Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress. Progress is illustrated in the Progress Quotient bar chart (see Figure 20-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

As shown in Figure 20-1, occupational skin diseases or disorders (20-8) exceeded its target. Moving toward their targets were work-related injury deaths (20-1), work-related injuries (20-2), overexertion or repetitive motion injuries (20-3), pneumoconiosis deaths (20-4), work-related assaults (20-6), elevated blood lead levels (20-7), and needlestick injuries (20-10). One objective could not be assessed because only baseline data were available at midcourse, and none moved away from its target.

Objectives that met or exceeded their targets. Occupational skin diseases or disorders (20-8) exceeded the targeted change by 20 percent. While preventable, occupational skin diseases or disorders were the second leading cause of occupational illness in 2001.¹³

NIOSH has extensive intramural and extramural programs to respond to the high numbers and preventable nature of skin diseases or disorders. One initiative is the NORA Dermal Exposure Research Program (DERP).¹⁴ DERP is an intramural program with the overall goal of promoting the development of improved NIOSH policies and recommendations for identifying and controlling harmful exposures of the skin to chemicals. In the past few years, most DERP research has focused on skin as a route for chemical absorption, including hand-to-mouth transfer.¹⁵ In the years following the establishment of NORA (1997–2001), the rate for chemicals and chemical products as the source of occupational skin diseases or disorders declined 40 percent (25 percent for dermatitis).^{16, 17} In addition, several hundred skin-related Health Hazard Evaluations have been conducted, including an investigation to address congressional concerns about handling irradiated mail after the 2001 anthrax attacks.¹⁸

Objectives that moved toward their targets. Seven objectives moved toward their targets: work-related injury deaths (20-1), work-related injuries (20-2), overexertion or repetitive motion injuries (20-3), pneumoconiosis deaths (20-4), work-related assaults (20-6), elevated blood lead levels (20-7), and needlestick injuries in hospital-based health care workers (20-10).

Overall, work-related injury deaths (20-1a) met 38 percent of the targeted change. Industry-specific rates also improved. Achieving 52 percent of the targeted change, construction (20-1c) showed the largest improvement; the smallest gain was made in mining (20-1b), which achieved 1 percent of the targeted change.^{19, 20, 21} In 2002, the highest fatality rates were observed in mining (23.5 deaths per 100,000 workers) and agriculture, forestry, and fishing (22.7 deaths per 100,000 workers), followed by construction (12.2 deaths per 100,000 workers) and transportation (11.3 deaths per 100,000 workers).²

Examples of programs addressing work-related injury death challenges include transportation initiatives, interventions aimed at reducing the incidents associated with mining fatalities, such as roof support technologies, and the Fatality Assessment and Control Evaluation (FACE) program.^{22, 23} FACE aims to identify work situations with a high risk of fatality and to disseminate prevention strategies to employers, workers, unions, public agencies, and others.²² In 2003, the FACE program targeted four priority areas for investigations: deaths of youth under 18 years of age, deaths in roadway construction work zones, deaths involving machinery, and deaths of Hispanic or immigrant workers.

Work-related injuries (20-2) achieved 42 percent of the targeted change for all industries (20-2a). The largest improvement occurred in mining, with 64 percent of the targeted change achieved (20-2f), followed by manufacturing with 60 percent of the targeted change achieved (20-2g). Rates for adolescent workers aged 15 to 17 years (20-2h) were the least improved, advancing to 14 percent of the targeted change.²¹

Despite improvements, nonfatal occupational injuries remain a significant public health problem. Inexperience and minimal training in occupational safety and health continue to result in high rates for emergency department visits among younger workers (20-2h).^{24, 25} Differences in the industries in which fatal and nonfatal occupational injuries are concentrated also present a challenge. For example, the highest fatality rates occur in mining and agriculture, while the highest nonfatal injury rates occur in construction and manufacturing, with high rates also in health services.

Accordingly, to prevent nonfatal as well as fatal injuries, research and prevention efforts should continue to focus on high-risk settings, occupations, and populations. For example, the National Children's Center for Rural and Agricultural Health and Safety²⁶ translates research on children's injuries in agriculture to practical prevention measures through efforts such as the North American Guidelines for Children's Agricultural Tasks. This resource assists parents in assigning farm jobs to their children 7 to 16 years of age, living or working on farms.²⁷

The rate for overexertion or repetitive motion injury and illness cases involving days away from work (20-3) met 45 percent of the targeted change. From a baseline of 675 injury and illness cases per 100,000 workers in 1997, the rate dropped to 522 per 100,000 workers in 2001.

More than 30 percent of all nonfatal occupational injuries and illnesses with days away from work continue to be attributable to overexertion and repetitive motion.²⁸ To help combat this issue, research continues on the relationship between musculoskeletal disorders and physical and psychological stressors.^{29, 30}

For pneumoconiosis deaths in persons aged 15 years and older (20-4), the 20 percent achievement of the targeted change reflected a gradually improving long-term trend. Pneumoconiosis is preventable through control of exposure to occupational dusts, and progress toward prevention has been noted since the baseline. Pneumoconiosis deaths of persons aged 15 years and older decreased from 2,928 in 1997 to 2,718 in 2002 and moved toward the 2010 target of 1,900. Enhanced medical screening programs for coal miners may help target "hot spots" of pneumoconiosis occurrence for preventive interventions.³¹

Also, a personal dust monitor has been developed. This monitor is the first device that allows immediate determination that a coal miner is exposed to airborne dust at concentrations posing a risk of pneumoconiosis.³² It represents the first advancement in monitoring coal worker dust exposure in over 30 years. The objective for work-related assaults (20-6) achieved 72 percent of the targeted change. Many efforts have been undertaken in the past decade to decrease work-related assaults. Examples include the Workplace Violence Research and Prevention Initiative³³ and conferences like "Partnering in Workplace Violence Prevention: Translating Research to Practice."³⁴

Elevated blood lead levels (20-7) met 24 percent of its targeted change of no employed adults with levels greater than 25 micrograms per deciliter. Elevated blood lead levels can cause a range of adverse health outcomes in individuals—from kidney or nervous system damage to potential infertility.³⁵ Through the Adult Blood Lead Epidemiology and Surveillance (ABLES) program, currently active in 37 States, cases of excessive lead exposure in adults are tracked and responded to. Through NIOSH, HHS is collaborating with State ABLES personnel and the Association of Occupational and Environmental Clinics to develop national clinical guidelines to improve the identification and treatment of lead overexposure in adults.

Needlestick injuries among hospital-based health care workers (20-10) met 60 percent of the targeted change. A substantial proportion of these injuries could be prevented through the use of safer medical devices and a comprehensive program of training and safe work practices. NIOSH develops recommendations for exposure management, disseminates strategies for reducing exposures, and conducts a variety of training and education programs. NIOSH also has partnered with hospitals, home health care agencies, nursing homes, and dental offices to identify, select, evaluate, and implement safer medical devices. Also, some health care facilities that already use medical devices are assisting other health care facilities by sharing their experiences.^{36, 37} These facilities have agreed to discuss how each step was accomplished, the barriers they encountered, how barriers were resolved, and, most important, the lessons learned.

Objectives that demonstrated no change. One objective did not show any movement toward or away from its target: work-related homicides for persons aged 16 years and older (20-5). The jobs where workers are at risk of being murdered share a number of common factors, including interacting with the public, handling exchanges of money, working alone or in small numbers, and working during late night or early morning hours. Examples of occupations with high homicide rates include taxicab drivers, police, gas station workers, and security guards. The strategies discussed in the section on work-related assaults (20-6) also address this objective.

Objectives that moved away from their targets. At the time of the midcourse review, no objectives moved away from their targets.

Objectives that could not be assessed. Two objectives lacked data to assess progress for the midcourse review: worksite stress reduction programs (20-9) and work-related, noise-induced hearing loss (20-11).

The progress of worksite stress reduction programs (20-9) is tracked by the National Survey of Worksite Health Promotion Activities (NSWHP). At the midcourse, only baseline data were available. For a rough midcourse comparison, the National Organizations Survey, a nationally representative survey of organizational practices among 507 U.S. companies, was used as an alternate data source. Analysis showed that 59 percent of companies with more than 50 employees reported providing stress management programs.³⁸ This substantially better rate found in the National Organizations Survey suggests improvement will be found in the results of the 2004 NSWHP. Formal appraisal of the NSWHP data collected in 2004 is anticipated for assessing progress by the end of the decade.

Work-related, noise-induced hearing loss (20-11) is also anticipated to have at least two data points to assess the progress by the end of the decade. Hearing loss is the most common occupational disease.³⁹ Because hearing loss is gradual and painless, workers do not necessarily recognize hearing loss and how it may affect their quality of life. NIOSH conducts significant research and prevention activities aimed at miners and construction workers for whom hearing loss is a major health problem.^{40, 41}

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