National Occupational Research Agenda

Foreword

In 1970, Congress passed the Occupational Safety and Health Act to assure, "so far as possible every working man and woman in the Nation safe and healthful working conditions." The Act created the National Institute for Occupational Safety and Health (NIOSH) to identify the causes of work-related diseases and injuries, evaluate the hazards of new technologies and work practices, create ways to control hazards so that workers are protected, and make recommendations for occupational safety and health standards.

The Act created the Occupational Safety and Health Administration (OSHA) to promulgate and enforce standards. In the 25 years since the passage of the Occupational Safety and Health Act, substantial progress has been made in improving worker protection. Much of this progress has been based on actions guided by occupational safety and health research. Fatal work injuries and the rate of disabling injuries have declined substantially. Specific health hazards have been controlled, and some occupational diseases, such as byssinosis (brown lung disease) from cotton dust exposure and angiosarcoma (liver cancer) from vinyl chloride exposure, have been nearly eliminated.

However, workplace hazards continue to inflict a tremendous toll in both human and economic costs. Employers reported 6.3 million work injuries and 515,000 cases of occupational illnesses in 1994. That same year, occupational injuries alone cost $121 billion in lost wages and lost productivity, administrative expenses, health care, and other costs. This figure does not include the costs of occupational diseases.

Despite the continuing need for occupational safety and health research, both public and private sector efforts are facing increasing fiscal constraints. These financial challenges, in the face of the large burden of work-related disease, injury, and death, led NIOSH to work with the occupational safety and health community to develop a National Occupational Research Agenda (NORA).

The Agenda, which identifies 21 priority research areas, is the first step in what will be an ongoing, concerted effort to target and coordinate occupational safety and health research. The Agenda should improve the use of existing resources by outlining the research priorities that can lead to improved worker safety and health. The Agenda is truly national in scope. The occupational safety and health community was broadly represented, with active participation by employers, employees, safety and health professionals, public agencies, and industry and labor organizations. Approximately 500 organizations and individuals outside NIOSH contributed to the Agenda. I thank the participants in the public meetings; the individuals and organizations that submitted written comments; the members of the Corporate Liaison, Worker Liaison, and Outreach Committees; representatives of other Federal agencies; NIOSH staff; the NIOSH Board of Scientific Counselors; the Mine Health Research Advisory Committee; and the National Advisory Committee on Occupational Safety and Health. I look forward to our continuing collaboration in implementing the Agenda presented here.

Linda Rosenstock, M.D., M.P.H.
Director

Executive Summary

The U.S. workplace is rapidly changing. Jobs in our economy continue to shift from manufacturing to services. Longer hours, compressed workweeks, shift work, reduced job security, and part-time and temporary work are realities of the modern workplace. New chemicals, materials, processes, and equipment are developed and marketed at an ever accelerating pace. The workforce is also changing. As the U.S. workforce grows to approximately 147 million by the year 2005, it will become older and more racially diverse. By the year 2005, minorities will represent 28% of the workforce, and women will constitute approximately 48%. These changes will present new challenges to protecting worker safety and health.

Each day, an average of 137 individuals die from work-related diseases, and an additional 16 die from injuries on the job. Every 5 seconds a worker is injured; every 10 seconds a worker is temporarily or permanently disabled. In 1994, occupational injuries alone cost $121 billion in lost wages and productivity, administrative expenses, health care, and other costs.

The high toll of work injuries and illnesses is not unchangeable. In fact, significant progress has been made in improving worker protection since Congress passed the Occupational Safety and Health Act in 1970 "to assure so far as possible every working man and woman in the Nation safe and healthful working conditions and to preserve our human resources." This progress has been largely based on actions--sometimes voluntary, sometimes regulatory--directed by the science and knowledge generated from occupational safety and health research.

The National Institute for Occupational Safety and Health (NIOSH), and its partners in the public and private sectors, have developed the National Occupational Research Agenda (NORA) to provide a framework to guide occupational safety and health research in the next decade--not only for NIOSH but also for the entire occupational safety and health community. Approximately 500 organizations and individuals outside NIOSH provided input into the development of the Agenda. This attempt to guide and coordinate research nationally is responsive to a broadly perceived need to address systematically those topics that are most pressing and most likely to yield gains to the worker and the nation. Fiscal constraints on occupational safety and health research are increasing, making even more compelling the need for a coordinated and focused research agenda.

The 21 Priorities

The Agenda identifies 21 research priorities (Table 1). These priorities reflect a remarkable degree of concurrence among a large number of stakeholders. The NORA priority research areas are grouped into three categories: Disease and Injury, Work Environment and Workforce, and Research Tools and Approaches.

Implementation

NORA is the first step in a collaborative effort between NIOSH and its many partners to guide occupational safety and health research over the next decade. Implementation is the necessary next phase. As the first step in the implementation phase, NIOSH is committed to bringing together its NORA partners in a public meeting for further refining the preliminary approaches they agreed to when identifying the Agenda.

Among these approaches is the commitment by NIOSH to (1) use the Agenda to guide both intramural and extramural funding decisions, (2) encourage and stimulate other government agencies to include NORA priorities in their internal and external research programs, (3) develop procedures and capacity to track the impact of NORA activities on health and safety outcomes using existing tracking models, if available, (4) update NORA, and (5) periodically review and communicate the overall role and effectiveness of NORA in occupational safety and health.

Throughout the process of implementing the Agenda, NIOSH will seek to build upon and extend its partnerships and to improve coordination throughout the occupational safety and health community, with the expectation that these activities hold great promise for improving the protection and well-being of workers.

Introduction

Work--when fulfilling, compensated fairly, healthy, and safe--can help build long and contented lives and strengthen families and communities. Such work can reduce health care costs and improve organizational effectiveness and profits. Although some workers may never face more than minor adverse health effects from exposures at work, (such as occasional eye strain resulting from poor office lighting), there is not a single industry that does not grapple with serious hazards.

There are about 125 million workers in the United States--almost one of every two Americans. Each day, an average of 137 individuals die from work-related diseases, and an additional 16 die from injuries on the job. Every 5 seconds a worker is injured; every 10 seconds a worker is temporarily or permanently disabled. In 1994, occupational injuries alone cost $121 billion in lost wages and productivity, administrative expenses, health care, and other costs. This figure does not include the cost of occupational illnesses. Clearly, work injury and disease create substantial human suffering and place a heavy burden on the U.S. economy.

The high toll of work injuries and illnesses can be drastically reduced. In fact, significant progress has been made in improving worker protection since Congress passed the Occupational Safety and Health Act in 1970 "to assure so far as possible every working man and woman in the Nation safe and healthful working conditions and to preserve our human resources." This progress has been largely based on actions--sometimes voluntary, sometimes regulatory--directed by the science and knowledge generated from occupational safety and health research. For example, vinyl chloride-induced liver cancers and brown lung disease (byssinosis) from cotton dust exposure have been almost eliminated. Reproductive disorders associated with certain glycol ethers have been recognized and controlled. Fatal work injuries have declined substantially through the years. Notably, since 1970, fatal injury rates in coal miners have been reduced by more than 75%, and there has been a general downward trend in the prevalence of coal miners' pneumoconiosis. Other occupational hazards have proved more intractable. For example, two age-old problems, silicosis and lead poisoning, continue to afflict workers. Their causes are well understood, but prevention is plagued by a myriad of complex factors.

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Every 5 seconds a worker is injured; every 10 seconds a worker is temporarily or permanently disabled. In 1994, occupational injuries alone cost $121 billion...

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In addition to these persistent, historical occupational safety and health problems, there are many current and emerging challenges. The U.S. workplace is rapidly changing and becoming more diverse. Jobs in our economy continue to shift from manufacturing to services, with the service sector now employing 70% of all workers. Major changes are also occurring in the way work is organized. Longer hours, compressed workweeks, shift work, reduced job security, and part-time and temporary work are realities of the modern workplace. New chemicals, materials, processes, and equipment (such as latex gloves in health care, or fermentation processes in biotechnology) are developed and marketed at an ever-accelerating pace. The workforce is also changing. As the U.S. workforce grows to approximately 147 million by the year 2005, it will become older and more racially diverse. By the year 2005, minorities will represent about 28% and women about 48% of the workforce. These changes are accompanied by new issues.

The National Institute for Occupational Safety and Health (NIOSH) and its partners in the public and private sectors have developed the National Occupational Research Agenda (NORA) to provide a framework to guide occupational safety and health research in the next decade--not only for NIOSH but for the entire occupational safety and health community. This attempt to guide and coordinate research nationally is responsive to a broadly perceived need to address systematically those topics that are most pressing and most likely to yield gains to the worker and the nation. Fiscal constraints on occupational safety and health research are increasing, making even more compelling the need for a coordinated and focused research agenda. For example, NIOSH resources (when adjusted for inflation) have shrunk by more than 25% since 1980. Resources in the private sector are similarly decreasing. A recent survey of safety, industrial hygiene, and environmental professionals found that almost 25% of the professionals said that "holding on to their jobs" will be a concern in 1996. This is consistent with the observed cutbacks in corporate safety and health programs that have accompanied the current trend of corporate downsizing. The decreased investment in occupational safety and health research in both the public and private sectors makes more compelling the need for a coordinated and focused research agenda.

Creating NORA

The process of forming NORA began with a list of 48 potential research topics developed by an initial planning work group of senior scientists inside and outside NIOSH. This planning work group incorporated into their decisions consideration of a broad range of data and information, such as the Public Health Service Healthy People 2000 goals for the Nation, the recently completed OSHA Priority Planning Process (which was aimed at identifying the top-priority workplace safety and health hazards in need of either regulatory or nonregulatory action), and the occupational health research planning strategies of several other countries. The potential topic list was expanded and modified to include approximately 60 items (Appendix A)--with input from four additional working groups (occupational safety and health researchers from outside NIOSH, NIOSH scientists, occupational safety and health professionals, and other professionals in the field) and oral and written comments from individuals and representatives of other institutions and organizations. Town meetings were held in Seattle, Boston, and Chicago to receive direct input from workers, employers, individual researchers, and policy makers. Written comments were accepted throughout the process until early March. Other Federal agencies are playing a critical role in the successful development and implementation of NORA: About 30 Federal agencies or programs with missions involving the safety and health of U.S. citizens (including workers) identified individuals to serve as agency representatives to contribute to the development of the Agenda (Appendix B). Liaison committees (corporate, worker, and outreach) were formed to obtain the broadest possible input into the Agenda. A final public meeting was held in Washington, D.C., to review the draft NORA document. Many members of the liaison and advisory committees, agency representatives, working group members, and the public participated. Appendix C summarizes the processes used to develop the Agenda and lists the members of the participating committees.

Selection Criteria

Final research priorities were determined based on consideration of the input from the five working groups, written comments, oral comments made at the public and town meetings, and comments made during deliberations throughout the process. The criteria used to guide evaluation of potential topics included some or all of the following, as appropriate:

The Agenda relied substantially on the expression of expert scientific and stakeholder opinion because sufficient quantitative data do not exist to address many of these criteria, and because different subsets of the criteria are relevant for different research topics.

The 21 Priorities

The Agenda identifies 21 research priorities (Table 1). These priorities reflect a remarkable degree of concurrence among a large number of stakeholders. Sixteen of the 21 research areas were identified as top priorities by three or more of the five working groups. These areas were also endorsed by many individuals through written and oral comments. Of the remaining five topics on the Agenda, four received support

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The Agenda identifies 21 research priorities... (that) reflect a remarkable degree of concurrence among a large number of stakeholders.

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from one or two work groups and were heavily endorsed by individuals through written and oral comments and in discussions at the final public meeting in March (Cancer Research Methods, Infectious Diseases, Allergic and Irritant Dermatitis, and Risk Assessment Methods). In the final public meeting in March, participants deemed one topic (Control Technology and Personal Protective Equipment) sufficiently distinct and important to warrant its separation from another topic (Intervention Effectiveness Research).

The priorities are not ranked and reflect an attempt to consider both current and emerging needs. Numerous items not included on the Agenda are still important and merit research effort. Moreover, research priorities may evolve with time.

The NORA priority areas are grouped into three categories: Disease and Injury, Work Environment and Workforce, and Research Tools and Approaches. Priority areas may not be mutually exclusive. For example, there is overlap between some aspects of Health Services Research and the Social and Economic Consequences of Workplace Illness and Injury. In addition, it is anticipated that researchers will draw from multiple categories to focus research needs. For example, researchers may use intervention effectiveness research to evaluate the barriers to preventing hearing loss; or a health services research project may compare the success of treatment protocols for occupational asthma.

During the development of the Agenda, the importance of sector-specific research was consistently raised. It was finally decided that the most effective way to integrate consideration of research efforts within specific sectors (such as construction, mining and agriculture) was to apply a matrix approach of coordinated research in some or all of the 21 priority areas, as appropriate for each sector. This approach is illustrated in Table 2. There was agreement that sector-focused research has had much success and continues to hold great promise for gathering and translating knowledge and information into prevention.

Table 2

Sector	Allergic and Irritant Dermatitis	Asthma and Chronic Obstructive Pulmonary Disease	Fertility and Pregnancy Abnormalities	Hearing Loss
Agriculture	X*	X	X	X
Construction	X	----	X	X
Service	X	X	X	----
Mining	X	X	----	X
Manufacturing	X	X	X	X

* = priority research area within a sector

The following section (NORA Priority Research Areas) presents an overview of the 21 priorities, organized by the three categories. Each topic summary emphasizes the reasons for its importance and examples of the kind of research that could be undertaken in connection with each priority. It should be emphasized that the research opportunities presented are illustrative only and do not constitute a comprehensive research strategy.

Implementation of NORA

NORA is the first step in a collaborative effort between NIOSH and its many partners to guide occupational safety and health research over the next decade. The success of NORA will be measured by its utility in directing occupational safety and health research and ultimately by improvements in worker safety and health. NIOSH will take a leadership role in disseminating the Agenda and tracking its implementation. However, no single organization has the resources necessary to accomplish the entire Agenda. Its success will be commensurate with the degree to which the entire occupational safety and health community engages in collaboration and coordination.

The following identifies some specific approaches to implementation. These approaches were generally endorsed in discussions among contributors to the Agenda, recognizing that the effort to date has focused on defining the Agenda, not designing its implementation strategy. Implementation is the necessary next phase of NORA. As the first step in the implementation phase, NIOSH is committed to bringing together its NORA partners in a public meeting to further refine the preliminary ideas presented in the following.

NIOSH is committed to facilitating the formation of partnership teams that will assist in the development, pursuit, review, and dissemination of research under each NORA topic. It is expected that although Partnership Teams will include a broad representation of researchers from the occupational safety and health community, they may differ by membership and structure. For example, some corporations represented on the Corporate Liaison Committee have offered to foster public-private partnerships to increase resources and efforts in selected research areas (e.g., as the "champion" of low back disorders).

Sector-specific interests in topics should also be reflected in team and other NORA-related activities. Teams can identify sectors associated with topics and obtain representation from the sectors and from leading researchers with experience in the sectors. Consensus on research needs for each topic should be sought through some or all of the following: (1) commissioning and reviewing an issue paper on the topic, (2) convening workshops, and (3) using other methods to ensure the complete and critical review of the available information and identification of specific research needs and strategies.

NIOSH is also committed to:

• Using the Agenda to guide both intramural and extramural funding decisions
• Encouraging and stimulating other government agencies to include NORA priorities in their internal and extramural research programs
  
• Developing procedures and capacity to track the impact of NORA activities on safety and health outcomes using existing tracking models, if available (e.g., Healthy People 2000 )
• Updating NORA
• Periodically reviewing and communicating the progress and successes of partnership teams, NIOSH intramural and extramural activities, and the overall role and effectiveness of NORA in occupational safety and health.

Working with its partners, NIOSH will take a leadership role in disseminating and promoting the results of NORA activities. All partners will be encouraged to pursue publication of peer-reviewed articles, issue papers, proceedings from public workshops, articles for trade and professional journals, employer/worker educational publications, and to use innovative electronic and other communication strategies to reach those who can protect worker safety and health. Implementation efforts will include the development of evaluation projects to assess the effectiveness of communication activities. NIOSH will also work with the partnership teams and others to publish periodic reports regarding NORA implementation and changes in NORA priorities.

Throughout the process of implementing the Agenda, NIOSH will seek to build upon and extend its partnerships and work to improve coordination throughout the occupational safety and health community. Our expectation is that these activities hold great promise for improving the protection and well-being of workers.