NOTE: This document is provided for historical purposes only.
Linda Rosenstock, Director NIOSH
MS. TAYLOR: At this time, I would like to introduce the first member of our distinguished welcoming panel.
Dr. Linda Rosenstock, who is currently the director of NIOSH and professor of the departments of medicine and environmental health with the University of Washington. Prior to becoming NIOSH's director, Dr. Rosenstock chaired the United Auto Workers, General Motors, Occupational Health Advisory Board.
Dr. Rosenstock has been active internationally in teaching and research in occupational health and has served as an advisor to the World Health Organization.
Please join me in welcoming Dr. Rosenstock.
DR. ROSENSTOCK: Thank you, Sandy.
For those of you standing in the back who would prefer to sit, there are actually seats scattered about in the front rows here, and we welcome you to come forward now.
It is great to be here. When we started planning this conference, there were some real concerns voiced that it would be very hard to get an active turnout. We were thinking then about 200 to maybe 500 people in Chicago in January, and I'm delighted to say we proved the skeptics wrong when we started to turn away interested individuals about a month ago as we exceeded our capacity of 1000.
So welcome. We are glad you're here.
One of the things I'd first like to do is again give recognition to our conference cosponsors. This has been a collaborative effort from the get go. It has certainly been an exemplary one of OSHA and NIOSH working together and, in addition, we'd like to thank the many individuals and organizations who made this possible.
I'd also like to give special recognition to the many individuals within NIOSH who have worked so hard on the issues of ergonomics in general and specifically in planning this conference and particularly to Larry Fine, who wears many hats in NIOSH but has done a superb job coordinating our ergonomics effort throughout the Institute.
I'm going to talk about roads a little bit in the next few minutes. The long and winding road is one way to talk about dealing with ergonomics issues. Some folks may be talking about high and low roads. I'll try to avoid that characterization for the moment.
I think one of the important things to note from the perspective of an Institute whose primary mission is to do research in this field is that we've been accumulating research over two decades that identifies the relation between work factors and upper extremity, low back, and musculoskeletal disorders.
As the evidence has accumulated, telling us more about the magnitude and scope of these problems, the controversy associated with this area has been raging on.
Part of the controversy has been how big a problem is this and how much of it is work related? I think the important role for all of us here who have been active in our various capacities in the organizations we work for, is that we recognize there may still be fine points to the debate about the exact scope and the exact relation to certain factors but at the same time we know the problem is a large one, and it's a large one both in health costs and economic costs, whatever numbers you use.
The numbers vary because our statistics are not perfect and often are systematic underestimates. But whatever statistics you use, the problem is large. For example, if you use a case-based example of workers' compensation claims for upper extremity musculoskeletal diorders, each cost about $20,000 using California data. The Bureau of Labor Statistics data point to several hundred thousands of cases of upper extremity musculoskeletal disorders. Certainly a far larger number of work-related low back disorders occur annually using National Health Interview Survey data. Overall, health-related costs are somewhere between a low estimate of approximately $2 billion to estimates of $11 billion or more.
And related costs -- lost productivity, other kinds of associated lost wages and the like, really start getting to the hundreds of billions of dollars.
Now, despite the debate going on, we know that workers and employers have recognized the scope of this problem for a long time, and they're trying to do something about it, and we're here to share the stories and success stories about what's being done.
Let me just share some recently reported data which looks at reports of relatively large companies, earning $500 million or more annually in revenues, and you get a sense of two things:
One is that most of these companies are identifying that even in a one-year period the problem is increasing, and we've certainly seen this trend over many years, in the last ten or so, when we've been tracking it.
The other thing is that companies are doing something about it and that's partly why we're here. Large percentages of companies are already working to modify jobs and equipment, analyzing work stations and jobs, investing in new equipment -- as we'll learn about, with the hope of reducing this serious problem -- as well as training workers and trying to get appropriate medical care.
These numbers really speak to the fact that whatever the controversy, there is a need to move past it and move on to solving this problem.
NIOSH's own experience is consistent with what we've seen nationally and actually globally in terms of a recognition of increasing reporting and risks for musculoskeletal disorders.
Just looking at our 1-800 number alone we are now at over 3,000 inquiries a year related to musculoskeletal disorders with the breakdown as shown here.
As you know, we have a Health Hazard Evaluation Program that can come in at the request of employers or employees, or other pertinent interested parties, and we have several hundred of those a year that we undertake. We're getting about 10 to 15 requests a year that are directly related to musculoskeletal problems.
Let me give you an example of just one.
Several years ago we were requested both by the company and by the workers to look at a problem area in a Harley Davidson plant. They had a problem in one particular department where they had both high workers' compensation costs and high injury rates. It was a very high skilled department, and they were having trouble keeping a critical process staffed because of musculoskeletal problems.
NIOSH came in and made some recommendations. They were implemented, and the bottom line, and I think we'll hear this bottom line repeatedly in the next few days, is that the health outcomes were improved, the rate of injuries decreased, and the economics of the situation improved.
These are win-win situations. We can make workers healthier and we can make productivity increase when we work together to apply these kinds of solutions.
Let me tell you a little bit more about what NIOSH is doing, and you've seen some of this in your packet. We expect in the next two months to finalize a comprehensive review of the science and scope of musculoskeletal disorders that has been extensively peer reviewed by some of you in the audience and many others.
We have provided for you in your packet a primer which is in draft final form, based on our own experience within NIOSH, doing these kinds of evaluations that are really targeted to those working or involved in small and medium businesses. The primer will provide some tools about how to implement an effective ergonomics program.
We continue to do research. Another document in your packet identifies about 80 research projects that are either being done in house or funded by NIOSH, specifically related to musculoskeletal problems. One such research project conducted in house identified some issues that are relevant in terms of alternative keyboard and exploratory studies actually showing for short duration that alternative designs did not have the intended benefit of reducing discomfort.
This is exploratory because it doesn't mean that when used over a longer period of time or in some populations alternative keyboards would not be helpful, but it's this kind of research that we need to keep doing, so that as we implement these changes we can evaluate whether or not they're effective.
Where are we going? Let me just identify an activity that many of you helped us with. NIOSH and its many partners, over 500 individuals and organizations, identified recently the top 21 priorities for the nation for occupational safety and health research.
Relevant to ergonomics let me identify two of the eight priority areas in the Disease and Injury category as ones we'll be dealing with here -- low back disorders and upper extremity disorders. Other priority areas are very directly related to ergonomics, and we are working with our partners in implementing this agenda to try to leverage resources, activities, and attention to these areas with the goal that increasing research and especially prevention research will result in reduction of illnesses and injuries.
The endorsement of these as priority areas has been extraordinarily strong. This gives you a flavor of the consensus for just one such category.
Five out of five expert working groups rated upper extremity disorders as a top priority. So did our Corporate Liaison Committee Survey, as did a survey of International Occupational Safety and Health Institute Directors, and many, many others.
The same high endorsement was provided as well for low back disorders. We all recognize this problem and recognize the work that needs to be done.
In addition, we know that once we've identified these priority areas -- and I give you here an example of low back disorders alone -- that we'll be able to work with others who are doing work within economic sectors.
Those who have done very effective work, for example, in agriculture or mining or construction or the service industry, know that of these 21 priorities, no surprise, musculoskeletal disorders will be a priority within almost all employment sector research. Such focus will help the research and prevention actions accordingly.
So, in summary of where we are and where we're going, I think the message you'll hear probably undoubtedly many times this morning is this is a large problem, no matter how you count it, and even if the numbers vary.
Yes, there are research gaps and certainly our role is to continue to fill those as fast as we can, but we know enough to take effective preventive action now, and we shouldn't be waiting for more research to take those steps. That's what this conference is about.
Seneca, a Roman philosopher and politician -- probably in reverse order -- talked about the "rough roads that lead to the heights of greatness." If this is at all true in the field of ergonomics, perhaps we're on our way to greatness now.
We are pleased to have you here. I hope we will all look back on this conference as a watershed when we started to change the way we talked about and solved this enormous problem in our country.
MS. TAYLOR: Thank you, Dr. Rosenstock.