changed in May 2007. Data from after 2014 had not yet been consolidated by the social security system when the data were collected for this study. Another limitation is that the database does not include people in informal employment and the analysis covered only accidents/ill-health in the groups associated with the highest accident/illness rates (both cause of accident/ill health and economic activity). In each group analyzed, the study also only presented the causes and economic activities with the highest incidence rates. As such, ongoing studies are recommended to get a better understanding of how work-related accidents and ill-health evolve over the years.