The National Occupational Research Agenda (NORA) In the past, occupational safety and health research has been conducted with minimal coordination or collaboration between NIOSH, other government agencies, university researchers, or industry- and labor-funded programs. NIOSH is working to change that pattern. Beginning in 1995, NIOSH spearheaded a broad-based national effort that resulted in the creation of the National Occupational Research Agenda (NORA) in 1996. This consensus agenda has the potential to guide occupational safety and health research into the next century — not just for NIOSH, but for the entire occupational safety and health community. The success of NORA will be measured by its utility in focusing occupational safety and health research. As a starting point, NIOSH will use NORA to direct and target intramural and extramural occupational safety and health research. Ultimately, this Nation will see improvements in worker safety and health.

Targeted Scientific Research The creation of NORA is a critical milestone on the road to improving the safety and health of America's workers; however, the Agenda was created with the knowledge that it would not, by its nature, include all areas that are "still important [occupational safety and health issues] and merit research effort." NIOSH itself undertakes research and other activities outside the NORA priorities that will provide crucial information to reduce injuries and illnesses in the workplace. Much of the work of NIOSH laboratories (such as developing new imaging methods for the early detection of occupational illnesses and injuries, and perfecting microscopic analysis of tissue samples to increase our understanding of disease development) are fundamental to optimizing occupational safety and health research in all areas. Measuring Basic Scientific Research Congress, the Office of Management and Budget, and the President's National Science and Technology Council (NSTC) understand that measuring the impact of basic scientific research is difficult. As stated by the Committee on Science of the U.S. House of Representatives, strategic planning and performance measures offer both "an opportunity and a significant challenge" for agencies such as NIOSH.

Committee on Science of the U.S. House of Representatives "However, assessment techniques are in relatively early stages of development and are only in their infancy for such areas as fundamental science. Further, the causal relationship between research outputs and their eventual outcome is very complex. Particularly for basic research, the primary goal is to produce new knowledge, with long term and frequently, unpredictable outcomes. Fundamental science often contributes to multiple societal goals. Further, the results of fundamental research may not appear for some length of time. Interpretation and evaluation of research results may require specialized expertise. Indeed quantitative measures may not be feasible for basic research." (emphasis added)

In July 1996, NSTC released a report entitled Assessing Fundamental Science intended as a "broad framework for the Government Performance Results Act (GPRA) implementation in assessment of fundamental science programs." With regard to efforts at measuring science, the report states the following: For evaluating current programs in individual agencies, merit review based on peer evaluation will continue to be the primary vehicle for assessing excellence and conduct of science at the cutting edge. . . . Balanced assessment of the various dimensions of program performance in an agency will require multiple sources and types of evidence. In addition to retrospective merit review, retrospective performance reports might draw on quantitative indicators, qualitative indicators, descriptive indicators or narrative text, examples of outstanding accomplishments and of more typical levels of achievement, information about context, and findings from special studies and analysis. Because pre-existing measures of research results were developed primarily for other purposes, they have not yet been adapted for use in reporting at the agency level. Pre-existing measures capture only a subset of research outputs and outcomes. They do not map neatly or cleanly onto GPRA concepts. Consequently, these measures (e.g., publication counts, citation counts, and rate-of-return and related economic measures)...can serve only as a starting point for agency thinking about how to design the most effective assessment strategies. Nevertheless, NIOSH is committed to tracking the implementation of NORA in the research community and in the workplace as well as continuing to perform — and evaluate — its other important scientific research in occupational safety and health. With regard to NORA, NIOSH will look first to increases in NIOSH and other Federal intramural and extramural research in NORA priority areas as indicators of NORA's impact. NIOSH will also develop a protocol by using bibliometrics and other existing methods of evaluation as indicators of the impact of its research efforts. At the same time, NIOSH will be working to develop new procedures and capacities to measure NORA's impact as well as that of other occupational safety and health research on safety and health outcomes.

Objectives

Strategic Goal 1

Objectives - FY 1999
	Disseminate NORA throughout the occupational safety and health research community.
	Implement NORA through the formation of partnership teams for each NORA topic.
	—	Teams will consist of partners from all aspects of safety and health.
	—	Teams will assist in the development, pursuit, review, and dissemination of research.
	Evaluate the success of focusing occupational safety and health research on NORA priorities and other target areas by
	—	determining current levels of NIOSH and other Federal agencies' intramural and extramural research funding in NORA priority areas and calculating any annual increases, and
	—	developing a protocol for the use of bibliometrics and other research proxy measures (i.e., numbers of patents, engineering control devices, laboratory methods development, peer-reviewed articles, spin-off technologies, etc.) to evaluate the level of NORA and other targeted research in the occupational safety and health community.
	Report on the progress of NORA.
Objectives - FY 2002
	Evaluate the adequacy of existing procedures and tracking models to measure the impact of NORA and other NIOSH research on safety and health outcomes.
	Develop new procedures and capacities to measure the impact of NORA and other NIOSH research on safety and health outcomes.
	Update NORA (2002 mid-course review).
Ongoing Objective
	Increase knowledge and understanding of occupational safety and health issues through conducting and funding peer-reviewed research in NORA and other priority areas.

In 1986, Congress reported that Federal surveillance of occupational illness was 72 years behind communicable disease surveillance. The Institute of Medicine further reported in 1987 that the Nation's occupational illness and injury surveillance systems were inadequate, especially with regard to occupational disease surveillance, and they remain inadequate today. Not surprisingly, given the state of occupational safety and health surveillance, the human toll of work continues. It is a human toll that we know in large part is preventable. The ability to identify, quantify, and report work-related injury and disease is vital to prevention. Targeted surveillance efforts (many supported by NIOSH) exist today to address specific conditions such as adult lead poisoning, occupational lung disease, and carpal tunnel syndrome. However, no national surveillance system exists for occupational disease and injury. To optimize the use of public resources and to obtain the most useful and accurate information, NIOSH has developed partnerships at the Federal, State, and local levels throughout the country. NIOSH currently supports limited surveillance activities of 12 occupational conditions, diseases, and injuries in more than half of the States. Although these programs are important, they are far from comprehensive. In only one State (New Jersey) do we have a surveillance program that examines even four of the 12 conditions. In four states, only one condition is monitored. NIOSH now operates a number of surveillance programs with its State partners: Adult Blood Lead Epidemiology and Surveillance (ABLES) ABLES is a surveillance system for identifying cases of elevated blood lead levels among U.S. adults. Started in the late 1980s, the ABLES program provides funding and technical assistance to participating States. As of January 1997, 27 states had surveillance programs reporting to ABLES, and seven more were developing programs. Sentinel Event Notification System for Occupational Risks (SENSOR). Through cooperative agreements with State health departments NIOSH supports surveillance for pesticide poisoning, asthma, silicosis, burns, dermatitis, youth injury, carpal tunnel syndrome, amputation, and noise induced hearing loss. To date, the SENSOR program is active in 13 States.

Fatality Assessment and Control Evaluation (FACE) Working with State health departments, NIOSH investigates worksites where fatalities have occurred. These efforts help us understand the factors that contribute to or cause deaths from injuries in the workplace. NIOSH supports fatality investigations in 20 States. In fiscal year 1996, NIOSH and its State partners investigated 135 occupational fatalities. Following such investigations, NIOSH disseminates prevention recommendations to the employers and workers.

At the Federal level, NIOSH partners with agencies such as the Consumer Product Safety Commission (to study the number of nonfatal occupational injuries), the Environmental Protection Agency (to study the number of acute pesticide poisonings), the Bureau of Labor Statistics, the Department of Energy, and the National Cancer Institute. Building on and learning from these experiences, NIOSH proposes to undertake a comprehensive surveillance planning process with NIOSH partners at the State and Federal levels. Much like the NORA process, this effort will be helpful in establishing surveillance priorities and will define roles for various agencies at all levels of government. Such a planning process will lead to enhanced surveillance of occupational injuries, illnesses, exposures, and health hazards that will in turn permit us to monitor trends, target prevention resources to populations at risk, and evaluate the impact of prevention efforts. Looking at occupational diseases and injuries in other countries, would help the United States understand threats to our citizens, and develop ways to manage them. In taking this important step, NIOSH intends to partner with other parts of CDC, state-based surveillance programs, and new NIOSH partners. NIOSH intends to partner with parts of CDC, state-based surveillance programs, and new NIOSH partners.

Objectives

Strategic Goal 2

Objectives - FY 1999
	Undertake a comprehensive surveillance planning process with NIOSH partners at the State and Federal levels to establish surveillance priorities and define roles for various agencies.
Objectives - FY 2000 - FY 2002
	Implement the recommendations of the surveillance planning process for NIOSH in the areas of occupational injuries, illnesses, exposures, and health hazards.
	Develop procedures and capacities to measure the impact of the recommendations of the surveillance planning process on safety and health outcomes.
	Develop a demographics database that will represent miners in all States with mining operations.
Ongoing Objective
	Collect, analyze, and disseminate information on the distribution of occupational illnesses, injuries, exposures, and health hazards to target and evaluate intervention and prevention efforts.

As stated in the NIOSH Vision, the Agency has an important role to play in prevention. Crucial to this role is the ability to link prevention policy and practice with scientific research. Throughout its 25-year history, NIOSH has used field research as one way to make this link.

Health Hazard Evaluations — Every year NIOSH conducts hundreds of evaluations at the request of workers, employers, and government agencies to evaluate health concerns at specific worksites. Following an investigation NIOSH makes recommendations for preventing hazards at that specific work-site and similar worksites.

Intervention Effectiveness Research — NIOSH also conducts research to evaluate the effectiveness of existing prevention approaches at worksites where a hazard is known or suspected to cause injury or disease. In order to most effectively invest future prevention resources NIOSH and others must be able to show which approaches work best in protecting worker safety and health. While much more research needs to be conducted in this area, NIOSH has many projects underway. For example, NIOSH is evaluating the use of lifting devices to reduce back injuries in nursing homes and the effectiveness of a NIOSH Alert in warning health care workers about the hazards of natural rubber latex. Information resulting from NIOSH intervention effectiveness research will be used by employers, workers, and the occupational safety and health community to ensure that the prevention strategies used to protect workers have been shown to effectively prevent injury and disease at work. Control Technology Assistance — NIOSH is working to improve the workplace environment by advancing the development of control technology. In this effort, NIOSH stresses practical, solutions-oriented efforts that will have broad impact on worksites. For example, ground- breaking guidelines were jointly developed by industry, labor and government to implement engineering controls for the asphalt paving industry. Similar guidelines are being developed for the dry-cleaning industry. Recommendations — NIOSH uses the information from all of its research and surveillance to make recommendations to the public as well as to Federal enforcement agencies, including the Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA). Many of these take the form of recommendations on levels of exposure to hazards (recommended exposure limits (REL) and levels considered to be immediately dangerous to life or health (IDLH). NIOSH recommendations are published in criteria documents and Current Intelligence Bulletins. Recommendations concerning new hazards or exposures are often made directly to the public through Alerts and special hazard reviews (see also Strategic Goal 4). NIOSH also publishes analytical methods which recommend the best methods to use for measuring workplace exposures. By working with the entire occupational safety and health community, NIOSH intends to continue expanding its overall recommendation efforts in the coming years. Respirator Certification — An additional area of prevention involves respirator certification. Through its mandated respirator certification program, NIOSH annually prevents untold numbers of workers from being exposed to dangerous substances. This program (1) provides site audits at the plants of respirator manufacturers to evaluate quality control (2) investigates respirator problems through field investigations (3) studies proposed modifications to certified respirators (4) conducts research to identify and address knowledge gaps relating to respirator use and performance and (5) to-date has certified nearly 4,800 respirator models. In 1995, NIOSH revised and streamlined the process for respirator certification and introduced new performance-based requirements for certain respirators. As a result of this effort new, better-performing, more efficient, less expensive respirators are being introduced into the workplace. Employers and employees alike will benefit from increased protection and cost savings. NIOSH is committed to maintaining the quality of this program, which is heavily relied upon by employers and employees.

Objectives

Strategic Goal 3

Objectives - FY 1999
	Work with the occupational safety and health community to develop a system for assessing, determining the baseline level, and increasing the extent to which NIOSH recommendations are utilized by employers, workers, and government agencies at worksites, industry-wide, and in standard setting.
	Implement targeted evaluation of the effectiveness of prevention programs (e.g., latex allergy and agriculture-related injuries to children) by tracking the prevalence of an illness or injury, the level of exposure, and the behavior of affected workers and employers before and after the implementation of the program.
	Use new technology (e.g., virtual reality) in the design of prevention measures.
	Develop and implement criteria for selecting field investigation sites. These criteria should include the selection of workplaces with NORA or other priority areas or hazards. Determine the number of such investigations performed in FY'98 that met this criterion.
	Develop and communicate a plan for updating respirator certification regulations. Ultimately, one measure of NIOSH success will be the extent to which its research priorities have been translated into prevention policy and practice. Such translation can occur through changes in the behavior of employers and workers at the worksite, industry-wide adoption of control or abatement measures or devices, through the amount of NIOSH- sponsored or - conducted intervention research, and standard-setting and enforcement activities. As discussed earlier, this measure of success depends largely on the voluntary actions of NIOSH partners in industry, labor, academia, community organizations, and Federal, State and local agencies. Over the coming years, NIOSH is committed to working with the entire occupational safety and health community to bring the results of its research into the workplace.
Objectives - FY 2002
	Increase the number of health hazard evaluations conducted at workplaces with NORA or other priority areas or hazards.
	Increase the number of work-site prevention activities implemented after a NIOSH report is issued.
	Increase the number of industry-wide control measures or devices put in place after the release of a NIOSH research report.
	Increase the number of NIOSH recommendations, including those in NORA priority areas and other targeted areas.
	Increase the number of NIOSH-sponsored or -conducted intervention effectiveness research projects in the occupational safety and health field, including projects in NORA or other priority areas.*
	Implement updated respirator certification regulations.
*Intervention effectiveness research is a NORA topic and will, therefore, be included under appropriate objectives of Goal 1 as well.