Roundtable #8 Safety and Brain Health
The Business Collaborative for Brain Health (BCBH) is a collaborative of private sector partners developing innovative solutions to cognitive health throughout the lifespan. The Collaborative hosts regular roundtables to learn from experts and stakeholders and refine the work.
The April 2024 Roundtable focused on the relationship of safety to brain health. Speakers included Magali Haas, MD, PhD, Founder and Senior Advisor, TBI Action Alliance; Burcin Ikiz, PhD, Founder and Director, EcoNeuro; David Rein, PhD, Senior Fellow, National Opinion Research Center (NORC); and Krystal Sexton, PhD, Global Health Analytics Manager, Shell.
Meeting Summary
The Collaborative discussion focused on the intersection of brain health and safety in the workplace, specifically the impact of traumatic brain injury, air pollution, and hearing loss on cognitive function. The group also discussed how the monthly roundtables are informing the development of tools and resources for employers to build brain healthy workplaces, with the Brain Health Best Practice Scorecard reflecting much of the information gained from experts who speak at the roundtables.
Traumatic Brain Injury
Dr. Magali Haas presented on traumatic brain injury (TBI) and its impact on the workplace. She stressed that TBI is a significant, unrecognized public health crisis, affecting 5.3 million Americans and estimated to be undercounted by 30-fold. A broadly defined and difficult to classify condition, TBI is essentially defined as an alteration in brain function, or any other evidence of brain pathology, that can be caused by an external force or a blast-related injury or repetitive exposure.
TBI can cause long-term disabilities and chronic degenerative conditions, impacting productivity and work capacity. The risks of TBI in the workplace include falls, accidents during commuting, and occupational hazards in specific industries. Dr. Haas also noted the potential impact on employees who care for someone with TBI at home, affecting their productivity. The consequences of TBI on employment are great and include reduced productivity, absenteeism, and presenteeism, along with the financial costs to employers, including the need for accommodations and disability claims. Despite these challenges, there are no FDA-approved diagnostics or therapeutics for TBI, leading to a substantial unmet need.
The TBI Action Alliance is a public-private partnership aimed at accelerating the development of therapeutics and diagnostics for traumatic brain injury. The alliance has developed a roadmap of activities and seven lines of effort to achieve their goal within five years. This includes multi-stakeholder engagement, securing new capital, and delivering clear wins within a few years. Thomas Soeh, a Collaborative member, asked about regulatory issues as a potential obstacle, and Dr. Haas confirmed it was a significant concern and part of their advocacy and awareness component. Dr. Burcin Ikiz asked about the long-term effects of TBI, and Dr. Haas explained the mechanisms linking TBI to neuroinflammation, blood-brain barrier breakdown, axonal changes, and elevated tau levels, which are risk factors for Alzheimer's disease, Parkinson's, and epilepsy. Richard Hatzfeld asked about the mechanisms of action in the therapeutics pipeline, to which Dr. Haas responded that there was a broad array of approaches but no validated targets yet.
In sum, Dr. Haas emphasized the need for national policies and workplace accommodations to support TBI patients' rehabilitation and return to work.
Air Quality
Dr. Ikiz discussed the adverse impacts of air pollution on both the environment and human health. She emphasized that outdoor and indoor sources contribute to air pollution, with the latter often being overlooked. Dr. Ikiz also shared that air pollution has significant long-term effects on health, including increased risk for cardiovascular diseases, lung diseases, and neurological disorders. She noted the economic costs associated with health damages caused by air pollution, and suggested measures to mitigate air pollution, such as promoting sustainable approaches, improving indoor air quality, enhancing commuting options, and educating employees about the dangers of air pollution.
Dr. Ikiz discussed the intersection of climate change and brain health, focusing on the impact of environmental factors on cognitive function. Collaborative member Sarah Hoit expressed interest in engaging younger people in the innovation and cross-sectional topics related to brain health, the environment, and sports-related injuries. Dr. Ikiz agreed, highlighting the importance of community engagement and outreach, particularly to vulnerable populations, as a key strategy for prevention and mitigation. Raj Ajuda with the Milken Institute noted the global momentum on the topic, mentioning a recent day-long summit at COP 28 in Dubai. The discussion underscored the need for solutions that consider social justice and health equity, particularly for frontline communities disproportionately impacted by climate change.
Ms. Hoit asked about the potential impacts of water sources on the brain and the tools to identify and prevent such issues. Dr. Burcin explained the dangers of pesticides and chemicals in agriculture and how they can contaminate water sources, leading to neurotoxins that can cause neurological diseases. Stephen White with the Center for Brain Health raised the importance of addressing the ”forgotten middle” of the workforce, emphasizing the need for preventive measures.
Hearing Loss, Cognitive Decline, and Prevention
Dr. David Rein discussed the connection between hearing loss and cognitive decline, specifically the risk of dementia. He shared evidence indicating that hearing loss is the largest modifiable risk factor for dementia in midlife, and provided other published sources that argue the cognitive effort required to hear in noisy environments may lead to damage in the medial temporal lobe associated with dementia pathology. He noted that using hearing aids could prevent or mitigate this cognitive decline.
He presented results from the Sound Check study which estimated the prevalence of hearing loss in the United States. Sound Check estimated that almost 38 million people, or one in 11 Americans, have bilateral hearing loss, with risk factors including older age, male gender, Caucasian race, noise exposure, untreated comorbidities, preterm birth, and poor healthcare access.
In line with previous studies, NORC found that prevalence of hearing loss increases exponentially with age; 11.6% of all Americans have hearing loss; however, the prevalence increases from less than half a percent among people ages 0 to 34, to almost 9% among people, ages 35 to 64, a huge increase in prevalence. In older ages, bilateral hearing loss is even more common – approximately 1 in 3 adults, ages 65 to 74 have some degree of bilateral hearing loss, and nearly 3 out of 4 Americans, ages 75+ have some degree of hearing loss.
The study also found that certain industries and geographic locations had higher rates of hearing loss, with implications for dementia prevention and worker productivity.
Rein presented published evidence about higher rates of hearing loss by industry. Many studies find that workers in noisier the industries have greater risks of hearing loss. There is evidence that workers and mining, manufacturing and construction have higher rates of hearing loss as well as people working in solid waste. However, research has also found that workers in the real estate and rental leasing industry have higher rates of hearing loss than other groups for reasons that are not well understood. Rein noted that the Sound Check study also found elevated rates of hearing loss in counties with a higher percentage of people working in mining, accommodation and food services, including and casino workers and bartenders, and retail trade, but noted that these findings are only associations and warrant further research.
Rein noted and emphasized that one of the strongest findings of the Sound Check Study was that rates of hearing loss were higher in more rural counties as compared to more urban ones.
Dr. Rein pointed out that an important implication centers around people ages 35 to 64 years old. This cohort is a key focus group for prevention. The prevalence of hearing loss increases dramatically among this group, and they are an age group that is frequently employed and reachable through employee health outreach. Efforts to integrate and normalize hearing health among working age could result in large lifetime benefits if they reduce or delay future cases of dementia as well as improving on the job performance for people that are experiencing hearing loss.
Workplace interventions are particularly important when considering that hearing loss in midlife is a risk factor for dementia and that people often delay treatment for hearing loss for many years. One study showed that on average, from the time a person is eligible to be fitted for a hearing aid until the time that they first seek treatment for their hearing problem there is a delay of around 9 years. Rein noted that this treatment gap represents an opportunity to have an impact worker quality of like, future health outcomes, and probably worker productivity as well.
Dr. Rien also reviewed the occupational and recreational causes of hearing loss, emphasizing the need for further research and normalization of hearing aids. Kelly O’Brien noted the QR code website link for the Sound Check website and recommended it to Collaborative Members to use and share. The website link is: https://soundcheckmap.org/
Stephen White with the Center on Brain Health suggested a shift in focus toward performance enhancement and fine-tuning hearing, while also acknowledging the stigma surrounding hearing loss. The relationship between hearing loss and traumatic brain injury, especially in rural areas and veteran populations, was discussed. The need for more specific research on Native American tribal areas was highlighted.
New Hearing Health Public Awareness Campaign
Sigurd Brandt with GN Group introduced a new public awareness campaign about hearing health—Listen to This (https://www.listentothis.com)—emphasizing the importance of good hearing for a healthy life and the potential link between hearing loss and cognitive decline. The campaign, a partnership with various organizations, aims to raise awareness, drive new research, and provide resources. The website for the campaign, launching at the end of April 2024, was previewed, and feedback was encouraged.
Wellbeing, Safety, and Brain Health at Shell
Dr. Krystal Sexton with Shell discussed the company’s focus on brain health as a component of overall health and well-being. She detailed how the organization's interventions, primarily aimed at improving or maintaining brain health, were like those for other aspects of health. Dr. Sexton highlighted the organization's shift toward a holistic health approach, which led to the development of programs based on scientific evidence linking stress, resilience, and employee engagement to improved safety. She shared that the combination of care and resilience programs resulted in significant improvements in employee engagement, safety, and other HR-related factors. A new department for their well-being program has been established at Shell, and a pilot program expanded to include physical, mental, and social health, with the aim of demonstrating the impact of well-being on both employees and the bottom line.
Specifically, regarding brain health and its relation to safety, Dr. Sexton discussed the impact of stress on our brain and cognition. Chronic stress, especially, affects our executive thinking and functioning. Shell’s data show a correlation between stress and negative outcomes like defensiveness, a blame culture, and risky decision-making, all of which contribute to poor safety performance. Additionally, their early findings indicate that implementing stress management programs improves employee engagement. This is crucial, as engagement often serves as a proxy for safety. Shell’s internal data suggests that a 10% increase in employee engagement correlates with a 30-40% reduction in safety incidents.
Dr. Sexton’s team at Shell pursued two parallel pilot programs aimed at holistic health. One focused on employee treatment and its impact on various business metrics such as engagement, productivity, and safety. The other program centered on resilience, showing a strong link between resilience, engagement, and safety performance. By aligning individual and organizational focus, her team observed higher levels of engagement and better safety outcomes.
A pilot mental health program was expanded to include physical and social health components. This global program, launched in November (2023), has garnered responses from approximately 20,000 employees across Shell's operations worldwide. These responses represent about 25% of Shell’s workforce, with a focus on frontline staff in the next phase. They are now analyzing the data to correlate employee well-being with engagement, diversity, equity, inclusion metrics, and safety performance. While individual-level data remain confidential, Shell is aggregating data by lines of business to assess safety performance.
Furthermore, her team recently secured an agreement to incorporate HR-related data, including attrition, absences, retention, and business performance metrics. This holistic approach not only interests Shell's leadership but also demonstrates their commitment to employee well-being and safety, beyond mere business profitability.
Dr. Sexton noted that she would be able to present some research results at a later scientific conference, with Ms. O’Brien expressing appreciation for the company's research efforts and emphasizing their potential benefit to others. Dr. Haas asked about the possibility of sharing data with the larger brain health community, to which Dr. Sexton responded that it is possible following legal and privacy procedures.