The Evolving Challenge of Workplace Safety
Lessons learned during the emergency response to 9/11 were applied during the Deep Water Horizon crisis. Photo courtesy of the United States Coast Guard.
Dr. John Howard was recently reappointed director of the National Institute for Occupational Safety and Health and the administrator of the World Trade Center Health Program.
In this Q&A, he discusses the nature of the workforce, how NIOSH is responding, and the future of the WTC Health Program.
Q: How have the workforce and NIOSH’s efforts changed since you were first appointed to NIOSH in 2002?
A: I think the major change that I’ve noticed is the changing nature of the employment relationship. In the new “gig economy,” or “sharing economy,” workers are in a different relationship to an employer and they may be viewed more as contractors. This becomes a very complicated issue of labor law and employment law.
The big change is that these patterns of employment are very different than the patterns of employment that existed in the mid-20th century when the Occupational Safety and Health Act was passed in 1970 where the paradigm was that workers had one employer, they usually worked at that employer’s facility, and they usually did it for their entire working life; so all of those characteristics of employment have changed.
Certainly they still exist, primarily in the public sector, but the private sector is experimenting with many new forms. That change has really been a challenge for occupational safety and health.
One aspect of that is it increases our responsibility to figure out a way to communicate better and more directly with workers who may not have representation or an employer that is responsible for their safety and health.
Obviously, there are all sorts of new technologies that come into play that present new hazards, but that’s the overriding one — how work is organized.
There’s more work intensification. Productivity is a major economic driver and increasing the output per worker is a big driver of economic growth. So that work intensification issue is one that I’ve seen increase over the last 13 years.
Q: NIOSH has been involved in cutting-edge research into the effects of certain types of work on workers’ safety and health over the years such as nanotechnology and fracking. What issues do you see on the horizon?
A: I think it’s important to recognize the motivation for a research agency like NIOSH, which certainly continues to do research in persisting or historical hazards. Falls in construction, for example. Those hazards have been around a long time, but we are still looking at it and trying to protect workers. The motivation for some of these newer initiatives is trying to get ahead of the risk.
I think a lot of us at NIOSH want to get ahead of the emerging risks at a time when we can really make a difference and at a time when employers and workers in new technologies are open to changing the way they are doing things.
Once a technology matures and there are a lot of sunk costs in how they are doing the technology, like hydraulic fracturing, the less likely the economic actors in that technology are willing to listen to people like us say, “well, we found this silica risk in the way you’re doing fracturing.”
Once they’ve solidified that and spent a lot of money, there is a resistance we often encounter. We are trying to look at these new technologies and characterize them fully at an early stage of economic development.
That explains some of the things we’ve done early on about fracturing, and our now decade-long research into nanotechnology.
There are a couple of emerging areas I think are important when looking to get ahead of potential risk. One is occupational robotics. We see these auto plants in which there are lines of robots that are welding and placing parts of the car in and that’s been going on for many years.
Now we’re starting to see more personal robots and more professional robots even some managerial robots where they are not on an assembly line, but actually working with human workers. So you have a robotic worker and human worker in the same workplace.
We’re seeing that more and more. What’s the risk profile for that human worker that’s next to the robot? One of the issues is how can we best protect the humans when they are working in close proximity to a professional robot who may have independent movement in that workplace where they are not attached like an industrial robot in a factory.
The other thing I think is emerging is the field of synthetic biology. This is a very interesting area. It involves biologic technology, genomics. To make a simple analogy, a lot of gene therapy is now being done with viral vectors, viruses like the adenovirus, which causes a cold.
The researcher strips out the genes of the adenovirus, and then places inside that shell the new gene that the researcher or clinician would like to insert in the individual. So it’s a vector, something that carries the new gene. The body picks it up, it’s administered orally.
One of the areas that’s interesting in that is one of the viruses that is used as a vector because it has the ability to insert itself into the host’s DNA and therefore become a permanent change is the human immunodeficiency virus, HIV, called a lentivirus.
One question that arises is, what is the occupational exposure of a researcher or a clinical health care worker to a viral vector made from a lentivirus. Even though the researcher may remove some of the HIV virus that causes it to replicate, there could still be the risk it could be replicating and cause problems years down the line in that health care worker. So synthetic biology is very interesting.
Q: In your Labor Day message you said: “How do we, as occupational safety and health professionals, continue our work to make sure every worker, including independent contractors, temporary, on-call, and freelance workers, stays safe and healthy?” What are your thoughts on how that can be accomplished and what is NIOSH doing toward this end?
A: One of the major things we’re trying to do is figure out how to reach the new worker who is not in the traditional employer/employee relationship. We now have many, many workers who are not represented by a union but also don’t seem to have an employer. They are sort of free range workers. That’s harder for us to be able to communicate with them.
What NIOSH is doing is trying to find every way possible to reach an unaffiliated, unrepresented contract employee to give them the information they need to keep them safe in a language that they can understand, which is always a struggle from a research perspective. NIOSH is trying to do that by getting on social media channels.
Also, we are trying to make sure all our content can be accessed by mobile devices because workers may not have access to the Internet through a desktop or home computer. In vulnerable populations, we find they frequently will have a mobile device.
We have a big effort in application development trying to get our material on Wikipedia, which has widespread national and international access. Because of algorithms on Google and Bing, after you enter a search question or term, Wikipedia comes up first.
So it’s a two-part answer. First is finding the new worker and where they go for information and getting that to them. Second is getting it into a basic understanding. Sometimes that involves pictographs rather than words. The most vulnerable contract workers are the ones who have language issues and access issues to the Internet. So it’s a challenge.
Q: As the administrator of the World Trade Center Health Program, how do you see that program evolving?
A: Right now the focus is on the reauthorization. We are in the fifth year of funding. It started July 2011, and it’s a five-year authorization. The members are very interested in seeing that the health care they are getting and physicians they are seeing are the same group who have been involved since the beginning.
We’re answering lots of questions about the program and what an experience it has been in the last four years.
I think the evolution of the program has been toward making it a more sound, professionally administered health plan that you would expect from any other health plan, whether Medicare or Medicaid or an individual health service. It started in 2001 and for over a decade was a grant program, not really a cohesive health program.
The authorization legislation was really the first step in professionalizing the services that are provided to the members. The evolution is continuing in that direction where the services are similar to a health plan administered that way. We don’t cover everything. It’s a different kind of health plan.
But our process of eligibility, determinations of the conditions people have, the certification of those conditions, various coverages for cancer for instance, and how that care is delivered are continuing to improve for the members.
The big evolution I see if it’s reauthorized is in the direction of improving the level of services for the members.
Q: What are some of the lessons that have been learned from 9/11?
A: One of the big lessons we learned, which we applied in the Deep Water Horizon situation, was keeping track of who was responding and having some contact information, some demographic information, and some information about what kind of response work they were doing and how long they were doing it. In 9/11 we didn’t have any of that so it’s very difficult to do a quantitative risk assessment for responders. We didn’t even have a roster of who responded.
In Deep Water Horizon, one of first things we did is develop a roster of responders. On our website we have information on 55,000 individuals. We then made it available to researchers who wanted to look at any kind of follow-on health conditions.
Another lesson was if you can’t find somebody after the response to evaluate, you can’t know the long-term effects. Before 9/11 all the emphasis in emergency response was on the pre-deployment phase — who was going to respond, how they were going to respond, how they were organized in the incident command structure, and what kind of equipment they needed.
The big lesson was we added a second phase during the deployment phase where we rostered people and sampled what they were exposed to. For a third phase post-deployment, we actually knew who they were and what things they were exposed to, and we were able to look at their health conditions afterward and be able to tell if they were adversely affected.
The big lesson was turning emergency preparedness from a single dimension activity into a multi-dimensional activity.