Mr. FRANK. Thank you, Dr. Norwood. I appreciate it, and without objection, the entire statement will go into the record and I want to thank you for its completeness and it is going to be useful basis for us. I also appreciate the fact that the Bureau has made-is constantly making improvements and is showing the concern it has. I say that because I want to focus on the area of weakness, not as a way of criticism, but because we want to recognize the problem we have got here. You have been very forthright in recognizing it. I guess the Bureau itself said, regarding illnesses in the annual survey-I guess in 1982, "The current statistics do not adequately reflect the portion of occupational illnesses which are chronic and long latent in nature because of problems of detection in occupational relationship," and you went on to say here that "the problem is presently intractable.' We understand that. We are going to see if we can intractablize it a little bit in the future. That is really what I would like if we could focus on now-and as I said, not in any way by criticism of the work of the Bureau, but understand that we have this very serious problem▬▬ Ms. NORWOOD. Yes. Mr. FRANK [continuing]. And as you point out, even with regard to illnesses, some illnesses, skin irritations become immediately apparent and they can be checked by workplace data, but we also have this serious problem, and I guess what I would be interested in is your sense of how we can begin to make that problem a better one. I notice in August 1982, two employees of the Bureau of Labor Statistics, Mr. Hilaski and Chao Ling Wang, in the Office of Occupational Health and Safety, wrote an article talking about some survey approaches. Are you familiar with that and I am wondering- Ms. NORWOOD. Yes, I am. Mr. FRANK [continuing]. Whether you think that they are right, that this kind of approach, this kind of broad survey based on the incidence of illness, would be a way that we ought to go? Ms. NORWOOD. Well, Mr. Chairman, I think that we have to start even before that. The real problem, in my view, is that, first, there is a public policy issue, and that is, what do we, as a nation, believe an occupational illness really is? I think it is quite clear that an occupational injury is one which occurs in the workplace and one does not begin to examine the particular condition of the individual who is injured, but if there is someone who has lung cancer, one begins immediately to look at the individual's personal habits, where he is living, what other exposure he may have had. So I think there is first, and I say this from the point of view of an economic statistician who is responsible for data-gathering, we first need to define what we mean by an "occupational illness." The second thing that we need to do is to use records which can provide us with that information. We have made many attempts in discussions with both business and labor to see whether there was some approach that we could develop which would involve examination of medical records. As I am sure you are quite aware, there is a very serious issue of indi vidual privacy and we have never been successful in having any of those suggestions taken up, either by business or by labor representatives. So I think there are some very serious issues here which need to be addressed before we can go out and develop a data system to collect the data. The Bureau of Labor Statistics is a statistical agency with a lot of expertise and if people will define a phenomenon and provide us access to the records upon which that phenomenon can be examined, we can do a very good job of collecting the statistics, but that hasn't been done yet. Mr. FRANK. I understand, although we have a little bit of a chicken-and-egg problem here because we need some of the information to better define the problem. I mean, part of it is that we are still not sure exactly when you talk about cancer and other kinds of diseases how much of it is from where you live and how much from your personal habits and how much from the workplace and we do need some of the data. In terms of confidentiality, obviously that is a problem when you are talking about named individuals, but having an illness reported with a brief work history, does that cause a confidentiality problem? Ms. NORWOOD. No, I would doubt that it would. Mr. FRANK. We could-sometimes, and if you said this man has hypertension and his work history is that he spent 8 years as Speaker of the House, that might presumably cause a confidentiality problem, but I think for occupations where there is a wider distribution, that might not happen. What you are saying, though, is if we were, in fact, better able to focus on what we want, you do think it would be within the capacity of the BLS to get us some information that we could work on, but that- MS. NORWOOD. If occupational illness can be specifically defined Mr. FRANK. Would you think- Ms. NORWOOD [continuing]. Now, and I don't mean just in medical terms. I mean also in public policy terms, and records are available, certainly we can collect the data. Mr. FRANK. By "defined," if we were to say we were trying to find the extent to which occupational conditions significantly contribute to the incidence of the following diseases-because as you said, we are talking here about—— Ms. NORWOOD. Now, are we talking about incidence or prevalence? Mr. FRANK. I would think we would want to look at both. We are not sure exactly what we want to look at until we have gotten more of the data. We are not sure exactly what the most serious problems are. Maybe what we are talking about with incidence and prevalence data is detecting how soon people die from these diseases. It may be that what happens is that when you get a certain disease and you are in a certain workplace, you are going to die more quickly than if not. I don't know that we can say all this at the outset. I think we would want to look at both. Ms. NORWOOD. Well, I think that there is a lot of anecdotal information that is around, some of it pretty good. I don't think it tells us what the data are for the country as a whole, but I think there is adequate information available for the policymakers to use in determining how to define occupational illness. Mr. FRANK. Well, you say in your survey in 1982, "The current statistics do not adequately reflect the portion of occupational illnesses which are chronic and long latent in nature." Did you have Ms. NORWOOD. That is correct. Mr. FRANK [continuing]. No definition in mind when you said that? I mean, presumably you had a definition in mind- Ms. NORWOOD. We have a definition- Mr. FRANK. What definition-was the definition you were using when you said that not adequate or how would it have to be refined? Ms. NORWOOD. We have a definition of recordable illness which are recognized. If someone Mr. FRANK. Well, you used the phrase "occupational illnesses," what Ms. NORWOOD. Yes. Mr. FRANK [continuing]. Was the definition of that in your report? Ms. NORWOOD. What we were suggesting at that time, and which we do continually in our surveys since we believe strongly that we should explain to people both the good points and the bad points about our data, is that it is easy to recognize certain kinds of illness; that other kinds of illness which take years to develop are very difficult to recognize in the workplace because people may have left the workplace and that, quite apart from that, there is the basic problem that illnesses which develop over some period of time are often illnesses which people are not yet willing to recognize as having been caused in the workplace. A statistical system cannot determine public policy. It has to be the other way around. Mr. FRANK. I guess I am not clear exactly what you mean. I don't know that anyone would suggest that a statistical system should determine public policy, but it would seem to me that some of these questions: to what extent occupational conditions increased the illness rate- Ms. NORWOOD. That is a medical question and I am sure that NIOSH and many others are working on Mr. FRANK. Aren't statistics relevant MS. NORWOOD [continuing]. Issues of that Mr. FRANK [continuing]. But aren't the statistics relevant to that determination? Are you saying that Ms. NORWOOD. I think that there are certainly elements of data which can be collected from public health systems and from physicians which could help to give us a view of that, but you can't get that kind of information in the workplace. Mr. FRANK. Oh, that I agree, and I guess if that is the point, that is the next thing I want to get to. Are you saying the BLS is basically confined to a workplace orientation? Ms. NORWOOD. No, we are not basically confined to it, but we do try to specialize in labor statistics— Mr. FRANK. Well, if that is the point, then I would agree completely. I think one of the things that is very clear-except for the short-term illnesses, you mentioned dermatitis and some others; when we are talking about those things you identify, in that case, I would agree. In fact, I think a workplace orientation would be distorting and will continue to underreport-there will be inevitable underreporting if you have a workplace orientation- Ms. NORWOOD. One could, of course Mr. FRANK. Would BLS have a role- Mr. FRANK. I just wanted to know, because I agree that the workplace orientation comes later on. Once we have-in that sense, I would agree with you. Once we have decided what we want to do, we then want to go back to the workplace and say, "We have decided the following conditions aren't healthy ones and we want to do workplace studies to see to what extent those conditions are there." Ms. NORWOOD. Yes. Mr. FRANK. Would BLS have a role-if we were not doing a workplace orientation in the initial collection of statistics, then it is basically not a BLS function; is that what you are saying? Ms. NORWOOD. Well, it would depend, I believe. For example, if one were to go out to employees or to unions, as well as to employers, then BLS would be involved. If it is an issue of collecting data from physicians and public health authorities, then that is properly a task for the National Center for Health Statistics. Mr. FRANK. OK. When we got into this discussion of the definition of occupational illness, I think the fact that you have used it in your own report and that we have used it shows that we have a generally good idea of what we mean by it. It needs to be refined, and I understand that, but I think we have enough of a basis now to start collecting some statistics. When we reach the point of trying to decide how we are going to affect particular workplace conditions, yes, then you need a more specific set of definitions, and it may be that the BLS' role would come in later in that regard. With regard to your current annual survey, when you say "the current statistics do not adequately reflect chronic and long latent diseases" does it make a great deal of sense to continue to even try to present them? Ms. NORWOOD. I think that it does. First of all, I would emphasize that we do explain to the public what it is we are doing and the limitations of all of our data, including the occupational illness. I think that it does because I do think that it sensitizes both employees and employers to the fact that there could be some dermatitis or other kinds of illnesses that are easily recognizable that can be reduced and I think that having the data, having the recordkeeping system can help that. Mr. FRANK. That I very much agree with. I am talking about those which are inevitably, because of the state of the art right now, going to be substantially underreported. I guess I am talking about- Ms. NORWOOD. Well, I think we have very little of those in any case, and we say so very clearly in our press releases. Mr. FRANK. All right, thank you. Mr. McKernan. Mr. McKERNAN. Just a couple of questions. I gather that you don't have any evidence that OSHA's inspection targeting program has resulted in any intentional underreporting of either occupational injuries or occupational illnesses? Ms. NORWOOD. No, sir. Mr. McKERNAN. Can you give us any suggestions on how you could either better train physicians or employers on what are occupational illnesses and how we could beef up the program? You have heard some of the testimony earlier today. Ms. NORWOOD. Yes, I have heard the testimony earlier today and I think a great deal of work is being done, particularly in the health field, and I would hope that that would continue to go forward. I believe that a Federal/State cooperative effort is an extremely efficient way of collecting data from public health officials, as well as from employers in some cases, as we do, because I think it helps sensitize. It helps to inform all of the people who need to be involved in this system, and so I would disagree, I think, with some of the former comments in that regard. Mr. McKERNAN. Do you think that there ought to be more of a leadership role from the Federal Government in that partnership with the States in saying, "This is at least the information that we want and any other things that you have come across in your own programs, we would obviously be interested in, too"? It seems to me that there isn't a lot of that being done right now. Ms. NORWOOD. Well, you know, the Bureau of Labor Statistics has a Federal/State survey relationship that goes way back to almost the beginning of this century, and it has served us all very well. It reduces the burden on respondents; it improves the quality of local data, which is an impossibility, I might point out, for the Nation as a whole to develop. The data for the large number of individual areas in this country is just too expensive for the Federal Government to develop all by itself. In addition, I think we shouldn't overlook the fact that it is the people who live in this country who are the ones who need to understand what the problems are and how they should be improved, particularly in this field of occupational illness. So I think that by working closely with them, the Federal Government always provides some leadership, and a lot of money usually, in these ventures. We have found that our employment hours and earning series, for example, which is a Federal/State cooperative survey, is really a very effective kind of relationship. Our occupational safety and health survey is one of the best in the world. I was in Australia recently discussing with the Occupational Safety and Health Commission of the Commonwealth approaches to data collection in this area. We are in many ways in the forefront of some of these developments. I hope that there will be progress over the coming years in the definition of illness by medical authorities and by the Congress. Then we will be able to collect data more effectively, more efficiently. Mr. McKERNAN. One final question: You have heard the rather disturbing colloquy that we had with the last panel on the difficul |