Making the Business Case for Prevention through Design

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PtD logoOne of the best ways to prevent and control occupational injuries, illnesses, and fatalities is to “design out” or minimize hazards and risks early in the design process. The National Institute for Occupational Safety and Health (NIOSH) is leading a National initiative called Prevention through Design (PtD) to promote this concept and highlight its importance in all business decisions. PtD addresses occupational safety and health needs by eliminating hazards and controlling risks to workers throughout the life cycle of work premises, tools, equipment, machinery, substances, and work methods, including their construction, manufacture, use, maintenance and ultimate disposal or re-use.

The reasons for this initiative are compelling. Each year in the U.S., 55,000 people die from work-related injuries and diseases, 294,000 are made sick, and 3.8 million are injured. The annual direct and indirect costs have been estimated to range from $128 billion to $155 billion. Recent studies in Australia indicate that design is a significant contributor in 37% of work-related fatalities; therefore, the successful implementation of prevention through design concepts can have substantial impacts on worker health and safety.

Although there is a long history of designing for safety for the general public, there has been less emphasis on designing for safety for workers. However, many U.S. companies support PtD concepts because they have witnessed first hand the business value of PtD and have developed successful PtD management practices. Several of these companies shared their PtD successes with 225 participants from diverse industry sectors and disciplines at the first Prevention through Design Workshop, held in Washington DC July 9–11, 2007. The proceedings from the Prevention through Design Workshop as well as six peer-reviewed papers demonstrating PtD principles have been included in a special Prevention through Design issue of the Journal of Safety Research.

The meeting participants provided feedback to NIOSH on the goals that should be included in the strategic plan for the Prevention through Design National initiative. Overwhelmingly, workshop participants from all of the National Occupational Research Agenda (NORA) industry sectors requested that NIOSH include goals that will assist them in demonstrating the business case for prevention through design. Specifically, the participants recommended that NIOSH:

  • Research the costs associated with implementing Prevention through Design as well as the long-term return on investment, or ROI;
  • Develop and distribute methods and tools that can be used by engineers, designers, finance professionals and H&S professionals to calculate return on investment for PtD options. Educate these professionals on the practical use of these tools;
  • Understand industry motivations and challenges and develop compelling business cases for PtD that address their concerns;
  • Educate business and finance leaders in the value of PtD to their organizations, not only in terms of human lives, injuries and illnesses but also in terms of improving business processes, productivity and creating workplaces of choice.

Your Feedback Is Important to Us

NIOSH understands that recognizing and defining the business case for PtD will strengthen this national strategy. As we move forward with the PtD initiative we would like to hear more from you, through this blog, about your success in building a business case for Prevention through Design as well as the challenges you have encountered. We would appreciate learning more about the outcomes you have experienced, in terms of reduction in the incidence of serious injuries, illnesses and/or exposures. Additionally, we would like to hear about any improvements in other business metrics, such as quality or productivity, that are the result of including prevention through design elements into the construction, manufacture, use, maintenance, and disposal of materials, equipment, and facilities.

Thank you in advance for your assistance in strengthening the PtD initiative.

—Donna S. Heidel, CIH, and Paul Schulte, Ph.D.

Ms. Heidel, a NIOSH Research Industrial Hygienist, is the Coordinator of the PtD National initiative

Dr. Schulte, Director of NIOSH’s Education and Information Division, is leading the NIOSH PtD National initiative.

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16 comments on “Making the Business Case for Prevention through Design”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    I am very interested in participating in the Prevention Through Design effort. At my organization, the San Francisco Public Utilities Commission (a water and wastewater agency), we have implemented a Safe Design Guidleines program for our capital improvement program. Please add me to the distribution list for PtD.

    I provide ergonomic, safety and loss control consulting services to a variety of industries. More often than not the best ideas for improving work processes come from the people on the manufacturing floor or constructing buildings. These are the professionals who implement and adapt design concepts in the field. They know what does and doesn’t work. Tapping into this resource should be a priority in this process.

    Also, industry would benefit if this concept is a core component of college curriculum for architects and engineers. Then the seed would be planted early on.

    Prevention Through Design’s long term goals should be convincing the corporate world and investors that it is the right thing to do. The focus should not be solely on ROI alone, as is all too often the case.

    What can I do to help?

    Thank you, Mr. Lambert, for your support of the Prevention through Design National initiative, your advice and your willingness to do more.

    At the Prevention through Design workshop last July, participants shared your observation that workers often have the best ideas for improving their work processes. The Rapporteur Report from the Services Sector break-out session (Johnson, J. V., Services Sector, Journal of Safety Research (2008), doi:10.1016/j.jsr.2008.02.003) identifies worker input as “critical in the design of work tasks and equipment,” and names this issue as one of the most compelling ideas to come out of the Service Sector workshop discussions. Our strategic plan will include elements to include workers in “designing out” hazards and risks in their work environments.

    We also intend to work with universities to include Prevention through Design principles in the curricula of engineers and designers by including concepts of safe design into textbooks. In addition, we will continue to educate practicing engineers, designers and H&S professionals to gain immediate impact.

    Based on stakeholder input, we have begun to develop our “strategic areas of focus” for the national initiative. We expect to mature these concepts into a strategic plan by the end of 2008. Once the strategic plan has been developed and goals are established, we will be searching for committed professionals like you to work with us on turning the plan into reality.

    You ask what you can do to help. Please consider supporting one of the NORA Sector Councils in the development of sector-specific goals that include Prevention through Design (contact the NORA coordinator at Please consider contributing an article about your experiences with Prevention through Design to “PtD in Motion,” ( our quarterly newsletter. And please offer your comments to our draft strategic plan when it is posted for public comment on the PtD page of the NIOSH Website at the end of this year.

    This is great stuff, and I look forward to NIOSH’s continued work in this area.

    Also, coming from a engineering background originally, I support whole heartedly Mr. Lambert’s comment that PtD concepts in an engineering curriculum would be invaluable in making our designs for buildings, processes, equipment, products, etc safer (and less costly in the long run). I believe every engineering curriculum should have an entire course dedicated to safety, inlcuding PtD.

    I have been a believer in safety process through designing for years, although this is the first time I have ever read concern about it through the safety and health industry. Many times, I have been through new developments in planned communities where it seemed no forethought went into its development. This inevitably causes the same problems from poor design leading to safety, health, and ergonomic problems for workers, to crowded streets and poor access, easy traffic flow and the ability to make changes in cases of emergencies. If the Archetects, planners, and builders would take the time to ask opinions of the professional employees that have to work within the building, or if they would look at future statistics and talk to futurists of civil planning, then this process could become a recognized discipline in the planning process, our future at work and in planned communities and cities will be better.

    Great initiative and one that should mesh well with the myriad of organizations striving to be “lean.” Since lean focuses on the identification and elimination of waste, the opportunity to eliminate and reduce hazards before they come into the workplace is a natural fit.

    Those of us in the health and safety field well recognize that injury and illness are sources of huge waste to any organization. We need to promote the idea that “you cannot be lean without being safe.”

    We, at the San Francisco Recreation and Park Department, are working to include design elements in our safe work practices to be used by all (planners, designers, field staff). Please include me on your mailing list.

    We are in the process of developing an employee injury reduction plan and I am very interested in your PtD. Please add me to your newsletter list. Thank you.

    I promote the importance of design by helping people to experience it directly. Once a person recognizes how design affects their own performance they can better appreciate the impact it has on others too.

    This is especially helpful when getting people to buy into the value of design on an individual level. It increases attention to design successes and failures and helps people recognize when an environmental factor may be the strain they experience, as opposed to age or arthritis or deconditioning. This work has been helpful when evaluating injuries as well as helping employee health and safety personnel engage management and workers successfully.

    I wonder if there is any way I may be of help in your efforts to promote design solutions in the workplace by helping laypersons find their ‘ergonomic voice’ and help employee health and safety professionals use that approach to enhance earlier reporting and problem solving.

    Thank you for your offer. We are intrigued by your ideas and will contact you directly to discuss further.

    Hello. I am a graduate student at the University of Miami’s School of Epidemiology & Public Health. I read in your article that “PtD addresses occupational safety and health needs by eliminating hazards and controlling risks to workers throughout the life cycle of work premises, tools, equipment, machinery, substances, and work methods, including their construction, manufacture, use, maintenance and ultimate disposal or re-use.” I am currently researching the hazardous risks of formaldehyde; specifically on the construction of the FEMA trailers used for short-term housing for the Hurricane Katrina displaced residents. I am curious to learn more about the exposure limits set by NIOSH (‘permissible exposure limits’ & ‘time-weighted average exposure’) as well as to learn if NIOSH has provided any safety regulatory measures in relation to construction of mobile trailers. In additional, has NIOSH provided any efforts to study formaldehyde-free construction material alternatives that could eventually supplant plywood/particleboard? Thank you for your time.

    The NIOSH recommended exposure limit (REL) for formaldehyde is an 8-hour time-weighted average (TWA) of 0.016 parts per million (ppm). The current REL is based on the lowest quantifiable airborne concentration of formaldehyde using NIOSH method 3500. As you will see if you explore the links below, NIOSH considers formaldehyde to be a potential occupational carcinogen. NIOSH is not aware of any data that describe a safe exposure concentration for carcinogens, so NIOSH recommends that occupational formaldehyde exposure should be controlled to the lowest feasible concentration. In order to establish a numerical value for the formaldehyde REL, NIOSH used the lowest quantifiable concentration for formaldehyde using NIOSH method 3500. The REL of 0.016 ppm represents the lowest airborne formaldehyde concentration for 8-hours of sampling that could be quantified using NIOSH method 3500.

    Earlier NIOSH documents on formaldehyde include the following:

    Criteria Document for Formaldehyde (Criteria for a Recommended Standard: Occupational Exposure to Formaldehyde [December, 1976])
    Current Intelligence Bulletin 34 (Formaldehyde: Evidence of Carcinogenicity [April, 1981])
    ◦NIOSH Technical Report, Industrial Hygiene Characterization for Urea Formaldehyde and Polyurethane Foam Insulation [April, 1983]), NIOSH Publication 83-108
    Note: This document is not available in electronic format on our website.
    It is important to note that NIOSH RELs are for workers who are potentially exposed to toxic substances for up to 10 hours a day (8-hours a day in the case of formaldehyde) for up to 40 hours per week. The RELs are not intended to describe safe or acceptable concentrations for residences. The duration of potential exposure in one’s residence would be expected to be greater than 8 hours per day and greater than 40 hours per week. In addition, NIOSH RELs would not be suitably applied to the potential exposure of children, the elderly, or other sensitive populations. NIOSH RELs are intended to protect workers from potential exposure to toxic substances.

    The NIOSH Technical Report (publication 83-108) mentioned above addresses the issue of formaldehyde exposure due to the use of formaldehyde in insulation. However, the research supporting that report dealt with worker exposures at facilities that used formaldehyde-based products. NIOSH does not have specific recommendations for formaldehyde-free construction material alternatives at this time.

    For recommendations and/or guidelines for residential or other non-occupational exposure you would need to consult with other agencies.

    ◦The National Center for Environmental Health (NCEH) addresses public health issues outside of the workplace, including a study of FEMA-provided trailers following Hurricane Katrina.
    ◦The U.S. Environmental Protection Agency (EPA) deals with environmental exposure to toxic substance, including formaldehyde.
    NIOSH provides recommendations for workplace exposure to formaldehyde. If you have any questions about the occupational guidelines I outlined above please respond so I can clarify. For non-occupational settings, including the FEMA-supplied trailers you asked about, please contact NCEH. You can reach them by telephone at 1-800-232-4636.

    I am a physician-researcher and an MPH graduate. I am interested in PtD, and specifically on guidelines for setting computer keyboard at the desk. In my clinical career I have encountered numerous healthcare employees who suffered from carpal-tunnel syndrom (CTS). Although there are several risk factors for CTS, most of the employees I treated used keyboards placed on an under-the-counter trays. I am interested to know more about guidelines regarding: 1. design of the keyboard; 2. keyboard placement at the desk; 3. placement of the keyboard tray under the counter. Also, are there any guidelines for minimum depth of the desk. Are any of these guidelines defined as ‘mandatory requirements’? I respectfully thank you for any information.

    The best guidelines for configuration of computer workstations would be the latest ANSI 100 guidelines released by the Human Factors and Ergonomics Society in the last year or so. None of the guidelines are mandatory in this country, but as European countries do have regulations on some of these things, the manufacturers in the U.S. tend to also comply with the European standards since they sell in Europe also.

    The NIOSH document Alternative Keyboards summarizes the results of NIOSH research on alternative keyboards. The study compared two alternative keyboards with a conventional keyboard for their usefulness in preventing or alleviating musculoskeletal problems. The subjects were employees at a large insurance company, and they used their assigned keyboard for two years. We found that the fixed split keyboard (like the Microsoft Natural) seemed to provide the most benefits as compared with the conventional keyboard and a split adjustable keyboard. The number of reported musculoskeletal symptoms were significantly reduced in all body parts measured (neck, shoulders, arms, elbows, wrists) during the first year, and those reductions were maintained through the second year. It also had a preventative effect—of those individuals with no symptoms at the beginning of the study, significantly more remained symptom free in the fixed split keyboard condition than in the other two. The split adjustable keyboard was beneficial for symptom reduction to the extent that people used the adjustments.

    It is true that Australian safety authorities have done quite some pioneering work in safety through design. This new push by NIOSH will certainly help the cause a lot for further improvements in safety standards in industrial designs all over the world.

    Basically it should be more of Insurance networks that should take up these PtD development effort because the ultimate advantage for foolproof designing in the industry will be directly for them.

    A set of standards for PtD will also have to be deveoped where needed and engineering colleges and polytechnics will also have to include the PtD concepts and practices in theit curriculums.

    A sustained campaign by all concerned is necessary to ensure “Healthy Profit for ALL.”

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Page last reviewed: November 23, 2016
Page last updated: November 23, 2016