Prevention through Design: Burden, Need, and Impact

Burden, Need, and Impact

NIOSH strives to maximize its impact in occupational safety and health. The Prevention through Design program identifies priorities to guide investments, and base those priorities on the evidence of burden, need and impact. Below are the priority areas for the Prevention through Design (PtD) program.


Work-related injuries have tremendous personal and societal health impacts, with about $250 billion per year in direct and indirect costs1. There were 3.7 million work-related injuries in 20142, and 4,679 deaths from injury. Of the 189,400 work-related illnesses that year3, 47,000 were fatal4.

One of the best and most cost effective ways to prevent occupational injuries, illnesses, and fatalities is to address hazards and reduce risks early in the design or re-design process. Unless design is considered early on, it can become a risk factor. Some key research findings:

  • An Australian study of work-related injuries from 2000-2002 found 37% of workplace fatalities are due to design-related issues. In another 14% of fatalities, design-related issues may have played a role.4
  • 22% of 226 injuries that occurred from 2000 to 2002 in Oregon, Washington, and California were linked partly to design.5
  • 42% of 224 fatalities in U.S. between 1990 and 2003 were linked to design.5
  • 63% of all fatalities and injuries could be attributed to design decisions or lack of planning.6


Research is important to evaluate the effectiveness of current PtD interventions, investigate additional solutions for existing design-related challenges, and identify future research needs. NIOSH has been identifying design solutions and making them available online for decades through the Fatality Assessment and Control Evaluation (FACE) program and the Health Hazard Evaluation (HHE) program.

Education efforts seek to inform and motivate others to use PtD priorities and processes in collaborative design and redesign of facilities, materials, work processes, facilities, equipment and tools. We prepare educational modules to help universities to integrate PtD principles into engineering curricula. We assist and encourage publishers and authors to revise engineering textbooks to include PtD. We encourage professional accreditation bodies to include PtD in their assessments. And we are involved in efforts to make business leaders aware of potential cost savings from PtD.

Practice of PtD occurs when new designs and designs processes reduce worker hazards. A major effort by NIOSH scientists and engineers since our beginning days has been the reduction of hazardous noise – preferably by elimination or reduction at the source.

Policy advances, whether by law and regulation, by voluntary consensus standards, or by competitive industry programs such as certifications, will serve to make PtD culture change permanent and not dependent on continuous promotion campaigns. Businesses do not have to wait for someone else to create clever new designs for them, as the American National Standards Institute and American Society of Safety Engineers PtD consensus standard, ANSI/ASSE z590.3, provides clear guidance and tools needed to implement a PtD design process within any business.


NIOSH is currently disseminating a systematic Health Hazard Banding approach to assist safety and health professionals in providing guidance for chemicals without authoritative occupational exposure limits (OELs). The NIOSH Hazard Banding process can be used with limited information and resources and can be performed quickly by in-house industrial hygienists and health and safety specialists.  The outcome of the Health Hazard Banding process is an occupational exposure band (OEB).  Health Hazard Banding can be used to supplement and support OEL development by facilitating a more rapid evaluation of health risks, providing guidance for chemicals without OELs, identifying hazards to be evaluated for elimination or substitution, providing the user with recommendations when minimal data is available and a tool for the development of NIOSH Recommended Exposure Limits.

Four educational modules are available to university instructors. Each encourages inclusion of worker health and safety considerations early in the design process for a specific topic, and identifies associated hazards.

A recent practice success story from our noise experts is the availability of a Workplace Design Solution (WDS) document on “Preventing Hazardous Noise and Hearing Loss during Project Design and Operation”, coupled with a “Buy Quiet” website and PowerTools database to help businesses design out hazardous noise with their own “Buy Quiet” program.

In regard to policy, the U.S. Green Building Council published a Leadership in Energy & Environmental Design (LEED) PtD pilot credit for building certifications. The pilot credit, encouraged by a NIOSH PtD “Safe Green Jobs” workshop, and developed by the NIOSH Construction Program, expands the protected occupants across the life cycle of facilities by including protective methods for the very first occupants, the construction workers, as well as the operations and maintenance occupants. LEED certification credits are now awarded by following specific PtD green building design and construction methods.


1Leigh J [2011]. Economic burden of occupational injury and illness in the United States. The Milbank Quarterly. 89(4):728-72. icon

2Bureau of Labor Statistics [2015]. Nonfatal News Release – 2014, icon

3Bureau of Labor Statistics [2015]. Fatal News Release – 2014, icon

4Driscoll TR, Harrison JE, Bradley C, Newson RS [2008]. The role of design issues in work-related fatal injury in Australia. J Safety Res 39(2):209–214.

5Behm M [2005]. Linking construction fatalities to the design for construction safety concept. Safety Sci 43:589–611.

6WorkCover New South Wales [2001]. CHAIR safety in design tool New South Wales, Australia: NSW WorkCover. icon

Page last reviewed: September 17, 2019