LETTERS TO THE EDITOR
Lorin E. Kerr, MD Director, Dept. of Occupational
Health United Mine Workers of America Washington, DC Frank Goldsmith, MPH Director
and Deborah Nagin, MPH Associate Director, Occupational Safety & Health Programs New York State School of Industrial & Labor Relations Cornell University Allen Silverstone, PhD Memorial Sloan-Kettering Hospital New York City Paul Witt The Oakwood School Los Angeles, CA Michael Gray, MD, MPH Core Director, Occupational Medicine Arizona Centerfor Occupational Safety & Health University ofArizona, Tucson, AZ
REFERENCES 1. Perkins JL, Rose VE: Occupational health priorities for health standards: the current NIOSH approach. Am J Public Health 69:444-448, 1979. 2. Whorton MD, Wegman DH: Occupational health standards: what are the priorities? (editorial). Am J Public Health 69:433-434, 1979.
On the Mission of NIOSH We are pleased that the Journal has devoted attention to the job of protecting workers. Whorton and Wegman,1 and Perkins and Rose2 wrote about the same issue that has confronted us since coming to the National Institute for Occupational Safety and Health (NIOSH)-how a government
ERRATUM
agency should pursue its mission. The NIOSH staff, labor groups, industry professionals, and the Department of Labor have all participated in our deliberations. Here's how it looks from the inside. The Institute, almost ten years old, has grown rapidly to where it has 950 staff and a budget of $80M. Despite good scientists, doing good work, its impact falls far short of what is needed. Its efforts have had surprisingly little impact on business, labor, government, or the general public. As Perkins and Rose indicate, NIOSH conscientiously picked its priorities. But the process of one by one selection obscured the original purpose of concentrating on important issues. Thus, while attempting to select the most serious hazards for study, the Institute failed to reach the public with the big picture: 1) occupational safety and health problems are the largest collection of preventable deaths, injuries, diseases and disabilities; 2) the exposed population-the workers-knows little about its dangerous exposures; 3) almost all exposures are preventable by control technology or substitution; 4) workplace carcinogens can be identified and exposures eliminated, because they are not innumerable as some would have us believe; 5) reproductive hazards are not just a problem for women. Three principles will guide our efforts to enhance the Institute's im-
pact. 1. There will be no final word from NIOSH until the hazard to workers is gone! Look at the list of serious occupational health risks: asbestos, lead, silica, benzene, arsenic. None is new, yet they are still killing workers. Our job is not over with a criteria document. Control technology and substitution becomes a new focus. TABLE
2. NIOSH's research will always be reported to all at risk, including the general public. Workers must know of the hazards to which they are exposed. This will broaden the concept of a "criteria document" to include all results and recommendations that can help protect workers. NIOSH will certainly fulfill its statutory role of advising the two regulatory agencies, but anyone capable of improving the safety and health of workers will receive NIOSH advice. 3. There will be a new emphasis on public health and epidemiology. Health hazard evaluations and industry-wide studies-where NIOSH investigators get out into the field, studying plants, talking with workers and confronting real occupational health problemswill be expanded. This NIOSH function has almost been kept a secret for fear that the nation's demand for assistance in exploring occupational health problems would outstrip the Institute's ability to respond. Indeed it would, and should overtax our resources. This demand would be a true reflection of the state of occupational health in our country. Anthony Robbins, MD Director John R. Froines, PhD Deputy Director National Institute for Occupational Health, DHEW, PHS, CDC 5600 Fishers Lane Rockville, MD 20852
REFERENCES 1. Whorton MD, Wegman DH: Occupational health standards: what are the priorities? (editorial). Am J Public Health 69:433-434, 1979. 2. Perkins JL, Rose VE: Occupational health priorities for health standards: the current NIOSH approach. Am J Public
2-Average Number of Primary Procedures per 100
Person-Years by Cooedinator Status for Preschool Children in the Neighborhood Heafth Center PopuDue to a typographical error in Table 2 of the published article by Colombo TJ, lation, Base Year, on or after September 1969 Freeborn DK, Mullooly UP, Burnham Without VR: The effect of outreach workers' Age: 0-4 Coordinator Coordinator educational efforts on disadvantaged preschool children's use of preventive Number 1353 325 368 services, Am J Public Health 69:465- Person-Years 101 368 322 468, 1979, we publish the complete cor- Rate SE 27 37 rected table: AJPH September 1979, Vol. 69, No. 9
957
Lorin E. Kerr, MD Director, Dept. of Occupational
Health United Mine Workers of America Washington, DC Frank Goldsmith, MPH Director
and Deborah Nagin, MPH Associate Director, Occupational Safety & Health Programs New York State School of Industrial & Labor Relations Cornell University Allen Silverstone, PhD Memorial Sloan-Kettering Hospital New York City Paul Witt The Oakwood School Los Angeles, CA Michael Gray, MD, MPH Core Director, Occupational Medicine Arizona Centerfor Occupational Safety & Health University ofArizona, Tucson, AZ
REFERENCES 1. Perkins JL, Rose VE: Occupational health priorities for health standards: the current NIOSH approach. Am J Public Health 69:444-448, 1979. 2. Whorton MD, Wegman DH: Occupational health standards: what are the priorities? (editorial). Am J Public Health 69:433-434, 1979.
On the Mission of NIOSH We are pleased that the Journal has devoted attention to the job of protecting workers. Whorton and Wegman,1 and Perkins and Rose2 wrote about the same issue that has confronted us since coming to the National Institute for Occupational Safety and Health (NIOSH)-how a government
ERRATUM
agency should pursue its mission. The NIOSH staff, labor groups, industry professionals, and the Department of Labor have all participated in our deliberations. Here's how it looks from the inside. The Institute, almost ten years old, has grown rapidly to where it has 950 staff and a budget of $80M. Despite good scientists, doing good work, its impact falls far short of what is needed. Its efforts have had surprisingly little impact on business, labor, government, or the general public. As Perkins and Rose indicate, NIOSH conscientiously picked its priorities. But the process of one by one selection obscured the original purpose of concentrating on important issues. Thus, while attempting to select the most serious hazards for study, the Institute failed to reach the public with the big picture: 1) occupational safety and health problems are the largest collection of preventable deaths, injuries, diseases and disabilities; 2) the exposed population-the workers-knows little about its dangerous exposures; 3) almost all exposures are preventable by control technology or substitution; 4) workplace carcinogens can be identified and exposures eliminated, because they are not innumerable as some would have us believe; 5) reproductive hazards are not just a problem for women. Three principles will guide our efforts to enhance the Institute's im-
pact. 1. There will be no final word from NIOSH until the hazard to workers is gone! Look at the list of serious occupational health risks: asbestos, lead, silica, benzene, arsenic. None is new, yet they are still killing workers. Our job is not over with a criteria document. Control technology and substitution becomes a new focus. TABLE
2. NIOSH's research will always be reported to all at risk, including the general public. Workers must know of the hazards to which they are exposed. This will broaden the concept of a "criteria document" to include all results and recommendations that can help protect workers. NIOSH will certainly fulfill its statutory role of advising the two regulatory agencies, but anyone capable of improving the safety and health of workers will receive NIOSH advice. 3. There will be a new emphasis on public health and epidemiology. Health hazard evaluations and industry-wide studies-where NIOSH investigators get out into the field, studying plants, talking with workers and confronting real occupational health problemswill be expanded. This NIOSH function has almost been kept a secret for fear that the nation's demand for assistance in exploring occupational health problems would outstrip the Institute's ability to respond. Indeed it would, and should overtax our resources. This demand would be a true reflection of the state of occupational health in our country. Anthony Robbins, MD Director John R. Froines, PhD Deputy Director National Institute for Occupational Health, DHEW, PHS, CDC 5600 Fishers Lane Rockville, MD 20852
REFERENCES 1. Whorton MD, Wegman DH: Occupational health standards: what are the priorities? (editorial). Am J Public Health 69:433-434, 1979. 2. Perkins JL, Rose VE: Occupational health priorities for health standards: the current NIOSH approach. Am J Public
2-Average Number of Primary Procedures per 100
Person-Years by Cooedinator Status for Preschool Children in the Neighborhood Heafth Center PopuDue to a typographical error in Table 2 of the published article by Colombo TJ, lation, Base Year, on or after September 1969 Freeborn DK, Mullooly UP, Burnham Without VR: The effect of outreach workers' Age: 0-4 Coordinator Coordinator educational efforts on disadvantaged preschool children's use of preventive Number 1353 325 368 services, Am J Public Health 69:465- Person-Years 101 368 322 468, 1979, we publish the complete cor- Rate SE 27 37 rected table: AJPH September 1979, Vol. 69, No. 9
957
