NORA has helped demonstrate that there is a new way of doing business at NIOSH. Although the transformation to the "new NIOSH" was in process prior to NORA, the development and implementation of the Agenda has proven to many in the private sector that collaboration with the government is not only possible, but worthwhile.

Research related to the Traumatic Injury Team has proven particularly fruitful. The Traumatic Injury Team document, Traumatic Occupational Injury Research Needs and Priorities, will help pave the way for future partnerships. The document provides a foundation for discussion with external partners to explore common research areas. In the first three examples below, industry approached NIOSH to collaborate on topics related to the traumatic injury priority research area. All of the following partnership success stories demonstrate the benefits of partnership for the improved safety and health of workers. In each, NIOSH provides its scientific expertise and creative problem-solving skills and the partners provide the "laboratories" for evaluating interventions in real work settings.

Wal-Mart
The effectiveness of back belts has been questioned in recent years. In 1994, NIOSH released a report stating that there is inadequate scientific evidence that back belts actually reduce the risk of back injury. The statement reflected concerns that many employers were providing (and often requiring) back belts as the only method to prevent back injury. In what promises to be the most definitive research study to date, NIOSH teamed with Wal-Mart to determine the efficacy of back- supporting belts in preventing first and recurrent low back injuries. Approximately 8,000 retail merchandise employees at 160 stores are being followed for two years to determine if low back injury rates in individuals wearing belts are different from rates in individuals not wearing belts. Results of the study will be reported in 1999.

Barnes Jewish Christian (BJC) Health System
Back injuries are one of the most common injuries among nursing home employees. Barnes Jewish Christian (BJC) Health System designed and implemented a "best practices" system, and approached NIOSH for help in scientific evaluation of the program as implemented in Illinois and Missouri. NIOSH and BJC will evaluate the efficacy of a "best practices" program in reducing the incidence and cost of back injury among nursing home workers. The "best practices" program includes: specialized, state of the art lifting equipment, training in lifting techniques, accident investigation, and medical management of injured workers.

Anthony Crane Rental
Crane operators, on-site workers, and the general public are at risk of serious and possibly fatal injury due to incidents involving cranes or hoists. In 1994, incidents involving cranes resulted in 88 fatalities. Damage to property can be extremely costly. Anthony Crane Rental (ACR) is the largest crane rental company in the U.S. and employs 800 crane operators. ACR and the International Union of Operating Engineers share the responsibility of certification of crane operators. NIOSH and ACR will collaborate to evaluate data on crane-related incidents in order to determine whether operator certification is effective in preventing crane-related injuries. The results will help industry, labor, and the public, as well as assisting OSHA in determining the value of mandatory certification.

Navistar, UAW, Aetna US Healthcare
NIOSH is working with Navistar International Transportation, the United Auto Workers, and Aetna US Healthcare to evaluate the results of expanding workplace-based occupational safety and health programs to include general health care. This study will assess the impact of this intervention on health care status, utilization and costs, and worker productivity.

Asphalt Partnership
In order to reduce worker exposure to asphalt fumes during paving operations, NIOSH formed a collaborative partnership with government, industry, and labor. The partnership developed a comprehensive engineering control strategy to reduce exposures to asphalt fumes during paving operations. The engineering control is a ventilation system attached to the paver that reduces fume and heat before they can reach the worker. As a result, as of July 1, 1997, all highway paving machines now have this effective control technology. This very successful program was a finalist in the prestigious Innovations in American Government Award Program in 1998. The broad-based network of partnerships created by NORA has helped foster these continuing and evolving efforts. As such, it is only fitting that this project received the first NORA Partnership Award.

Department of Veterans Affairs
The Veterans Health Administration (VHA) within the Department of Veterans Affairs (DVA) employs one of the largest groups of healthcare workers in the U.S. There were 223,602 employees in the VHA as of November 1997. In October 1998, a Memorandum of Understanding (MOU) was signed by NIOSH and the DVA formally establishing a research partnership combining NIOSH's research capabilities and the DVA's large health care organization. This unique partnership will make the DVA facilities available to NIOSH for many types of health care research, and will ultimately lead to better understanding of prevention interventions for health care workers. Initially, the partnership is supporting a joint study on latex allergy which will provide NIOSH with new insights into developing more effective recommendations to protect workers, and will provide the DVA with an accurate estimate of the extent of latex sensitization among its employees. Effectiveness of preventive intervention activities will also be studied. The partnership directly relates to the Health Services Research, Asthma and COPD, and Allergic and Irritant Dermatitis priority research areas.

One of the most encouraging testaments to the success of NORA is the number of other organizations using NORA as a model for creating research agendas or other types of partnership and planning. NORA has generated tremendous interest- especially at the federal level- because of its innovative approach to strategic planning. NIOSH has shared its experience with many who have sought to undertake a similar effort. Examples of such planning efforts follow. The first five summaries are new additions to this comprehensive listing.

• The Japanese National Institute of Industrial Health is using NORA as a model as the Institute moves forward with the development of a national occupational health research plan for Japan. Development of the plan was mandated in 1998 by the Ministry of Labor of Japan and, like the NORA process, will involve the cooperation of several government agencies and health and safety research organizations.
• The European Agency for Safety and Health at Work is undertaking a planning effort in the European Union, using NORA as a model.
• The Department of Defense used NORA in developing its Deployment Toxicology Research and Development Master Plan, "Protecting the Fighting Force".
• CDC's National Center for Health Statistics and the National Committee on Vital and Health Statistics are undertaking a planning process and using NORA as a model for outreach to stakeholders.
• CDC's National Center for Injury Prevention and Control is exploring the use of NORA as a model to develop their National Research Agenda for Injury Prevention and Control.
• Istituto Superiore Per La Prevenzione E La S Curezza Del Lavoro (the Italian Institute for Occupational Safety and Health) is undertaking a priority-setting effort in Italy, using NORA as a model.
• The Norwegian National Institute of Occupational Health is conducting a priority setting process based, in part, on NORA.
• The Environmental Protection Agency is considering using NORA as a guide for the Human Health Indoors Project to explore how the EPA should protect human health indoors in the 21st century.
• Washington State is undertaking a state-wide needs and priorities planning process for health and safety much influenced by the NORA process.
• The Pacific Northwest Agricultural Safety and Health Center organized a farm summit modeled after NORA to develop areas of consensus about key agricultural safety and health problems that can be addressed by research and intervention programs.
• The Chemical Safety and Hazard Investigation Board is using NORA as a model to develop its own priorities.
• The American Association of Occupational Health Nurses (AAOHN) and the American College of Occupational and Environmental Medicine (ACOEM) established a joint research award. As stated by the AAOHN Executive Director, "In support of the work of NIOSH and to promote the National Occupational Research Agenda (NORA), emphasis has been give to NORA in the selection criteria."
• The Chemical Industry Institute of Toxicology, the Chemical Manufacturers Association, and other organizations undertook a prioritization activity using some strategies of NORA development. Eight of the topics identified in their process closely relate to NORA priority areas.

NIOSH announced the first NORA Partnership Award For Worker Health and Safety at the 1999 NORA Symposium at the National Academy of Sciences in Washington, D.C. The award recognizes outstanding NORA partnership activities that lead to improved worker health and safety. To be eligible for the award, NORA partnership activities must include collaborative research in at least one NORA priority area that results in the development of interventions that reduce hazardous exposures or adverse outcomes. Partners should represent a broad and diverse spectrum of organizations and individuals, such as manufacturers, end-users, labor, the public health community, academia, and government.

The 1999 winner of the NORA Partnering Award For Worker Health and Safety is the Asphalt partnership. This unique collaboration brought together diverse partners to achieve the goal of reducing workers' exposure to asphalt fumes during highway paving. The partners included NIOSH, the National Asphalt Pavement Association, the Federal Highway Administration, the Occupational Safety and Health Administration, the International Union of Operating Engineers, the Laborers' Health and Safety Fund of North America, the Laborers' International Union of North America, and the Asphalt Institute. Through use of innovative engineering controls, the partners achieved an unprecedented accomplishment -- 100 percent of an industry voluntarily agreeing to implement control technology equipment (which reduces worker fume exposure by about 80 percent) on all new highway pavers produced after July 1997.

The partnership formed amid ongoing controversies surrounding the health effects of asphalt fume exposures and possible regulatory activity aimed at reducing these exposures. Working together, the partners avoided the protracted regulatory process and ensured that effective control technologies, designed and evaluated by NIOSH and its partners, were implemented to protect the approximately 300,000 highway paving workers across the nation.

This unique partnership was also selected as one of 25 finalists (out of 1,420 applicants) in the 1998 Innovations in American Government Awards Competition sponsored by the Ford Foundation, the John F. Kennedy School of Government at Harvard University, and the Council for Excellence in Government. The prestigious Innovations Award recognizes excellence in government and celebrates outstanding examples of creative problem-solving in the public sector.

This page was last updated: June 4, 1999