Organizations complain they were left out of the loop
Not since new ergonomics guidelines were announced several years ago has the occ-health profession been so up in arms. The e-mail lines have been burning up with postings of letters complaining to Centers for Disease Control and Prevention (CDC) leaders about their plans for reorganization, and specifically, what that reorganization will do to the National Institute for Occupational Safety and Health (NIOSH).
That reorganization includes the establishment of new Coordinating Centers — including one called the Coordinating Center for Environmental and Occupational Health and Injury Prevention, which will comprise the National Center for Environmental Health, Agency for Toxic Substances and Disease Registry, NIOSH, and National Center for Injury Prevention and Control.
Industry complaints focus on a number of areas, but perhaps the two most prominent are these: First, this reorganization reduces the importance and profile of NIOSH, by making it a branch or subgroup of this new center; and second, that professional organizations and other stakeholders were not consulted about this specific change.
A less robust NIOSH?
Occ-health leaders pulled no punches in expressing their concerns. For example, the American Association of Occupational Health Nurses (AAOHN) in Atlanta assails the new "lack of visibility of NIOSH." By placing NIOSH into the aforementioned center, it asserts in a release, "NIOSH is moved down one level within the CDC structure and thus loses its identity as an independently created entity by the Occupational Safety and Health Act. As a result, the director of NIOSH would report to the head of the Coordinating Center, and not the Director of CDC."
The budgetary implications of this move are unknown, says Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, president of AAOHN.
"If you are a separate institute, as NIOSH is now, Dr. John Howard [NIOSH head] can go on the Hill and talk about funding, etc., because he is at the head of his agency, reporting directly up to Dr. [Julie] Gerberding [CDC’s director]," Randolph explains. "Now we have this coordinating center, and the head of that cluster on environmental injury and occupational health would be the one doing the lobbying. This can make a big difference if you depend on whether your views as you communicate them up [the chain of command] are further relayed." Now in other words, "It would be inappropriate for NIOSH to go directly to Congress," she asserts.
In addition, Randolph says, NIOSH will not be as visible as it once was, and that may communicate the message that it is not as important as it once was. "Of course, the CDC will continue to advocate for keeping people healthy; but when they talk about the various target groups, workers are certainly not in that list," she complains. "Where does the health and safety piece come out now?"
"NIOSH has an important role that’s different from the CDC, in that it focuses on occupational health, while the rest of the CDC focuses primarily on personal health and infectious diseases; it really runs as an independent unit," adds Laura S. Welch, MD, of the Center to Protect Workers’ Rights, Silver Spring, MD. "Will it continue to fulfill its mission? Will it have the same budget? We have no answer on this."
Welch adds that the act of Congress that established NIOSH placed it within the CDC as "a marriage of convenience." In other words, she explains, "Congress clearly intended it to be a separate agency with a very separate role. If it’s just one small element of the CDC, is it still going to be doing all it has been doing?"
Sharon L. Morris, senior lecturer and assistant chair for community outreach at the Department of Environmental and Occupational Health Sciences in Seattle, a former NIOSH employee, also is very concerned what impact the recently announced CDC reorganization will have on NIOSH. "It is a clear demotion of NIOSH, burying it one layer further in the bureaucracy," she says. "Having been with NIOSH since shortly after it was formed, I have some sense of the intent of Congress in creating it — and that’s what I’m concerned about," she continues. "If you look at the CDC web site, there is almost nothing there about occupational safety and health, even though NIOSH is the largest center within the CDC."
It was the intent of Congress, she maintains, that NIOSH be rather independent, and make its recommendations directly to the assistant secretary of labor. "What’s different now is the director doesn’t even report directly to the head of the CDC, but to the head of the Coordinating Center for Injury and Occupational Health," she says. "It’s lumped in with other programs — which is a different mission."
In addition, she says, over the years the CDC has had a branding program that has diminished the visibility of it individual components. "It may work in a lot of areas, but NIOSH’s constituents really look to NIOSH — not the CDC," Morris contends. "The will get really confused."
It would have been nice to know . . .
What has occ-health proponents almost as upset as the reorganization itself is the fact that they didn’t see it coming. "The people who are stakeholders in NIOSH have expressed resentment that they didn’t even know the reorganization was to take place, and that NIOSH was to be reduced from a separate institute to a center," says Welch. "They were asked for input on future CDC initiatives, but not on how they would feel about reorganization."
"We were really not aware this was going on," adds Randolph. "In April, our national office received an opportunity to comment from the ATSDR [the Agency for Toxic Substances and Disease Registry, an agency of the U.S. Department of Health and Human Services], as we have a grant from them to do training. At that time, the CDC had three prototypes for structures and how they might look, and we were given a short window in which to comment — but it really did not even talk about a lot of the institutes."
Had AAOHN been given a clearer picture of the proposed new structure, "Our comments back to ATSDR would have been different," Randolph asserts. "If we had seen that it was affecting NIOSH, a lot of the things in our recent letter to Dr. Gerberding would have been in that, but it was all sort of generic. It referred to the CDC proper, and not necessarily to NIOSH."
While none of the experts contacted by Occupational Health Management had positive predictions, they conceded it was difficult to predict the exact extent of the reorganization’s impact on occupational health professionals and the profession in general.
"A lot of [NIOSH’s] important roles are to summarize the existing research and give it to practitioners and to OSHA," says Welch. "There’s a lot of information that comes out of NIOSH that people use in their day-to-day practice. There will likely be fewer hazard alerts, fewer health hazard evaluations — the real service NIOSH provides."
Research is also a big concern to Welch. "Their budget is small as is," she contends. "I don’t want to jump out and say it’s definitely bad; it’s more of a concern — but the CDC is not doing anything to assuage those concerns by saying, We see you’re not happy, but here’s what we will do in return’ or Here’s what we see is the impact.’ There’s none of that."
According to AAOHN, the reorganization will decrease the importance of occupational safety and heath. "The reorganization will discourage partnerships and the lower level of NIOSH in the CDC structure will inhibit participation," it asserts. What impact may it have on AAOHN members? "For our members, I do not really know what the effect could be," Randolph concedes. "It’s up to us to really be out there and promoting occupational safety and health and promoting the needs of workers, so we don’t lose that focus." For workers, she adds, "OSHA is still there, looking at laws and various regulations. A lot of research is done through the NIOSH piece — hopefully, it will still continue."
Randolph is unsure of what the implications are for funding, and where the education piece will fall in terms of budget priorities. "A lot will depend on the head of that new center," she says. "Perhaps it will be a positive; there is certainly an injury focus, but nonworkplace injuries are a concern, too."
"I believe that NIOSH, which does have its own line item in the budget, will see that budget and mission diminished," Morris predicts. "For example, we have a mining lab in Spokane [WA]; what’s happened now is their outreach function that used to make videos and other educational documents for mine owners and workers has been taken to Atlanta, so we do not have much of an outreach budget anymore. We won’t be able to make and distribute the specific videos — and no one in Atlanta really knows about mines."
In addition, she says, "Right now, there’s not much happening at OSHA — not many standards are being dealt with — so you have to look to NIOSH for research and recommendations. It’s really the only strong center of activity in the area of federal safety and health. I’m concerned this will be diluted and diminished with this reorganization."
AAOHN has been collaborating with The American College of Occupational and Environ-mental Medicine (ACOEM) and with other occupational safety and health stakeholders about this issue and encouraging others to voice their concerns. They have been seeking to have the reorga-nization put on hold, but Randolph is not too sanguine about those prospects. "It’s looking like a fait accompli, although you can always hope," she says.
Meanwhile, Welch summarizes the common feeling about what is likely an inevitable change: "This is a demotion without any major benefit to NIOSH that one can see.
[For more information, contact:
• Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, President, American Association of Occupational Health Nurses, 2920 Brandywine Road, Suite 100, Atlanta, GA 30341. Phone: (770) 455-7757. Internet: www.aaohn.org.
• Sharon L. Morris, Senior Lecturer and Assistant Chair for Community Outreach, Department of Environmental and Occupational Health Sciences, 4225 Roosevelt Way, N.E., Suite 100, Seattle, WA 98105-6099. Telephone: (206) 543-9540. Fax: 206-685-3872.
• Laura S. Welch, MD, Center to Protect Workers’ Rights, 8484 Georgia Ave., Suite 1000, Silver Spring, MD 20910. Telephone: (301) 578-8500.]