An estimated 60,000 deaths every year in the United States are related to occupational disease and injury. In 1994, occupational injuries alone were responsible for an estimated $120 billion in lost wages and productivity, administrative expenses, health care, and other costs, although the annual occupational fatality rate has been reduced from 18 per 100,000 workers in 1970 to 8 per 100,000 in 1993. The Occupational Safety and Health Administration (OSHA), established in 1970 as a part of the Department of Labor, was charged with the responsibility of reducing worker injury, illness, and death caused by workplace hazards and exposures to toxic substances and harmful physical agents. The Occupational Safety and Health Act of 1970 directed OSHA "to assure so far as possible every working man and woman in the nation safe and healthful working conditions." That is to be accomplished by several means, including "providing medical criteria which assure insofar as practicable that no employee will suffer diminished health, functional capacity, or life expectancy as a result of his work experience and providing for the development and promulgation of occupational safety and health standards". The mandate specifies that workplace standards that OSHA promulgates must be economically feasible, be technologically feasible, and have demonstrable benefits.

The National Institute for Occupational Safety and Health (NIOSH) was established by the Occupational Safety and Health Act as a part of the Department of Health and Human Services to conduct scientific research in occupational safety and health; to develop innovative methods, techniques, and approaches for addressing problems in occupational safety and health; to train a workforce of professionals in occupational safety and health; and to make recommendations to OSHA about standards for occupational safety and health. NIOSH identifies the causes of work-related diseases and injuries and the potential hazards of new work technologies and practices. With this information, it determines new and effective ways to protect workers from exposure to toxic substances, harmful physical agents, machine- and equipment-related hazards, and hazardous working conditions.

FINDING 6.2.1: The nation's recordkeeping system for job-related injuries is widely accepted although underreporting is considered as substantial. In contrast, estimates of the incidence or prevalence of fatal and nonfatal work-related illnesses are very imprecise, partly because there is no adequate national surveillance system and partly because of complexities associated with discerning cause and effect. The economic burden of occupational injuries amounts to almost half the total cost of all injuries in the United States, and the cost of occupational illnesses is believed to exceed that attributable to injuries. For example, including lost work days and reduced productivity, the costs of occupational skin diseases alone might reach $1 billion a year. The impact of occupational injuries, disabilities, and diseases spreads in ripples beyond the affected worker and employer to families and society at large in ways that are not easily measured or expressed in monetary terms. The effectiveness of OSHA's regulatory activities directed towards reducing occupational risks cannot be assessed in the absence of adequate national surveillance data.

RECOMMENDATION: To assess the effects of OSHA's regulations on workplace health and safety for the purpose of guiding NIOSH and OSHA research and regulatory priorities, Congress should direct NIOSH to strengthen its surveillance and intervention-effectiveness research and OSHA to expand its evaluation program.

RATIONALE

A substantial proportion of the estimated 60,000 worker fatalities each year is believed to result from occupational diseases associated with exposures to toxic substances and harmful physical agents. Many cases of fatal, chronic, and disabling occupational diseases develop over 10-30 years and are poorly counted by employer reporting or workers-compensation systems. For the cases that are reported, the attributable costs underestimate costs due to lost productivity and reduced earning potential, and such human values as reduced quality of life are not considered. The lost work day is an inadequate measure of the impact of chronic diseases. Without accurate information on the incidence and prevalence of occupational illnesses, the effect of a regulation on incidence or prevalence cannot be assessed. Without information on the effect of regulations, it is difficult to target research and regulatory priorities toward the exposures and illnesses of greatest concern.

Over the last 2 years, a comparative risk analysis for priority-setting has been conducted by OSHA with strong participation from NIOSH and many stakeholders. The product of that effort, OSHA's priority-planning process, is the identification of 18 emerging or persistent occupational-safety and occupational-health issues most in need of agency action, both regulatory and nonregulatory. The results were unveiled in December 1995; work has begun on their implementation. The agenda outlines regulatory priorities based on objective data, subjective judgment, and expert knowledge. Whether workplace interventions based on the identified priorities will have the desired effect on occupational illnesses, however, can be assessed and, hopefully, verified through an effective surveillance program.

In a similar process over the last year, NIOSH led 500 federal agencies, industries, associations, labor unions, academics, and private citizens in the development of the National Occupational Research Agenda. The agenda outlines priorities for the nation's public and private research in occupational safety and health. It is intended to increase the efficiency and effectiveness of such research by focusing efforts on the most important current and emerging scientific needs for improving the safety and health of workers. It is also an important step in efforts by NIOSH to engage in and promote extensive research coordination and collaboration among organizations and scientists throughout the public and private sectors. Risk assessment itself was identified through testimony as a priority.

In both the OSHA and NIOSH priority-setting projects, information on the incidence and prevalence of occupational injuries and illnesses was used to the extent that they were available. However, both OSHA and NIOSH drew heavily on the expert judgment and experience of the stakeholders who participated in the open and iterative processes by which the final products were developed.

FINDING 6.2.2: The Occupational Safety and Health Act institutionalized the clear separation of health research (NIOSH) and science-based policy decisions (OSHA). Although it is important that OSHA and NIOSH have distinct responsibilities, it is also critical that these interdependent organizations work closely together.

RECOMMENDATION: OSHA and NIOSH should focus on ways to facilitate effective collaboration so that OSHA's regulatory needs guide NIOSH's research efforts and NIOSH's contributions to OSHA are well-targeted toward OSHA's regulatory and science-policy needs, as well as towards serving private-sector worker-protection programs. Current programs focused on cooperation between the organizations should be strengthened.

RATIONALE

As the 1994 National Research Council report Science and Judgment in Risk Assessment emphasized, science-policy judgments made in the course of risk assessment would be improved if they were more clearly informed by a regulatory agency's priorities and goals in risk management. Protecting the integrity of risk assessment and building more productive linkages to risk management were both considered essential. OSHA and NIOSH have different responsibilities and play different roles in protecting worker health and safety, but they are clearly interdependent. NIOSH provides OSHA with scientific criteria and recommendations in support of OSHA's mandate to set health and safety standards. NIOSH identifies health-based exposure limits, and OSHA uses them to develop occupational standards that reflect feasibility considerations.

An interagency task force was formed to conduct the priority-planning process. There is an exchange of senior staff, who serve as full-time liaisons within the agencies' directors' offices. Because their risk-assessment and risk-management responsibilities are closely linked, it is important that they seek ways to ensure an effective interaction.

FINDING 6.2.3: OSHA seems to have relied upon a case-by-case approach for performing risk assessment and risk characterization in support of risk-management policy decisions. Its 1980 "cancer policy" is rarely used and was written before the many scientific advances of the 1980s and 1990s. Its risk-management targets--for example, reducing cancer risk to less than one case per 1,000 workers exposed--might reflect the difficulty of demonstrating technical or economic feasibility at lower risk levels.

RECOMMENDATION: OSHA should publish, after appropriate public involvement and review, one or more sets of guidelines that lay out its scientific and policy defaults. The guidelines should, at a minimum, cover the following: an explicit rationale for choosing the defaults and an explicit standard for how and when to modify them, methods for assessing risk for noncancer health effects of concern in occupational settings, methods for quantifying and expressing uncertainty and individual variability in risk, and a statement of the magnitude of individual risk that it considers negligible for the various adverse health effects. The guidelines should help OSHA decide how extensive a risk assessment is needed in different situations. Finally, OSHA should explain and justify its actions when it evaluates or regulates a substance differently than other federal agencies that regulate the same substance.

RATIONALE

Risk-assessment guidelines have served EPA well over the years. OSHA has similar needs but its analyses are sufficiently different that it cannot simply adopt EPA's guidelines or the recommendations of Science and Judgment in Risk Assessment (NRC 1994a). In their testimony before the Commission, Adam Finkel, director of OSHA's Directorate of Health Standards Programs, and Frank White, vice president of Organization Resources Counselors, Inc., agreed that articulated risk-assessment guidance is urgently needed. They also agreed with the testimony of Frank Mirer, director of the Health and Safety Department of the International Union of United Auto Workers, that OSHA's risk-assessment procedures should not be uniform, but should be consistent with the magnitude of effect or controversy that a particular standard is likely to generate. To be useful, OSHA's guidelines must recognize that OSHA cannot treat each risk assessment with the same degree of rigor and detail, particularly as it seeks to make up the ground lost in a 1992 court decision vacating more than 400 permissible exposure limits (PELs). Because of the large number of PEL risk assessments that are needed and the fact that substances regulated via PELs will not be subject to the numerous ancillary provisions of OSHA's substance-specific rule-makings (such as medical surveillance and worker training), OSHA should outline a less-exhaustive risk-assessment template for this category of analysis.