Preparing for the Future: NIOSH Applications of Strategic Foresight

Posted on by Jessica MK Streit, MS, PhD, CHES® and Sarah A Felknor, MS, DrPH


Change is all around us, and it is happening more intensely and more rapidly than ever before. NIOSH recognizes that many of the social, technological, economic, environmental, and political changes we experience can impact the design of work and the lives of working people.1 We also understand the benefit of proactively preparing for future changes and the implications they may bring for the practice of occupational safety and health (OSH).

Since 2020, NIOSH has been engaged in the practice of strategic foresight to better understand, prepare for, and influence the future.2 Strategic foresight includes a series of activities that help us identify, assess, and monitor early signals of key changes that may arrive in the future.3 The purpose of strategic foresight is not to accurately predict the future. Instead, the activities work together to help us more clearly and creatively consider what might happen if certain changes arrive and impact OSH in the near-, mid-, and far-term future.4

To date, NIOSH has completed two strategic foresight projects to expand our futures thinking and readiness. In early 2023, we published the results of the inaugural NIOSH strategic foresight project, which explored four possible futures and their implications for OSH research and service.5 This project identified eight evidence-based drivers of change that will likely impact or shape the future of OSH:

  • Advanced technologies
  • Climate change
  • Data security
  • Generating new knowledge
  • Social credit and trustworthiness
  • Work arrangements
  • Virtual work
  • Workforce demographic shifts

These drivers were combined in different ways to develop scenarios, or stories, about four possible futures for OSH. The stories were then analyzed to identify strategic focus areas OSH should consider to increase the field’s readiness for the future.

In late 2023, NIOSH published the results of a second strategic foresight project. This project was conducted in response to the COVID-19 pandemic and sought to identify how we might best prepare the OSH workforce for future disruptions.6 We used nine critical and unanswered questions about the future to develop four unique scenarios for disruptive futures. By analyzing those scenarios, we identified the following critical actions that might better position OSH researchers and practitioners to effectively respond to a wide variety of possible future disruptions:

  • Develop effective communication and partnerships between information technology specialists and researchers.
  • Bring OSH to individual workers through our research and communications.
  • Build public trust in OSH leaders while developing a strategy to stop the spread of mis- and dis-information.

We invite you to use the links provided above to read our papers to learn more about these two important NIOSH strategic foresight projects. We also invite you to contribute to the OSH futures conversation. What issues and trends do you think will shape the future of OSH? What can OSH researchers and practitioners start doing now to be better prepared for future disruptions when they arrive? Comment below to share your thoughts.

Sarah A Felknor, MS, DrPH, is Associate Director for Research Integration at NIOSH.

Jessica MK Streit, MS, PhD, CHES® is Deputy Director of the Office of Research Integration at NIOSH.



1 Schulte PA, Delclos G, Felknor S, Chosewood LC. Toward an Expanded Focus for Occupational Safety and Health: A Commentary. International Journal of Environmental Research and Public Health. 2019;16(24):4946. doi:10.3390/ijerph16244946

2 Streit JMK, Felknor SA, Edwards NT, Howard J. Leveraging Strategic Foresight to Advance Worker Safety, Health, and Well-Being. International Journal of Environmental Research and Public Health. 2021;18(16):8477. doi:10.3390/ijerph18168477

3 Bishop PC, Hines A. Teaching About the Future. Palgrave Macmillan; 2012.

4 Futures School. Can We Count on the Future? Accessed 19 January 2023,

5 Felknor SA, Streit JMK, Edwards NT, Howard J. Four Futures for Occupational Safety and Health. International Journal of Environmental Research and Public Health. 2023;20(5):4333. doi: 10.3390/ijerph20054333.

6 Streit JMK, Felknor SA, Edwards NT, Caruso DL, Howard J. Preparing the occupational safety and health workforce for future disruptions. Am J Ind Med. 2023 Nov 14. doi: 10.1002/ajim.23548. Online ahead of print.

Posted on by Jessica MK Streit, MS, PhD, CHES® and Sarah A Felknor, MS, DrPH

3 comments on “Preparing for the Future: NIOSH Applications of Strategic Foresight”

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    Thank you, Dr. Streit, for this vision for the future of worker health and safety. I appreciate the opportunity to share my perspective as a healthcare worker, as an older worker, and as someone who now spends my work hours trying to make the bedside a safer place for the next generation of healthcare workers.
    I am sorry to say that I spent many years contributing to an unsafe and unhealthy workplace. As a nurse in emergency and critical care medicine, I considered it routine to go through 12-hour shifts without any real break. We ate on the run like toddlers, grabbing bites here and there to make it to shift change. We joked about our 13-hour bladders, but we weren’t really kidding. We created a workplace culture that accepted unsafe staffing, unfair work practices, and the exploitation of people like me, who were eager to be invaluable.
    I have helped children make it to another birthday, get adults successfully weaned from the ventilator, and helped others die with as little pain and fear, as much dignity, as we could make possible. I have cried in locker rooms, stairwells, and way too many trips home. I have also been hit, bitten, threatened, and exposed to pathogens too numerous to count. I have bathed and turned patients three times my size and lifted many from chair to bed who were sure they could stand on their own. The sheer physicality of bedside care is staggering. Patient safety has been emphasized and championed. Staff safety has not.
    I also didn’t know what I didn’t know. I had been a nurse for 28 years when I took care of the first Ebola patient. Twenty-eight years at the bedside and I never knew there were different levels of gowns. I knew nothing about air exchanges, permeability of textiles, or the fluid resistance of masks. Fit testing was, and is, rare, and I didn’t know that was a problem.
    I see the staff shortages. I understand leaving the bedside. I am not surprised enrollment in nursing schools is down. I also hear the complaints about people just not being willing to work these days, and I think that is just not true. We should not have worked the way we did. We should not have tolerated the staffing, the hours, the injuries, illnesses, or threats that we did. Healthcare is an industry that will never be remote or outsourced, but it must be made healthier and safer. As our population ages, more workers will be needed in both acute and long-term care, and we don’t have them. We desperately need a true assessment of the risks these workers face from injuries, ergonomics, noxious and infectious exposures, workplace violence, stress and burn-out. We need a “culture of safety” to mean something for workers, not just patients.
    Thank you again for sharing your strategic vision and the challenges of your agency. I know without improvements in funding, little progress can be made, so I hope that others will understand the critical needs there are to advance worker health and safety.

    Thank you for all you do as a nurse and for sharing your heartfelt experience. Healthcare workers play a critical role in the health of society. Your personal experience is an example of how nurses who serve on the frontlines of healthcare delivery are routinely at risk for exposure to a range of hazards, both physical and those causing stress and burnout. Furthermore, the burden of occupational injury and illness for healthcare workers, including nurses, is likely to increase. Several healthcare occupations are projected to be among the fastest growing in coming years, including in settings such as home health care, increasing the number of workers at risk. Our aging population will likely increase the workload on healthcare workers. This, combined with budgetary stresses, has the potential to exacerbate stress and burnout. Increasing prevalence of obesity in the population will increase musculoskeletal hazards related to patient handling. New infectious agents will continue to emerge. These and other changes mean that occupational safety and health challenges faced by healthcare workers will only increase in coming years.

    We agree that actions at the organizational level, including development and promotion of strong organizational safety culture, are needed now and in the future to protect the safety and health of nurses and other healthcare workers. NIOSH recently released a free Safety Culture in Healthcare Settings training course. This course is designed to improve healthcare worker knowledge about work-related hazards and address organizational strategies to promote a safe and healthy work environment. NIOSH also developed the Impact Wellbeing campaign to provide healthcare leaders with the tools to build an environment that supports healthcare worker well-being. The National Academy of Medicine (NAM) Well-Being initiative provides healthcare systems with seven priority areas needed to develop a healthy and equitable healthcare workforce. Under each priority, the initiative lists goals and actors needed for success at each level of healthcare. Much work is needed to make the healthcare profession safer and healthier for workers. Strategic foresight is just one tool that can help us think about, prepare for, and influence movement toward a preferred future for healthcare workers. Thank you for contributing to this important conversation!

    Insightful discussion! Your exploration of NIOSH’s strategic foresight applications in preparing for the future is enlightening. Anticipating and addressing emerging occupational safety and health challenges is crucial for creating a resilient workforce. Thanks for highlighting the importance of proactive measures in safeguarding workers’ well-being!

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Page last reviewed: January 12, 2024
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