SAFE WORK in the 21ST CENTURY

Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel

Committee to Assess Training Needs for Occupational Safety and Health Personnel in the United States

Board on Health Sciences Policy

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, DC



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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel SAFE WORK in the 21ST CENTURY Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel Committee to Assess Training Needs for Occupational Safety and Health Personnel in the United States Board on Health Sciences Policy INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, DC

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel NATIONAL ACADEMY PRESS 2101 Constitution Avenue, NW Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competences and with regard for appropriate balance. Support for this project was provided by the National Institute for Occupational Safety and Health, the Occupational Safety and Health Administration, the U.S. Department of Veterans Affairs, the National Institute of Environmental Health Sciences, the American Association of Occupational Health Nurses, and the American Academy of Industrial Hygiene. This support does not constitute endorsement of the views expressed in the report. Library of Congress Cataloging-in-Publication Data Safe work in the 21st century : education and training needs for the next decade’s occupational safety and health personnel / Committee to Assess Training Needs for Occupational Safety and Health Personnel in the United States, Health Sciences Policy Division, Institute of Medicine. p. cm Includes bibliographical references. ISBN 0-309-07026-0 1. Industrial hygiene. 2. Industrial safety. I. Institute of Medicine (U.S.). Committee to Access Training Needs for Occupational Safety and Health Personnel in the United States. RC967.S215 2000 616.9′803—dc21 00-055005 Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, NW, Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s on-line bookstore at www.nap.edu. The full text of the report is available on-line at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2000 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. Cover photograph: Window Washer on the Empire State Building. Photographer: Earl Dotter. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel COMMITTEE TO ASSESS TRAINING NEEDS FOR OCCUPATIONAL SAFETY AND HEALTH PERSONNEL IN THE UNITED STATES JAMES A. MERCHANT (Chair), Dean, College of Public Health, University of Iowa, Iowa City LINDA HAWES CLEVER, Chairperson, Department of Occupational Health, California Pacific Medical Center, San Francisco RUTH HANFT, Independent Health Policy Consultant, Charlottesville, Virginia RONALD KUTSCHER, Retired Associate Commissioner, Office of Economic Growth and Employment Projections, Bureau of Labor Statistics, Washington, D.C. JAMES A. OPPOLD, Occupational Safety and Health Consultant, Raleigh, North Carolina M.E. BONNIE ROGERS, Director, Occupational Health Nursing Program, School of Public Health, University of North Carolina at Chapel Hill SCOTT SCHNEIDER, Director, Occupational Health and Safety Program, Laborers’ Health and Safety Fund of North America, Washington, D.C. MARTIN SEPULVEDA, Vice President, Global Occupational Health Services, IBM Corporation, Somers, New York ROBERT C. SPEAR, Professor of Environmental Health Sciences, School of Public Health, University of California at Berkeley LOIS E. TETRICK, Professor of Psychology, Department of Psychology, University of Houston NEAL A. VANSELOW, Chancellor Emeritus, Professor of Medicine Emeritus, School of Medicine, Tulane University M. DONALD WHORTON, Occupational Medicine Practitioner, President, M. Donald Whorton, Inc., Alameda, California Board on Health Sciences Policy Liaison MARK R. CULLEN, Professor of Medicine and Public Health, Occupational and Environmental Medicine Program, Yale University School of Medicine, New Haven, Connecticut Study Staff FREDERICK J. MANNING, Project Director ALDEN B. CHANG II, Project Assistant

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel Institute of Medicine Staff ANDREW POPE, Director, Board on Health Sciences Policy HALLIE WILFERT, Administrative Assistant CARLOS GABRIEL, Financial Associate

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel INDEPENDENT REPORT REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report: JOHN M. DEMENT, Associate Professor, Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical School BERNARD D. GOLDSTEIN, Director, Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School JOSEPH LADOU, Professor of Occupational Medicine and Toxicology, Division of Occupational and Environmental Medicine, University of California at San Francisco JANE A. LIPSCOMB, Associate Professor, School of Nursing, University of Maryland, Baltimore EDWARD B. PERRIN, Professor Emeritus, Department of Health Services, Center for Cost and Outcomes Research, University of Washington GORDON REEVE, Corporate Epidemiologist, Health Care Management, Ford Motor Company, Dearborn, Michigan JONATHAN D. ROSEN, Director, Health and Safety Department, New York Public Employees Federation, Albany DAVID ROSNER, Professor of History and Public Health, and Codirector, Program in History of Public Health and Medicine, Mailman School of Public Health, Columbia University GAVRIEL SALVENDY, Professor of Industrial Engineering, Purdue University DAVID TOLLERUD, Director, Center for Environmental and Occupational Health, C.P. Hahnemann University School of Public Health, Philadelphia While the individuals listed above provided many constructive comments and suggestions, responsibility for the final content of the report rests solely with the authoring committee and the Institute of Medicine.

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel Acronyms and Abbreviations AAIHN American Association of Industrial Nurses AAOHN American Association of Occupational Health Nurses AAOM American Academy of Occupational Medicine ABET Accreditation Board for Engineering and Technology ABOHN Accreditation Board for Occupational Health Nurses ABIH American Board of Industrial Hygiene ABPM American Board of Preventive Medicine ACGIH American Conference of Governmental Industrial Hygienists ACGME Accreditation Council for Graduate Medical Education ACOEM American College of Occupational and Environmental Medicine ADA Americans with Disabilities Act AEP Associate Ergonomics Professional AHC academic health center AIHA American Industrial Hygiene Association AMT advanced manufacturing techniques AOMA American Occupational Medicine Association ASP Associate Safety Professional ASSE American Society of Safety Engineers BCPE Board of Certification in Professional Ergonomics BCSP Board of Certified Safety Professionals

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel CAE Certified Associate Ergonomist CE continuing education CEA Certified Ergonomics Associate CEAP Certified Employee Assistance Professional CEPH Council on Education in Public Health CEU continuing education units CHCM Certified Hazard Control Manager CHFEP Certified Human Factors Engineering Professional CHFP Certified Human Factors Professional CIE* Certified Industrial Engineer CIH Certified Industrial Hygienist CMI computer-managed instruction COHN Certified Occupational Health Nurse COHN-S Certified Occupational Health Nurse-Specialist CPE Certified Professional Ergonomist CSP Certified Safety Professional DOE U.S. Department of Energy DOJ U.S. Department of Justice EAP employee assistance program EAPA Employee Assistance Professional Association EFS Educational Field Services program EPA Environmental Protection Agency ERC Education and Research Center (Educational Resource Center until 1999) GATT General Agreement on Tariffs and Trade GDP gross domestic product HMO health maintenance organization HWWT hazardous waste worker training IHIT Industrial Hygienist in Training IOM Institute of Medicine IVD interactive video disc JIT just-in-time inventory control MAC maximum allowable concentrations MCW Medical College of Wisconsin MSHA Mine Safety and Health Administration MWT Minority Worker Training program

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel NAFTA North American Free Trade Agreement NIEHS National Institute of Environmental Health Sciences NIOSH National Institute for Occupational Safety and Health NLN National League for Nursing OEM occupational and environmental medicine OM occupational medicine OSH occupational safety and health OSHA Occupational Safety and Health Administration OSHAct Occupational Safety and Health Act RPE Registered Professional Engineer

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel Acknowledgments George W. Anstadt Eastman Kodak Co. Roger L. Brauer Board of Certified Safety Professionals Thomas Bresnahan American Society of Safety Engineers Ann Brockhaus Organization Resources Counselors, Inc. Leo Carey National Safety Council Scott Clark University of Cincinnati Jerome Congleton Texas A&M University Ann Cox American Association of Occupational Health Nurses Ann Cronin National Institute for Occupational Safety and Health Cathy Cronin Occupational Safety and Health Administration Training Institute Gregory DeLapp Employee Assistance Professional Association Don Ethier American Industrial Hygiene Association Julia Faucett University of California at San Francisco

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel Adam Finkel Occupational Safety and Health Administration Bruce G. Flynn Washington Business Group on Health Roy Gibbs United States Department of Energy Manuel Gomez American Industrial Hygiene Association Larry Grayson National Institute for Occupational Safety and Health William Greaves Medical College of Wisconsin Colonel Mark Hamilton Office of the Deputy Undersecretary of Defense Eugene Handley American College of Occupational and Environmental Medicine Larry Hardy American College of Occupational and Environmental Medicine Joseph Hughes, Jr. National Institute for Environmental Health Sciences Sharon Kemerer American Board for Occupational Health Nurses W. Monroe Keyserling University of Michigan Bernadine B. Kuchinski National Institute for Occupational Safety and Health Tom Leamon Liberty Mutual Insurance Co. Tom MacLeod Mine Safety and Health Administration Michael S. Morgan University of Washington Royce Moser, Jr. University of Utah Frances M. Murphy U.S. Department of Veterans Affairs Julie B. Norman University of Montana John Olson University of Wisconsin-Stout Nico Pronk Health Partners Jonathan Rosen New York State Public Employees Federation Linda Rosenstock National Institute for Occupational Safety and Health

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel Karl Sieber National Institute for Occupational Safety and Health Rosemary Sokas National Institute for Occupational Safety and Health Tim Stephens University of North Carolina at Chapel Hill John T. Talty National Institute for Occupational Safety and Health Victor Toy American Association of Industrial Hygienists Lawrence W. Whitehead University of Texas-Houston Jerry Williams American Society of Safety Engineers Samuel Wilson National Institute of Environmental Health Sciences

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel Contents     EXECUTIVE SUMMARY   1 1   INTRODUCTION   17      Charge to the Committee,   20      Legislative and Regulatory Background,   21      Previous Studies of the OSH Workforce,   25      Methods of the Present IOM Study,   30      Organization of This Report,   31 2   OCCUPATIONAL SAFETY AND HEALTH PROFESSIONALS   32      The Nature and Scope of OSH Services,   35      Safety Professionals,   39      Industrial Hygiene,   49      Occupational Medicine,   57      Occupational Health Nursing,   68      Other OSH Professionals,   77      Supply, Demand, and Need,   85 3   THE CHANGING WORKFORCE   90      Review of the Past Workforce Changes,   91      A Look to the Future,   97      Implications of Changing Demographics for Occupational Injuries and Illnesses,   100      Implications for Training Needs of Occupational Safety and Health Personnel,   103

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel 4   THE CHANGING WORKPLACE   105      Review of Past Workplace Changes,   106      A Look to the Future,   110      Implications for Occupational Fatalities, Injuries, and Illnesses,   120      Implications for Training Needs of Occupational Safety and Health Personnel,   121 5   THE CHANGING ORGANIZATION OF WORK   125      Globalization of Trade,   126      Work Design,   128      Organizational Design,   135      Work-Life Balance,   139      Implications for Occupational Safety and Health Education and Training,   140 6   THE CHANGING DELIVERY OF HEALTH CARE   141      Elements of Health Care Reform,   144      Implications for Education and Training of Occupational Safety and Health Professionals,   150 7   EDUCATION AND TRAINING PROGRAMS   152      Research Training,   154      Occupational Safety Programs,   155      Industrial Hygiene Programs,   161      Occupational Medicine Residencies,   164      Occupational Health Nursing Programs,   170      21st Century Knowledge and Expertise,   173      Funding Sources for Occupational Safety and Health Education and Training,   174      Future Needs in Worker and Employer Safety and Health Training,   193 8   ALTERNATIVES TO TRADITIONAL CLASSROOMS   196      Distance Education Modalities,   199      Distance Education and Workforce Relationships: Potential Benefits and Costs,   200      Current Examples,   202      Education Outlook for Occupational Safety and Health,   206      Conclusion,   206

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel 9   SUMMARY OF FINDINGS AND RECOMMENDATIONS   207      Current OSH Work Force and Training,   208      Future OSH Work Force and Training,   209     REFERENCES   213     APPENDIXES         A  Committee and Staff Biographies   227     B  Statement on Committee Composition by Committee Member James A. Oppold   234     C  Significant Events in the History of Occupational Safety and Health   236     D  Locations of the National Institute for Occupational Safety and Health’s Education and Research Centers (ERCs) and Training Program Grants (TPGs)   241 LIST OF TABLES, FIGURES, AND BOXES Tables 2-1   Percentage of Respondents Reporting the Indicated Activities as Among the Three Most Important Worked on During the Preceding Year,   55 2-2   Percentage of Respondents Reporting Hands-on Involvement in the Indicated Activities,   56 2-3   Percentage of Respondents Reporting That They Manage the Indicated Activities,   56 2-4   Primary Board Certifications of ACOEM Members, April 1999,   64 2-5   Percentage of ACOEM Members Providing the Listed OM Service,   66 2-6   Most Important Work Activities Reported by Occupational Health Nurses,   76 2-7   Job Titles Reported by Two Samples of Occupational Health Nurses,   77 2-8   Estimated Number of Active OSH Professionals in the United States, 1999,   85 3-1   Percentage of Mothers in Labor Force, 1975–1998 by Age of Youngest Child in March 1973,   93 3-2   Employment of Persons Ages 21–64 Years, 1991–1992 and 1994–1995,   95 3-3   Real Disposable Per Capita Income, Selected Years, 1986–1998, and Projected to 2010,   97

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel 3-4   Civilian Labor Force, 1988, 1998, and Projected to 2010,   99 3-5   Total Civilian Labor Force, Entrants, Leavers, and Stayers, 1988, 1998, and Projected to 2010,   101 4-1   Employment by Major Industry Division in 1988 and 1998 and Projected Employment for 2010,   107 4-2   Employment by Major Occupational Group for 1988 and 1998 and Projected Employment for 2010,   108 4-3   Incidence of Nonfatal Occupational Injures and Illnesses by Private Industry Division, Selected Years,   112 4-4   Fatal Occupational Injuries, 1992 to 1998 in Private Industry and Government,   113 4-5   Percentage of Workforce That Is Unionized by Major Sector, Selected Years, 1983 to 1998,   114 4-6   Employed Persons by Full- or Part-Time Status, 1970 to 1998,   118 4-7   Employment by Size of Establishment in Selected Years, 1980 to 1997,   120 7-1   Subject Area and Number of Susan Harwood Training Grants Program Grants Awarded in Fiscal Year 1999,   183 Figures 1-1   Deaths per 100,000 workers due to injury, 1913 to 1998,   18 2-1   Percentage of professional members reporting safety-related certifications in three surveys,   45 2-2   Primary job focus of ASSE members,   46 2-3   Employers reported by certified safety professionals in a 1997 survey,   48 2-4   Percentage of respondents reporting daily direct interaction with the indicated groups,   57 2-5   Primary practice setting of ACOEM members,   65 2-6   Practice settings for ACOEM survey respondents,   65 2-7   Highest level of formal education reported by occupational health nurses in 1999 compensation and benefits survey,   73 3-1   Age of civilian labor force, 1988 and 1999,   92 3-2   Minorities in the civilian labor force, 1988 and 1998,   94 3-3   New entrants to the labor force projected from 1998 to 2010, by race and ethnicity, as a percentage of total new entrants,   102 4-1   Occupations with the highest number of nonfatal occupational injuries and illnesses, 1997,   112

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel 4-2   Employment in personnel supply services, 1986 to 1998,   114 4-3   Mean number of jobs held between the ages of 18 and 32 (1978 to 1995) reported in 1995 by individuals ages 31 to 38 in 1995, by level of education,   117 4-4   Aggregate employment increase between 1990 and 1995 for firms of various sizes,   119 5-1   U.S. investment in computer equipment and software, 1990 to 1998,   129 5-2   Information technology as a means of integrating various basic manufacturing activities,   130 6-1   National expenditures for health services and supplies, 1970 to 1997 and projections for 2002,   143 7-1   Number of degrees awarded from 1990 to 1999 by schools responding to ASSE survey on graduates,   156 7-2   Funding, by discipline, by NIOSH of ERCs and TPG, 1995 to 1999,   175 7-3   Master’s degrees awarded with support of NIOSH training programs, 1987 to 1997,   176 7-4   Graduates of “other” NIOSH-supported educational programs, 1987 to 1997,   177 7-5   Student-days of continuing education and number of courses supported by NIOSH, 1991 to 1997,   178 7-6   Employers of students attending NIOSH-supported continuing education courses in 1996–1997,   179 7-7   Backgrounds of students attending NIOSH-supported continuing education in 1996–1997,   179 7-8   Student-days of instruction by OSHA Training Institute, all sites, in fiscal years 1995 to 1998,   181 7-9   Source of fiscal year 1998 students for OSHA Training Institute and OSHA Training Institute Education Centers,   182 Boxes 1   Summary of Recommendations,   15 2-1   Occupational Health and Safety Pyramid,   34 2-2   Competencies in Occupational and Environmental Nursing,   72 9-1   Summary of Recommendations,   212

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