CSTE POSITION STATEMENT 1992-2

COMMITTEE: Environmental/Occupational/Injury

TITLE: Guidelines for State/Territory-based Activities in Occupational Health and Safety

ISSUE: For nearly a decade, CSTE has recognized the specialty area of occupational epidemiology and its role in state health departments and has passed resolutions to address specific occupational health issues. However, no generally recognized guidelines exist which state/territorial health officers can use to evaluate the adequacy of their epidemiology programs in this area. Healthy People 2000 objective 10-10, "Implement occupational safety and health plans in 50 states for the identification, management, and prevention of leading work-related diseases and injuries within the state," recognizes the central role for state/territory-based occupational health and safety activities.

POSITION TO BE ADOPTED: CSTE recommends that ASTHO adopt the principles identified in the "Guidelines for Minimum and Comprehensive State-based Activities in Occupational Health and Safety" drafted by the CSTE environmental/occupational/injury committee, circulate the guidelines to all state and territorial health departments and encourage incorporation of the guidelines into their year 2000 plans. In this survey of state/territory activities, the Public health Foundation should include questions to assess the progress toward all states’/territories’ achieving the minimum of the guidelines.

BACKGROUND/JUSTIFICATION: See below

CONSULTATION WITH OTHER ORGANIZATIONS:

Agencies for Response: ASTHO, PHF

Agency for Information: CDC

CONTACT: 
Henry Anderson, M.D.
Department of Health and Social Services
Division of Health
One W. Wilson Street
P.O. Box 309
Madison, WI 53701-2832
608-266-1253  

Guidelines:  Minimum and Comprehensive State-Based Activities
Occupational and Environmental Health Committee
Council of State and Territorial Epidemiologists
Association of State and Territorial Health Officers
August 1992

I. Introduction

In 1990 the Public Health Service released Healthy People 2000: National Health Promotion and Disease Prevention Objectives, which presents the framework of a national strategy to significantly improve the health of the Nation by the turn of the century. Healthy People 2000 addresses major prevention goals for occupational safety and health. The central role for state-based programs to achieve these goals is recognized in objective 10.10: Implement occupational safety and health plans in 50 states for the identification, management, and prevention of leading work-related diseases and injuries within the state.

These goldenness provide a framework for state health departments to explicitly recognize and address objective 10.10 as part of their mission. Methods to implement the minimum guidelines are likely to be highly state specific because of the different organizational structures for addressing occupational health and safety in each state.

This document provides minimum and comprehensive approaches that can be taken by state health departments to implement occupational safety and health objectives in Health People 2000. These approaches are presented in three functional areas: surveillance, policy development, and intervention. An infrastructure and resources sufficient to meet the needs of the proposal are described.

II. Surveillance

Overview
The foundation for public health activity in occupational illness and injury prevention rests on a comprehensive and integrated approach to the collection, analysis, and interpretation of occupational illness and injury data. A surveillance program should be able to; identify specific cases of illness, injury or hazardous exposure requiring a targeted public health response; identify disease patterns that suggest problem areas; offer guidance in setting program priorities and resource allocation; and describe trends in the occurrence of particular conditions over time.

At a minimum, monitoring of trends over time can be accomplished by accessing existing data bases already collected for other reasons. Each data collection system’s utility needs to be assessed as different data bases may be most appropriate for specific conditions and purposes. Existing systems often include death certificates, hospital discharge data, cancer registry data, workers’ compensation records and medical examiners reports. Identified data sources can be supplemented by voluntary or mandatory reporting from clinical laboratories (heavy metals toxicity), poison control centers (work-related toxic exposures), and physician reports of occupational diseases. The data can be used to describe the overall burden of occupational disease and injuries in the state. If occupation and industry data are available in existing data sources, those data sources can be used for hypothesis generating analyses that identify associations between diseases and occupations warranting further investigation. Birth defects registries, mortality and cancer registries are useful for this activity. Most existing data sources for disease or injury and all mandated reporting systems include personal identifiers. Case identification allows for follow-back to the reported patient to identify worksites where causative exposures occurred and to obtain other relevant information. Site-specific interventions, such as industrial hygiene evaluations, can take place at worksites identified from case follow-back.

Tabulations of data on the incidence, prevalence, and distribution of hazardous occupational exposures can complement illness and injury surveillance data by identifying targets for intervention before the disease or injury occurs. Existing data sources useful for this include workplace inspections reports from the Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA) and data from the Environmental Protection Agency on toxic substances inventories collected under the Superfund Amendments and Reauthorization Act - Title III.

Minimum:

If another state agency(s) has the lead in addressing occupational health and safety, establish a liaison activity, facilitate meeting at least twice a year to discuss data sharing, public health issues and priorities.

Compile and publish annually a report on the incidence and prevalence of occupational illnesses and injuries identified in existing data sources.

Comprehensive:

In addition to the above:

• Develop the capacity to systematically use surveillance data to target interventions and public health programs (SENSOR models).

• Mandate laboratory reporting of heavy metals and physician reporting of occupational diseases.

• Collect/code occupation and industry in all data sources, if missing.

• Maintain computerized registries of all individuals with occupational illness or injury identified from existing data bases and/or from case reports.

• Conduct periodic hypothesis generating analyses of relevant data sets.

• Compile and publish annually a report on the incidence, prevalence, and distribution of occupational illnesses, injuries, and hazards based on epidemiologic analyses of all health and hazard data.

III. Policy Development

Overview
Policy development involves planning and priority setting, regulatory and legislative action, and resource mobilization. Public health policies in occupational health are often intertwined with complex legal and regulatory issues. Leadership, to ensure that the public interest in occupational health is served, requires only technical knowledge and professional expertise, but also sensitivity to larger political issues. Specific strategies can be developed to promote comprehensive public health policy making in occupational health. Institutionalized communication with constituencies is essential. Advisory boards should include representatives from other public health agencies, other governmental agencies, labor, industry, and health professionals. Regular mailings to interested individuals and agencies also assure an informed public. A comprehensive needs assessment document can serve an important role in promoting legislation and identifying necessary resources. Reports published in Connecticut, New Jersey, New York, and Pennsylvania can serve as models for such a document.

Recommended Approaches and Activities for State Health Departments

Minimum:

• Develop and maintain a mailing list of individuals and agencies in the state with a responsibility for, and an interest in, occupational health. This mailing list should be shared with other agencies and used to target mailings of materials of public health interest, including the Occupational health Surveillance Annual Report.

• Develop working relationships with state and federal agencies conducting occupational health activities for the purpose of sharing data and resources.

• Assure that public health perspectives are adequately represented on occupational health and safety advisory groups to other agencies. If none exist, establish a public health advisory group that includes representatives from employee groups, employers, public health agencies, other governmental agencies (e.g., state Department of Labor, state or federal OSHA), public health and medical professionals. This group should meet at least twice annually with state health department officials.

Comprehensive:

In addition to the above:

• Conduct, and periodically update a statewide needs assessment that includes, in addition to surveillance data, data on occupational health resources, status of relevant legislation, population assessments, and projections of future needs in primary, secondary, and tertiary prevention.

• Compile and disseminate a planning document that utilizes needs assessment data in conjunction with state and federal health priorities (e.g., Health People 2000 objectives). This document should establish long range goals and objectives in occupational safety and health for the state, set priority areas for surveillance and intervention, and propose resource allocation.

Overview
Interventions to assure that identified needs and problems in occupational health are addressed can include: education, technical consultation, development of new, or enforcement of existing applicable laws and regulations, and delivery of medical services. In some instances it may be appropriate to undertake or contract for research to answer etiologic questions. Even if the state health department is not the lead occupational health agency, it should be responsible for assuring that public health agencies in local governments have sufficient expertise and resources, or reliable, convenient access to them, to meet at least some of the occupational health needs of their constituencies. Evaluations of interventions should be conducted to determine if they have achieved the desired impact.

Recommended Approaches and Activities for State Health Departments

• Distribute the Occupational Health Surveillance Annual Report to concerned individuals and agencies on the mailing list.

• Have sufficient expertise, written materials, and lists of resources so that telephone inquiries from employees, employers, health professionals, and others about the nature, causes, and control of adverse health effects of occupational hazards can be addressed or referred appropriately.

In addition to the above:

• Develop and implement necessary regulations and statutes. These may include, for example, establishment of an occupational health program, right-of-entry to workplaces, minimum standards in occupational health for local health departments, extension of federal Occupational Safety and Health regulations to public employees, or provisions for state-funded occupational clinic services.

• Compile a comprehensive library of current educational materials and technical resources. This library should include access to computerized medical and toxicologic data bases.

• Conduct follow-back to worksites identified from occupational disease and injury surveillance case investigations as likely sources of hazardous exposures. This activity should include assessment of exposure and hazardous conditions. If appropriate, screening for occupational disease in co-workers of reported cases should be undertaken. A report should be generated with recommendations to prevent subsequent development of additional adverse health effects.

• Develop educational strategies for high-risk industries identified from data on occupational hazards.

• Develop programmatic linkages with academic medical centers to promote medical education and research in occupational safety and health.

State based occupational health programs should be established as core public health programs. Epidemiology is the foundation for the program. As the program expands in scope other disciplines will be needed, including hygiene, safety, health education, occupational health nursing, occupational medicine, and toxicology.