A Smarter National
Surveillance System
for Occupational
Safety and Health
in the 21st Century

Committee on Developing a Smarter National Surveillance System for
Occupational Safety and Health in the 21st Century

Board on Agriculture and Natural Resources
Division on Earth and Life Studies

Committee on National Statistics
Division of Behavioral and Social Sciences and Education

Board on Health Sciences Policy
Health and Medicine Division

A Consensus Study Report of

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by Grant 200-2011-38807 from the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Grant HHSP233201400020B from the Department of Labor, Bureau of Labor Statistics, and Grant DOL-OPS-16-P-000193 from Department of Labor, Occupational Safety and Health Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-46299-0
International Standard Book Number-10: 0-309-46299-1
Digital Object Identifier: https://doi.org/10.17226/24835

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24835.

COMMITTEE ON DEVELOPING A SMARTER NATIONAL SURVEILLANCE SYSTEM FOR OCCUPATIONAL SAFETY AND HEALTH IN THE 21ST CENTURY

Chair

EDWARD H. SHORTLIFFE, NAM,¹ Arizona State University, Tempe

Members

DAVID K. BONAUTO, Washington State Department of Labor and Industries, Tumwater

DAVID L. BUCKERIDGE, McGill University, Montreal, Quebec, Canada

STEVEN B. COHEN, RTI International, Washington, DC

LETITIA K. DAVIS, Massachusetts Department of Public Health, Boston

GERALD F. KOMINSKI, University of California, Los Angeles

SCOTT A. MUGNO, FedEx Ground, Moon Township, PA

KENNETH D. ROSENMAN, Michigan State University, East Lansing

NOAH S. SEIXAS, University of Washington School of Public Health, Seattle

MARGARET M. SEMINARIO, AFL-CIO, Washington, DC

GLENN M. SHOR, California Department of Industrial Relations, Oakland

DAVID H. WEGMAN, University of Massachusetts Lowell

Staff

PEGGY TSAI YIH, Study Director, Board on Agriculture and Natural Resources

JENNA BRISCOE, Research Assistant, Board on Agriculture and Natural Resources

CATHY LIVERMAN, Scholar, Board on Health Sciences Policy

MICHAEL COHEN, Senior Program Officer, Committee on National Statistics

YASMIN ROMITTI, Research Associate, Board on Atmospheric Sciences and Climate, Board on Earth Sciences and Resources

ROBIN SCHOEN, Director, Board on Agriculture and Natural Resources

___________________

¹ National Academy of Medicine.

BOARD ON AGRICULTURE AND NATURAL RESOURCES

Chair

CHARLES W. RICE, Kansas State University, Manhattan

Members

SHANE C. BURGESS, University of Arizona, Tucson

SUSAN CAPALBO, Oregon State University, Corvallis

GAIL CZARNECKI-MAULDEN, Nestle Purina PetCare, St. Louis, MO

GEBISA EJETA, Purdue University, West Lafayette, IN

JAMES S. FAMIGLIETTI, California Institute of Technology, Pasadena

FRED GOULD, NAS,¹ North Carolina State University, Raleigh

DOUGLAS B. JACKSON-SMITH, Ohio State University, Wooster

MOLLY M. JAHN, University of Wisconsin–Madison

ROBBIN S. JOHNSON, Cargill Foundation, Wayzata, MN

JAMES W. JONES, NAE,² University of Florida, Gainesville

A.G. KAWAMURA, Solutions from the Land, Washington, DC

STEPHEN S. KELLEY, North Carolina State University, Raleigh

JULIA L. KORNEGAY, North Carolina State University, Raleigh

JAN E. LEACH, Colorado State University, Fort Collins

JILL J. MCCLUSKEY, Washington State University, Richland

KAREN I. PLAUT, Purdue University, West Lafayette, IN

JIM E. RIVIERE, NAM,³ Kansas State University, Manhattan

Staff

ROBIN A. SCHOEN, Director

___________________

¹ National Academy of Sciences.

² National Academy of Engineering.

³ National Academy of Medicine.

COMMITTEE ON NATIONAL STATISTICS

Chair

ROBERT M. GROVES, NAS,¹ NAM,² Georgetown University, Washington, DC

Members

FRANCINE BLAU, Cornell University, Ithaca, NY

MARY ELLEN BOCK, Purdue University, West Lafayette, IN

ANNE E. CASE, NAM,² Princeton University, Princeton, NJ

MICHAEL CHERNEW, NAM,² Harvard Medical School, Boston, MA

JANET CURRIE, NAM,² Princeton University, Princeton, NJ

DONALD A. DILLMAN, Washington State University, Pullman

CONSTANTINE GATSONIS, Brown University, Providence, RI

JAMES S. HOUSE, NAM,² University of Michigan, Ann Arbor

THOMAS L. MESENBOURG, Retired; formerly, U.S. Census Bureau

SARAH M. NUSSER, Iowa State University, Ames

COLM A. O’MUIRCHEARTAIGH, University of Chicago, IL

JEROME P. REITER, Duke University, Durham, NC

ROBERTO RIGOBON, Massachusetts Institute of Technology, Cambridge

JUDITH A. SELTZER, University of California, Los Angeles

EDWARD H. SHORTLIFFE, NAM,² Arizona State University, Tempe

Staff

BRIAN A. HARRIS-KOJETIN, Director

___________________

¹ National Academy of Sciences.

² National Academy of Medicine.

BOARD ON HEALTH SCIENCES POLICY

Chair

JEFFREY KAHN, Johns Hopkins University, Baltimore, MD

Members

WYLIE BURKE, NAM,¹ University of Washington, Seattle

R. A. CHARO, NAM,¹ University of Wisconsin–Madison

LINDA H. CLEVER, NAM,¹ California Pacific Medical Center, San Francisco

BARRY S. COLLER, NAS,² NAM,¹ The Rockefeller University, New York, NY

BERNARD A. HARRIS, Jr., Vesalius Ventures, Houston, TX

MARTHA N. HILL, NAM,¹ Johns Hopkins University School of Nursing, Baltimore, MD

STEVEN E. HYMAN, NAM,¹ Broad Institute, Cambridge, MA

ALAN M. JETTE, NAM,¹ Boston University School of Public Health, MA

PATRICIA A. KING, NAM,¹ Georgetown University Law Center, Washington, DC

STORY C. LANDIS, NAM,¹ National Institute of Neurological Disorders and Stroke, Bethesda, MD

HARRY T. ORR, NAM,¹ University of Minnesota, Minneapolis

UMAIR A. SHAH, Harris County Public Health and Environmental Services, Houston, TX

ROBYN STONE, NAM,¹ LeadingAge, Washington, DC

SHARON TERRY, Genetic Alliance, Washington, DC

Staff

ANDREW POPE, Director

___________________

¹ National Academy of Medicine.

² National Academy of Sciences.

Preface

Many threats to health and well-being occur in the workplace. Understanding those risks to prevent injury, illness, or even fatal incidents is an important function of society. We expect interested parties to measure the frequency of incidents, to determine causes when possible, and to offer preventive measures to stakeholders so that the work environment becomes safer and healthier over time. This all needs to occur in the context of a changing workforce and the evolution of the nature of work, suggesting that new kinds of threats to health and well-being can occur, even as others are being optimally managed or are becoming less pertinent as jobs or industries fade away and are replaced by others. In the United States, both the federal and state governments are heavily involved in monitoring occupational health and safety and developing policies or interventions intended to mitigate work-related injuries and disease. At the federal level, principal agencies involved with such work include the Bureau of Labor Statistics (BLS), the National Institute for Occupational Safety and Health (NIOSH, a division of the Centers for Disease Control and Prevention), and the Occupational Safety and Health Administration (OSHA).

Many of the challenges faced by these agencies relate to gathering the information necessary to measure and assess the frequency of workplace-related injuries and illnesses so that suitable policies and interventions can be proposed. In 1987, the agencies sought the advice of the National Research Council regarding surveillance for occupational safety and health (OSH). The resulting report, Counting Injuries and Illnesses in the Workplace: Proposals for a Better System, provided seminal guidance on how to

organize and enhance the U.S. programs for OSH surveillance. In the subsequent 30 years, despite many efforts developed in response to the 1987 recommendations, both the technology for surveillance and the nature of work have evolved considerably.

In the intervening years, the National Academies of Sciences, Engineering, and Medicine have been involved in many workshops, studies, and reports that have touched on issues related to occupational safety and health. For example, from 2006-2009, NIOSH requested that the National Academies undertake programmatic reviews of some NIOSH research programs. The need for better surveillance was a theme that emerged from each of those reviews. In 2014, sequestration forced federal agencies to re-examine their programs as they were asked to address their agency’s mission more effectively but with fewer resources. More recently, the director of NIOSH again approached the National Academies to assist them and other agencies to come up with creative solutions across many categories of occupation for surveillance and monitoring, and to be able to do so in a “smarter” and cost-effective manner.

THE COMMITTEE AND ITS CHARGE

To obtain forward-looking advice, NIOSH, BLS, and OSHA jointly asked the National Academies to conduct a study in response to the need for a more coordinated, cost-effective set of approaches for occupational safety and health surveillance in the United States. Our study committee has addressed this task, gathering information about the strengths and limitations of existing national and state approaches, reviewing a variety of methodologies and technologies that might be applied usefully and cost-effectively. The resulting report is a product of more than a year of deliberations, offering the consensus advice of a diverse set of individuals who have studied the issues carefully and learned a great deal in the process. We have formulated a future vision that is intended to assist all stakeholders, including the agencies, as they seek to improve occupational safety and health in the coming years.

Some of the committee members are career professionals who have worked in the area of occupational safety and health, both at state and national levels. Others brought complementary skill sets that were pertinent to the committee’s charge: epidemiology, occupational medicine, survey methodologies, biomedical informatics, data analytics, economics, cost-benefit analysis, and workplace organization and management. I was honored to help lead this diverse group of talented professionals, all of whom contributed enthusiastically and tirelessly to the discussions, deliberations, and the final report. We quickly realized that the topic is very large

and complex, with nuances that many of us had not anticipated when we joined the study group. Our knowledge of the topic was broadened, in the first three meetings and several conference calls during the early months, by informative sessions with invited experts who helped us to address the task. Large portions of the early meetings were open, with members of the public invited to attend and to provide comments.

We turned, for our final two meetings, to private deliberations, reviewing all that we had learned in order to develop a shared vision of what was possible and seeking to offer recommendations that were responsive to the committee’s charge and were actionable. Our task was further influenced by a change in government during the study period, leading to uncertainties about future budgets and focus for the pertinent federal agencies.

ACKNOWLEDGMENTS

This report benefited from the combined talents of many people, including those who were directly associated with the project and many who were not. First, thanks are due to members of the committee itself, all of whom maintained a high level of enthusiasm, energy, and dedication over the course of the project. Committee members found time for five project meetings, for multiple conference calls, and for drafting portions of the text despite their many other responsibilities and commitments.

Many other people volunteered their time and expertise to help the committee to understand better the ways in which OSH surveillance might be strengthened and modernized in ways that would be acceptable, and even inspirational, for all stakeholders. The information gathered during these interactions proved invaluable to the committee’s deliberations and forms the backbone of this report. Those who provided us with briefings are summarized in Appendix C to the report. We thank them all for their important contributions.

The committee members, many of whom have served on previous study groups, stand in awe of the remarkable, patient work of the National Academies staff in supporting its deliberations over the course of this study. Staff members kept the committee on track and helped its members to put their ideas and analyses into coherent prose.

Our thanks, finally, to representatives of the sponsoring agencies who worked closely with us when we needed information. Not only did they offer insights in the public sessions during the first committee meetings, but they responded fully and promptly to information requests that we submitted to them throughout the study. The committee accordingly hopes that its findings and recommendations will assist the agencies in moving forward

to assure the design and implementation of a “smarter” OSH surveillance system for the 21st century.

Edward H. Shortliffe, Chair
Committee on Developing a “Smarter” National Surveillance
System for Occupational Safety and Health in the 21st Century

Acknowledgments

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

James J. Cimino, University of Alabama School of Medicine

Eric Frumin, Change to Win

Erica Groshen, Cornell University

James S. House, University of Michigan

Joel Kaufman, University of Washington

Anthony LaMontagne, Deakin University, Australia

Harold Lehmann, Johns Hopkins School of Medicine

Virginia Lesser, Oregon State Department of Statistics

Sharon Levine, Kaiser Permanente

Barbara Materna, California Department of Public Health

Carrie A. Redlich, Yale University

John W. Ruser, Workers Compensation Research Institute

Gregory R. Wagner, Harvard School of Public Health

Marc Younis, ExxonMobil

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by Dr. Mark R. Cullen, Stanford University, and Dr. James A. Merchant, the University of Iowa. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Contents

SUMMARY

1 INTRODUCTION

Background

Purpose of This Study

Key Terms and Definitions

Organization of the Report

References

2 BUILDING A “SMARTER” NATIONAL SURVEILLANCE SYSTEM

Guiding Principles

Objectives

An Ideal Surveillance System

Tools and Sources for Data Collection

Data Curation

Barriers to a Smarter Surveillance System

References

3 OVERVIEW OF AGENCIES AND STAKEHOLDERS

Bureau of Labor Statistics

Occupational Safety Health Administration

National Institute for Occupational Safety and Health

Mine Safety and Health Administration

Other Federal Agencies

State Agencies

Employees, Employers, and Other Stakeholders

Federal and State Agency Coordination, Collaboration, Information Exchange, and Public Engagement on OSH Surveillance

Updates of the Recommendations of the 1987 Report

Summary and Conclusions

References

4 CURRENT STATUS OF FEDERAL AND STATE PROGRAMS AND CROSS-CUTTING ISSUES

Introduction

Surveillance of Fatal Occupational Injuries

Surveillance of Nonfatal Occupational Injuries

Occupational Disease Surveillance

Occupational Hazard and Exposure Surveillance

Cross-cutting Issues

Summary

References

5 INTERNATIONAL APPROACHES TO OCCUPATIONAL HEALTH SURVEILLANCE

Occupational Fatalities

Occupational Injuries

Occupational Disease

Work Hazards or Exposures

References

6 PROMISING DEVELOPMENTS AND TECHNOLOGIES

Introduction

Implementing a Household Survey

Electronic Health Records

Coding of Occupational Data

Electronic Employer-Based Reporting of Occupational Injury and Illness

Mobilizing Use of Workers’ Compensation Data

Leveraging Existing Surveys and Data Systems

Improving Occupational Hazard and Exposure Surveillance

Summary

References

7 KEY ACTIONS TO MOVE FORWARD WITH AN IDEAL NATIONAL OCCUPATIONAL SAFETY AND HEALTH SURVEILLANCE SYSTEM

Set Forth a Clear Rationale and Prioritization for OSH Surveillance

Coordinate Surveillance Strategies and Operations Among Key Agencies, Organizations, and Stakeholders

Use Information Technology Effectively

Enhance Training and Support for OSH Surveillance Practitioners

References

8 NEXT STEPS FOR IMPROVING WORKER SAFETY AND HEALTH THROUGH A SMARTER OCCUPATIONAL SURVEILLANCE SYSTEM

Vision for a Smarter System

Action Steps – Report Recommendations

Concluding Remarks

References

APPENDIXES

A RECOMMENDATIONS

B BIOGRAPHICAL SKETCHES OF COMMITTEE MEMBERS

C OPEN SESSION MEETING AGENDAS

D UPDATES ON RECOMMENDATIONS FROM THE 1987 NATIONAL RESEARCH COUNCIL REPORT COUNTING INJURIES AND ILLNESSES IN THE WORKPLACE: PROPOSALS FOR A BETTER SYSTEM

E OSHA FORM 300 AND RELATED PAGES

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Select Acronyms and Abbreviations

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