Core occupational health surveillance in Massachusetts.
Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-007302, 2007 Sep; :1-36
Work-related injuries and illnesses are a significant public health problem in the United States, imposing substantial human and economic costs. Surveillance of work-related illnesses, injuries, and hazards is essential to target, design, and evaluate prevention efforts and to establish research priorities. Surveillance is needed at the state as well as the national levels. State occupational health surveillance programs are few and limited in scope, typically focusing on a few specific health conditions. In a comprehensive national surveillance system, most states would have basic core capacity to carry out surveillance of multiple occupational conditions. What constitutes a "core state program" has not been well established. Since the mid-1980s, the Massachusetts Department of Public Health (MDPH) has established surveillance systems for selected occupational health conditions and has conducted a wide range of intervention activities to address identified occupational health and safety concerns in the Commonwealth. The MDPH Occupational Health Surveillance Program (OHSP) has also worked closely with other public health programs to integrate occupational health into mainstream health practice. This Cooperative Agreement (7/2001-6/2006) enabled MDPH-OHSP to build on this experience and to develop a Core Occupational Health Surveillance Program that could serve as a model for other states. The proposed activities were based on the assumption that a core program should have the capacity to conduct both case-based and population-based surveillance and working relationships with a wide range of intervention partners. Specific aims of the project fell into four major categories as follows: Sentinel Event Surveillance: 1) refine the list of high priority occupational health conditions that require immediate response and should be placed under sentinel case surveillance; 2) develop surveillance protocols for these conditions and implement surveillance; 3) evaluate the prevention impact of sentinel event surveillance activities and revise the model as indicated; Population-based Surveillance: 4) describe existing population-based sources of data on health conditions, hazards and populations-at-risk (denominator data) that may be used for occupational health surveillance at the state and local levels; 5) conduct analyses of priority data sets, and prepare and disseminate surveillance reports; 6) assess the utility of these population-based approaches to surveillance and propose a schedule of population-based activities; Intervention and Prevention: 7) continue and expand working relationships with prevention partners to promote the use of surveillance data for public health action; 8) develop mechanisms to improve dissemination of surveillance findings; Regional Collaboration: 9) work with other states in the Northeast to obtain their input in defining core surveillance functions and to promote development of state occupational health surveillance capacity; and 10) produce a set of written surveillance tools that can be used/adapted by other states to build core surveillance programs. MDPH-OHSP successfully implemented surveillance of serious work-related carbon monoxide poisoning and serious work-related burns. While the numbers of cases identified were few, surveillance led to interventions to address life threatening hazards and established a capacity to respond to other serious events. A compendium of data sources for occupational health surveillance was developed and analyses of priority data sets, including hospital discharge data, emergency department data, and lead registry data, were carried out.. Streamlined approaches for routine use of these data sets were developed. For the first time, MDPH-OHSP accessed the statewide database of all Workers' Compensation indemnity claims; approaches to cleaning and coding this administrative database to allow its use for occupational health surveillance were developed and information on several targeted conditions was generated. Routine use of this database for broad-based surveillance was beyond scope of what could be accomplished with Core Program resources. MDPH-OHSP played a leading role in working with other states and NIOSH to develop a set of recommended state Occupational Health Indicators (OHI) now being implemented in a number of states. MDPH-OHSP also worked closely with hospitals and health care workers to develop a new statewide surveillance system for sharps injuries to hospital workers, the only system of its kind in the country. The discretionary nature of Core funding proved key in enabling MDPH-OHSP to build this system and to engage in the OHI development process. Working relationships with government and private sector partners were also continued and enhanced. A 25-member community OHSP Advisory Board met regularly to advise the program, and a new "research committee links" group was established to both promote academic research response to local community needs and facilitate student projects at MDPH. A number of collaborative activities grew out of this effort. MDPHOHSP also became a practicum site for occupational and environmental medicine residents at the Harvard School of Public Health. These strengthened relationships with the local academic community expanded the capacity of the Core Program, while providing students experience in applied public health. MDPH-OHSP engaged in a number of successful collaborations with other MDPH programs, integrating occupational health into the ongoing work of the Department. In addition, MDPH-OHSP facilitated continued communication and collaboration among states in the Northeast. Overall, this project strengthened the state's capacity to identify and address occupational health concerns and provided the basis for a continuing Expanded Occupational Health Surveillance Program in Massachusetts. It also generated a number of approaches and tools that can be adapted by other states. Lessons learned informed Massachusetts' input to both NIOSH and the Council of State and Territorial Epidemiologists (CSTE) regarding the core elements of successful state programs.
Workers; Work-areas; Work-environment; Injuries; Public-health; Humans; Men; Women; Hazards; Preventive-medicine; Surveillance-programs; Health-programs; Safety-programs; Poison-gases; Burns
Letitia K. Davis, ScD. Director, Occupational Health Surveillance Program, Massachusetts Department of Public Health, 250 Washington Street, Boston, Massachusetts 02108
Final Cooperative Agreement Report
NTIS Accession No.
National Institute for Occupational Safety and Health
Massachusetts State Department of Public Health - Boston