OCCUPATIONAL HEALTH DISPARITIES

Inputs: NIOSH Strategic Goals

Health disparities exist across many priority working populations, defined as groups of workers who have (1) biological, social, or economic characteristics that place them at increased risk of developing work-related conditions and (2) inadequate information collected about them in the past. These priority populations include racial and ethnic minority workers, immigrant workers, younger and older workers, workers with medical or genetic susceptibility, and workers with disabilities. These disparities arise both from overrepresentation of these priority working populations in the most hazardous industries as well as from the inadequate penetration of occupational health and safety interventions to certain worker populations due to barriers created by social, cultural, and economic issues including language, literacy, and marginal economic status. And these priority working populations may have less access to or lower quality of care after acquiring a work-related illness or injury. The goal of the occupational health disparities program is to better identify and prevent these health disparities by identifying research methods and disseminating tools and information to the occupational safety and health community.

NIOSH Program Portfolio Approach

NIOSH has been organizing research, guidance, information, and service efforts into specific programs that can be readily communicated and strategically governed and evaluated. Ten Sector Programs represent industrial sectors, and twenty-four Cross-sector Programs organized around adverse health outcomes, statutory programs and global efforts.

The Sector Programs intersect with Cross-Sector Programs in a matrix-like fashion. For example, an Agriculture, Forestry and Fishing Program goal of reducing farm-related deaths and injuries due to tractor rollovers and trucks would likely be a shared goal with the Transportation Program and if appropriate would be adopted by both programs. This approach provides an added advantage and will allow multiple Programs to work towards accomplishment of intersecting goals.

Each of the 34 programs in the NIOSH Program Portfolio has a Manager and Coordinator. Each of the 10 NIOSH Sector Programs facilitates the work of a NORA Sector Council to engage external stakeholders in the process of developing sector goals for the nation and methods to measure the short-term, intermediate and long-term outcomes arising from those goals. The NORA goals for the nation will be considered when choosing NIOSH sector program goals. Cross Sector programs have internal Steering Committees that develop program goals and monitor outcome measures.

These planning efforts will position NIOSH to align with the most current governmental approaches for evaluating program effectiveness, i.e., the Program Assessment Rating Tool (or PART). PART is a mechanism to hold governmental agencies accountable for accomplishing results. As part of our comprehensive approach to performance measurement, NIOSH has engaged the National Academies to independently evaluate our sector and cross-programs for relevance and impact.

Occupational Health Disparities Goals

Surveillance

Strategic Goal 1: Improve surveillance to describe the nature, extent, and economic burden of occupational illnesses, injuries, and fatalities among priority working populations; identify priorities for research and intervention; and evaluate trends.

Intermediate Goal 1A: Improve illness, injury, and exposure surveillance by using existing morbidity data or creating new databases to identify injuries, illnesses, and hazards that appear in excess within priority working populations.

• Expand occupational health surveillance capacity by enhancing existing databases to provide information on occupational health disparities and economic costs among priority working populations. Opportunities include population-based studies such as NHIS, NHANES, and BRFSS; health registries; and occupational injury data from BLS, OSHA, health insurance providers, Medicare, VA hospitals, labor organizations, and trade associations.
• Improve survey question design and administration methods that consider language, literacy, and cultural differences among priority working populations.
• Improve exposure surveillance methods to describe hazards in sectors where priority populations are disproportionately employed, especially among temporary or contingent workers, such as day laborers.

Intermediate Goal 1B: Support funding for expanded surveillance capacity of states to track priority working populations, utilizing community-based data collection approaches, such as through community and migrant clinics and other community-based organizations and institutions serving priority working populations.

Intermediate Goal 1D: Ensure that surveillance data on priority populations’ occupational illnesses, injuries, and fatalities are readily available to intramural and extramural research scientists and the public.

• Update NIOSH Web page and Worker Health Chart Book with new data targeting priority working populations.

Research

Strategic Goal 2: Improve the effectiveness of occupational safety and health research to eliminate occupational health disparities by expanding and improving the research infrastructure.

Intermediate Goal 2A: Improve the capacity of occupational health researchers to address social and cultural dimensions of occupational health

• Increase the number of permanent and visiting NIOSH researchers with experience in examining minority health and health disparities through new positions, “guest” researcher programs, and internship programs.
• Develop training programs for NIOSH researchers to promote better collection of social and cultural dimensions of health through the use of seminar series and online or short courses at NIOSH research centers.

Intermediate Goal 2B: Promote the development of improved research through dissemination of research tools and approaches that better consider language, literacy, and cultural differences among working populations.

• Improve survey question design and administration methods that consider language, literacy, and cultural differences among minority working populations. Examples include the use of peer interviewers and improved translation and cognitive testing of survey questions.
• Increase the incorporation of qualitative research approaches in occupational health research that allow greater exploration of social and cultural factors in the workplace, such as racism, risk acceptance, and economic and job insecurity.
• Promote the use of community-based participatory research methods, especially in intervention research. These methods permit greater input and participation by the community in developing and culturally tailoring interventions and may improve the intervention acceptance by workers.
• Improve the measurement of race and ethnicity in occupational health studies through improved dissemination and incorporation of the updated standards for classification of race and ethnicity.
• Promote and fund small pilot and “add-on” projects to better address issues of occupational health disparities in NIOSH research projects. For example, projects could promote dissemination of intervention products in languages other than English when appropriate.
• Explore partnership opportunities that will promote research by improving access to “hard to reach” working populations
• Expand collaborations with epidemiologic researchers studying chronic diseases such as cardiovascular disease, diabetes, reproductive disease, and cancer to include expanded occupational modules

Intermediate Goal 2C: Partner with interested NORA sectors to identify and understand sector-specific interventions and approaches for addressing occupational safety and health disparities.

• Participate in sector discussions involving safety and health disparities and vulnerable populations.
• Improve the recognition of sector-specific problems, sector-specific solutions and sector-specific communication channels relevant for health and safety disparities.
• Promote the dissemination of information on sector-specific problems and approaches between disparity researchers and sectors and among different sectors.

Improve Partnerships, Outreach, and Information Dissemination

Strategic Goal 3: Improve outreach to stakeholders to promote the elimination of occupational health disparities.

Intermediate Goal 3A: Expand outreach to community-based organizations, national stakeholder organizations, labor unions, and state and federal agencies interested in the health of racial and ethnic minorities and adolescent and older populations.

• Develop outreach and other r2p materials that present occupational health information consistent with the interests, language, and literacy needs of the target populations these stakeholders serve.
• Promote partnerships to overcome barriers such as immigration status, racism, literacy level, language, or the fear of intimidation that prevent workers from seeking healthcare services, reporting injuries and illnesses, or filing for due compensation.
• Promote outreach to clinics, health departments, and other healthcare providers that serve priority populations such as immigrant, minority, older, and younger workers, and provide educational materials about relevant occupational safety and health issues and prevention approaches
• Explore partnerships with state and federal agencies interested in worker safety and health such as OSHA, MSHA, USDA, state health departments, and other institutes and centers within CDC and NIH to develop collaborative outreach and dissemination of information and intervention materials.

Intermediate Goal 3B. Expand r2p efforts to enhance or complement efforts by existing epidemiological studies that target minority and other priority populations to explore work-related factors and to develop practical intervention programs and policies based upon the research findings.