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PREPUBLICATION COPY A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century Committee on Developing a Smarter National Surveillance System for Occupational Safety and Health in the 21st Century Board on Agriculture and Natural Resources Division on Earth and Life Studies Committee on National Statistics Division of Behavioral and Social Sciences and Education Board on Health Sciences Policy Health and Medicine Division A Consensus Study Report of

THE NATIONAL ACADEMIES PRESS 500 Fifth Street NW Washington, DC 20001 This activity was supported by Grant 200-2011-38807 from the Centers for Disease Control and Preven- tion, National Institute for Occupational Safety and Health, Grant HHSP233201400020B from the De- partment of Labor, Bureau of Labor Statistics, and Grant DOL-OPS-16-P-000193 from Department of Labor, Occupational Safety and Health Administration. Any opinions, findings, conclusions, or recom- mendations expressed in this publication do not necessarily reflect the views of any organization or agen- cy that provided support for the project. Digital Object Identifier: https://doi.org/10.17226/24835 Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2018 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24835 . Prepublication Copy

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Acad- emy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medi- cine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public under- standing in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national academies.org. Prepublication Copy

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. Prepublication Copy

COMMITTEE ON DEVELOPING A SMARTER NATIONAL SURVEILLANCE SYSTEM FOR OCCUPATIONAL SAFETY AND HEALTH IN THE 21ST CENTURY Chair EDWARD H. SHORTLIFFE, NAM 1, Arizona State University, Tempe, AZ Members DAVID K. BONAUTO, Washington State Department of Labor and Industries, Tumwater, WA DAVID L. BUCKERIDGE, McGill University, Montreal, Quebec, Canada STEVEN B. COHEN, RTI International, Washington, DC LETITIA K. DAVIS, Massachusetts Department of Public Health, Boston, MA GERALD F. KOMINSKI, University of California, Los Angeles, CA SCOTT A. MUGNO, FedEx Ground, Moon Township, PA KENNETH D. ROSENMAN, Michigan State University, East Lansing, MI NOAH S. SEIXAS, University of Washington School of Public Health, Seattle, WA MARGARET M. SEMINARIO, AFL-CIO, Washington, DC GLENN M. SHOR, California Department of Industrial Relations, Oakland, CA DAVID H. WEGMAN, University of Massachusetts Lowell, MA Staff PEGGY TSAI YIH, Study Director, Board on Agriculture and Natural Resources JENNA BRISCOE, Research Assistant, Board on Agriculture and Natural Resources CATHY LIVERMAN, Scholar, Board on Health Sciences Policy MICHAEL COHEN, Senior Program Officer, Committee on National Statistics YASMIN ROMITTI, Research Associate, Board on Earth Sciences and Resources ROBIN SCHOEN, Director, Board on Agriculture and Natural Resources 1 National Academy of Medicine. Prepublication Copy v

BOARD ON AGRICULTURE AND NATURAL RESOURCES Chair CHARLES W. RICE, Kansas State University, Manhattan, KS Members SHANE C. BURGESS, University of Arizona, Tucson, AZ SUSAN CAPALBO, Oregon State University, Corvallis, OR GAIL CZARNECKI-MAULDEN, Nestle Purina PetCare, St. Louis, MO GEBISA EJETA, Purdue University, West Lafayette, IN JAMES S. FAMIGLIETTI, California Institute of Technology, Pasadena, CA FRED GOULD, NAS 1, North Carolina State University, Raleigh, NC DOUGLAS B. JACKSON-SMITH, Ohio State University, Wooster, OH MOLLY M. JAHN, University of Wisconsin–Madison, WI ROBBIN S. JOHNSON, Cargill Foundation, Wayzata, MN JAMES W. JONES, NAE 2, University of Florida, Gainesville, FL A.G. KAWAMURA, Solutions from the Land, Washington, DC STEPHEN S. KELLEY, North Carolina State University, Raleigh, NC JULIA L. KORNEGAY, North Carolina State University, Raleigh, NC JAN E. LEACH, Colorado State University, Fort Collins, CO JILL J. MCCLUSKEY, Washington State University, Richland, WA KAREN I. PLAUT, Purdue University, West Lafayette, IN JIM E. RIVIERE, NAM 3, Kansas State University, Manhattan, KS Staff ROBIN A. SCHOEN, Director 1 National Academy of Sciences. 2 National Academy of Engineering. 3 National Academy of Medicine. vi Prepublication Copy

COMMITTEE ON NATIONAL STATISTICS Chair ROBERT M. GROVES, NAS 1, NAM 2, Georgetown University Members FRANCINE BLAU, Cornell University, Ithaca, NY MARY ELLEN BOCK, Purdue University, West Lafayette, IN ANNE E. CASE, NAM2, Princeton University, Princeton, NJ MICHAEL CHERNEW, NAM2, Harvard Medical School, Boston, MA JANET CURRIE, NAM2, Princeton University, Princeton, NJ DONALD A. DILLMAN, Washington State University, Pullman, WA CONSTANTINE GATSONIS, Brown University, Providence, RI JAMES S. HOUSE, NAM2, University of Michigan, Ann Arbor, MI THOMAS L. MESENBOURG, Retired; formerly, U.S. Census Bureau SARAH M. NUSSER, Iowa State University, Ames, IA COLM A. O’MUIRCHEARTAIGH, University of Chicago, Chicago, IL JEROME P. REITER, Duke University, Durham, NC ROBERTO RIGOBON, Massachusetts Institute of Technology, Cambridge, MA JUDITH A. SELTZER, University of California, Los Angeles, CA EDWARD H. SHORTLIFFE, NAM2, Arizona State University, Tempe, AZ Staff BRIAN A. HARRIS-KOJETIN, Director 1 National Academy of Sciences. 2 National Academy of Medicine. Prepublication Copy vii

BOARD ON HEALTH SCIENCES POLICY Chair JEFFREY KAHN, Johns Hopkins University Members WYLIE BURKE, NAM 1, University of Washington R. A. CHARO, NAM1, University of Wisconsin-Madison LINDA H. CLEVER, NAM1, California Pacific Medical Center BARRY S. COLLER, NAS 2, NAM1, The Rockefeller University BERNARD A. HARRIS, Jr., Vesalius Ventures MARTHA N. HILL, NAM1, Johns Hopkins University School of Nursing STEVEN E. HYMAN, NAM1, Broad Institute ALAN M. JETTE, NAM1, Boston University School of Public Health PATRICIA A. KING, NAM1, Georgetown University Law Center STORY C. LANDIS, NAM1, National Institute of Neurological Disorders and Stroke HARRY T. ORR, NAM1, University of Minnesota, Minneapolis UMAIR A. SHAH, Harris County Public Health and Environmental Services ROBYN STONE, NAM1, LeadingAge SHARON TERRY, Genetic Alliance Staff ANDREW POPE, Director 1 National Academy of Medicine. 2 National Academy of Sciences. viii Prepublication Copy

Preface Many threats to health and well-being occur in the workplace. Understanding those risks to prevent injury, illness, or even fatal incidents is an important function of society. We expect interested parties to measure the frequency of incidents, to determine causes when possible, and to offer preventive measures to stakeholders so that the work environment becomes safer and healthier over time. This all needs to oc- cur in the context of a changing workforce and the evolution of the nature of work, suggesting that new kinds of threats to health and well-being can occur, even as others are being optimally managed or are becoming less pertinent as jobs or industries fade away and are replaced by others. In the United States, both the federal and state governments are heavily involved in monitoring occupational health and safety and developing policies or interventions intended to mitigate work-related injuries and disease. At the federal level, principal agencies involved with such work include the Bureau of Labor Statistics (BLS), the National Institute for Occupational Safety and Health (NIOSH, a division of the Centers for Disease Control and Prevention), and the Occupational Safety and Health Administration (OSHA). Many of the challenges faced by these agencies relate to gathering the information necessary to measure and assess the frequency of workplace-related injuries and illnesses so that suitable policies and interventions can be proposed. In 1987, the agencies sought the advice of the National Research Council regarding surveillance for occupational safety and health (OSH). The resulting report, Counting Injuries and Illnesses in the Workplace: Proposals for a Better System, provided seminal guidance on how to or- ganize and enhance the US programs for OSH surveillance. In the subsequent 30 years, despite many ef- forts developed in response to the 1987 recommendations, both the technology for surveillance and the nature of work have evolved considerably. In the intervening years, the National Academies of Sciences, Engineering, and Medicine have been involved in many workshops, studies, and reports that have touched on issues related to occupational safety and health. For example, from 2006-2009, NIOSH requested that the Academies undertake pro- grammatic reviews of some NIOSH research programs. The need for better surveillance was a theme that emerged from each of those reviews. In 2014, sequestration forced federal agencies to reexamine their programs as they were asked to address their agency’s mission more effectively but with fewer resources. More recently, the director of NIOSH again approached the National Academies to assist them and other agencies to come up with creative solutions across many categories of occupation for surveillance and monitoring, and to be able to do so in a “smarter” and cost-effective manner. The Committee and Its Charge To obtain forward-looking advice, NIOSH, BLS, and OSHA jointly asked the National Academies to conduct a study in response to the need for a more coordinated, cost-effective set of approaches for oc- cupational safety and health surveillance in the United States. Our study committee has addressed this task, gathering information about the strengths and limitations of existing national and state approaches, reviewing a variety of methodologies and technologies that might be applied usefully and cost-effectively. The resulting report is a product of more than a year of deliberations, offering the consensus advice of a diverse set of individuals who have studied the issues carefully and learned a great deal in the process. Prepublication Copy ix

Preface We have formulated a future vision that is intended to assist all stakeholders, including the agencies, as they seek to improve occupational safety and health in the coming years. Some of the committee members are career professionals who have worked in the area of occupa- tional safety and health, both at state and national levels. Others brought complementary skill sets that were pertinent to the committee’s charge: epidemiology, occupational medicine, survey methodologies, biomedical informatics, data analytics, economics, cost-benefit analysis, and workplace organization and management. I was honored to help lead this diverse group of talented professionals, all of whom contrib- uted enthusiastically and tirelessly to the discussions, deliberations, and the final report. We quickly real- ized that the topic is very large and complex, with nuances that many of us had not anticipated when we joined the study group. Our knowledge of the topic was broadened, in the first three meetings and several conference calls during the early months, by informative sessions with invited experts who helped us to address the task. Large portions of the early meetings were open, with members of the public invited to attend and to provide comments. We turned, for our final two meetings, to private deliberations, reviewing all that we had learned in order to develop a shared vision of what was possible and seeking to offer recommendations that were responsive to the committee’s charge and were actionable. Our task was further influenced by a change in government during the study period, leading to uncertainties about future budgets and focus for the perti- nent federal agencies. Acknowledgments This report benefited from the combined talents of many people, including those who were directly associated with the project and many who were not. First, thanks are due to members of the committee itself, all of whom maintained a high level of enthusiasm, energy, and dedication over the course of the project. Committee members found time for five project meetings, for multiple conference calls, and for drafting portions of the text despite their many other responsibilities and commitments. Many other people volunteered their time and expertise to help the committee to understand better the ways in which OSH surveillance might be strengthened and modernized in ways that would be ac- ceptable, and even inspirational, for all stakeholders. The information gathered during these interactions proved invaluable to the committee's deliberations and forms the backbone of this report. Those who pro- vided us with briefings are summarized in Appendix C to the report. We thank them all for their im- portant contributions. The committee members, many of whom have served on previous study groups, stand in awe of the remarkable, patient work of the Academies staff in supporting its deliberations over the course of this study. Staff members kept the committee on track and helped its members to put their ideas and analyses into coherent prose. Our thanks, finally, to representatives of the sponsoring agencies who worked closely with us when we needed information. Not only did they offer insights in the public sessions during the first committee meetings, but they responded fully and promptly to information requests that we submitted to them throughout the study. The committee accordingly hopes that its findings and recommendations will assist the agencies in moving forward to assure the design and implementation of a “smarter” OSH surveillance system for the 21st century. Edward H. Shortliffe, Chair Committee on Developing a “Smarter” National Surveillance System for Occupational Safety and Health in the 21st Century x Prepublication Copy

Acknowledgments This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and crit- ical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quali- ty, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manu- script remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: James J. Cimino, University of Alabama School of Medicine Eric Frumin, Change to Win Erica Groshen, Cornell University James S. House, University of Michigan Joel Kaufman, University of Washington Anthony LaMontagne, Deakin University, Australia Harold Lehmann, Johns Hopkins School of Medicine Virginia Lesser, Oregon State Department of Statistics Sharon Levine, Kaiser Permanente Barbara Materna, California Department of Public Health Carrie A. Redlich, Yale University John W. Ruser, Workers Compensation Research Institute Gregory R. Wagner, Harvard School of Public Health Marc Younis, ExxonMobil Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by Dr. Mark R. Cullen, Stanford University, and Dr. James A. Merchant, the University of Iowa. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. Prepublication Copy xi

Contents SUMMARY ......................................................................................................................................................... 1 1 INTRODUCTION...................................................................................................................................... 10 Background, 10 Purpose of This Study, 13 Key Terms and Definitions, 15 Organization of the Report, 18 References, 19 2 BUILDING A “SMARTER” NATIONAL SURVEILLANCE SYSTEM ............................................ 20 Guiding Principles, 20 Objectives, 21 An Ideal Surveillance System, 22 Tools and Sources for Data Collection, 24 Data Curation, 25 Barriers to a Smarter Surveillance System, 26 References, 27 3 OVERVIEW OF AGENCIES AND STAKEHOLDERS ....................................................................... 28 Bureau of Labor Statistics, 28 Occupational Safety Health Administration, 30 National Institute for Occupational Safety and Health, 32 Mine Safety and Health Administration (MSHA), 34 Other Federal Agencies, 34 State Agencies, 36 Employees, Employers, and Other Stakeholders, 38 Federal and State Agency Coordination, Collaboration, Information Exchange, and Public Engagement on OSH Surveillance, 40 Updates of the Recommendations of the 1987 Report, 43 Summary and Conclusions, 44 References, 44 4 CURRENT STATUS OF FEDERAL AND STATE PROGRAMS AND CROSS-CUTTING ISSUES...................................................................................................................... 48 Introduction, 48 Surveillance of Fatal Occupational Injuries, 48 Surveillance of Non-Fatal Occupational Injuries, 53 Occupational Disease Surveillance, 67 Occupational Hazard and Exposure Surveillance, 78 Cross-cutting Issues, 80 Summary, 85 References, 85 Prepublication Copy xiii

Contents 5 INTERNATIONAL APPROACHES TO OCCUPATIONAL HEALTH SURVEILLANCE.................................................................................................................... 95 Occupational Fatalities, 95 Occupational Injuries, 95 Occupational Disease, 98 Work Hazards or Exposures, 100 References, 103 6 PROMISING DEVELOPMENTS AND TECHNOLOGIES............................................................... 106 Introduction, 106 Implementing a Household Survey, 106 Electronic Health Records, 110 Coding of Occupational Data, 112 Electronic Employer-Based Reporting of Occupational Injury and Illness, 115 Mobilizing Use of Workers’ Compensation Data, 118 Leveraging Existing Surveys and Data Systems, 123 Improving Occupational Hazard and Exposure Surveillance, 127 Summary, 135 References, 135 7 KEY ACTIONS TO MOVE FORWARD WITH AN IDEAL NATIONAL OCCUPATIONAL SAFETY AND HEALTH SURVEILLANCE SYSTEM..................................... 141 Set Forth a Clear Rationale and Prioritization for OSH Surveillance, 141 Coordinate Surveillance Strategies and Operations Among Key Agencies, Organizations, and Stakeholders, 144 Use Information Technology Effectively, 146 Enhance Training and Support for OSH Surveillance Practitioners, 158 References, 159 8 NEXT STEPS FOR IMPROVING WORKER SAFETY AND HEALTH THROUGH A SMARTER OCCUPATIONAL SURVEILLANCE SYSTEM .................................. 164 Vision for a Smarter System, 164 Action Steps – Report Recommendations, 165 Concluding Remarks, 170 References, 170 APPENDIXES A RECOMMENDATIONS......................................................................................................................... 171 B BIOGRAPHICAL SKETCHES OF COMMITTEE MEMBERS....................................................... 179 C OPEN SESSION MEETING AGENDAS.............................................................................................. 183 D UPDATES ON RECOMMENDATIONS FROM THE 1987 NATIONAL RESEARCH COUNCIL REPORT COUNTING INJURIES AND ILLNESSES IN THE WORKPLACE: PROPOSALS FOR A BETTER SYSTEM............................................................................................ 187 E OSHA FORM 300 AND RELATED PAGES ........................................................................................ 190 xiv Prepublication Copy

Select Acronyms and Abbreviations ABLES Adult Blood Lead Epidemiology and Surveillance ACA Affordable Care Act ACS American Community Survey AHRQ Agency for Healthcare Research and Quality ATS American Thoracic Society BLS Bureau of Labor Statistics, U.S. Department of Labor BRFSS Behavioral Risk Factor Surveillance System CalSIM California Simulation of Insurance Markets CAREX CARcinogen EXposure System CBA Cost Benefit Analysis CDC Centers for Disease Control and Prevention CEA Cost-effectiveness Analysis CEHD Chemical Exposure Health Data CFID Commercial Fishins Incident Database CFOI Census of Fatal Occupational Injuries CFR Code of Federal Regulations CHIS California Health Interview Survey CIC Census Industry Codes COC Census Occupation Codes COPD Chronic Obstructive Pulmonary Disease CPS-ASEC Current Population Survey - Annual Social and Economic Supplement CPSC Consumer Products Safety Commission CPWR The Center for Construction Research and Training CSELS Center for Surveillance, Epidemiology, and Laboratory Services CSTE Council of State and Territorial Epidemiologists CUA Cost-utility Analysis CWCS Center for Workers’ Compensation Studies CWHSP Coal Workers' Health Surveillance Program CWP Coal Workers’ Pneumoconiosis CWXSP Coal Workers’ X-ray Surveillance Program DAFW Days Away From Work DHHS Department of Health and Human Services DIR Department of Industrial Relations DOE Department of Energy DOL Department of Labor DOT Department of Transportation DSR Division of Safety Research, National Institute for Occupational Safety and Health EHR Electronic Health Records ELF Employed Labor Force EPA Environmental Protection Agency EU European Union eWorld Work-Related Lung Disease Surveillance System Prepublication Copy xv

Select Acronyms and Abbreviations FACE Fatality Assessment and Control Evaluation FARS Fatality Analysis Reporting System FINJEM Finnish Job Exposure Matrix FOG Fatalities in the Oil and Gas Extraction Industry FRA Federal Railroad Administration FTE Full-Time Equivalent GP General Practitioners HCUP The Healthcare Cost and Utilization Project HHE Health Hazard Evaluation HHS Department of Health and Human Services HITECH Health Information Technology for Economic and Clinical Health HIV Human Immunodeficiency Virus HSE Health and Safety Executive HSOII Household Survey of Nonfatal Occupational Injuries and Illnesses IAIABC International Association of Industrial Accidents Boards and Commissions ICD International Classification of Diseases ILO International Labour Organization IMIS Integrated Management Information System IOM Institute of Medicine IT Information Technology JEMs Job Exposure Matrices LAUS Labor Statistics Local Area Unemployment Statistics LFS Labour Force Survey MassCOSH Massachusetts Coalition for Occupational Safety and Health MC Methylene Chloride MDI Methyldiisocyante MDRS Mine Data Retrieval System MEPS Medical Expenditure Panel Survey MIFACE Michigan Fatality Assessment and Control Evaluation MSD Musculoskeletal Disorder MSHA Mine Safety and Health Administration NAICS North American Industry Classification System NBDPS National Birth Defects Prevention Study NCCDP National Center for Chronic Disease Prevention and Health Promotion NCCI National Council on Compensation Insurance NCHS National Center for Health Statistics NCIPC National Center for Injury Prevention and Control NCVS National Crime Victimization Survey NEISS National Electronic Injury Surveillance System NHANES National Health and Nutrition Examination Survey NHIS National Health Interview Survey NHTSA National Highway Traffic Safety Administration NIH National Institutes of Health NIOCCS NIOSH Industry and Occupation Computerized Coding System NIOSH National Institute for Occupational Safety and Health NLP Natural Language Processing NNDSS Nationally Notifiable Disease Surveillance Systems NOES National Occupational Exposures Survey NOHS National Occupational Hazards Survey NOMS National Occupational Mortality Surveillance System NORA National Occupational Research Agenda NORC National Opinion Research Center NORMS National Occupational Respiratory Mortality System xvi Prepublication Copy

Select Acronyms and Abbreviations NRC National Research Council NUBC National Uniform Billing Committee O*NET Occupational Network Database ODI OSHA Data Initiative OHSN Occupational Health Safety Network OIICS Occupational Injury and Illness Classification System OIS OSHA Information System ONC National Coordinator for Health Information Technology ORS Occupational Requirements Survey OSH Occupational Safety and Health OSHA Occupational Safety and Health Administration OWCP Office of Workers’ Compensation Programs PRAMS Pregnancy Risk Assessment Monitoring System QA Quality Assurance QALYs Quality-adjusted Life Years QCEW Quarterly Census of Employment and Wages QWS Quality of Worklife Survey RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations RISQS Related Injury Statistics Query System ROI Return on Investment RTW Return to Work S&H Safety and Health SAE Small-area Estimation SENSOR Sentinel Event Notification System for Occupational Risks SFIB IST Surveillance and Field Investigation Branch Injury Surveillance Team SHARP Safety and Health Assessment and Research for Prevention SOC Standard Occupational Classification SOII Survey of Occupational Injuries and Illnesses THOR The Health and Occupation Research network TIRES Trucking Injury Reduction Emphasis through Surveillance UAW United Automobile, Aerospace and Agricultural Implement Workers of America UB Uniform Bill UI Unemployment Insurance UMLS Unified Medical Language System USDOL United States Department of Labor WCIO Workers Compensation Insurance Organizations WISQARS Web-based Injury Statistics Query and Reporting System WR Work Related WRII Work-related Injury and Illness YWP Young Workers Project Prepublication Copy xvii

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The workplace is where 156 million working adults in the United States spend many waking hours, and it has a profound influence on health and well-being. Although some occupations and work-related activities are more hazardous than others and face higher rates of injuries, illness, disease, and fatalities, workers in all occupations face some form of work-related safety and health concerns. Understanding those risks to prevent injury, illness, or even fatal incidents is an important function of society.

Occupational safety and health (OSH) surveillance provides the data and analyses needed to understand the relationships between work and injuries and illnesses in order to improve worker safety and health and prevent work-related injuries and illnesses. Information about the circumstances in which workers are injured or made ill on the job and how these patterns change over time is essential to develop effective prevention programs and target future research. The nation needs a robust OSH surveillance system to provide this critical information for informing policy development, guiding educational and regulatory activities, developing safer technologies, and enabling research and prevention strategies that serves and protects all workers.

A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century provides a comprehensive assessment of the state of OSH surveillance. This report is intended to be useful to federal and state agencies that have an interest in occupational safety and health, but may also be of interest broadly to employers, labor unions and other worker advocacy organizations, the workers’ compensation insurance industry, as well as state epidemiologists, academic researchers, and the broader public health community. The recommendations address the strengths and weaknesses of the envisioned system relative to the status quo and both short- and long-term actions and strategies needed to bring about a progressive evolution of the current system.

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