State-based Occupational Safety and Health Surveillance

How did NIOSH and its partners find out that dusty work conditions were putting highway repair workers at risk for developing a potentially severe lung disease called silicosis? The answer: state-based occupational health surveillance. Occupational health surveillance, which is the tracking of occupational injuries, illnesses, hazards and exposures for the purposes of improving worker safety and health and monitoring trends and progress over time, plays a vital role in worker protection. Surveillance data are used by the safety and health community to inform real-world safety and health prevention efforts and focus resources to protect workers. For example, New Jersey’s identification of silicosis in road construction workers led to incorporation of protective language into the New Jersey Department of Transportation’s road repair contracts. This language directs contractors to establish an approved Silica Safety and Health Program when airborne crystalline silica exceeds the Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL).* Given its significance, Dr. Tom Frieden, Director, Centers for Disease Control and Prevention (CDC), has designated enhancing public health surveillance as a priority agency objective.

Tracking occupational injuries, illnesses, hazards and exposures has always been integral to the NIOSH mission. NIOSH surveillance complements important statistical or surveillance activities carried out by other Federal agencies (including the Bureau of Labor Statistics, the Occupational Safety and Health Administration, the Mine Safety and Health Administration, and the National Center for Health Statistics), state governments, and private sector groups, such as employers. Data collected by all of these sources are essential for successful nationwide occupational health surveillance. States have a vital role to play in this endeavor.

Surveillance at NIOSH involves activities that are both intramural (within NIOSH) and extramural (outside of NIOSH). Within NIOSH, we focus on surveillance and collect and analyze data in a variety of occupational areas including respiratory diseases, non-respiratory diseases (e.g., dermatitis, cancer, lead, and pesticide poisoning), mining, commercial aviation, commercial fishing, and occupational injuries and fatalities. (See Surveillance Publications and Other Resources.)

Extramurally, through cooperative agreements, NIOSH supports occupational health surveillance efforts in state health departments and other agencies. These cooperative agreements provide financial and technical resources to build occupational health capacity in the states and to support more in-depth surveillance programs in areas of importance to the states. Capacity building, at a minimum, requires the collection of Occupational Health Indicators (OHI). Created collaboratively by the states and NIOSH, OHI establish a baseline view of state-specific occupational health conditions from which programs are able to track trends.

In addition to the OHI, some states have established expanded programs that focus surveillance activities on one or more health conditions, injuries, or worker populations of special interest or of high priority to the state. These focused efforts involve more in-depth data acquisition, analysis, and dissemination using existing or new data and/or new case finding and case follow-up. Importantly, these focused efforts also provide opportunities to develop new approaches to interventions to reduce exposures, illness and injury. Examples of priority focus areas include work-related asthma (WRA) surveillance, the Sentinel Event Notification System for Occupational Risks-Pesticides (SENSOR-Pesticides), and the Fatality Assessment and Control Evaluation (FACE) Program.

Ideally, all states would have the core capacity to conduct surveillance of occupational injuries, diseases, and hazards that would contribute to state and local prevention efforts and to national data. In addition, states would have the ability to conduct focused, in-depth surveillance, follow-up investigations and intervention for selected, targeted diseases, injuries or hazards that they find to be important in their state.

Given inevitable resource constraints, NIOSH recognizes that it is not realistic to expect all states to conduct in-depth surveillance for all occupational conditions at the present time. To assist states, a recent publication, Guidelines for Minimum and Comprehensive State-Based Public Health Activities in Occupational Safety and Health, prepared by the Council of State and Territorial Epidemiologists (CSTE) and NIOSH, provides guidelines for states with minimal resources to address occupational safety and health issues in their states.

NIOSH state-based programs have demonstrated numerous successes in preventing work-related injury and disease. Examples include:

• In Massachusetts and Michigan, utilizing their respective state surveillance systems, new substances that cause WRA were identified, confirmed, and published in peer-reviewed literature.
• In Oregon and Massachusetts, child labor laws were changed to reduce teen injuries by controlling working hours and requiring additional supervision.
• In Washington and California, heat illness protection standards for outdoor workers were developed to prevent deaths from heat stroke.
• New Jersey and California adopted masonry “dry cutting laws” to reduce worker exposure to crystalline silica dust.
• In Wisconsin, the state has succeeded in reducing the number of workers with high blood lead levels by 90% since 1988.

The National Institute for Occupational Safety and Health is interested in learning about the experiences of others who have expertise in this area or are currently working to improve state-based occupational safety and health surveillance. Please share your story.

Dr. Boudreau is the Deputy Director of the NIOSH Western States Office

Ms. Dalsey is a Health Communications Specialist at the NIOSH Western States Office

Mr. Kiefer is the Director of the NIOSH Western States Office

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