Denny Dobbin, MSc Occ Hyg (London), CIH (ret.)

Disclosures

May 31, 2005

Introduction

The National Institute for Occupational Safety and Health (NIOSH) is currently the nation's premier group for understanding the scientific basis for preventing work-related injury and illness. Congress created it in 1970, intending it to have the visibility, funding, and stature to serve as a national focus for occupational safety and health research and training in the United States.

In a recent reorganization plan, the Centers for Disease Control and Prevention (CDC) proposed placing NIOSH into an organizational 'cluster' along with the National Center for Environmental Health, the National Center for Injury Control and Prevention, and the Agency for Toxic Substance Disease Registries. The purpose of the reorganization, called the Futures Initiative,[1] is ostensibly to reform the basic approach to public health to a "stage-of-life" model, while reducing the number of those who report to CDC's Director.

The CDC reorganization proposal led to universal opposition across all sectors of the occupational safety and health professional community. Management, labor, academics, former assistant secretaries of federal regulatory agencies, and all the living former directors of NIOSH, trade and professional associations spoke with one voice against this change. The unanimity of opinion within the occupational health and safety field is unprecedented, as the vested interests are rarely in agreement on anything. Yet in this case, the unified outcry led to language in the 2005 appropriations legislation directing CDC to continue NIOSH as it was within CDC.

But more importantly, opposition to downgrading NIOSH led to discussions about the appropriateness of NIOSH being a part of CDC at all. This led to further discussions of where it would best fit within the federal bureaucracy.

So where would NIOSH best fit? For those in public health not familiar with NIOSH or the current quest for placement, it's imperative to briefly review organizational history and address some key questions.

The predecessor of NIOSH was the Bureau of Occupational Safety and Health (BOSH) located in the Environmental Control Administration, an organization of the US Public Health Service. The Environmental Control Administration was conceived in the late 1960s to combine occupational, clean air, clean water, radiological health, and other environmentally related programs.

In 1970, the Congress passed a flurry of laws dealing with each of these areas separately. At that time, the Environmental Protection Agency and Occupational Safety and Health Administration (OSHA) were created as regulatory agencies for addressing environmental and occupational health issues. OSHA provided the first national system for policing occupational safety and health hazards. An Assistant Secretary for OSHA was politically appointed to serve within the US Department of Labor.

NIOSH was born in this milieu, for the specific purpose of conducting research that would lead to better prevention of work-related injury and illness. As an independent source of health-related research in the workplace, it was to conduct industry-wide studies to identify illness and injury that might otherwise escape notice. It was to conduct health hazard evaluations at the request of workers and employers and, independent of the complaints to enforcement agencies, develop criteria for standards based on scientific data. In turn, these criteria would be transmitted to OSHA for consideration in their standard-setting process. It was also to develop a registry of toxic effects of chemicals and have unique roles in assuring an adequate supply of health and safety professionals in the workplace.

The Occupational Safety and Health Act of 1970[2] directly delegated authority, through the Secretary of Health, Education and Welfare (DHEW) (now the Department of Health and Human Services [DHHS]), to the Director of NIOSH. In turn, the Director of NIOSH transmits recommendations based on research findings to the Assistant Secretary of OSHA and the Assistant Secretary of Mine Safety and Health (MSHA) in the Department of Labor regarding the best ways to protect workers from workplace hazards.

It was no mistake that Congress used 'National Institute' in naming NIOSH, thus sending the message that directed research was essential for improving worker health and safety. As the research arm, NIOSH was to be kept away from overt political influence. Congress very specifically placed NIOSH in the DHEW (now DHHS), to keep it separate and independent from the Department of Labor, providing a check and balance to the highly political workplace-enforcement environment. Further, NIOSH's director was to be appointed by the Secretary of DHHS for terms of 6 years to insulate it from presidential politics.

Although Congress very clearly tried to de-politicize this office in this manner, it did not provide specific direction for which level within DHHS that NIOSH should be located. This organizational mandate, based on legislation, was unique, and consequently, somewhat awkward. But as a national institute, NIOSH survived several DHHS reorganizations, eventually landing at CDC.

NIOSH was administratively placed within the CDC for convenience in the mid-1970s in an earlier governmental reorganization. Since that time, NIOSH has continued to communicate directly with the Assistant Secretaries in the Department of Labor at a level of government at least 1 tier higher than the level at CDC to which NIOSH currently reports. Many individuals working in occupational safety and health oppose any future reorganization within CDC that would further demote NIOSH organizationally and believe that NIOSH might better serve its purpose by being placed elsewhere in the federal bureaucracy.

Some advocates, including the American Society of Safety Engineers, recommend moving NIOSH to the US Department of Labor. Yet one does not have to go far back to see the conflicts between the bright light of independent public health research and the murkier political waters of the regulatory agencies. An example of this type of conflict is provided by the recent reorganization of the components of the Bureau of Mines, the group that previously conducted health-related research related to mining. Research within this structure was always clouded by the interest of the Bureau of Mines in economic development, which took priority over the health and safety protection of miners. Miner health and safety research is now conducted by NIOSH in their Pittsburgh, Pennsylvania and Spokane, Washington laboratories.

Another proposed alternative is to move NIOSH out of CDC and have it report directly to the Secretary of DHHS. This could be achieved without legislative change because the authorizing legislation is silent on placement within the federal bureaucracy. This move would have the advantage of placing the director of NIOSH on more equal footing with the Assistant Secretaries of OSHA and the Bureau of Mines. This would enable it to serve as a stronger voice for the health and safety of the nation's 150 million workers.[3] Yet, in an era of federal agency streamlining, it is difficult to see how putting a relatively small agency composed of about 1200 scientists and support personnel, with a budget of about $276.9 million, on par with those having thousands of staff members and significantly larger budgets. Or, it could be an agency parallel to CDC and the National Institutes of Health (NIH) and reporting to the Assistant Secretary of Health. However, that would again have the disadvantage of NIOSH being so much smaller than the other agencies.

Location within NIH is an alternative many in the field of occupational health and safety have thoughtfully considered. This was proposed in the late 1970s as DHHS came into being. In many ways, this placement would be ideal, as the research conducted through NIOSH most closely parallels the interests of the other Institutes, Centers, and Divisions of NIH.

Yet, historically there was the problem of "for" vs "of" to contend with. NIOSH is "for" work-related safety and health while the NIH Institutes are "of" health. In the past, an argument against this relocation was that NIOSH's applied research focus was not in keeping with the NIH's pure research mission. Also, NIOSH deals with whole beings and groups of workers, rather than with organ systems or with finding cures for specific diseases.

However, the majority of individuals and groups interested in highly focused occupational health and safety research believe that now is the time to revisit the idea of placing NIOSH within the NIH. This is due to growth in the number and diversification of new NIH Institutes, and to the current interest at NIH in making research increasingly relevant through the transformation of scientific findings to tangible benefits for people.[4] Although basic biological research is the primary focus of the new approach, perhaps it is time to think more broadly about prevention at NIH.

Placement of NIOSH in CDC is a failed experiment that should be ended immediately.

If you would like to provide feedback about this article, you may contact Mr. Dobbin by email at ergo2003@hotmail.com .

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....