Perspectives in Disease Prevention and Health Promotion Progress Toward Achieving the 1990 Objectives in Occupational Safety and Health

In 1980, the Public Health Service published Promoting Health/Preventing Disease: Objectives for the Nation (1), which identified public health objectives in 15 areas and targeted them for accomplishment by or before the year 1990. Occupational safety and health was one of these 15 areas, and the National Institute for Occupational Safety and Health (NIOSH), CDC, was given the responsibility of monitoring efforts to accomplish these objectives. On February 4, 1987, a panel of experts from the U.S. Department of Health and Human Services and the U.S. Department of Labor met to report on progress toward these goals.

In all, 20 objectives had been identified in occupational safety and health (see page 627). The panel grouped them under the broad, general categories of improving health status, reducing risk factors, increasing public and professional awareness, and improving services and protection as well as surveillance and evaluation. The major obstacle to measuring progress in occupational safety and health has been the lack of comprehensive and reliable methods for surveillance of work-related diseases and injuries. Currently available surveillance systems were designed for different purposes, and none of them adequately covers occupational safety and health. As a result, many gaps exist in the information received, and a regular comparison of disease trends, which would be essential for tracking the objectives, has not been possible.

Despite these limitations, there is enough information to indicate progress. Some reasonable tracking systems are now available for evaluating progress toward 16 of the 20 objectives. Four of these relate directly to improved health status or to a reduction in the incidence of disease or injury. For the latter, available data indicate reductions in two categories of work-related injuries: accidental deaths occurring in the workplace (Figure 1) and work-related disabling injuries (Figure 2).

Although documenting the precise status of the remaining objectives would be extremely difficult and costly, each participating agency described activities that indicate progress in the general categories defined by the panel. The ten strategies proposed by NIOSH for preventing the leading work-related diseases and injuries have been a major contribution. These strategies, which were developed over the past 2 years, were based on a list of ten leading work-related diseases and injuries that NIOSH first published in 1983 (2). A group of multidisciplinary experts reviewed the strategies at national symposia in 1985 and 1986, and the first five have been published (3). The second five are being prepared for publication.

NIOSH has now developed a program to implement these strategies and to encourage active participation by all relevant constituencies. All ten strategies call for epidemiologic surveillance of the target condition, and nine of the ten also call for environmental surveillance of the causative agents. The Sentinel Event Notification System for Occupational Risks (SENSOR) is being developed to assure the reporting of all significant occupational health problems. By 1986, NIOSH had acquired death certificates for all occupationally related deaths occurring during the period 1980- 1984 and had begun preliminary analysis to provide occupation- and job-specific .data. NIOSH, the Bureau of Labor Statistics, and the National Center for Health Statistics signed a memorandum of understanding early in 1987 to assure broader and more consistent cooperation in the surveillance of occupational safety and health problems

Although the proposed prevention strategies embody concepts found in the 1990 Objectives for the Nation, they also include diseases and conditions not addressed in the objectives and add process objectives specifically aimed at implementing the strategies. Thus, implementing the strategies will mean not only meeting the objectives but also taking an additional step toward preventing the ten leading work-related diseases and injuries in the United States. Reported by: Office of Disease Prevention and Health Promotion, Public Health Svcs, DHHS. Office of Program Planning and Evaluation, National Institute for Occupational Safety and Health, CDC.

1990 Objectives for the Nation in Occupational Safety and Health (1) Objective 1: By 1990, workplace accident deaths for firms or employers with 11 or more employees should be reduced to less than 3,750 per year.

Objective 2: By 1990, the rate of work-related disabling injuries should be reduced to 8.3 cases per 100 full time workers.

Objective 3: By 1990, lost workdays due to injuries should be reduced to 55 per 100 workers annually.

Objective 4: By 1990, the incidence of compensable occupational dermatitis should be reduced to about 60,000 cases.

Objective 5: By 1990, among workers newly exposed after 1985, there should be virtually no new cases of four preventable occupational diseases--asbestosis, byssinosis, silicosis and coal worker's pneumoconiosis.*

Objective 6: By 1990, the prevalence of occupational noise-induced hearing loss should be reduced to 415,000 cases.*

Objective 7: By 1990, occupational heavy metal poisoning (lead, arsenic, zinc) should be virtually eliminated.*

Objective 8: By 1985, 50 percent of all firms with more than 500 employees should have an approved plan of hazard control for all new processes, new equipment and new installations.

Objective 9: By 1990, all firms with more than 500 employees should have an approved plan of hazard control for all new processes, new equipment and new installations.

Objective10: By 1990, at least 25 percent of workers should be able, prior to employment, to state the nature of their occupational health and safety risks and their potential consequences, as well as be informed of changes in these risks while employed.*

Objective11: By 1985, workers should be routinely informed of lifestyle behaviors and health factors that interact with factors in the work environment to increase risks of occupational illness and injuries.

Objective12: By 1985, all workers should receive routine notification in a timely manner of all health examinations or personal exposure measurements taken on work environments directly related to them.

Objective13: By 1990, all managers of industrial firms should be fully informed about the importance of and methods for controlling human exposure to the important toxic agents in their work environments.

Objective14: By 1990, at least 70 percent of primary health care providers should routinely elicit occupational health exposures as part of patient history, and should know how to interpret the information to patients in an understandable manner.

Objective15: By 1990, at least 70 percent of all graduate engineers should be skilled in the design of plants and processes that incorporate occupational safety and health control technologies.

Objective16: By 1990, generic standards and other forms of technology transfer should be established, where possible, for standardized employer attention to such major common problems as: chronic lung hazards, neurological hazards, carcinogenic hazards, mutagenic hazards, teratogenic hazards and medical monitoring requirements.

Objective17: By 1990, the number of health hazard evaluations being performed annually should increase tenfold; the number of industrywide studies being performed annually should increase threefold.

Objective18: By 1985, an ongoing occupational health hazard/illness/injury coding system, survey and surveillance capability should be developed, including identification of workplace hazards and related health effects, including cancer, coronary heart disease and reproductive effects. This system should include adequate measurements of the severity of work-related disabling injuries.

Objective19: By 1985, at least one question about lifetime work history and known exposures to hazardous substances should be added to all appropriate existing health data reporting systems, e.g., cancer registries, hospital discharge abstracts and death certificates.

Objective20: By 1985, a program should be developed to: 1) follow up individual findings from health hazard and health evaluations, reports from unions and management and other existing surveillance sources of clinical and epidemiological data; and 2) use the findings to determine the etiology, natural history and mechanisms of suspected occupational disease and injury.

References:

1. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, DC: US Department of Health and Human Services, Public Health Service, 1980.

2. CDC. Leading work-related diseases and injuries -- United States. MMWR 1983;32:24-6,32.

3. Association of Schools of Public Health. Proposed national strategies for the prevention of leading work-related diseases and injuries, part 1. Washington, DC: The Association of Schools of Public Health under a cooperative agreement with the National Institute for Occupational Safety and Health, 1986. *Denotes objectives for which no accurate measure of progress is now available.

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