Background
Methods
Description of study design
Sample & Procedures
Survey
Interviews
Data Collection Instruments & Measures
Survey
Activities | Question: The following activities are performed (check all that apply): by your Health Department, independently; in partnership with another organization(s); by another organization(s), on behalf of your department (WHP)/ by a “bona-fide agent,” acting on behalf of your Health Department (OSH); your Health Department has not performed this activity in the last 12 months | |
Surveillance | WHP: Monitoring of Healthy People 2020 worksite-related objectives; Monitoring of other workplace health promotion activities in the state, beyond the Healthy People 2020 objectives
Scoring: “high” if both activities, “some” if one, “none” if neither
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OSH: Compile, analyze, and interpret Occupational Health Indicators (If “yes”: What proportion of these 22 indicators are compiled, analyzed, and interpreted in your state?); Workers’ Compensation surveillance, beyond the collection of Workers’ Compensation-related OHIs; Surveillance of occupational lead levels in adults and submission of data to the NIOSH Adult Blood Lead Epidemiology and Surveillance program; Monitoring data from the National Surveillance System for Pneumoconiosis Mortality; Monitoring of indicators for the Healthy People 2020 occupational safety and health objectives; Targeted surveillance for Fatality Assessment, Control, and Evaluation; Targeted surveillance of occupational respiratory disease; Targeted surveillance of pesticide illness and injury; Targeted surveillance of musculoskeletal disorders; Targeted surveillance of “target worker populations” (e.g., youth, older age workers, immigrant workers, temporary workers, and workers in high-risk industries/occupations); Presentation of OSH surveillance data to relevant staff (occupational health professionals and health care providers) at workplaces within your state.
Scoring: “high” if 4 to 9 points, “some” if 1 to 3 points, “none” if no points. 0 to 6 points assigned based on proportion of the 22 Occupational Health Indicators compiled, analyzed, and interpreted; 0 to 3 points assigned based on proportion of 10 additional surveillance activities completed
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Implementation support to employers | WHP: Providing …educational materials, resources and/or toolkits to employers; …training to employers, such as training sessions and/or webinars designed to introduce a group of employers to a workplace health promotion topic; …technical assistance to employers, such as individualized, on-demand consultations and/or phone-based support; …employers with assistance in monitoring the quality of their workplace health promotion programs, for example through providing organizational audits, health assessments, and/or other evaluation resources. | |
OSH: Development and dissemination of educational materials to employers; Providing …training and education programs to employers; …technical assistance to employers, upon request; …employers with assistance in monitoring the quality of their occupational safety and health programs, for example through providing organizational audits or other evaluation resources.
Scoring for both WHP and OSH: four, three, two, one, or no implementation support activities provided.
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Direct services to workers | WHP: Delivering health promotion programs directly to workers across your state, such as flu shots or blood pressure screening programs. | |
OSH: Providing educational materials, training, and/or technical assistance to workers directly.
Scoring for both WHP and OSH: “providing” or “not providing”.
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Follow-back investigation | OSH: Worksite follow-back investigations; Referrals of employers/worksites to OSHA or other agencies for follow-back investigations.
Scoring: “both”, “either”, or “neither”
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Standard and policy development | OSH: Standard and policy development.
Scoring: “active” or “inactive”
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Capacity | Financial resources | OSH and WHP: Health Department’s total funding for OSH (or WHP) activities during the past 12 months, including federal, state, and other funds. Free response. |
Human resources | OSH and WHP: Total number of FTEs performing OSH (or WHP) activities in the Health Department during the past 12 months. Include all those employed by the state, all those working at the state-level who are either federal assignees or contract employees, and state employees assigned to work in a regional office. Free response. | |
Competency | WHP: Health Department’s level of competency (knowledge and skills) to perform the following workplace health promotion activities: Workplace health promotion surveillance activities; Implementation support activities (providing support to employers with design and implementation of workplace health promotion initiatives); Direct service activities (delivering workplace health promotion services directly to employees across your state). “Minimal or none”, “Basic”, “Intermediate”, “Advanced”, or “Expert” | |
OSH: Health Department’s level of competency (knowledge & skills) to perform the following occupational safety and health activities: Occupational safety and health surveillance activities; Follow-up intervention and prevention activities; Direct service activities (delivering occupational safety & health services directly to employees). “Minimal or none”, “Basic”, “Intermediate”, “Advanced”, or “Expert” | ||
Organizational support | OSH and WHP: Health Department’s commitment to OSH (or WHP)? “Not at all”, “Slightly”, “Moderately”, “Very”, “Extremely”. What level of priority does your Health Department assign to OSH (or WHP) efforts, in comparison to other efforts your Health Department is involved in? “Not a priority”, “Low level”, “Moderate level”, “High level”, “Very high level” | |
Overall capacity | OSH and WHP: Health Department’s overall capacity to support workplace health promotion among employers in the state? “No capacity”, “Minimal”, “Some”, “Moderate”, “Substantial” |
Interview guide
What do you think your department would need the most right now if it wanted to expand its efforts in OSH (or WHP)? | |
What do you think it is important for us to know when it comes to funding for OSH (or WHP) programming? | |
In your opinion, what might your health department’s ideal staffing be to do OSH (or WHP) work in this state? | |
What could your health department leadership do to better support OSH (or WHP) in your state? Can you think of any ways the CDC could help health department leadership become more supportive of OSH (or WHP)? | |
In the survey, we asked about helpful resources that your health department uses to conduct OSH (or WHP) work. You replied [response] were the most helpful resources. Pick the one you consider to be the most helpful – In what way did you use it? What characteristics made it so helpful? Is there anything you would change? |
Analysis
Results
Sample description
Current workplace health and safety activities
OSH survey respondents (n=39) | WHP survey respondents (n=40) | |
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Level of surveillance activity SHDs engage in | ||
None | 8% (3) | 18% (7) |
Some | 26% (10) | 36% (14) |
High | 67% (26) | 46% (18) |
Percent who provided each of the following types of implementation support to employers | ||
Tools & educational materials to employers | 68% (25) | 90% (36) |
Training to employers | 41% (15) | 78% (31) |
Technical assistance to employers | 59% (22) | 79% (31) |
Assist employers in monitoring program quality | 18% (6) | 64% (25) |
How many types of implementation support did SHDs provide to employers? | ||
None | 28% (11) | 10% (4) |
1 | 21% (8) | 8% (3) |
2 | 13% (5) | 8% (3) |
3 | 26% (10) | 15% (6) |
All 4 | 13% (5) | 60% (24) |
Percent (Yes) who provided direct services to workers | 61% (23) | 51% (20) |
Percent who engaged in follow-back investigation activities (OSH only) | ||
None | 31% (12) | … |
EITHER conduct investigations OR refer to other agencies for investigations | 28% (11) | … |
BOTH conduct investigations AND refer to other agencies for investigations | 41% (16) | … |
Percent (Yes) who engaged in standard and policy development? (OSH only) | 39% (15) | … |
Current capacity and respondents’ recommended strategies for increasing capacity
Funding and staffing
OSH survey respondents (n=39) | WHP survey respondents (n=40) | |
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Total funding for OSH/WHP activities over the past 12 months | ||
Median | $150,000 | $57,500 |
$0 | 19% (6) | 30% (9) |
Up to $50 K | 13% (4) | 17% (5) |
$51 K - $150 K | 26% (8) | 30% (9) |
$151 K - $500 K | 29% (9) | 20% (6) |
More than $500 K | 13% (4) | 3% (1) |
Total FTEs conducting OSH/WHP activities over the past 12 months | ||
Median | 1 FTE | 1 FTE |
Interquartile range | 0.3 FTE – 4.5 FTE | 0.1 FTE – 1.5 FTE |
Perception of SHDs’ competency to perform the following: | ||
Surveillance activities | ||
Advanced-Expert | 58% (21) | 44% (17) |
Basic-Intermediate | 33% (12) | 49% (19) |
Minimal or None | 8% (3) | 8% (3) |
Implementation support/Follow-up intervention and prevention activities* | ||
Advanced-Expert | 31% (11) | 56% (22) |
Basic-Intermediate | 53% (19) | 36% (14) |
Minimal or None | 17% (6) | 8% (3) |
Direct service activities | ||
Advanced-Expert | 22% (8) | 35% (13) |
Basic-Intermediate | 36% (13) | 43% (16) |
Minimal or None | 42% (15) | 22% (8) |
Organizational and leadership support | ||
SHD’s commitment to OSH/WHP | ||
Very-extremely | 30% (11) | 44% (17) |
Slightly-moderately | 56% (20) | 56% (22) |
Not at all | 14% (5) | 0% (0) |
Level of priority SHD assigns to OSH/WHP | ||
High-very high | 13% (5) | 21% (8) |
Low-moderate | 66% (25) | 74% (28) |
Not a priority | 21% (8) | 5% (2) |
Overall capacity to support employers with OSH/WHP in the state (self-reported) | ||
Moderate-substantial | 21% (8) | 33% (13) |
Minimal-some | 68% (26) | 62% (24) |
None | 11% (4) | 5% (2) |
Recommendation | Barrier addressed |
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OSH | |
Reduce the number of requirements associated with the NIOSH State Occupational Health and Safety (OHS) Surveillance Program applications. | SHD leadership viewed application requirements as too time-consuming, prohibiting submission: “…there are letters of support required. Well, because this is a brand new program and there’s such a long wait time on applying for it…our management is unwilling for me to go out and try and start. It wants you to actually start having a committee…and they don’t want us to do that…” (OSH7) |
Revise the NIOSH State OHS Surveillance Program application to focus on public health practice rather than research. | Funding surveillance through a research grant created administrative burden and limited the OSH practice activities SHDs could engage in: “…the way the funding occurs is…it’s actually a research grant…And the fact that it’s a research grant significantly limits our ability to conduct certain activities…we have to consider ‘is this research activities, does it need to be approved by IRB?’ and the fact that it’s research typically says we’re trying to make generalizations about other populations, when a state-based health program should be aimed at trying to improve the population in our state” (OSH6) |
Give states greater flexibility in how grant funds are used. | Flexibility would give SHDs increased ability to respond to emerging priorities: “Right now our staff almost entirely, each one, is tied to a specific funding source that dictates what they’re able to work on and that really doesn’t leave us with staffing that we can decide what they should work on” (OSH4) |
WHP | |
Provide more resources within grants for administrative and grant management personnel. | This will give SHDs the grant management infrastructure that allows them to expand programming: “So we’ve turned down at least 2 or 3 funding opportunities because we didn’t have the bandwidth to add the bureaucratic levels to deal with that and manage that funding. So, I think that building into funding opportunities ways to reach that would be really useful” (WHP2) |
Provide greater stability in funding sources from year to year. | Stable funding would ensure that fluctuations in funding wouldn’t undo the SHD’s capacity to expand or continue WHP activities that were previously supported: “It’s hard when funding comes and goes, you know? It’s just like the latest greatest this year, but then next year it’s taken away. And so efforts come and efforts go, which I think is really sad” (WHP5) |
Organizational and leadership support
Recommendation 1: Integrate OSH/WHP approaches into other public health initiatives. | |
Benefits of integration | For the Health Department • Including OSH/WHP expertise on teams brings a specialist perspective that improves program outcomes: “…if you are trying to address infection control or Ebola…the people who know the most about personal protective equipment (PPE) are occupational health and safety people, and those are the people that need to be at the table when you’re talking about PPE requirements…so you need to have more of a team approach.” (OSH1) • Using WHP to coordinate chronic disease efforts at the worksite fosters a more strategic approach and allows chronic disease programs to expand reach: “…there must be some sort of worksite objective or goal that, the money that goes to the chronic disease program, can go to that. Because that’s where so much of their reach needs to be is in the worksite and they’re not taking advantage of it…or if they do work with the worksite, it’s very limited. Maybe just something on blood pressure or something on diabetes. So they miss the big picture piece where we go in there with the CDC Health ScoreCard and we do an assessment and then we figure out what does this worksite really need to focus on.” (WHP3) For OSH/WHP programs, specifically • Integration boosts leadership awareness of the contributions of OSH/WHP to health department goals: “You know, occupation is not listed over there as the agency priority. But we can say through occupational health surveillance…what kind of mother in what kind of occupation, what kind of industry is more likely to have a pre-term or very low-birthweight baby...So through this link…the agency says ‘Oh! Occupational surveillance can help the agency to achieve the agency’s goal…’” (OSH2) • Integration provides access to other funding streams coming into the department (especially important when existing OSH/WHP capacity precludes applying for targeted funding): “…since we’re not likely to start from scratch and establish [OSH] as a new program area…I think that CDC looking at ways that OSH can be incorporated into other programs…kind of more of a “one health” approach is probably gonna be more successful…for example there’s a lot of money that gets funneled into health care associated infections. And that’s a program we have here. So if there are tools and resources and funding towards expanding HIE surveillance programs to also include some aspects of occupational health and safety, I think that would be the most successful way to go.” (OSH3) |
Strategies for promoting integration | • CDC can fund integration by specifying that a certain amount of existing awards be applied to OSH/WHP activities, make collaboration with OSH/WHP a requirement to receive funding, or require integrated teams. |
Recommendation 2: Recognize OSH/WHP as core disciplines in public health. | |
Barriers to recognizing OSH/WHP as core public health | • NIOSH funding only half of states for OSH surveillance perpetuates view that OSH is optional/elective: “There’s no consistent model for occupational safety and health in a public health department, that you can reliably expect to be there for every single state in the country…like half the states in the country don’t have anybody in the public health department!…it’s a real shame…that there is no consistent, core funding or expectation for occupational safety and health in public health.” (OSH8) • OSH not viewed as public health’s responsibility because of other state agencies (e.g., Department of Labor) that work in this field: “I’m asked all the time ‘What do you need more resources for in Occupational Health, doesn’t OSHA take care of that?’” (OSH4) |
Strategies for promoting OSH/WHP as core disciplines in public health | • NIOSH fund all SHDs for basic OSH surveillance: “I think it should be essential funding, by the federal government…because there is no clear commitment from CDC, OSHA, or federal government…the locals don’t see it as a problem.” (OSH5) • Add industry and occupation indicators to all major public health data sets (e.g., BRFSS) • CDC encourage inclusion of occupational and environmental objectives in State Healthy People objectives • Increased federal funding for WHP • CDC release more WHP-focused tools (e.g., CDC Worksite Health ScoreCard) and training: “…we haven’t had that coming from CDC saying this is important and we’re going to have a conference...But I think those kind of things are what gets the SHD leaders and staff thinking ‘Oh so this matters too, and it’s a part of all that we do’” (WHP3) |