NIOSH lower profile spurs reorganization protest

NIOSH to move down in CDC organization

Worried that the future clout of the National Institute for Occupational Safety and Health (NIOSH) is in jeopardy, occupational health advocates are pressing the Centers for Disease Control and Prevention (CDC) to alter its reorganization plans.

NIOSH has a significant influence on occupational health practice through its research, recommendations, and hazard alerts. While its mission would remain the same, it could suffer from a lower profile, says Susan Randolph, RN, MSN, COHN-S, FAAOHN, president of the American Association of Occupational Health Nurses.

"NIOSH had its own identity. Under this new proposed [CDC] structure, it would lose some of that identity," says Randolph, who is a clinical instructor with the occupational health nursing program at the University of North Carolina at Chapel Hill. "It would be essentially [moved] down a level organizationally."

Randolph was one of several occupational health professionals who recently wrote CDC director Julie Gerberding about those concerns.

Franklin E. Mirer, PhD, director of the health and safety department for the United Auto Workers, also wrote Gerberding that the business-labor-academic partnerships could be weakened if NIOSH has a lower organizational status.

"All of the work functions that the National Institute for Occupational Safety and Health perform are and will continue to be a high priority here at CDC," responded CDC spokesman Tom Skinner.

By integrating resources and coordinating with the CDC centers, "we’ll be able to have an even greater impact on occupational safety and health than we do right now," he says.

NIOSH was created in 1970 by the Occupational Safety and Health Act to be a sister agency to the Occupational Safety and Health Administration (OSHA). With its research mission, it works closely with OSHA, employers, and unions.

At its inception, the Department of Health and Human Services placed NIOSH within CDC, but NIOSH has maintained a measure of independence. For example, each year, NIOSH officials lobby Congress for the agency’s budget allocations.

In the reorganization, which becomes effective on Oct. 1, NIOSH will be part of the Coordinating Center for Environmental Health, Injury Prevention and Occupational Health. That center also will include the National Center for Environmental Health/Agency for Toxic Substances and Disease Registry and the National Center for Injury Prevention and Control. It will be headed by Henry Falk, MD.

The change came as a surprise for some in the occupational health field who had commented on the reorganization, but not the NIOSH move.

"In reading the materials that were sent, it appeared as if it was more of a realigning within CDC itself and not so much [of] a separate organization, such as NIOSH," says Randolph. "I really did not think that would affect the placement of NIOSH."

In fact, NIOSH actually should have a more independent status, contends Bill Borwegen, MPH, health and safety director of the Service Employees International Union. "I think the intent of Congress is that it be a separate institute of health like all the other institutes of health," he explains.

The CDC reorganization is part of the "Futures Initiative," which is intended to streamline the agency and focus its resources. CDC’s two overarching goals are preparedness and "health promotion and prevention of disease, injury, and disability." Targeted goals will focus on improving health in "every stage of life," CDC says.

However, working is not linked with a particular life stage, notes Sharon Morris, who was a former legislative officer at NIOSH and worked at the agency from 1972 to 1982.

CDC says in its explanation of the Futures Initiative that the agency will "meet statutory requirements regarding CDC’s Centers, Institute, and Agency (for example the director of NIOSH will continue to serve at the pleasure of the secretary of Health and Human Services)."

Little else is mentioned of NIOSH’s distinctive position. "The institute has a separate law that governs it and a separate mission from the rest of CDC," says Morris, who is now assistant chair of the department of environmental and occupational health sciences at the University of Washington in Seattle. "Its mission is worker safety and health, not general public safety and health.

"It’s an important mission. It needs to be visible and able to fulfill that mission and not become homogenized with a lot of other related or unrelated missions."

This is not the first conflict between CDC and NIOSH, or supporters of NIOSH. NIOSH’s headquarters have moved from Washington, DC, to Atlanta and back to Washington, notes Morris. "There have been a number of issues over the years where there have been differences of opinion, which relate sometimes to their different constituencies," she says.