Congratulations to the conference committee for putting together a vigorous and well-thought out schedule. I'm confident it will encourage deep as well as practical discussion and provide momentum for dealing with the issues of work, stress and their effects on health. I also want to thank all of you for joining APA and the government sponsors in this very timely conference on how stress can result in injuries, illness and death in the work environment.

Someone once said that stress is the condition where the body sweats bullets--but the mind shoots blanks. After testifying at more than a few Congressional hearings, I can attest to that. These are pretty stressful times for everyone at the Occupational Safety and Health Administration. The House has approved an appropriations bill that would slash funds for our critical enforcement programs by a third. The same bill would cut NIOSH's appropriations by 25%. Our budget is under consideration by a Senate appropriations committee today.

Unless the Senate and/or President Clinton can intervene to modify those cuts, workplace safety and health in America will be severely impacted.

OSHA, since it was established by another Congress 25 years ago, has accomplished a great deal. The workplace fatality rate has been reduced by more than 50%. OSHA standards make a real difference -- often the difference between life and death -- to millions of working Americans.

Since OSHA strengthened trenching protection in 1990, trenching fatalities have declined by 35 percent. OSHA's lead standard reduced blood poisoning in battery plant and smelter workers by two-thirds. OSHA's cotton dust standard virtually eliminated brown lung disease in the textile industry. The grain handling standard protects workers from grain dust explosions and has helped reduce fatalities in grain facilities by 58 percent and injuries by 41 percent. OSHA saves lives.

Millions of working Americans also have benefitted directly from OSHA's enforcement program for manufacturing establishments. In the three years following an OSHA inspection and fine, injuries at the inspected worksite decline by as much as 22 percent. In fact, since 1975 injury and illness rates have FALLEN in the industries in which OSHA has concentrated 84 percent of its enforcement activities (manufacturing, construction and oil and gas extraction), while they have risen in other industries.

But, our work is far from done. Every year, work-related accidents and illnesses cost an estimated 56,000 American lives -- more than the total American lives lost in battle during the entire 9-year Vietnam war. On an average day, 17 working Americans are killed in safety accidents, an estimated 137 more die from occupational disease, and another 16,000 are injured.

Safety accidents alone cost our economy over $100 billion a year, and occupational illnesses cost many times more. We all bear these costs, as employers, as workers and as taxpayers.

There is a tremendous gap between OSHA's mission, which encompasses safety and health for some 100 million workers employed at over 6 million workplaces and our resources, $312 million and 2,300 people. To narrow that gap -- to effectively conduct our mission with existing resources -- we have to change the way we do business.

And we are. If you think you know how OSHA works, you may want to think again. Today's OSHA is not the OSHA you knew even as recently as two years ago. OSHA is a reinvention success story -- with the awards to prove it. Our reinvention strategy is Common Sense at Work, offering employers a choice between partnership with OSHA and traditional enforcement. Requiring employers to institute effective safety and health programs that find and fix hazards, and that actively involve their workers. It is a strategy we believe will transform occupational safety and health in America because it forms partnerships -- employers and employees working together with OSHA -- to improve worksite safety and health.

One of the fundamental principles of such a program is addressing emerging occupational hazards. A 1992 survey by Northwestern National Life Insurance Co. found that four out of 10 employees (40%) feel their jobs are "very" or "extremely stressful." With statistics like that, it should come as little surprise that the number of stress-related disability claims by American workers doubled during the period from 1982 to 1990, according to the Employee Assistance Professionals Association in Arlington, Va. The American Institute of Stress (based in Yonkers, N.Y.) reports as many as 75 to 90% of visits to physicians are related to stress. -- with an estimated cost to industry of $200 billion to $300 billion a year.

The workplace has been identified as the greatest single source of stress. The causes of such stress can range from the anxieties produced by corporate down-sizing to factors that result in physical disorders such as carpal tunnel syndrome. Stress also can result from simply a feeling on the part of the individual worker that he or she is not appreciated on the job or is being overwhelmed by family obligations.

In 1994, the Women's Bureau of the Department of Labor conducted a landmark survey of how working women in America feel about their jobs. More than a quarter of a million women told of their concerns and experiences.

Stress ranks as working women's No. 1 problem, the survey found. This problem was identified by almost 60% of all respondents, cutting across all income and occupational groups. Stress is particularly acute for women in their 40's who hold professional and managerial jobs (74%) and for single mothers (67%).

We in OSHA are concerned that stress on the job can breed violence, even homicide. And when violence does occur or is even a potential threat, stress increases. Northwestern National Life Insurance Co. found that in companies where violence has been threatened, the employee burnout rate goes up to 49%, compared with 34% for all companies.

Homicide has become the second leading cause of job-related deaths, accounting for 16% of the 6,588 fatal work injuries in the U.S. in 1994, according to the Bureau of Labor Statistics. (Highway deaths are No. 1, with 20% of fatal work injuries in 1994).

For women, homicide is the leading cause of death in the workplace. It accounted for 35% of their fatal work injuries in 1994. Popular conception is that workplace homicides are the product of co-worker assaults or spillovers from domestic disputes. Not so. The vast majority of fatal assaults are criminal in nature, perpetrated by strangers.

Of even greater magnitude than the number of homicides in the workplace is the number of assaults. The Department of Justice estimates that about one million persons are assaulted annually at work. Little wonder that for many the workplace and stress go hand in hand.

OSHA is committed to addressing the issue of workplace violence.

Industries have come to OSHA asking for help. We want to assist them in developing comprehensive safety and health programs that include the prevention of workplace violence.

We have developed voluntary guidelines that will assist employers and employees in preventing violence in health care establishments. This industry was our first focus because the BLS Survey of Occupational Injuries and Illnesses reports it has the highest number of nonfatal assaults.

These draft voluntary guidelines for workplace violence prevention programs for health care workers in institutional and community settings have been circulated to interested stakeholder groups. We are asking for comments so that we can determine the final content of these guidelines. And we're already beginning work on a second set of guidelines for night retail establishments, which have the highest rate of homicides.

The OSHA professionals who developed the guidelines for the health care industry found that violence against employees in areas such as psychiatric facilities, community mental health clinics, infirmaries in corrections departments, pharmacies and community care facilities has been a serious problem for many years.

In psychiatric practice areas alone, some experts believe that violence is the major health and safety hazard, contributing to serious injury, high stress, and ultimate "burn out."

The risks of work-related assaults for health care and community workers are probably due to several factors, including the prevalence of handguns, the decrease in medical and mental health care for the mentally ill, and the increasing use of hospitals by police and the criminal justice system for acutely disturbed violent cases of drug overdose or severe mental illness.

This situation is compounded by the fact that hospitals, clinic and pharmacies frequently have drugs or money which can tempt robberies.

An important risk factor at hospitals and psychiatric facilities is that patients and their family or friends may carry weapons. One study found that 25% of major trauma patients treated in the emergency room carried weapons.

Our guidelines include recommendations on analyzing the health care workplace to recognize, identify and correct security hazards, with the use of a checklist. Some examples of security and engineering controls are: installing alarm systems or panic buttons in areas where risk can be anticipated, using metal detectors to screen patients and visitors in psychiatric facilities for weapons and even such relatively simple measures as providing lockable and secure bathrooms for staff members that are separate from client restrooms.

Once we have completed the final guidelines, we intend to use them as the basis for education and outreach efforts. Our goal is not to penalize---it is to prevent injuries. Most workplace violence is in fact preventable. And we hope these guidelines will give employers the tools necessary to keep their workers safe.

Another emerging hazard are work-related musculoskeletal disorders, or occupational overuse disorders. These are not simply minor aches and pains but debilitating injuries such as carpal tunnel syndrome that can affect many life activities of a worker, including driving a car, typing, picking up a child or even writing. One physician wrote to OSHA, "The gradual shrinkage of virtually all activities of daily living leads to a pitifully circumscribed life style that is difficult for many to bear."

BLS estimates that there are more than 700,000 lost workday injuries and illnesses related to musculoskeletal disorders each year. They represent the most expensive occupational health hazard in the American workplace today and account for one of every three dollars spent on workers' compensation or about $20 billion a year. What's more, the problem is getting worse. BLS data show an increase in repeated trauma cases (for example, carpal tunnel syndrome and shoulder tendinitis) from 22,700 in 1981 to 302,000 in 1993.

There is a solution -- ergonomics. It means fitting the job to the person to improve efficiency, productivity and quality and to protect worker health, including the reduction of stress.

OSHA has been working on the ergonomics solution to musculoskeletal disorders for several years. Many of our colleagues around the world have realized the seriousness of this type of injuries and already have standards and guidelines. Here in the United States, OSHA has used enforcement and compliance assistance with some success, particularly in the automobile and meatpacking industries. In 1990, we issued voluntary guidelines for ergonomic program management in the meatpacking industry.

And in August, 1992, we began formal rulemaking on an ergonomic program management standard. Since then, the agency has: reviewed hundreds of written comments and thousands of scientific articles on ergonomics; conducted a survey of 3,200 establishments to determine what employers have been doing to solve the problem; visited sites to show ergonomics programs work in practices; field tested some proposals to see if they work from a practical standard; conducted stakeholder meetings to enable the regulated community to participate in the rulemaking; and released a pre-proposal draft which has been accessed electronically by computer more than 15,000 times.

We have not yet proposed an ergonomic standard. But there are those in Congress who want us to halt all our efforts to address this workplace epidemic because, as one congressman said, "no one ever died from a carpal tunnel syndrome."

A rider on our budget bill that passed the House would prevent OSHA from spending any money for the "promulgation or issuance" of a proposed standard, a final standard, or voluntary guidelines on ergonomic protection. The rider also would prohibit the agency from "recording or reporting" musculoskeletal disorders.

We would not even be able to collect data on musculoskeletal disorders to determine how many workers are being hurt, and in what jobs and industries they are being injured. Without data on the problem, any dialogue on the issue would be based on politics rather than science. This outrageous interference is Congress at its worst-- making calls for better science in government regulations seem a hypocritical exercise and clearly using the budget to serve narrow special interests.

There was a poll recently done for an organization called the Council for Excellence in Government. It asked a thousand adult Americans their opinions of government at all levels, federal, state and local, and across a variety of activities--including regulatory programs.

When asked whether they agreed or disagreed with the statement "Government has gone too far in regulating business and interfering with the free market system," a not too surprising 73% strongly or somewhat agreed. That explains why regulatory reform efforts in Congress seem to have so much support.

The poll also asked if respondents agreed or disagreed with this statement, "Workplaces are much safer as a result of government regulation than they would be if business was left to its own devices."

Seventy-two percent of the people surveyed agreed with that statement.

The public is not satisfied with the performance of regulatory programs. They want more value for the tax money they put in. But they also want the protections that workplace safety and health, or environmental, or food safety, or other government protective programs provide. They're not willing to trust their fate willy-nilly to the values of economic markets.

Our strategy to meet their concerns and support their desire for health and safety has been to reinvent OSHA, not roll back worker protection.

But Congress is trying to take a different approach...so-called OSHA reform legislation. The legislation introduced by Congressman Cass Ballenger of North Carolina would literally gut efforts to protect workers through enforcement and grind standard-setting to a halt. The Ballenger bill also would abolish NIOSH. No other entity in the nation is capable of performing the epidemiologic, laboratory exposure and engineering studies needed to develop the data necessary to protect American workers. And, as if we needed one more Congressional obstacle, there's the budget.

The House approved a FY 1996 budget for OSHA that would cut OSHA enforcement funding by a third. It would mean shrinking the present force of only 1,100 inspectors for more than 6 million workplaces by up to a half. Yet, OSHA inspections have caused significant declines in injuries and illnesses. The disruption and loss of resources resulting from a 33% reduction in OSHA enforcement would result in an estimated 50,000 additional injuries and illnesses, that could otherwise have been prevented.

OSHA's standard-setting program would be seriously damaged by the proposed reductions, and would be further hindered by the proposed 25% cut in appropriations for NIOSH. Secretary of Labor Reich has rightly termed such budget cuts not a legitimate attempt to balance the budget, but "a war on American workers."

The Secretary in his Labor Day speech said, "the economy has caught fire. But the gains to most workers have gone up in smoke. Last year at this time, the median worker in this country--the person who'd be smack in the middle if we lined up Americans by their earnings--was taking home $479 a week. this year, factoring in inflation, the median wage is $475 a week--four dollars less in every weekly paycheck. And both this year's and last year's figures are lower (again adjusted for inflation) that the $498 median weekly wage in 1979.

"On Labor Day 1995, the earnings of most American workers are either stuck in the mud or sinking. Millions of white-collar supervisors and mid-level managers are joining blue-collar production workers in a common category, frayed collar workers--frayed collar workers in gold plated times."

It is within this larger context that we want to continue building the "New OSHA" that will meet the challenges of emerging workplace hazards, like workplace violence or cumulative traumas.

But our ability to protect America's working men and women --- and indeed working men and women themselves ---are at risk from a Congress bent on wrong-minded reform. Creating healthier workplaces can only be possible when there consequences for those who refuse to do so. And, as stressful as it is often is, we at OSHA remain committed to ensuring every working American's right to a healthy and safe workplace.