Federal agency officials involved in reducing work-related injuries and illnesses believe there is still a lot to learn about the relationship between work and injuries. According to the experts, the government needs smarter workplace surveillance and data collection practices.
The National Institute for Occupational Safety and Health (NIOSH) should lead a collaborative effort with the U.S. Bureau of Labor Statistics (BLS), Occupational Safety and Health Administration (OSHA), and states to establish and strengthen regional occupational safety and health surveillance programs, says the new report prepared by the National Academies of Sciences, Engineering and Medicine.
The authors say an improved surveillance system will minimize the undercounting of occupational injuries and illnesses by using different datasets and surveys, and will make better use of technology.
Currently the U.S. does not have a single, comprehensive surveillance system. Rather it has an evolving set of systems that use a variety of data sources that meet different objectives, the report says. So far, the principal focus has been on collecting data on health outcomes, with less attention given to collecting information on hazards and exposures.
In the 200-page report, the panel recommends better collaboration among state and federal agencies and the health system. The report cites a need for better reporting on race and ethnicity, on self-employed and at-home workers, on occupational diseases and on people working multiple jobs. Also, it urges expanded use of biomedical informatics.
“Ensuring and improving worker safety and health is a serious commitment, and federal and state agencies along with other stakeholders should diligently act upon it,” said Edward Shortliffe, professor of biomedical informatics at Arizona State University and chair of the committee that conducted the study and wrote the report. “We are experiencing rapid changes in the nature of work, and with new risks developing; the nation is in dire need of a smarter surveillance system that tracks occupational injuries, illnesses, and exposures.”
The last report examining the U.S. workplace was released in 1987, more than 30 years ago. That workplace surveillance report, “Counting Injuries and Illnesses in the Workplace: Proposals for a Better System,” by the National Research Council, offered key insight into the American workplace.
Last week, officials offered additional insight into the need to identify and update the reporting on today’s workplace during a webcast based on the new report, “A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century Report.”
With 156 million adults working in the U.S. and an annual cost of $250 billion in workplace injuries (as of 2007 figures), the federal agencies that sponsored the latest report (BLS, NIOSH and OSHA) agree there is a need to better understand the relationship between work, workplace injuries and illnesses.
According to Margaret Seminario, director of Safety and Health at AFL-CIO, a lot has changed in the 30 years since the last report. The committee was created to oversee how a new, smarter and updated workplace surveillance system might work. The agencies looked at the strengths and limitations of national and state approaches, as well as different methodologies and approaches to surveillance.
Reflecting on changes since the 1987 NRC report, they identified critical gaps where data is lacking and evaluated new ways to collect, analyze, interpret and disseminate data in a cost-effective manner. In additional, they examined the roles of current federal and state agencies as well as how other countries study workplaces.
While the report offers numerous long and short-term recommendations, they focused four major categories during the webcast.
First, prioritize and coordinate OSHA surveillance. In addition, updates should be published on a regular basis, such as every five years to improve the health of the nation. The committee determined there should be a balanced approach across states, since some are more proactive in reporting than others.
“There needs to be a priority on capturing exposure surveillance,” said Seminario, who noted it should include the risks, hazards and exposures in the workplace.
Second, improve data collection. The experts identified gaps in safety and health surveillance that need to be addressed. For example, they called for enhancement and uniformity of information collected relating to race and ethnicity. In addition, they said it has become increasing important to know the type of employee arrangement and whether employees are contract or temporary.
Seminario added that millions of workers are self-employed, yet the BLS doesn’t have any information on those workers. The committee recommended a household survey to capture information on self-employed worker injury and illness occurrence. She said this type of survey could be used in the future to evaluate potential illnesses and exposures. Occupational information could also be pulled from general health surveys, she said.
Another area that suffers from a lack of information is occupational disease. The committee suggested obtaining this information from state resources.
Third, expand biomedical informatics use and capabilities. Essentially, the committee found that NIOSH doesn’t have the right experts in this area in-house, so the agency will need to search for outside expertise to evaluate appropriate computational methods and communication tools. In addition, this will aid in the merging of datasets from multiple sources, Seminario added.
Fourth, strengthen data analysis and information dissemination to encourage injury and illness prevention. According to David Buckeridge, a professor within the department of Epidemiology, Biostatistics and Occupational Health at McGill University in Montreal, this is critical for analysis and objectives to be clear. This will also help to avoid duplicative reporting and offer a way to provide the information back to employers.
According to Seminario, who is the only committee member to have been on both projects, prior to the 1987 report, the government had no idea of the number of occupational fatalities in any given year. She said that report led to three major advances: a census of occupational fatal injury, added information on injuries including case and individual demographics, and administration data to target compliance efforts.
Since that time, there’s been a big change in what’s happening at work, changing exposures, and a variety of employment arrangements. For example, the report highlights how manufacturing industry employment has declined while there has been substantial growth in the service sector. Now, a person might work multiple jobs and there’s a more diverse workforce. Workplace surveillance hasn’t kept up with the changes, she said.
In addition, Seminario said NIOSH will work with states to pull together information on nonfatal or fatal diseases because a lot of information exists at the state level. For example, information can be obtained from state poison control centers. The committee also suggested obtaining information from electronic health records. The goal, she said is to mine the information for industry and occupation, looking not only at a point of time but over time.
“We think that with this information and with some modest investment… we can make an impact on the cost,” she said, adding that it will be vital to “identify high risk groups and then take interventions.”
Lastly, recognizing the advances in data collection since the first report, surveillance will have to leverage new technology and tools.