national institute for occupational safety and health · national institute for occupational safety...

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Strategic Goals

1. Conduct a targeted program of research to reducemorbidity, injuries, and mortality among workers inhigh-priority areas and high-risk sectors.

2. Develop a system for surveillance of major occupa-tional illnesses, injuries, exposures, and healthhazards.

3. Increase occupational disease and injury preventionactivities through workplace evaluations, interven-tions, and recommendations.

4. Provide workers, employers, the public, and theoccupational safety and health community withinformation, training, and capacity to prevent occu-pational diseases and injuries.

ision — Delivering on the Nation’s promise: safety and health at work forall people through research and prevention.

ission — Provide national and world leadership to prevent work-relatedillness, injury, and death by gathering information, conducting scientificresearch, and translating the knowledge gained into products and services.

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National Institute for OccupationalSafety and Health

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BackgroundIn 1970, Congress passed the Occupational Safety and Health Act “toassure so far as possible every working man and woman in the Nation safeand healthful working conditions.” In passing this landmark legislation,Congress developed a two-pronged approach to meet this ambitious goal:research concerning the causes of occupational injuries and illnesses andbased on that research, the development and enforcement of standards toremove those hazards from the workplace. The Act created the Occupa-tional Safety and Health Administration (OSHA) to perform the enforce-ment function and the National Institute for Occupational Safety and Health(NIOSH) to perform the research function. NIOSH has dedicated itself tothat research function throughout its 25-year history.

Congress has reiterated and enhanced the NIOSH research function twice inthe last 20 years with regard to occupational safety and health in mines.With the 1977 amendments to the Coal Mine Health and Safety Act andthe 1995 consolidation of the U.S. Bureau of Mines safety and healthresearch with NIOSH, Congress gave NIOSH responsibilities in mining thatparalleled its work for the rest of industry.

Specifically, NIOSH has the responsibility to:

♦ enumerate hazards present in the workplace,

♦ identify the causes of work-related diseases andinjuries,

♦ evaluate the hazards of new technologies andwork practices,

♦ create ways to control hazards,

♦ train safety and health professionals, and

♦ recommend occupational safety and healthstandards.

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TheChallenge:

Using research to protect workers in a constantlychanging work environment.

Each day, 16 people diefrom work-related traumaticinjuries and 137 people dieform work-related diseases.

In 1996, occupationalinjuries cost $121 billion.

NIOSH employees face a daunting challenge every day. Al-though the Nation has made substantial progresstoward improving worker protections since 1970,(largely a result of occupational safety and healthresearch), workplace hazards continue to inflict atremendous toll on this nation in terms of humanand economic costs. Each day, an average of 16people die from work-related acute traumaticinjuries, and 137 people die from work-relateddiseases. In 1996, occupational injuries alone cost$121 billion in lost wages and productivity, admin-istrative expenses, health care, and other costs.Clearly, there is much work to be done.

In addition, it is rare that any NIOSH effort — no matter howimportant — can, by itself, bring an end to a workplace hazard.The practical impact of the NIOSH program on the workplacelargely depends on the actions of employers, employees, andNIOSH partners in other Federal agencies, state and local govern-ments, industry, labor, academia, and community organizations.

This dilemma can be seen in the Department of Health andHuman Services (DHHS) Healthy People 2000 program. HHShas described Healthy People as “a conceptual model for theNation . . . that sets the agenda for prevention programs in thepublic and private sectors. . . ”. (emphasis added).

Among the Healthy People objectives for improving the health ofthis Nation are improvements that will be evidenced at the work-place. These objectives include target levels of improvements inwork-related conditions. Examples are reducing work-relateddeaths and injuries, reducing lost work days and incidences ofcumulative trauma and skin disorders, and increasing the number

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of workplaces with rehabilitation and safety and health programs.(For a complete list of Healthy People objectives, see page 21.)

The work of NIOSH has had and will continue to have an impacton improving health and safety at the workplace; it will thereforehelp the Nation meet many Healthy People objectives. NIOSHhas ongoing efforts to address many of the Healthy People areasof work-related hazards, injuries, illnesses, and deaths (such asmusculoskeletal problems, skin diseases, violence in the work-place, employee stress, and back injuries) as well as categories ofworkers and prevention strategies for mine workers, farm work-ers, and adolescents. In addition, NIOSH goals for surveillancewill assist the overall Healthy People effort by moving toward amore comprehensive database, thereby helping to establishbaseline and trend information in the occupational safety andhealth area. Several Healthy People objectives for the work-place related to State law changes, enforcement, and standardsetting that fall outside the NIOSH mandate.

The combined efforts of all sectors are needed to have a positiveoverall impact on the health of this Nation. As one partner in thiseffort, we have therefore developed strategies that will contributeto achieving Healthy People objectives, but we have not incorpo-rated specific Healthy People goals into this plan.

As NIOSH develops its plan for moving forward into the nextcentury in a time of fiscal constraints, it must ensure that itsresources and efforts are focused on the most important workplacehazards and that the information it gains through research isaccessible to its partners in prevention.

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NIOSH and its employees are ready to meet the challenge of assuring safetyand health at work for all people. To accomplish this mission, NIOSH hasestablished four Institute-wide objectives that complement the goals set outby DHHS and the Centers for Disease Control and Prevention (CDC). Notethat NIOSH has not attempted to make all of its activities fit within thesegoals. The Institute has instead looked to those activities that represent themajority of its work.

The four NIOSH goals concern the targeting of research, surveillance,prevention, and information dissemination and training. These four goalsrepresent the broad spectrum of NIOSH work, and the interplay of thesegoals has formed and will formthe NIOSH contribution torealizing the Vision of thisInstitute — safer and healthierworkplaces. Achievement ofthese goals in the United Statescan provide a beacon for othercountries in the world, many ofwhich are struggling to defineoccupational safety and healthproblems and ways to combatthem.

Throughout its 25-year history, NIOSH has had proven successes in all ofthese areas. For example, because of research performed by NIOSH , thisNation has virtually eliminated byssinosis (brown lung) and substantiallyreduced coal workers’ pneumoconiosis (black lung). NIOSH has alsoaddressed the critical need for occupational safety and health professionalsthrough training for doctors, nurses, industrial hygienists, and engineers.NIOSH efforts have led to the banning of ethylene dibromide (a fruitfumigant and proven human toxin ), an action that protected an estimated108,000 workers from possible reproductive damage, and recently, NIOSHwork with the asphalt paving industry resulted in an agreement with theindustry to install ventilation systems on paving machines — therebyreducing worker exposure to asphalt fumes by 80 percent.

As recently stated by a Vice President of the General Motors Corporation,“. . .we recognize NIOSH’s distinct role as a R&D entity which has beenvery effective in injury prevention research over the last 25 years. Thiseffort has ultimately saved the Nation billions of dollars annually in medi-cal costs and also improved the health and welfare of every Americanworker and their families.”

“. . .we recognize NIOSH’s distinct role as a R&Dentity which has been very effective in injury preven-tion research over the last 25 years. This effort hasultimately saved the Nation billions of dollars annuallyin medical costs and also improved the health andwelfare of every American worker and their families.”

— a vice president of the General Motors Corporation

NIOSH Strategic Goals:Safety and Health at Work for All People

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To remain successful, NIOSH must continue to integrate efforts inall four strategic goal areas. For example, in 1990 Congress di-rected NIOSH to expand its efforts directed at health problemsaffecting construction and agricultural workers. In response, NIOSHdeveloped comprehensive prevention programs by expandingexisting NIOSH activities in the areas of surveillance, research,intervention, and information transfer. NIOSH conducted or fundedmore than 100 such activities to identify, characterize, and controlwork-related injuries, diseases, and hazards experienced by con-struction and agricultural workers and to disseminate the informa-tion generated from these and other research efforts.

In the end, progress toward the NIOSH Vision can be measuredonly by a reduction in occupational injuries, illnesses, and fatalities.In fact, the Nation has made measurable progress since the inceptionof NIOSH. From 1970 to 1995, the rate of workplace fatalities fellby 78%, and the number of workplace deaths has declined by 62%.We have also seen a 25% decline in the rate of occupational injuriesand illnesses from 1973 through 1994.

These reductions are the result of the combined efforts of all theNIOSH partners in occupational safety and health: industry, labor,academic researchers, OSHA, MSHA, State and local agencies andothers. No single partner can claim exclusive credit for the progresswe have made or will make in protecting this Nation’s workers. Forif progress is to be made, all of the partners must act — fromidentifying the causes of disease and injury through controlling oreliminating the hazards or exposures at the worksite. For thisreason, NIOSH has not included reductions of specific hazards,injuries, or diseases in its list of goals.

Although we have placed NIOSH activities under each strategicgoal, it is difficult to categorize some of our activities as belongingto one goal rather than another. For example, workplace and indus-try interventions are described here as prevention activities, but wecould also describe them as efforts at problem identification orapplications of targeted applied research and place them under thesurveillance or targeted research goal.

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Department of Health andHuman ServicesStrategic Goals

1. Reduce the major threatsto the health and pro-ductivity of all Ameri-cans.

2. Improve the economicand social well-being ofindividuals, families,and communities in theUnited States.

3. Improve access to healthservices and assure theintegrity of the Nation’shealth entitlement andsafety net programs.

4. Improve the quality ofhealth care and humanservices.

5. Improve public healthsystems.

6. Strengthen the Nation’shealth sciences researchenterprise and enhanceits productivity.

The NIOSH Strategic Goals relate to and complement those ofDHHS and CDC.

Much of the work of NIOSH could also be characterized asanticipating the next crisis in the workplace and working toensure that it does not come to pass. Examples include thefollowing:

• Mine disasters that did not occur because NIOSHengineers developed a new pillar system for longwallmining that has become the worldwide industry stan-dard.

• Firefighter deaths that did not happen because of thelessons learned from a NIOSH fatality investigation.

• Health emergencies avoided because employers andemployees called the NIOSH information number andlearned that the respirators they were about to usewould not protect them from acute toxic exposure.

Events such as these occur every day. We cannot preciselymeasure the number of workers who benefit, since even theymay have no idea that it was knowledge obtained by NIOSHthat enabled them to go home at the end of the day. Neither dothese events translate easily into measures of NIOSH perfor-mance. We acknowledge this fact and are committed to ensur-ing that these preventive acts continue to occur every day in thefuture as they have in the past.

Centers for Disease Control and PreventionStrategic Goals

1. Science: Assure a strong science base for publichealth action.

2. Assessment: Detect and assess threats to publichealth.

3. Policy: Provide leadership for the Nation inprevention policy and practice.

4. Assurance: Assure the public’s health throughtranslation of research into effective community-based action.

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The National Occupational Research Agenda (NORA)

In the past, occupational safety and health research has been conductedwith minimal coordination or collaboration between NIOSH, othergovernment agencies, university researchers, or industry- and labor-funded programs. NIOSH is working to change that pattern. Begin-ning in 1995, NIOSH spearheaded a broad-based national effort thatresulted in the creation of the National Occupational Research Agenda(NORA) in 1996. This consensus agenda has the potential to guideoccupational safety and health research into the next century — notjust for NIOSH, but for the entire occupational safety and healthcommunity.

The success of NORA will be measured by its utility in focusingoccupational safety and health research. As a starting point, NIOSHwill use NORA to direct and target intramural and extramural occupa-tional safety and health research. Ultimately, this Nation will seeimprovements in worker safety and health.

NIOSH Strategic Goal 1onduct a targeted program of research to reduce morbidity, injuries, and mortalityamong workers in high- priority areas and high-risk sectors.C

Allergic and Irritant DermatitisAsthma and Chronic Obstructive Pulmonary DiseaseFertility and Pregnancy AbnormalitiesHearing LossInfectious DiseasesLow Back DisordersMusculoskeletal Disorders of the Upper ExtremitiesTraumatic Injuries

Emerging TechnologiesIndoor EnvironmentMixed ExposuresOrganization of WorkSpecial Populations at Risk

Cancer Research MethodsControl Technology and Personal Protective EquipmentExposure Assessment MethodsHealth Services ResearchIntervention Effectiveness ResearchRisk Assessment MethodsSocial and Economic Consequences of Workplace Illness and InjurySurveillance Research Methods

Disease and Injury

Work Environmentand Workforce

Research Tools andApproaches

CATEGORY PRIORITY RESEARCH AREAS

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Targeted Scientific Research

The creation of NORA is a critical milestone on the road toimproving the safety and health of America’s workers; however,the Agenda was created with the knowledge that it would not, byits nature, include all areas that are “still important [occupationalsafety and health issues] and merit research effort.” NIOSHitself undertakes research and other activities outside the NORApriorities that will provide crucial information to reduce injuriesand illnesses in the workplace. Much of the work of NIOSHlaboratories (such as developing new imaging methods for theearly detection of occupational illnesses and injuries, and perfect-ing microscopic analysis of tissue samples to increase our under-standing of disease development) are fundamental to optimizingoccupational safety and health research in all areas.

Measuring Basic Scientific Research

Congress, the Office of Management and Budget, and thePresident’s National Science and Technology Council (NSTC)understand that measuring the impact of basic scientific researchis difficult. As stated by the Committee on Science of the U.S.House of Representatives, strategic planning and performancemeasures offer both “an opportunity and a significant challenge”for agencies such as NIOSH.

Committee on Science of the U.S. House of Representatives

“However, assessment techniques are in relatively early stages of development and areonly in their infancy for such areas as fundamental science. Further, the causal relation-ship between research outputs and their eventual outcome is very complex.

Particularly for basic research, the primary goal is to produce new knowledge, with longterm and frequently, unpredictable outcomes. Fundamental science often contributes tomultiple societal goals. Further, the results of fundamental research may not appear forsome length of time. Interpretation and evaluation of research results may requirespecialized expertise. Indeed quantitative measures may not be feasible for basicresearch.” (emphasis added)

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In July 1996, NSTC released a report entitled AssessingFundamental Science intended as a “broad framework for theGovernment Performance Results Act (GPRA) implementationin assessment of fundamental science programs.” With regard toefforts at measuring science, the report states the following:

For evaluating current programs in individual agencies,merit review based on peer evaluation will continue to bethe primary vehicle for assessing excellence and conduct ofscience at the cutting edge. . . .

Balanced assessment of the various dimensions of programperformance in an agency will require multiple sources andtypes of evidence. In addition to retrospective meritreview, retrospective performance reports might draw onquantitative indicators, qualitative indicators, descriptiveindicators or narrative text, examples of outstandingaccomplishments and of more typical levels of achieve-ment, information about context, and findings from specialstudies and analysis.

Because pre-existing measures of research results weredeveloped primarily for other purposes, they have not yetbeen adapted for use in reporting at the agency level. Pre-existing measures capture only a subset of research outputsand outcomes. They do not map neatly or cleanly ontoGPRA concepts. Consequently, these measures (e.g.,publication counts, citation counts, and rate-of-return andrelated economic measures)...can serve only as a startingpoint for agency thinking about how to design the mosteffective assessment strategies.

Nevertheless, NIOSH is committed to tracking the implementa-tion of NORA in the research community and in the workplaceas well as continuing to perform — and evaluate — its otherimportant scientific research in occupational safety and health.With regard to NORA, NIOSH will look first to increases inNIOSH and other Federal intramural and extramural research inNORA priority areas as indicators of NORA’s impact. NIOSHwill also develop a protocol by using bibliometrics and otherexisting methods of evaluation as indicators of the impact of itsresearch efforts. At the same time, NIOSH will be working todevelop new procedures and capacities to measure NORA’simpact as well as that of other occupational safety and healthresearch on safety and health outcomes.

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Objectives - FY 1999

n Disseminate NORA throughout the occupational safety and health researchcommunity.

n Implement NORA through the formation of partnership teams for eachNORA topic.

— Teams will consist of partners from all aspects ofsafety and health.

— Teams will assist in the development, pursuit,review, and dissemination of research.

n Evaluate the success of focusing occupational safety and health research onNORA priorities and other target areas by

— determining current levels of NIOSH and other Federal agencies’intramural and extramural research funding in NORA priority areasand calculating any annual increases, and

— developing a protocol for the use of bibliometrics and other researchproxy measures (i.e., numbers of patents, engineering controldevices, laboratory methods development, peer-reviewed articles,spin-off technologies, etc.) to evaluate the level of NORA and othertargeted research in the occupational safety and health community.

n Report on the progress of NORA.


n Evaluate the adequacy of existing procedures and tracking models to mea-sure the impact of NORA and other NIOSH research on safety and healthoutcomes.

n Develop new procedures and capacities to measure the impact of NORA andother NIOSH research on safety and health outcomes.

n Update NORA (2002 mid-course review).

Ongoing Objective

n Increase knowledge and understanding of occupational safety and healthissues through conducting and funding peer-reviewed research in NORA andother priority areas.

ObjectivesStrategic Goal 1

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In 1986, Congress reported that Federal surveillance of occupa-tional illness was 72 years behind communicable disease surveil-lance. The Institute of Medicine further reported in 1987 that theNation’s occupational illness and injury surveillance systems wereinadequate, especially with regard to occupational disease surveil-lance, and they remain inadequate today. Not surprisingly, given thestate of occupational safety and health surveillance, the human tollof work continues. It is a human toll that we know in large part ispreventable.

The ability to identify, quantify, and report work-related injury anddisease is vital to prevention. Targeted surveillance efforts (manysupported by NIOSH) exist today to address specific conditionssuch as adult lead poisoning, occupational lung disease, and carpaltunnel syndrome. However, no national surveillance system existsfor occupational disease and injury.

To optimize the use of public resources and to obtain the mostuseful and accurate information, NIOSH has developed partner-ships at the Federal, State, and local levels throughout the country.NIOSH currently supports limited surveillance activities of 12occupational conditions, diseases, and injuries in more than half ofthe States. Although these programs are important, they are far fromcomprehensive. In only one State (New Jersey) do we have asurveillance program that examines even four of the 12 conditions.In four states, only one condition is monitored.

NIOSH now operates a number of surveillance programs with itsState partners:

Adult Blood Lead Epidemiology and Surveillance (ABLES)ABLES is a surveillance system for identifying cases of elevatedblood lead levels among U.S. adults. Started in the late 1980s, theABLES program provides funding and technical assistance toparticipating States. As of January 1997, 27 states had surveillanceprograms reporting to ABLES, and seven more were developingprograms.

evelop a system of surveillance for major occupational illnesses, injuries,exposures, and health hazards.

NIOSH Strategic Goal 2

D

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Sentinel Event Notification System for Occupational Risks(SENSOR) Through cooperative agreements with State healthdepartments NIOSH supports surveillance for pesticide poisoning,asthma, silicosis, burns, dermatitis, youth injury, carpal tunnelsyndrome, amputation, and noise induced hearing loss. To date, theSENSOR program is active in 13 States.

Fatality Assessment and Control Evaluation (FACE) Workingwith State health departments, NIOSH investigates worksites wherefatalities have occurred. These efforts help us understand the factorsthat contribute to or cause deaths from inju-ries in the workplace. NIOSH supportsfatality investigations in 20 States. In fiscalyear 1996, NIOSH and its State partnersinvestigated 135 occupational fatalities.Following such investigations, NIOSHdisseminates prevention recommendations tothe employers and workers.

At the Federal level, NIOSH partners withagencies such as the Consumer ProductSafety Commission (to study the number of nonfatal occupationalinjuries), the Environmental Protection Agency (to study the numberof acute pesticide poisonings), the Bureau of Labor Statistics, theDepartment of Energy, and the National Cancer Institute.

Building on and learning from these experiences, NIOSH proposesto undertake a comprehensive surveillance planning process withNIOSH partners at the State and Federal levels. Much like theNORA process, this effort will be helpful in establishing surveillancepriorities and will define roles for various agencies at all levels ofgovernment.

Such a planning process will lead to enhanced surveillance ofoccupational injuries, illnesses, exposures, and health hazards thatwill in turn permit us to monitor trends, target prevention resourcesto populations at risk, and evaluate the impact of prevention efforts.Looking at occupational diseases and injuries in other countries,would help the United States understand threats to our citizens, anddevelop ways to manage them. In taking this important step,NIOSH intends to partner with other parts of CDC, state-basedsurveillance programs, and new NIOSH partners.

NIOSH intends topartner with parts ofCDC, state-basedsurveillance programs,and new NIOSHpartners.

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ObjectivesObjectives - FY 1999


n Undertake a comprehensive surveillance planning process withNIOSH partners at the State and Federal levels to establishsurveillance priorities and define roles for various agencies.

Objectives - FY 2000 - FY 2002

n Implement the recommendations of the surveillance planningprocess for NIOSH in the areas of occupational injuries, ill-nesses, exposures, and health hazards.

n Develop procedures and capacities to measure the impact of therecommendations of the surveillance planning process on safetyand health outcomes.

n Develop a demographics database that will represent miners inall States with mining operations.

Ongoing Objective

n Collect, analyze, and disseminate information on the distributionof occupational illnesses, injuries, exposures, and health hazardsto target and evaluate intervention and prevention efforts.

Strategic Goal 2

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As stated in the NIOSH Vision, the Agency has an important role toplay in prevention. Crucial to this role is the ability to link preven-tion policy and practice with scientific research. Throughout its 25-year history, NIOSH has used field research as one way to makethis link.

Health Hazard Evaluations — Every year NIOSHconducts hundreds of evaluations at the request of work-ers, employers, and government agencies to evaluatehealth concerns at specific worksites. Following aninvestigation NIOSH makes recommendations for pre-venting hazards at that specific work-site and similarworksites.

Intervention Effectiveness Research — NIOSH also conductsresearch to evaluate the effectiveness of existing prevention ap-proaches at worksites where a hazard is known or suspected tocause injury or disease. In order to most effectively invest futureprevention resources NIOSH and others must be able to showwhich approaches work best in protecting worker safety and health.

While much more research needs to be conducted in this area,NIOSH has many projects underway. For example, NIOSH isevaluating the use of lifting devices to reduce back injuries innursing homes and the effectiveness of a NIOSH Alert in warninghealth care workers about the hazards of natural rubber latex.

Information resulting from NIOSH intervention effectivenessresearch will be used by employers, workers, and the occupationalsafety and health community to ensure that the prevention strategiesused to protect workers have been shown to effectively preventinjury and disease at work.

Control Technology Assistance — NIOSH is working to im-prove the workplace environment by advancing the development ofcontrol technology. In this effort, NIOSH stresses practical, solu-tions-oriented efforts that will have broad impact on worksites. Forexample, ground- breaking guidelines were jointly developed byindustry, labor and government to implement engineering controlsfor the asphalt paving industry. Similar guidelines are beingdeveloped for the dry-cleaning industry.

NIOSH Strategic Goal 3ncrease occupational disease and injury prevention activities throughworkplace evaluations, interventions, and recommendations.I

Every year NIOSH conducts hun-dreds of investigations at the requestof workers, employers, and govern-ment agencies to evaluate healthconcerns at specific worksites.

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Recommendations — NIOSH uses the information from all of itsresearch and surveillance to make recommendations to the public aswell as to Federal enforcement agencies, including the OccupationalSafety and Health Administration (OSHA) and the Mine Safety andHealth Administration (MSHA). Many of these take the form ofrecommendations on levels of exposure to hazards (recommendedexposure limits (REL) and levels considered to be immediatelydangerous to life or health (IDLH). NIOSH recommendations arepublished in criteria documents and Current Intelligence Bulletins.Recommendations concerning new hazards or exposures are oftenmade directly to the public through Alerts and special hazard re-views (see also Strategic Goal 4). NIOSH also publishes analyticalmethods which recommend the best methods to use for measuringworkplace exposures.

By working with the entire occupational safety and health commu-nity, NIOSH intends to continue expanding its overall recommenda-tion efforts in the coming years.

Respirator Certification — An additional area of preventioninvolves respirator certification. Through its mandated respiratorcertification program, NIOSH annually prevents untold numbers ofworkers from being exposed to dangerous substances. This program(1) provides site audits at the plants of respirator manufacturers toevaluate quality control (2) investigates respirator problems throughfield investigations (3) studies proposed modifications to certifiedrespirators (4) conducts research to identify and address knowledgegaps relating to respirator use and performance and (5) to-date hascertified nearly 4,800 respirator models.

In 1995, NIOSH revised and streamlined the process for respiratorcertification and introduced new performance-based requirementsfor certain respirators. As a result of this effort new, better-perform-ing, more efficient, less expensive respirators are being introducedinto the workplace. Employers and employees alike will benefitfrom increased protection and cost savings. NIOSH is committed tomaintaining the quality of this program, which is heavily relied uponby employers and employees.

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n Work with the occupational safety and health community to develop asystem for assessing, determining the baseline level, and increasing theextent to which NIOSH recommendations are utilized by employers,workers, and government agencies at worksites, industry-wide, and instandard setting.

n Implement targeted evaluation of the effectiveness of preventionprograms (e.g., latex allergy and agriculture-related injuries to chil-dren) by tracking the prevalence of an illness or injury, the level ofexposure, and the behavior of affected workers and employers beforeand after the implementation of the program.

n Use new technology (e.g., virtual reality) in the design of preventionmeasures.

n Develop and implement criteria for selecting field investigation sites.These criteria should include the selection of workplaces with NORAor other priority areas or hazards. Determine the number of suchinvestigations performed in FY’98 that met this criterion.

n Develop and communicate a plan for updating respirator certificationregulations.

Ultimately, one measure of NIOSH success will be the extent to whichits research priorities have been translated into prevention policy andpractice. Such translation can occur through changes in the behaviorof employers and workers at the worksite, industry-wide adoption ofcontrol or abatement measures or devices, through the amount ofNIOSH- sponsored or - conducted intervention research, and standard-setting and enforcement activities. As discussed earlier, this measureof success depends largely on the voluntary actions of NIOSH part-ners in industry, labor, academia, community organizations, andFederal, State and local agencies. Over the coming years, NIOSH iscommitted to working with the entire occupational safety and healthcommunity to bring the results of its research into the workplace.

Objectives Strategic Goal #3

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n Increase the number of health hazard evaluations conducted at work-places with NORA or other priority areas or hazards.

n Increase the number of work-site prevention activities implementedafter a NIOSH report is issued.

n Increase the number of industry-wide control measures or devices putin place after the release of a NIOSH research report.

n Increase the number of NIOSH recommendations, including those inNORA priority areas and other targeted areas.

n Increase the number of NIOSH-sponsored or -conducted interventioneffectiveness research projects in the occupational safety and healthfield, including projects in NORA or other priority areas.*

n Implement updated respirator certification regulations.

*Intervention effectiveness research is a NORA topic and will, therefore, beincluded under appropriate objectives of Goal 1 as well.

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In conjunction with recommending actions for preventing occupational diseaseand injuries, NIOSH believes that the Nation’s health can be improved bytranslating its basic and field research into forms of information that the entireoccupational safety and health community can understand and act upon.

Many varied audiences rely on the results of NIOSH activities. The list ofindividuals and organizations to which NIOSH must communicate occupa-tional safety and health information includes researchers, employers, employ-ees, OSHA, MSHA, policy makers, manufacturers, trade associations, unions,other government agencies, students and the media. A key NIOSH goal is tocommunicate scientific findings to diverse stakeholders and the public. Today,NIOSH publishes and distributes a wide array of documents to meet the needsof these varied audiences. Examples include Health Hazard Evaluation Re-ports, Alerts, Current Intelligence Bulletins, criteria documents, fact sheets,and reports.

In recent years, NIOSH has focused its obligation to disseminate safety andhealth information through its Office for Health Communication in Washing-ton, D.C., its Division of Education and Information in Cincinnati, Ohio, andits new Health Communications Research Branch in Morgantown, WestVirginia. Together these units have moved health communications into the21st century through the use of mass media, publicly accessible data bases, andthe Internet.

In addition, NIOSH understands that the future of occupational safety andhealth prevention efforts rests greatly on the development and training of safetyand health professionals as well as the integration of occupational medicineinto mainstream medical training. To this end, NIOSH currently funds 15universities to conduct degree programs throughEducation and Research Centers and 35 universitieswith single programs (training project grants)throughout the United States. These centers trainphysicians, nurses, industrial hygienists, safetyprofessionals, engineers, and other safety and healthprofessionals. In addition, NIOSH supports theInternational Training and Research in Environmen-tal and Occupational Health Program (ITREOH),which links 13 U.S. institutions with occupationalsafety and health professionals in 23 countries. As we move into the nextcentury — where the needs of the workforce and workplace will be continu-ously changing — NIOSH must evaluate and update its training programs.

NIOSH Strategic Goal 4rovide workers, employers, the public, and the occupational safetyand health community with information, training, and capacity toprevent occupational diseases and injuries.

P

NIOSH currently funds 15universities to conduct degreeprograms through Education andResearch Centers and 35 univer-sities with single programs

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n Review the most widely distributed existing documents and new documentsand training materials to ensure that they are designed and written for theintended user.

n Conduct a review and a user survey of NIOSH public documents that affect thegreatest number of workers or employers. This review and user survey shouldinclude recommendations made after interventions. Objectives should be toevaluate quality, usefulness, content relevancy, and distribution.

n Review existing communications efforts to ensure that they focus on high-risksectors and NORA priority areas.

n Design and implement two model information dissemination and trainingprograms for key target hazards (silicosis ) or populations (e.g., adolescents).

n Make the data obtained through NIOSH field research accessible to a broadpopulation through the use of the Internet and other devices.

n Expand the training of occupational safety and health professionals through thein-house use of internships and fellowships to graduate students and others.

n Make NIOSH materials available on the NIOSH homepage on the Internet.

n Develop interactive expert systems for NIOSH information on the Internet.

n Increase employer and employee knowledge and use of the NIOSH toll-freeinformation number.

n Provide technical assistance to the mining industry though technology andtraining materials.


n Develop assessment strategies that will identify the demand and need foroccupational safety and health professionals, future trends, and gaps in NIOSHtraining programs.

n Develop assessment strategies that will identify the demand and need foroccupational safety and health information, future directions in deliveringinformation, and potential information gaps in NIOSH dissemination pro-grams.

ObjectivesStrategic Goal 4

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NIOSH Strategic ToolsScientific Research

Without a doubt, the core of NIOSH activity is research — in the laboratoryand in the field. Research allows the Institute to (1) understand the causes andmechanisms of diseases and disorders (2) investigate exposures, illnesses,fatalities, and injuries, and (3) develop and evaluate control technologies atthe worksite. NIOSH is committed to continuing and expanding intramuraland extramural research activities in NORA priority areas and other criticalareas. This commitment is demonstrated by our ongoing efforts to bring thenew Morgantown research facility on line. Only through continued support ofoccupational safety and health research can we continue to move toward asafe and healthy future for this Nation’s workers.

NORA — A Process of Consultation With Partners

NIOSH is in a position to demonstrate what the Federal government canachieve when it works closely with public and private partners and stakehold-ers. More than 500 external groups and individuals contributed to the devel-opment of NORA — a cohesive national strategy for public and privateoccupational health research investments over the next decade. Moreover,additional partners have become involved in NORA implementation underNIOSH leadership. Over the coming years, NIOSH plans to bring the lessonslearned in this process to other areas of NIOSH activity such as preventionand training. NIOSH will also seek out opportuni-ties to form partnerships with other components ofthe occupational safety and health community andthereby expand the impact of its work.

Partners are also important on the internationalfront. One of the strengths of NIOSH in recent yearshas been its coordination and collaboration withother countries having similar occupational safetyand health problems and international organiza-tions. We pledge to continue these efforts.

Flexibility to Adapt to the Changing Nature of the Workplace

As this Nation moves into the next century, the issues at the workplace willchange. NIOSH is committed to changing as well. The Institute will main-tain the flexibility to meet the research needs associated with (1) new andemerging technologies as they are brought to the workplace of the future, and(2) the workplace changes brought about by changes in the organization ofwork and the increasing globalization of the economy. We are also committedto adapting as the workforce becomes older and more diverse and includesworkers at a younger age. The needs of these workers will require innovativeapproaches and solutions.

More than 500 external groupsand individuals contributed tothe development of NORA — acohesive national strategy forpublic and private occupationalhealth research investments overthe next decade.

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Impact FactorsNIOSH Reliance on Partners

Congress purposely placed NIOSH (which is primarily a re-search institute) in a position where it must rely on others in theoccupational safety and health community to have a directimpact on the overall level of hazards in the workplace. NIOSHhas developed a number of systems and programs to bring it intopartnership with all segments of the occupational safety andhealth community. But it is the designated role of NIOSH andits required reliance on the actions of others that have and willcontinue to have an important impact (both positive and nega-tive) on its ability to deliver fully on its vision of a safe andhealthful workplace for all.

Government Decisions

The NIOSH strategic plan is contingent on the support of allaspects of the U.S. government. That is, for NIOSH to meet thegoals of this plan, it requires growing resources, thesupport of Congress and the Administration for theNIOSH mission and the research it envisions, andjudicial rulings that support the continuing role ofscience in protecting the health of this Nation. Changesin any of these areas will have a negative impact on thework of NIOSH and on the ability of NIOSH to meetthe expectations of GPRA and this plan. If governmentsupport should decrease in the coming years, NIOSHwill adjust its expectations accordingly.

With regard to financial resources, it must be noted that theFY’97 budget for NIOSH was 25% below its budget for FY’80when adjusted for inflation using the biomedical research anddevelopment index. Simply stated, without an influx of resourcesto restore its research capacity NIOSH will be unable to meet thegoals it has set for itself and for the safety and health of thisNation’s workforce. Failure to provide sufficient resources willrequire NIOSH to scale back or eliminate important goals — anoutcome that will be negatively affect NIOSH and the level ofworkplace safety and health for all of our Nation’s workers.

The FY’97 budget for NIOSH was25% below its budget for FY’80when adjusted for inflation usingthe biomedical research and devel-opment index.

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The NIOSH Strategic Plan was developed by working withNIOSH employees throughout the Institute. Meetings were held inconjunction with the local partnership councils at various NIOSHlocations throughout the Nation. Employees were encouraged toconsider an early draft and answer questions including:

n Are the four strategic objectives the right ones forNIOSH?

n Does the plan portray NIOSH correctly?

n Does the plan include a broad enough cross-section of ongoing or planned NIOSH work?

n Does the plan relate to the work of my Division?Are there ways to tie the two together?

n Does the plan include measurements that willallow us to judge our progress?

Input from those meetings was included in thisplan.

Following that effort, a draft plan was distrib-uted to partners and stakeholders to obtain theirinput. Many of their thoughts and suggestionshave likewise been incorporated into this plan,and we are thankful for their input.

NIOSH believes that this plan represents thebeginning of an ongoing process that will assistthe Institute in its efforts to deliver on its Vision for this Nation’sworkers.

The NIOSH StrategicPlanning Process

The NIOSH StrategicPlan represents thebeginning of an ongoingprocess that will assist theInstitute in its efforts todeliver on its Vision forthis Nation’s workers.

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Healthy People 2000 is a Health and Human Services preventioninitiative that provides a national strategy for significantly improv-ing the health of the American people over the decade of the 1990’s.Healthy People calls on the Nation to make the following changesby the year 2000.

n Increase to 40 percent the proportion of worksites employ-ing 50 or more people that provide programs to reduceemployee stress.

n Reduce deaths from work-related injuries to no more than 4per 100,000 full-time workers, with sub-goals for mining,construction, transportation, and farm workers.

n Reduce work-related injuries resulting in medical treatment,lost time from work, or restricted work activity to no morethan 6 cases per 100 full-time workers, with subgoals forconstruction, nursing and personal care, transportation,mining, adolescent and farm workers.

n Reduce cumulative trauma disorders to an incidence of nomore than 60 cases per 100,000 full-time workers withsubgoals for manufacturing and meat product workers.

n Reduce occupational skin disorders or diseases to an inci-dence of no more than 55 per 100,000 full-time workers.

n Reduce hepatitis B infections among occupationally exposedworkers to an incidence of no more than 623 cases.

n Increase to at least 95 percent the proportion of worksiteswith 50 or more employees that mandate employee use ofoccupational protection systems such as seatbelts during allwork-related motor vehicle travel.

n Reduce to no more than 15 percent the proportion of work-ers exposed to average daily noise levels that exceed 85decibles.

n Eliminate exposures that result in worker blood lead concen-trations greater than 25 micrograms per deciliter (ug/dl) ofwhole blood.

Healthy People2000

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n Increase hepatitis B immunization levels to 90 percent amongoccupationally exposed workers.

n Implement occupational safety and health plans in 50 States toidentify, manage, and prevent leading work-related diseasesand injuries within the State.

n Establish 50 State exposure standards adequate to preventmajor occupational lung diseases to which their worker popu-lations are exposed.

n Increase to at least 70 percent the proportion of worksites with50 or more employees that have implemented programs onworker health and safety.

n Increase to at least 50 percent the proportion of worksites with50 or more employees that offer back injury prevention andrehabilitation programs.

n Establish in 50 States either public health or labor departmentprograms that provide consultation and assistance to smallbusinesses to implement safety and health programs for theiremployees.

n Increase to at least 75 percent the proportion of primary careproviders who routinely elicit occupational health exposures asa part of the patient history and provide relevant counseling.

n Reduce deaths from work-related homicides to no more than0.5 per 100,000 full-time workers.

n Reduce the overall age-adjusted mortality rate for four majorpreventable occupational lung diseases (byssinosis, asbestosis,coal workers’ pneumoconiosis, and silicosis) to 7.7 per100,000.

n Increase to 100 percent the proportion of worksites with aformal smoking policy that prohibits or severely restrictssmoking at the workplace.

n Enact in 50 States and the District of Columbia comprehensivelaws on clean indoor air that prohibit smoking or limit it toseparately ventilated areas in the workplace and enclosedpublic places.

n Reduce to zero the number of States that have clean indoor airlaws preempting stronger clean air laws on the local level.

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Increase occupational diseaseand injury prevention activi-ties through workplaceevaluations, interventions,and recommendations.

NIOSH Strategic Goals


Conduct a targeted program ofresearch to reduce morbidity,injuries, and mortality amongworkers in high-priority areasand high-risk sectors.

An Outline of the Future


• Disseminate NORA throughout theoccupational safety and healthresearch community.

• Implement NORA through theformation of partnership teams foreach NORA topic.-- Teams will consist of partners

from all aspects of safety andhealth.

-- Teams will assist in the develop-ment, pursuit, review, anddissemination of research.

• Evaluate the success of focusingoccupational safety and healthresearch on NORA priorities andother target areas by-- determining current levels of

NIOSH and other Federalagencies’ intramural and extra-mural research funding in NORApriority areas and calculating anyannual increases, and

-- developing a protocol for the useof bibliometrics and otherresearch proxy measures (i.e.,numbers of patents, engineeringcontrol devices, laboratorymethods development, peer-reviewed articles, spin-offtechnologies, etc.) to evaluate thelevel of NORA and other tar-geted research in the occupa-tional safety and health commu-nity.

• Report on the progress ofNORA.


• Evaluate the adequacy ofexisting procedures and trackingmodels to measure the impact ofNORA and other NIOSHresearch on safety and healthoutcomes.

• Develop new procedures andcapacities to measure the impactof NORA and other NIOSHresearch on safety and healthoutcomes.

• Update NORA (2002 mid-course review).

Ongoing Objective

• Increase knowledge and under-standing of occupational safetyand health issues throughconducting and funding peer-reviewed research in NORA andother priority areas.


• Undertake a comprehensivesurveillance planning processwith NIOSH partners at theState and Federal levels toestablish surveillance prioritiesand define roles for variousagencies.

Objectives -FY 2000 - FY 2002

• Implement the recommenda-tions of the surveillanceplanning process for NIOSHin the areas of occupationalinjuries, illnesses, exposures,and health hazards.

• Develop procedures andcapacities to measure theimpact of the recommenda-tions of the surveillanceplanning process on safety andhealth outcomes.

• Develop a demographicsdatabase that will representminers in all States withmining operations.

Ongoing Objective

• Collect, analyze, and dissemi-nate information on thedistribution of occupationalillnesses, injuries, exposures,and health hazards to targetand evaluate intervention andprevention efforts.


• Work with the occupationalsafety and health community todevelop a system for assessing,determining the baseline level,and increasing the extent to whichNIOSH recommendations are

Develop a system ofsurveillance for majoroccupational illnesses,injuries, exposures, andhealth hazards.


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• Increase the number ofNIOSH recommendations,including those in NORApriority areas and othertargeted areas.

• Increase the number ofNIOSH-sponsored or -con-ducted intervention effective-ness research projects in theoccupational safety and healthfield, including projects inNORA or other priorityareas.*

• Implement updated respiratorcertification regulations.

__________* Intervention effectiveness research is

a NORA topic and will, therefore, beincluded under appropriate objectives

of Goal 1 as well.


• Review the most widelydistributed existing documentsand new documents andtraining materials to ensurethat they are designed andwritten for the intended user.

• Conduct a review and a usersurvey of NIOSH publicdocuments that affect thegreatest number of workers oremployers. This review anduser survey should includerecommendations made afterinterventions. Objectivesshould be to evaluate quality,usefulness, content relevancy,and distribution.


Provide workers, employers,the public, and the occupa-tional safety and healthcommunity with information,training, and capacity toprevent occupational diseasesand injuries.

• Review existing communicationsefforts to ensure that they focus onhigh-risk sectors and NORApriority areas.

• Design and implement two modelinformation dissemination andtraining programs for key targethazards (silicosis ) or populations(e.g., adolescents).

• Make the data obtained throughNIOSH field research accessible toa broad population through the useof the Internet and other devices.

• Expand the training of occupa-tional safety and health profession-als through the in-house use ofinternships and fellowships tograduate students and others.

• Make NIOSH materials availableon the NIOSH homepage on theInternet.

• Develop interactive expert systemsfor NIOSH information on theInternet.

• Increase employer and employeeknowledge and use of the NIOSHtoll-free information number.

• Provide technical assistance to themining industry though technologyand training materials.


• Develop assessment strategies thatwill identify the demand and needfor occupational safety and healthprofessionals, future trends, andgaps in NIOSH training programs.

• Develop assessment strategies thatwill identify the demand and needfor occupational safety and healthinformation, future directions indelivering information, and poten-tial information gaps in NIOSHdissemination programs.

utilized by employers, workers,and government agencies atworksites, industry-wide, and instandard setting.

• Implement targeted evaluationof the effectiveness of preven-tion programs (e.g., latexallergy and agriculture-relatedinjuries to children) by trackingthe prevalence of an illness orinjury, the level of exposure,and the behavior of affectedworkers and employers beforeand after the implementation ofthe program.

• Use new technology (e.g.,virtual reality) in the design ofprevention measures.

• Develop and implement criteriafor selecting field investigationsites. These criteria shouldinclude the selection of work-places with NORA or otherpriority areas or hazards.Determine the number of suchinvestigations performed inFY’98 that met this criterion.

• Develop and communicate aplan for updating respiratorcertification regulations.


• Increase the number of healthhazard evaluations conducted atworkplaces with NORA or otherpriority areas or hazards.

• Increase the number of work-site prevention activitiesimplemented after a NIOSHreport is issued.

• Increase the number of indus-try-wide control measures ordevices put in place after therelease of a NIOSH researchreport.

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