pational 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 ...
Public Health Policy Forum
The National Occupational Research Agenda: A Model of Broad Stakeholder Input into Priority Setting Linda Rosenstock, MD, MPH, Christopher Olenec, JD, MS, and Gregory R. Wagner, MD
Introduction
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The United States has made significant progress in changing the high toll of work injurnes and illnesses and 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." Research has generated the data and knowledge that directed the actions-sometimes voluntary, sometimes regulatory-that served as the basis for much of this progress. And although regulatory and enforcement activities in occupational safety and health are often controversial and adversarial, there has generally been agreement on the need for sound science to inform public policy.
Despite this progress, the health and economic toll of work-related conditions is enormous. Each day, an average of 137 individuals die of work-related diseases, and an additional 16 die of injuries sustained at work.' Every 5 seconds a worker becomes injured; every 10 seconds a worker becomes temporarily or permanently disabled. In 1995, occupational injuries alone cost $121 billion in lost wages and productivity, administrative expenses, health care expenses, and other costs.2 In addition, the US workplace is rapidly changing. Jobs in our economy continue to shift from manufacturing to the service sector. Longer hours, compressed workweeks, shift work, reduced job security, and part-time and temporary work have become realities of the modem workplace. The workforce is also changing. As the US workforce grows to approximately 147 million by the year 2005, it will become older and more racially diverse.3 By the year 2005, minorities will represent 28% and
women approximately 48% of the workforce.3 These changes are presenting new challenges to protecting worker safety and health. No single organization has the resources necessary to conduct occupational safety and health research to adequately serve the needs of workers in the United States. These constraints mandate that the entire occupational safety and health community collaborate and coordinate its resources. The National Institute for Occupational Safety and Health (NIOSH) and its public and private partners developed the National Occupational Research Agenda to provide a framework to guide research in the next decade-for NIOSH and the entire occupational safety and health community. Approximately 500 organizations and individuals outside NIOSH participated in the development of the research agenda.' NIOSH undertook the task of setting research priorities in response to a broadly perceived need to systematically address those topics most pressing and most likely to yield gains to workers and to the nation.
Process The stated goal of the process was to develop priorities that would guide research in both the public and private sectors, with decision makers, scientists, and safety and health professionals working in all areas of the occupational safety and health field The authors are with the National Institute for
Occupational Safety and Health, Washington, DC. Requests for reprints should be sent to Linda Rosenstock, MD, MPH, National Institute for Occupational Safety and Health, 200 Independence Ave, SW, Washington, DC 20201. American Journal of Public Health 353
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using the research agenda. Because of the research agenda's national scope, the process focused on achieving openness and inclusiveness via the broadest possible public participation. NIOSH used a consensusbuilding process to determine final research priorities based on input from working groups, written comments, oral comments made at the public and town meetings, and other comments made during deliberations throughout the process (Figure 1). An initial working group of senior scientists from both inside and outside NIOSH developed a master topic list that identified about 50 potential priority areas. Through an iterative process, the top 23 topics were chosen to form the priority list for this working group. The following criteria guided the selection of focused research priorities: seriousness of hazard; number of workers exposed; potential for risk reduction; sufficiency of existing research; expected trend in importance of topic; and probability that research will make a difference. Three external working groups (researchers, stakeholders, and health professionals) used the same technique to add to the master topic list and rank the top priorities. Internal NIOSH working groups generated a single list of priority topics. A public meeting was held soon after the initial working group's meeting to obtain comments on the master topic list, the criteria used to select research priorities, and the proposed public process for developing the research agenda. All interested individuals and organizations that could not attend were encouraged to submit written comments. Three liaison committees-Corporate (chaired by General Motors), Worker (chaired by United Auto Workers), and a broader based stakeholder Outreach committee (chaired by National Safety Council)-increased the range of input into the agenda. Each liaison committee reached out to obtain the broadest possible input into the research agenda by securing the involvement of employers, employees, health officials, health professionals, scientists, and public health, advocacy, scientific, industry, and labor organizations. Town meetings in Boston, Chicago' and Seattle captured input directly from health professionals, researchers, organized labor, workers, consumers, businesses, state and local public health officials, elected officials, and the public at large. The input helped shape the selection of the final research priorities and provided insight into public opinion on occupational safety and health issues. Thirty-one federal agencies or programs with missions related to the safety 354 American Journal of Public Health
Initial working group generates - Proposed framework - Master topic list
- Priority list
Public meeting and NIOSH-wide meeting generate -
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Expanded master topic list Priority list
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7 Other information including - Written comments - Liaison committee input - Town meetings
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Four working groups generate - Expanded master topic list - Priority list
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IPublic review and comment
Revision and finalization of NORA document The document - Describes the process - Identifies master topic list - List priority research areas with brief summary of each
FIGURE 1-The consensus-building process used by the National Institute for Occupational Safety and Health (NIOSH) to develop the National Occupational Research Agenda (NORA).
and health of US citizens (including workers) appointed individuals to serve as agency representatives to the development process. NIOSH also solicited opinions about research priorities through a survey of international occupational safety and health institutes. NIOSH used all of this information to create a draft National Occupational Research Agenda that was widely distributed prior to a final all-partners meeting in Washington, DC. Participants included members of liaison and advisory commit-
tees, agency representatives, working group
members, and interested individuals.
Results NIOSH selected those research priorities endorsed by 3 or more of the 5 working groups (Table 1) for inclusion in the draft final research agenda. In addition to being ranked as priorities by the working groups, most items selected had much March 1998, Vol. 88, No. 3
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TABLE 1 -Top Priorities of the 5 Working Groups Working to Develop a National Occpational Research Agenda Initial Working Group Allergic and irritant dermatitis Asthmaa Behavioral risk factors Biomechanical stressors Cancer Changing economy and workforce Chronic obstructive pulmonary diseasea Construction Critical path methods development Database linkage Depression and anxiety Emerging technologies Engineering and technologic solutions Ethics Exposure assessment methods development Fertility and pregnancy abnormalities Health care employees Health services research Hearing loss Indoor air Infectious disease Inorganic dusts Interactions Intervention research Mixed exposures Motor vehicles Musculoskeletal disorders of the upper extremities Musculoskeletal disorders of the lower back Oils and related derivatives exposure Pesticides Particles 10 micrometers or smaller in size Premature disability Psychological disorders Psychosocial stressors Risk assessment methodology Sector-focused research Service workers Small businessesb Social and economic consequences of work Solvents Stress Surveillance research methods Training professionals Traumatic injuries Violence Vulnerable populations Work organization
x
Internal NIOSH Groupsc
Researchers
Stakeholders
Health Professionals
x x x
x
x x
x x
x x
x x X
x x x
x x
x x x x x
x x x x
x x
x x
x x x x x
x x x x x x
x x
x x x x
x x x
x x
x
x x x
x x
x
x x x x x
x x x x
x x x
x x x x x x x x x x x
x
x
x
x
x x
x x
x
x x
x x
x x
x
x x
x x
x x
x x
x x
x x x x x x x x x x
Note. Topics shown in bold type were selected for the draft National Occupational Research Agenda. NIOSH = National Institute for Occupational Safety and Health. aAsthma and chronic obstructive pulmonary disease are combined in the final research agenda. bEliminated at the final all-partners meeting. cSummary ranking of multiple internal NIOSH groups.
broader support. For example, low-back disorders were identified as a priority by all 5 working groups, by a corporate liaison committee survey, by a survey of international occupational safety and health institute directors, and by numerous individuals and organizations in oral and written comments. March 1998, Vol. 88, No. 3
The final National Occupational Research Agenda, including designation of precise topic headings, reflected input received at a final all-partners meeting, resulting in broad-based support for 21 priority items (Table 2). Three or more of the working groups had identified 17 of the final 21 research areas as top priorities.
Four other topics-cancer research methods, infectious diseases, allergic and irritant dennatitis, and risk assessment methodswere placed in the final research agenda owing to support from one or two working groups, from individuals through written and oral comments, and in discussions at the final all-partners meeting. American Journal of Public Health 355
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TABLE 2-The National Occupational Research Agenda Disease and Injury Allergic and irritant dermatitis Asthma and chronic obstructive pulmonary disease Fertility and pregnancy abnormalities Hearing loss Infectious diseases Low-back disorders Musculoskeletal disorders of the upper extremities Traumatic injuries Work Environment and Workforce Emerging technologies Indoor environment Mixed exposures Organization of work Special populations at risk Research Tools and Approaches Cancer research methods Control technology and personal protective equipment Exposure assessment methods Health services research Intervention effectiveness research Risk assessment methods Social and economic consequences of workplace injury and illness Surveillance research methods
Discussion We have demonstrated that it is possible to reach a broad national consensus on research priorities for occupational safety and health. Efforts to prioritize research have recently been undertaken in a number of settings in the United States and abroad. The United Kingdom,4 the Netherlands,5 and the American Association of Occupational Health Nurses6 have recently set research priorities in occupational medicine. Differences in categorization make it difficult to compare the final research priorities determined by these 3 processes with
356 American Journal of Public Health
the final priorities in the research agenda detailed here. However, 5 of the top 8 health outcome priority areas identified through the United Kingdom process, which used categories most similar to ours, were also identified in the US process. Substantial working group discussion and public comments generated broad concurrence that most priority areas apply to major occupational sectors such as agriculture, construction, mining, the service sector, and small businesses. Sector-specific research in various priority areas is appropriate and is anticipated during implementation of the agenda.
The final list of priorities reflects an attempt to consider both current and emerging research needs. These priorities are not mutually exclusive. Many research topics not included on the agenda remain important and merit effort. Moreover, priorities may evolve over time. The development process resulted in the creation of a broad-based agenda to guide research in both the public and private sectors. In addition to using the agenda to guide its own intramural and extramural efforts, NIOSH expects decision makers, scientists, and professionals working in all areas of occupational safety and health to use the research agenda. NIOSH is now engaged with its partners in implementation and will track the nation's progress on the agenda. LO
References 1. National Occupational Research Agenda. Cincinnati, Ohio: National Institute for Occupational Safety and Health; 1996. DHHS publication NIOSH 96-115. 2. Accident Facts. Itasca, Ill: National Safety Council; 1995. 3. Fullerton H. The 2005 labor force: growing, but slowly. Monthly Labor Rev. 1995;1 18(1 1): 29-44. 4. Harrington JM. Research priorities in occupational medicine: a survey of United Kingdom medical opinion by the Delphi technique. Occup Environ Med. 1994;51:289-294. 5. van der Beek AJ, Frings-Dresen MHW, van Dijk FJH, Houtman ILD. Priorities in occupational health research: a Delphi study in the Netherlands. Occup Environ Med. 1997; 54:504-510. 6. Rogers B. Establishing research priorities in occupational health nursing. Am Assoc Occup Health Nurs J. 1989;37(12).
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