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NIOSH being marginalized? GAO study called for
OH leaders express concern
Concerned that occupational health and safety research is getting short shrift from the Bush administration, professional organizations are calling for a study of the National Institute for Occupational Safety and Health (NIOSH) and a commitment to boosting its financial resources.
In letters to key Congressional leaders, the American College of Occupational and Environmental Medicine (ACOEM), the Ameri-can Industrial Hygiene Association, and the American Society of Safety Engineers have asked for a General Accounting Office study of NIOSH, which is a part of the Centers for Disease Control and Prevention (CDC) in Atlanta. Such a study would consider whether moving NIOSH out of the CDC would increase its effectiveness.
"The key issue isn't as much where NIOSH is placed, but that NIOSH is appropriately supported to do its work," says Robert McLellan, MD, MPH, FACOEM, president of ACOEM, chief of the section of occupational and environmental medicine at Dartmouth Medical School, and medical director of employee health and safety at Dartmouth-Hitchcock Medical Center.
Since FY 2006, after the CDC reorganization, the CDC has taken $34.8 million from the NIOSH budget to fund administrative overhead costs. Since then, NIOSH's budget has remained flat. For FY 2008, the president has requested $253 million for NIOSH, the same as last year.
That flat-lined budget — a reduction from FY 2005 due to the payments to the CDC — means there is less money to fund research conducted by external researchers. The success rate of applications has declined by almost 50% since FY 2005, McLellan says. This year, NIOSH is expected to fund fewer than 8% of grant applications submitted, he says.
"Their extramural research program is key to advancing science with respect to occupational health and safety," McLelland says. "NIOSH is the only federal agency responsible for research in occupational health and safety. Their research program has historically been an important venue for prompting that research. It serves as a lifeblood for academics in occupational medicine."
The research also is a vital contribution to improving worker health and safety, he says.
"This is the only agency in the federal government that conducts occupational health and safety research, so it's very, very important," agrees Aaron Trippler, American Industrial Hygiene Association (AIHA) director of governmental affairs.
Congress created NIOSH in 1970 as a research counterpart to the Occupational Safety and Health Administration, through the Occupational Safety and Health Act. Although it is a part of the CDC, it has maintained some autonomy.
When CDC director Julie L. Gerberding, MD, MPH, announced that NIOSH would become part of one of the new coordinating centers as part of the CDC reorganization, NIOSH's advocates went into high gear. Industry, union, and academic stakeholders complained that NIOSH would be weakened.
That change was halted when Congress included in the FY 2005 omnibus budget bill directing CDC to "maintain the status quo with respect to the direct reporting relationship of the NIOSH director to the CDC director" and "make no changes to NIOSH's current operating procedures and organizational structure."
Now NIOSH advocates are once again raising the alarm about its status. The industrial hygienists have suggested that NIOSH might fare better as a part of the National Institutes of Health. The safety engineers suggested a move to the Department of Labor.
The occupational health physicians expressed caution in their letter to Congress: "ACOEM fully supports NIOSH and we want to emphasize that any decision about NIOSH becoming an independent agency within the Department of Health and Human Services or moving to the National Institutes of Health or the Department of Labor must very closely evaluate the upheaval of such a move."
McLellan also noted: "A GAO study should look at whether NIOSH has the necessary resources to undertake a robust research agenda, and whether it is permitted under the current structure to exercise the authority intended by the Occupational Safety and Health Act."
AIHA supports a GAO study as well. "It's time to take a look at the organizational structure of CDC and whether NIOSH fits within that," says Trippler.
Not all of NIOSH's supporters think that an organizational move would enhance its mission. As a part of the CDC, NIOSH has balanced the infection control perspective and played an important role in agency guidance, says Bill Borwegen, MPH, safety and health director of the Service Employees International Union (SEIU).
For example, NIOSH was successful in modifying the personal protective equipment guidance related to pandemic influenza, which now states that it would be "prudent" to use N95 respirators with direct patient care activities. NIOSH also has been involved in respiratory protection guidance for other diseases, such as tuberculosis.
"If we left CDC to their own devices, those products would be quite inferior to what was eventually produced," he says.
"By cleaving NIOSH from CDC, it's not clear if it's going to be an improvement," he says. "Then we just leave it to the infection control people to dictate occupational health and safety policy in CDC documents, and I don't think that's going to be helpful."
Borwegen also notes that a National Academy of Sciences panel has been reviewing NIOSH's research programs.
A GAO study would consider more broadly what NIOSH needs to carry out its mission, says Patrick O'Connor, ACOEM director of governmental affairs. For example, the CDC has taken over much of the NIOSH communications activities, limiting NIOSH's ability to publicize and promote its research findings, he says.
"The ACOEM position has always been that NIOSH should be placed where it can be most effective," he says.