Summary of Findings and Recommendations
The major trends that the committee has identified in the workplace and the workforce, most of which arise from the movement away from a long-term employee-employer relationship at a fixed work site, are elements of larger societal changes related to the way social services are delivered in modern industrial economies. Destabilization of employment relationships has led to increasing movement toward making the individual even more responsible for his or her own financial welfare over a lifetime. The notion of altering the social security system to allow individuals to manage their own funds in individual retirement account-like schemes is a recent example. The traditional provision of health insurance and a retirement program through the employer is also becoming less prevalent. Moreover, public support to strengthen mechanisms to provide these services through governmental programs appears to be declining as well. Churches, labor unions, and fraternal organizations cannot fulfil the role of social services conduit on a broad scale. Indeed, labor unions themselves are struggling to survive in sectors of the economy where employment is increasingly transient. The end result is that the evolving circumstances of employment are increasingly placing responsibility for occupational illness and injury prevention on the individual worker. The committee does not believe that this trend is in the best interest of U.S. workers and has thus devoted much of its analysis and recommendations to actions that will counter or mitigate this development instead of a more straightforward calculation of the occupational safety and health (OSH) personnel likely to be needed by the large, fixedsite, stable-workforce industries that have traditionally hired them.
Enhanced and innovative approaches to OSH and education are needed at the graduate level for health and safety managers, for industrial sector-specific training for those doing worker training, and for the general public with an emphasis on reaching children, parents, and the workforce. The committee makes the following specific recommendations, numbered for ease of reference and not as an indication of priority.
CURRENT OSH WORKFORCE AND TRAINING
The current supply of OSH professionals, though diverse in knowledge and experience, generally meets the demands of large and some medium sized workplaces. However, the burden of largely preventable occupational diseases and injuries and the lack of adequate OSH services in most small and many medium-sized workplaces indicate a need for more OSH professionals at all levels. The committee also finds that OSH education and training needs to place more emphasis on injury prevention and that current OSH professionals need easier access to more comprehensive and alternative learning experiences.
To address the critical need to mitigate the enormous and continuing impacts of acute and chronic injuries on worker function, health, and well-being, to develop new leaders in this neglected field, and to strengthen research and training in it at all levels:
Recommendation 1: Add a new training initiative focused on prevention of occupational injuries.
NIOSH should develop a new training initiative focused on the prevention of occupational injuries, with special attention to the development of graduate-level faculty to teach and conduct research in this area. Possible approaches would include regional Occupational Injury Research, Prevention, and Control Centers as an entirely new program or by modification of the existing NIOSH training programs or collaboration with the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control.
To enhance needed multidisciplinary research in injury prevention and in occupational safety and health in general:
Recommendation 2: Extend existing training programs to support of individual Ph.D. candidates.
NIOSH should extend existing training programs to support individual Ph.D. candidates whose research is deemed of importance to the prevention and treatment of occupational injuries and illnesses, independent of academic department or program. Restricting support to students in Education and Research Centers or Training Project Grants–affiliated departments or disciplines deprives the OSH field of individuals who may have innovative responses to changing circumstances.
To address the lack of formal training among OSH professionals:
Recommendation 3: Encourage distance learning and other alternatives to traditional education and training programs.
NIOSH should encourage the use and evaluation of distance education and other nontraditional approaches to OSH education and training, especially as a means of facilitating education and certification of the many practicing OSH personnel without formal specialty training in the area.
Recommendation 4: Reexamine current pathways to certification in occupational medicine.
The American Board of Preventive Medicine should reexamine the current pathways to certification in occupational medicine. Specifically, it should consider
extending eligibility for its existing equivalency pathway to include physicians who graduated after 1984 and
developing a certificate of special competency in occupational medicine for physicians who are board certified in other specialties but who have completed some advanced training in occupational medicine.
FUTURE OSH WORKFORCE AND TRAINING
Expected changes in the workforce and in the nature and organization of work in the coming years will result in workplaces that will be quite different from the large fixed-site manufacturing plants in which OSH professionals have previously made their greatest contributions. The delivery of OSH services will become more complicated, and additional
types of OSH personnel and different types of training than have been relied upon to date will be needed. Simply increasing the numbers or modifying the training of occupational health professionals will not be sufficient, since the primary difficulty will be to provide training to underserved workers and underserved workplaces. Traditional OSH programs must be supplemented by a new model that focuses on these workers and worksites.
To help ensure high-quality occupational safety and health programs for the full spectrum of American workers:
Recommendation 5: Solicit large-scale demonstration projects that target training in small and mid-sized workplaces.
NIOSH, in collaboration with OSHA, should fund and evaluate large-scale demonstration projects that target training in small and midsized workplaces. These innovative training programs should encourage the use of new learning technologies, should include a recommended core of competencies, and could lead to the creation of a new category of health and safety personnel—OSH managers.
Recommendation 6: Evaluate current worker training and establish minimum quality standards.
OSHA should join together with NIOSH, NIEHS, unions, industries, and employer associations to evaluate the efficacy of OSHA and other worker training programs and better define minimum training requirements.
Recommendation 7: Solicit demonstration projects to create model worker training programs for occupational safety and health trainers.
NIOSH, in collaboration with OSHA, should fund demonstration project grants that target specific employment sectors as an incentive to develop model training programs for another category of health and safety personnel—OSH trainers.
To address the challenges posed by the increasing diversity of the U.S. workforce:
Recommendation 8: Increase attention to special needs of older, female, and ethnic/cultural minority workers.
All aspiring OSH professionals must be made aware of ethnic and cultural differences that may affect implementation of OSH programs. In addition, because OSH programs are social as well as scientific endeavors, NIOSH, OSHA, NIEHS, other federal and state agencies, educational institutions, unions, employers, associations, and others engaged in the training of OSH personnel should foster and/or support efforts to provide a body of safety and health professionals and trainees that reflects age, gender, and ethnic/cultural background of the workforces that they serve. These organizations should also foster meaningful instruction on the aging process, the interaction of disabilities and chronic diseases with workplace demands, and communication skills to interact with minority workers and workers with low levels of literacy and those for whom English is a second language.
To prepare present and future OSH professionals to address continuing changes in the U.S. workforce, in the workplace, and in the organization of work itself as major determinants of workplace safety, health, and well-being:
Recommendation 9: Examine current accreditation criteria and standards.
Boards and other groups that accredit academic programs in the OSH professions, in conjunction with appropriate professional organizations, should carefully examine their current accreditation criteria and standards, paying special attention to the needs of students in the areas of behavioral health, work organization, communication (especially risk communication), management, team learning, workforce diversity, information systems, prevention interventions, healthcare delivery, and evaluation methods.
Recommendation 10: Broaden graduate training support to include behavioral health science programs.
NIOSH should broaden its graduate training support to include the behavioral health sciences (e.g., psychology, psychiatry, and social work) by developing and maintaining training programs in work organization and the prevention and treatment of physical and mental effects of work-related stress.
BOX 9-1 SUMMARY OF RECOMMENDATIONS
Current OSH Workforce and Training
Future OSH Workforce and Training