‘Historical and emerging challenges’: A Q&A with NIOSH Director John Howard

Dr. John Howard is NIOSH’s longest-serving director. Except for a brief period from mid-2008 to mid-2009, Howard has been in the role since 2002. Before coming to NIOSH, he was chief of the California Division of Occupational Safety and Health for 11 years. He is board-certified in internal medicine, legal medicine and occupational medicine. Here, Howard talks with Safety+Health about the agency, its accomplishments and his vision for its future.

Safety+Health: You are the first person appointed to three six-year terms as director of NIOSH. What has that stability meant to you and to the agency?

John Howard: Changes in leadership for any agency or company can be disruptive for both personnel and for ongoing and future activities, even with the best intentions of keeping things steady. The opportunity to serve as the NIOSH director for more than one six-year term has given the agency stability in the leadership structure, which I hope helps to facilitate the important work of NIOSH scientists in addressing the historical and emerging challenges to worker safety and health.

S+H: What worker health and safety issues keep you up at night? What are your biggest concerns for the future?

Howard: At night, I sleep very well. But during the day, I think about the emerging hazards that NIOSH may not be researching. I think about how best to expand our mission to focus on worker injury and illness and not just limit our science to work-related injury and illness. I think about how to transfer the knowledge we do generate into messages that better reach employers and workers alike.

Emerging technologies (including nanotechnology, advanced manufacturing and robotics) will continue to be innovative. Often, knowledge of how safe and healthy these innovations are for workers lags behind the knowledge of how the technology works, so they need to be evaluated and managed to ensure their safe operation for workers. To highlight the challenge we face, there is a lack of standard classification codes for robot-related injuries, making it hard to identify how often these may be occurring. However, using keyword searches of the Bureau of Labor Statistics Census of Fatal Occupational Injuries database, NIOSH researchers identified 61 robot-related deaths between 1992 and 2015.

To address worker safety around emerging technologies, NIOSH established in 2017 the Center for Occupational Robotics Research to provide scientific leadership to guide the development and use of occupational robots that enhance worker safety, health and well-being. The center’s research will look at traditional industrial robots, such as work in robotic cells and cages away from human workers, as well as emerging robotic technologies, such as collaborative robots, wearable robotics or powered exoskeletons, remotely controlled or autonomous vehicles and drones, and future robots using advanced artificial intelligence.

Another challenge I see for occupational safety and health is the current opioid crisis. Drug overdose deaths have continued to increase in the United States. According to the Centers for Disease Control and Prevention, in 2017, more than 70,000 people died from drug overdoses. The majority of these were among the working age population (15-64 years old). The effects of the opioid crisis are not isolated to work or to home, and the potential for addiction may be preceded by work-related factors, including injuries.

Approaching the crisis from an occupational perspective, NIOSH developed a framework that looks at workplace conditions that can be risk factors for medically prescribed opioid use becoming opioid misuse. The framework details the approach of looking at workplace conditions that can be risk factors for medically prescribed opioid use becoming opioid use disorder. It also focuses on protecting responders from exposure to illicit fentanyl and its equivalents, and developing methods of rapid detection of dangerously potent opioids in a workplace, as well as information about effective decontamination of workplaces.

You can learn more about how we are working to address the opioid crisis on the CDC.gov website.

S+H: Now that the National Occupational Research Agenda is more than 20 years old, can you describe the impact it has had on occupational safety and health?

Howard: The National Occupational Research Agenda facilitates not only discussion on research, but also partnerships on addressing the priority areas for occupational safety and health facing our nation. The structure promotes a way for academia, industry, labor and government to collaborate and identify shared priorities and goals.

An example of this is the National Campaign to Prevent Falls in Construction. This campaign encourages everyone in the construction industry to work safely and use the right equipment to reduce falls, especially those from roofs, ladders and scaffolds. Launched in April 2012, the campaign grew out of multi-stakeholder discussions in the NORA Construction Sector Council. The signature event of the campaign is the annual National Safety Stand-Down, where companies stop work to give a toolbox talk on fall prevention. [From] 2014 through 2016, stand-down activities reached more than 10,000 construction employers and almost 4.5 million workers.

S+H: What are some notable injury-prevention innovations NIOSH has helped create?

Howard: As a research agency, we must keep our eyes on the future, including how we can leverage new technologies and innovations to improve the safety and health of all workers. This includes our Research to Practice (r2p) approach, which focuses on collaborations with partners and stakeholders on the use, adoption and adaptation of NIOSH knowledge, interventions and technologies.

While not a comprehensive list, some brief examples of innovations include:

Ambulance crash test methods. Ambulance crashes are a major safety concern for workers and patients. Early NIOSH research focused on advanced harness-like systems similar to those used in military helicopters, which allow workers to be safely restrained but fully mobile. This initial work showed promise, and some early adopters purchased the systems for their ambulances. NIOSH formed a diverse team of more than 30 industry partners that included ambulance builders, cot and seat suppliers, and other parts of government to tackle a range of safety concerns. The research was co-funded by the Department of Homeland Security’s Science and Technology Directorate and resulted in the publication of 10 new crash test methods that address everything from seating to storage cabinets in the patient compartment.

Apps. [NIOSH apps transfer] research findings into cost-effective and actionable solutions to make work safer, healthier and more productive for workers and employers. This includes developing apps to provide safety and health information directly into the hands of those who need it.

One of our earliest apps, which has seen a lot of success, is the Ladder Safety App. This is NIOSH’s award-winning first mobile application and has over 112,000 downloads. Falls from ladders are common in the construction industry but are preventable. The free NIOSH Ladder Safety App provides visual and audio signals to help users set the proper angle.

Since this first app, we have gone on to develop additional apps to help workers and employers say safe on the job, including the NIOSH/OSHA Heat Safety Tool App, Sound Level Meter App, Lifting Equation App, ErgoMine Audit Tool App and the NIOSH Mobile Pocket Guide.

S+H: Can you talk about the Total Worker Health approach? What steps have been taken? What are some of the challenges?

Howard: The NIOSH Total Worker Health approach seeks to broaden the conversation on worker safety and health. It takes a more comprehensive view of the opportunities that exist in higher quality work, safer work and better designed work. This work builds on a legacy of NIOSH efforts to keep workers safe, but expands the discussion to look at other factors influencing health risks and opportunities for workers, on and off the job and in the economy.

TWH research focuses on comprehensive solutions for workers, workplaces and employers, expanding practice, policy and capacity building for worker safety, health and well-being. Much of the TWH research happens at the six NIOSH-funded extramural Centers of Excellence for TWH. This research includes looking at systems and approaches to worker well-being, organization of work and workplace exposures.

One pressing challenge that is part of the TWH approach is the need for comprehensive remedies to the U.S. opioid epidemic. At NIOSH, we are diligently working on actionable guidance and recommendations, materials and resources to help address the opioid crisis affecting workers and employers. Another challenge is the need for additional research on the best ways to understand the lifetime of exposure that workers face, how these interact and contribute to injury and to chronic conditions and disability outcomes.

S+H: What do you consider your greatest accomplishments during your tenure?

Howard: Any accomplishment that is attributed to me is one that I share with others at NIOSH. I have generated a number of ideas over the years, and I am indeed fortunate that a few of them have been welcomed by stakeholders, funded by Congress and implemented by scientists at NIOSH.

I would consider it my greatest accomplishment during my time at NIOSH if I have contributed to creating an atmosphere in which quality science can flourish at NIOSH.