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that is, how you measure occupational illnesses, which is one that has been with us for a long time. We are not doing a very good job in that area, in my judgment, but it is not the fault of any one group of individuals or agency. It is a failure, I think, Governmentwide to deal with this problem.
The injury question is a somewhat easier one to deal with because it is more specific. The illness one is obviously very important, among other things, and from the perspective of myself and my colleagues on the committee, we have no more perplexing domestic problem than health care costs.
If you look at budget projections, if you look at the kinds of conflicts in value we have, trying to control health care costs is as serious a domestic issue as Congress confronts.
If you look at the trends projected with the population aging, you get very frightening figures about health care costs down the road. Clearly, one essential way to cope with that is to try and reduce the incidence of illness to the extent possible. Benefit/cost analysis has become kind of common these days.
I think we have undervalued in just dollars and cents terms the importance of trying to curtail illnesses. If we are not able to do a better job of measuring occupational illnesses and then using that measurement, obviously, to take steps to try and reduce them, the health care cost crisis that we face is going to get worse and worse.
So this is not simply a humanitarian concern-that is, reducing illness, the causation factors in the workplace. It also is very much a dollars and cents one for this society because the health care crisis is an enormous one and I am convinced of this from what I've read and heard so far. Of course, I will be listening today for further evidence or perhaps refutation of this. But one reason we are going to face that health care crisis in years to come, unless we change things, is our failure to deal much better than we have been with the question of occupational illness. So I will be particularly interested, as we get to the question period from all of our witnesses, in specifics about what we might begin to do about this; what kind of methodologies; what kind of surveys, and what kind of government, private sector, maybe union cooperation we need to do a much better job that we have done.
It is clear to me now that we don't do a very good job of measuring occupational illness and we have both humanitarian and cost reasons to do a better job.
Mr. McKERNAN. Thank you, Mr. Chairman. I just want to commend you for holding this hearing because I, too, was concerned at the hearing we had some months ago with Mr. Auchter, who I thought did an excellent job in explaining the changes that have taken place in OSHA as it relates to workplace injuries. Frankly, I think that we are moving in the right direction as far as trying to do something about the incidence of injuries.
I felt, though, that from that testimony, it became clear how difficult it really is to address the problem of workplace illnesses, especially since there is a long time sometimes between seeing the results of exposure to various problems in the workplace and when the illness actually develops. So I think that this hearing is timely and it is one that I think all of us are interested in and realize that
we have to take steps to prevent illnesses in the workplace. I think we are looking for information on how we can better do that, how we can better get a grasp on what the problem is and how we can come up with the right formula for making sure that we document these illnesses and that we are doing everything that is possible to protect the health of workers.
So, with that, Mr. Chairman, let me just again thank you, because I think this is a timely hearing and one that is of great importance.
Mr. FRANK. I want to thank the gentleman for his cooperation. As some of you may know, if you have appeared before other subcommittees, this degree of cooperation that I think exists on this subcommittee, at both the level of the members and the staff, is quite high, but I do, in all candor, have to say that in-oh, approximately 10 hours from now-8 hours from now, it will be ending at the House baseball night when the gentleman and I will be on opposite sides, and he is going to be pitching. And I just want to remind him that I am vindictive and not very well coordinated. [Laughter.]
With that, we will begin with our witnesses. We want to express our appreciation to the witnesses for coming today. Our first panel is Dr. J. Donald Millar, the Director of the National Institute for Occupational Safety and Health; and Karl Kronebusch, who is an analyst in the health program, and in whatever order, Dr. Millar, you want us to proceed. It is up to you. STATEMENT OF DR. J. DONALD MILLAR, DIRECTOR, NATIONAL
INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH, ACCOMPANIED BY DR. PHILIP LANDRIGAN, DIRECTOR OF THE DIVI. SION OF SURVEILLANCE, HAZARD EVALUATIONS, AND FIELD STUDIES, AND TODD FRAZIER, CHIEF OF THE SURVEILLANCE BRANCH, DIVISION OF SURVEILLANCE, HAZARD EVALUATIONS, AND FIELD STUDIES
Dr. MILLAR. Mr. Chairman, I am Dr. Millar, Director of NIOSH, and I have with me today Dr. Philip Landrigan, who is the Director of our Division of Surveillance, Hazard Evaluations and Field Studies; and also Mr. Todd Frazier, who is Chief of the Surveillance Branch in that Division. Mr. Frazier is also chairperson of the Occupational Cancer Risk Subcommittee of the Committee to Coordinate Environmentally Related Programs of the Public Health Service. We hope to provide you with some useful information.
Mr. FRANK. Thank you, Dr. Millar. We just want to make sure the first time that any of the gentlemen speak, make sure the recorder knows exactly who it is that is speaking?
Dr. MILLAR. As you know, Mr. Chairman, we filed a rather lengthy written testimony as a detailed response to your letter of invitation to provide descriptions of the various data collection systems NIOSH uses to gather information about occupational illness.
I don't want to rehash that testimony before you, but instead, would like to provide a little personal perspective on these issues. Data are collected for all kinds of reasons and it is important to make distinctions between the purposes for the collection of data. Now, in our case, the various data systems we describe in the testimony provide us with information that is very useful for epidemiologic research. Bear in mind, however, that all these systems were designed to meet other needs, compliance, compensation, the recording of births and deaths, even to assure that people pay their income taxes. We try to ride the systems, as it were, to get additional information that is useful to us for doing epidemiologic research.
Now, we assume that these systems adequately do the jobs for which they were originally designed, but, of course, they don't always prove entirely adequate for good epidemiologic research. Hence, we find ourselves trying to push or amend the systems to make them produce data that are better for our uses.
We are rarely satisfied in this effort, but this should not be viewed as evidence that will attack or are displeased with the way these systems function for their original purposes.
I would like to spend a few minutes this morning, however, discussing a second important purpose for data collection-one that is clearly not being met in this nation today—that is: the need for current, meaningful epidemiologic information to help us prevent occupational illness. This kind of information says, “Hey, there is a public health problem here that needs being dealt with now to prevent disease and injury in workers.”
It really doesn't matter who intervenes, a county health officer, a State health or labor agency, or the Federal Government. Whoever intervenes needs this kind of current information.
For over 20 years now, I have been involved in the disease control activities of the U.S. Public Health Service, and in a sense, I see myself and my colleagues as fighters in a war against disease and death. In this current assignment as Director of NIOSH, in fact, I see myself at war with diseases and injuries that maim, disable, and kill American workers.
Now, in a shooting war, it would be foolhardy to engage an enemy without knowledge of his whereabouts, behavior, and strength; in disease control, the situation is very similar. The chances for preventing a disease depend directly on how well we understand its epidemiology, that is, its whereabouts, its habits, and its vulnerabilities to prevention.
The process by which we get this information about diseases is called epidemiologic surveillance, and in my judgment, this epidemiologic surveillance of occupational diseases is essential if we are to prevent these problems and, therefore, reduce burden on American society.
As a Nation, we have been very successful in controlling many diseases. Indeed, we were world leaders in the global campaign that eradicated smallpox. That success was possible only because we knew the whereabouts and behavior of smallpox, its seasonal ups and downs, and its vulnerabilities to prevention.
In this successful campaign and other Public Health activities, we have learned that preventing a disease depends on epidemiologic surveillance. Well, what is this process that I am talking about?
Epidemiologic surveillance is the collection, analysis, and sharing of information that makes it possible to practice aggressive prevention. In essence, epidemiologic surveillance has three elements: first, to rapidly detect and report cases of a disease; second, to analyze and synthesize reports into a meaningful understanding of the situation; and third, to initiate some appropriate action, either setting up a preventive measure or at least providing information and understanding back to the source of reporting.
Epidemiologic surveillance has been crucial in control in many diseases, so crucial in the eradication of smallpox in fact, that it, became the cornerstone of the global program.
Now, as we said in our written testimony, numerous systems in occupational safety and health, produce reports of death, claims, lost workdays, injuries, and other information, but none of thesenor indeed, all of them taken together-provide a systematic national epidemiologic surveillance of work-related health problems.
As our society creates goods and services, workers are the first members of society to be exposed to new hazards and, indeed, the first to develop diseases and injuries from these exposures. Physicians and other health care providers who see these problems first are on the leading edge of biomedical science and also in the front lines of public health. Frankly, Mr. Chairman, in the practice of epidemiologic surveillance, the field of occupational safety and health, is at least 70 years behind the field of communicable disease control.
Why do I say this? In communicable disease control, effective surveillance has been present for a long time. Indeed, in 1912, the Conference of State and Territorial Health Authorities recommended weekly telegraphic reporting to the Federal Government of selected communicable diseases. Since then, on a regular basis, the Federal Government has published table 1, the Summary of Cases of Specified Notifiable Diseases in the United States. These days, this appears each week in the MMWR, a publication produced by the Centers for Disease Control.
In 1913, this table appeared in the Public Health Reports, and, in that year the editor of that journal wrote, “No health department, State or local, can effectively prevent or control diseases without knowledge of when, where, and under what conditions cases are occurring
This statement is as true today as it was when written 71 years ago.
Now, to prevent occupational diseases and injuries, Mr. Chairman, I believe we need nationwide epidemiologic surveillance of these problems. That would not require any new Federal law or regulation. It would not require any new burden to be placed on any employer. It would not, in fact, even require a new surveillance system. It requires only that our existing national surveillance system be made to serve the purposes of occupational health as well.
Lest there be a misunderstanding about this, let me briefly summarize this existing system, which has served us so well for the past 70 years. Every State and territory in the Union requires that certain conditions be reported to the local health department when they are seen by a physician or other health care deliverer treating patients.
Each locality reports its data regularly to the State_health department, which colates and analyzes these findings. Each week, the State health agencies voluntarily report their aggregated data to the Centers for Disease Control, and CDC analyzes and publishes this information in its weekly morbidity and mortality report.
In the process of this transmission of data, the responsible health agencies at the local, State, and Federal level react to these reports and conduct investigations or execute control measures as necessary and appropriate. To provide national epidemiologic surveillance for occupational diseases, these occupational conditions must be declared "reportable" by the State health departments.
The strategic vision here, Mr. Chairman, is that one day all diseases and injuries of occupational origin will be reportable by any physician seeing them. Now, obviously, this is a utopian state that we cannot achieve overnight. However, it is clearly possible to move in that direction and, indeed, we have already started moving in that direction as a nation.
State health agencies have indicated a considerable interest in this and a considerable willingness to proceed. Just yesterday Dr. Landrigan met in Minnesota with the Conference of State and Territorial Epidemiologists who are very interested in making silicosis a reportable disease in their States. This would be the first noninfectious occupational problem to be added to the list of specific notifiable diseases.
Now, I feel certain that many labor and industrial leaders would also support these efforts to move occupational disease into the forefront of public health, along with other conditions of clear national significance.
Sir, I believe that the prevention of occupational diseases, and hence, assuring safe and healthful workplaces for all Americans depends on this type of traditional public health activity. We in NIOSH are doing what we can to bring it about.
Thank you, Mr. Chairman, and I would be pleased to respond to your questions.
[The prepared statement of Dr. Millar follows:] PREPARED STATEMENT OF J. DONALD MILLAR, M.D., DIRECTOR, NATIONAL INSTITUTE FOR
OCCUPATIONAL SAFETY AND HEALTH CENTERS FOR DISEASE CONTROL, PUBLIC HEALTH SER CE, DEPARTMENT OF HEALTH AND HUMAN SERVICES
Mr. Chairman and members of the subcommittee, I am Dr. J. Donald Millar, Director of the National Institute for Occupational Safety and Health, Centers for Disease Control. With me today is Dr. Philip Landrigan, Director of the Division of Surveillance, Hazard Evaluations, and Field Studies; and Mr. Todd Frazier, Chief of the Surveillance Branch within that Division. Thank you for this opportunity to appear before you to comment on the information systems used by NIOSH to assess and report the extent of occupational illnesses and injuries in the United States.
NIOSH relies on six data collection systems to assess the extent and monitor the trends in occupational diseases, injuries, disabilities, and deaths. In addition, we have in place a system to collect data on potential occupational exposures. I will briefly describe each of these seven systems to you.
First, we use two surveys which are conducted by the Bureau of Labor Statistics (BLS) of the Department of Labor. The first, the BLS Annual Survey of Occupational Injuries and Illnesses, is a probability sample of employer reports of work-related injuries and illnesses. Although we recognize that occupational illnesses are considerably under-reported in this system, the survey nevertheless provides us with information on the occurrence in each of the nation's major industrial sectors on the incidence of such occupationally related illnesses as skin diseases; dust-induced and toxic disorders of the lungs; chemical poisonings; disorders due to physical agents such as noise and heat; and disorders caused by trauma.