Safety Leadership

The Evolving Challenge of Workplace Safety

The recently reappointed director of NIOSH discusses the changing nature of the workforce and how the agency is responding.
By: | October 26, 2015 • 9 min read

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.

John Howard, director, National Institute for Occupational Safety and Health; administrator, World Trade Center Health Program

John Howard, director, National Institute for Occupational Safety and Health; administrator, World Trade Center Health Program

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.

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Exclusive | Hank Greenberg on China Trade, Starr’s Rapid Growth and 100th, Spitzer, Schneiderman and More

In a robust and frank conversation, the insurance legend provides unique insights into global trade, his past battles and what the future holds for the industry and his company.
By: | October 12, 2018 • 12 min read

In 1960, Maurice “Hank” Greenberg was hired as a vice president of C.V. Starr & Co. At age 35, he had already accomplished a great deal.

He served his country as part of the Allied Forces that stormed the beaches at Normandy and liberated the Nazi death camps. He fought again during the Korean War, earning a Bronze Star. He held a law degree from New York Law School.


Now he was ready to make his mark on the business world.

Even C.V. Starr himself — who hired Mr. Greenberg and later hand-picked him as the successor to the company he founded in Shanghai in 1919 — could not have imagined what a mark it would be.

Mr. Greenberg began to build AIG as a Starr subsidiary, then in 1969, he took it public. The company would, at its peak, achieve a market cap of some $180 billion and cement its place as the largest insurance and financial services company in history.

This month, Mr. Greenberg travels to China to celebrate the 100th anniversary of C.V. Starr & Co. That visit occurs at a prickly time in U.S.-Sino relations, as the Trump administration levies tariffs on hundreds of billions of dollars in Chinese goods and China retaliates.

In September, Risk & Insurance® sat down with Mr. Greenberg in his Park Avenue office to hear his thoughts on the centennial of C.V. Starr, the dynamics of U.S. trade relationships with China and the future of the U.S. insurance industry as it faces the challenges of technology development and talent recruitment and retention, among many others. What follows is an edited transcript of that discussion.

R&I: One hundred years is quite an impressive milestone for any company. Celebrating the anniversary in China signifies the importance and longevity of that relationship. Can you tell us more about C.V. Starr’s history with China?

Hank Greenberg: We have a long history in China. I first went there in 1975. There was little there, but I had business throughout Asia, and I stopped there all the time. I’d stop there a couple of times a year and build relationships.

When I first started visiting China, there was only one state-owned insurance company there, PICC (the People’s Insurance Company of China); it was tiny at the time. We helped them to grow.

I also received the first foreign life insurance license in China, for AIA (The American International Assurance Co.). To date, there has been no other foreign life insurance company in China. It took me 20 years of hard work to get that license.

We also introduced an agency system in China. They had none. Their life company employees would get a salary whether they sold something or not. With the agency system of course you get paid a commission if you sell something. Once that agency system was installed, it went on to create more than a million jobs.

R&I: So Starr’s success has meant success for the Chinese insurance industry as well.

Hank Greenberg: That’s partly why we’re going to be celebrating that anniversary there next month. That celebration will occur alongside that of IBLAC (International Business Leaders’ Advisory Council), an international business advisory group that was put together when Zhu Rongji was the mayor of Shanghai [Zhu is since retired from public life]. He asked me to start that to attract foreign companies to invest in Shanghai.

“It turns out that it is harder [for China] to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

Shanghai and China in general were just coming out of the doldrums then; there was a lack of foreign investment. Zhu asked me to chair IBLAC and to help get it started, which I did. I served as chairman of that group for a couple of terms. I am still a part of that board, and it will be celebrating its 30th anniversary along with our 100th anniversary.


We have a good relationship with China, and we’re candid as you can tell from the op-ed I published in the Wall Street Journal. I’m told that my op-ed was received quite well in China, by both Chinese companies and foreign companies doing business there.

On August 29, Mr. Greenberg published an opinion piece in the WSJ reminding Chinese leaders of the productive history of U.S.-Sino relations and suggesting that Chinese leaders take pragmatic steps to ease trade tensions with the U.S.

R&I: What’s your outlook on current trade relations between the U.S. and China?

Hank Greenberg: As to the current environment, when you are in negotiations, every leader negotiates differently.

President Trump is negotiating based on his well-known approach. What’s different now is that President Xi (Jinping, General Secretary of the Communist Party of China) made himself the emperor. All the past presidents in China before the revolution had two terms. He’s there for life, which makes things much more difficult.

R&I: Sure does. You’ve got a one- or two-term president talking to somebody who can wait it out. It’s definitely unique.

Hank Greenberg: So, clearly a lot of change is going on in China. Some of it is good. But as I said in the op-ed, China needs to be treated like the second largest economy in the world, which it is. And it will be the number one economy in the world in not too many years. That means that you can’t use the same terms of trade that you did 25 or 30 years ago.

They want to have access to our market and other markets. Fine, but you have to have reciprocity, and they have not been very good at that.

R&I: What stands in the way of that happening?

Hank Greenberg: I think there are several substantial challenges. One, their structure makes it very difficult. They have a senior official, a regulator, who runs a division within the government for insurance. He keeps that job as long as he does what leadership wants him to do. He may not be sure what they want him to do.

For example, the president made a speech many months ago saying they are going to open up banking, insurance and a couple of additional sectors to foreign investment; nothing happened.

The reason was that the head of that division got changed. A new administrator came in who was not sure what the president wanted so he did nothing. Time went on and the international community said, “Wait a minute, you promised that you were going to do that and you didn’t do that.”

So the structure is such that it is very difficult. China can’t react as fast as it should. That will change, but it is going to take time.

R&I: That’s interesting, because during the financial crisis in 2008 there was talk that China, given their more centralized authority, could react more quickly, not less quickly.

Hank Greenberg: It turns out that it is harder to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.

R&I: Obviously, you have a very unique perspective and experience in China. For American companies coming to China, what are some of the current challenges?


Hank Greenberg: Well, they very much want to do business in China. That’s due to the sheer size of the country, at 1.4 billion people. It’s a very big market and not just for insurance companies. It’s a whole range of companies that would like to have access to China as easily as Chinese companies have access to the United States. As I said previously, that has to be resolved.

It’s not going to be easy, because China has a history of not being treated well by other countries. The U.S. has been pretty good in that way. We haven’t taken advantage of China.

R&I: Your op-ed was very enlightening on that topic.

Hank Greenberg: President Xi wants to rebuild the “middle kingdom,” to what China was, a great country. Part of that was his takeover of the South China Sea rock islands during the Obama Administration; we did nothing. It’s a little late now to try and do something. They promised they would never militarize those islands. Then they did. That’s a real problem in Southern Asia. The other countries in that region are not happy about that.

R&I: One thing that has differentiated your company is that it is not a public company, and it is not a mutual company. We think you’re the only large insurance company with that structure at that scale. What advantages does that give you?

Hank Greenberg: Two things. First of all, we’re more than an insurance company. We have the traditional investment unit with the insurance company. Then we have a separate investment unit that we started, which is very successful. So we have a source of income that is diverse. We don’t have to underwrite business that is going to lose a lot of money. Not knowingly anyway.

R&I: And that’s because you are a private company?

Hank Greenberg: Yes. We attract a different type of person in a private company.

R&I: Do you think that enables you to react more quickly?

Hank Greenberg: Absolutely. When we left AIG there were three of us. Myself, Howie Smith and Ed Matthews. Howie used to run the internal financials and Ed Matthews was the investment guy coming out of Morgan Stanley when I was putting AIG together. We started with three people and now we have 3,500 and growing.

“I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

R&I:  You being forced to leave AIG in 2005 really was an injustice, by the way. AIG wouldn’t have been in the position it was in 2008 if you had still been there.


Hank Greenberg: Absolutely not. We had all the right things in place. We met with the financial services division once a day every day to make sure they stuck to what they were supposed to do. Even Hank Paulson, the Secretary of Treasury, sat on the stand during my trial and said that if I’d been at the company, it would not have imploded the way it did.

R&I: And that fateful decision the AIG board made really affected the course of the country.

Hank Greenberg: So many people lost all of their net worth. The new management was taking on billions of dollars’ worth of risk with no collateral. They had decimated the internal risk management controls. And the government takeover of the company when the financial crisis blew up was grossly unfair.

From the time it went public, AIG’s value had increased from $300 million to $180 billion. Thanks to Eliot Spitzer, it’s now worth a fraction of that. His was a gross misuse of the Martin Act. It gives the Attorney General the power to investigate without probable cause and bring fraud charges without having to prove intent. Only in New York does the law grant the AG that much power.

R&I: It’s especially frustrating when you consider the quality of his own character, and the scandal he was involved in.

In early 2008, Spitzer was caught on a federal wiretap arranging a meeting with a prostitute at a Washington Hotel and resigned shortly thereafter.

Hank Greenberg: Yes. And it’s been successive. Look at Eric Schneiderman. He resigned earlier this year when it came out that he had abused several women. And this was after he came out so strongly against other men accused of the same thing. To me it demonstrates hypocrisy and abuse of power.

Schneiderman followed in Spitzer’s footsteps in leveraging the Martin Act against numerous corporations to generate multi-billion dollar settlements.

R&I: Starr, however, continues to thrive. You said you’re at 3,500 people and still growing. As you continue to expand, how do you deal with the challenge of attracting talent?

Hank Greenberg: We did something last week.

On September 16th, St. John’s University announced the largest gift in its 148-year history. The Starr Foundation donated $15 million to the school, establishing the Maurice R. Greenberg Leadership Initiative at St. John’s School of Risk Management, Insurance and Actuarial Science.

Hank Greenberg: We have recruited from St. John’s for many, many years. These are young people who want to be in the insurance industry. They don’t get into it by accident. They study to become proficient in this and we have recruited some very qualified individuals from that school. But we also recruit from many other universities. On the investment side, outside of the insurance industry, we also recruit from Wall Street.

R&I: We’re very interested in how you and other leaders in this industry view technology and how they’re going to use it.

Hank Greenberg: I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.

R&I: So as the pre-eminent leader of the insurance industry, what do you see in terms of where insurance is now and where it’s going?

Hank Greenberg: The country and the world will always need insurance. That doesn’t mean that what we have today is what we’re going to have 25 years from now.

How quickly the change comes and how far it will go will depend on individual companies and individual countries. Some will be more brave than others. But change will take place, there is no doubt about it.


More will go on in space, there is no question about that. We’re involved in it right now as an insurance company, and it will get broader.

One of the things you have to worry about is it’s now a nuclear world. It’s a more dangerous world. And again, we have to find some way to deal with that.

So, change is inevitable. You need people who can deal with change.

R&I:  Is there anything else, Mr. Greenberg, you want to comment on?

Hank Greenberg: I think I’ve covered it. &

The R&I Editorial Team can be reached at [email protected]