The Changing Worlds of Work and Health
Adapting Industrial Hygiene for the 21st Century
BY PAUL J. MIDDENDORF, JOHN PIACENTINO, AND RENE PANA-CRYAN

In the words of Doctor Who, the universe “is forever growing and shrinking and creating and destroying and never remaining the same for a single millisecond. And there is so much, so much to see.” The same can be said for the ever-changing worlds of work, health, and industrial hygiene. Changes in work force demographics, employment patterns, technology, and even business models for creating and sharing value all signal the need for industrial hygienists to continuously adapt and find ways to improve worker safety and health.

Fortunately, the functional paradigm of our profession offers a sturdy foundation for moving into the future. Anticipation, recognition, evaluation, communication, control, and confirm are as relevant today as they have ever been, and they are likely to serve the profession well into the future. 
In our view, industrial hygienists and allied occupational safety and health professionals too often try to deal with each challenge separately—and, even more often, they work independently of each other. However, to effectively address oncoming challenges, the modern industrial hygienist must continuously find and understand connections between complex factors affecting workers, businesses, and society. To keep pace with the trends affecting the profession, industrial hygienists need to reach across professional disciplines, organizational structures, and a variety of influences. DEMOGRAPHICS AND EMPLOYMENT PATTERNS The Bureau of Labor Statistics (BLS) reports that, in the U.S., the number of workers older than 65 years is expected to increase by more than 80 percent between 2006 and 2016. Older workers are projected to make up 6.1 percent of the total labor force by 2016 compared with just 3.6 percent in 2006. Today, older workers are more likely to work full time (click to see an enlarged view of the chart below). Before 1990, the percentage of older workers who worked full time was consistently below 50 percent, and the trend was slowly decreasing. Since the mid-1990s, however, this percentage has been increasing. In 2001 it exceeded 50 percent and reached 56 percent in 2007. 
As the U.S. population continues to age, fewer and increasingly older workers will have to support the rising portion of persons who do not work. Industrial hygienists can play a vital role in protecting and promoting the health of older workers. Think about how a work environment might be redesigned to accommodate changes in vision, such as presbyopia, or made more ergonomically friendly for individuals with arthritis.
Application of the industrial hygiene paradigm to a mobile, diverse, international work force represents another example of modern challenges and opportunities for the profession. BLS estimates that foreign-born workers in the U.S. are more likely than native-born workers to be employed in service occupations, such as production, transportation, and material moving occupations, and natural resources, construction, and maintenance occupations. In addition, work teams are more often geographically dispersed, sometimes spreading across the globe, which requires work to be conducted in a virtual environment.

Finally, workers are more mobile today than ever before. They have multiple employers during their working lifetime, work a variety of full-time and part-time work schedules, have nonstandard work arrangements, work alternative shifts, or occupy temporary positions.

The end result is that workers today encounter a variety of workplaces with unique hazards, business models, and work cultures that they must understand and to which they have to adapt in order to be successful. The diversity of today’s workplaces greatly complicates the industrial hygienist’s task of ensuring that all workers understand and avoid hazards. Today, industrial hygienists must respond to emerging conditions that affect workers in specific locales and provide sufficient training to mobile work teams to effectively address language, generational, and cultural differences. Success in these areas will require working with allied professionals. SCIENCE AND TECHNOLOGY Advances in science and technology are already affecting the practice of industrial hygiene. Improvements in toxicity assessment, availability of real-time exposure monitoring, and greater understanding of how a lifetime of exposure may lead to the progression of disease are intensifying the need for industrial hygiene expertise. 
EPA estimates that more than 84,000 chemicals are manufactured or processed in the U.S.; yet little toxicity information exists for many of the agents to which workers are exposed. The Toxicology in the 21st Century program (Tox21), a collaboration involving several U.S. agencies, develops methods to quickly and efficiently test whether certain chemical compounds have the potential to disrupt processes in the human body that may lead to adverse effects for human health and the environment. The program takes advantage of recent advances in science and technology, such as genomic toxicology, gene expression analysis, human tissue stem cells and integrated pathway information, as well as a robotic high-throughput screening system. Accelerated toxicity information is likely to affect all phases of risk assessment, including hazard identification, dose-response assessment, exposure assessment, and risk characterization. 
One of the challenges industrial hygienists often face is that occupational exposure information is not timely. The push has been on for many years to develop direct-reading instruments and sensors (think Star Trek “tricorder”) that provide real-time information on environmental conditions and worker exposures. NIOSH recently announced a new virtual center to coordinate research and develop recommendations for direct-reading instruments and sensor technologies. Along with more sensitive and detailed exposure information will come volumes of data: concentrations second-by-second, or faster, will be recorded. This will present a need for competent interpretation and application to the work environment.
The practices of exposure monitoring and biomonitoring are likely to change significantly with advances made by discoveries in the exposome. The exposome is the summation of all exposures over a person’s lifetime. According to an article published in Science in 2010, each individual’s susceptibility to disease is a function of her genetic makeup (10–30 percent) as well as her occupational, environmental, and endogenous exposures (up to 70–90 percent). Understanding the exposome will rely on the application of both internal and external exposure assessment methods. Much of this exploration will focus on developing a better understanding of the cellular and biochemical processes and the timing and combinations of agents that contribute to disease. Many of the “omics” technologies (for example, genomics, metabolomics, and proteomics) have the potential to contribute to our understanding of disease causation and progression. 
Each of these technologies produces large amounts of data. Integrating the magnitude of toxicity data, exposure data from new sensors, and “omics” data to aid discovery of associations with disease and protection of workers will require new techniques for interpretation and application. Once integrated and interpreted, all of this information can be used to enhance the application of our paradigm to anticipate, recognize, evaluate, communicate, control, and confirm workplace hazards. Conveying this information in meaningful ways to other allied professionals in medicine, engineering, and human resources can reduce exposures and improve medical outcomes. BUSINESS MODELS Trends in how businesses create and share value with civil society and government offer additional opportunities for the industrial hygienist. Shared value can be thought of as the policies and practices that improve a firm’s competitiveness as well as the economic and social conditions in the communities in which they operate. A recent article by Michael E. Porter and Mark R. Kramer in the Harvard Business Review notes that some companies continue to optimize short-term financial performance with little regard for worker and customer needs, and ignore the broader societal context that determines their longer-term success. For example, companies may not understand the implications of depleting natural resources vital to their businesses or maintaining the viability of their key suppliers. These strategies focus on tradeoffs between the firm’s interest in creating value and societal interests, such as environmental sustainability or community health. 
In contrast, the authors point out that companies, government, and civil society should focus on shared value and find synergies between corporate value chains and social interests. To achieve synergies, Porter and Kramer recommend that companies integrate societal issues in their business models by focusing on benefits relative to costs, rather than just benefits. Conducting a life cycle assessment is a good example of how business may find shared value and produce a win-win scenario with society. Attention to the occupational and environmental impact of a product through all stages of the product’s life cycle can identify opportunities for more efficient production while reducing energy and the use of hazardous chemicals. These types of strategies align with community interest and can result in shared value.
Additional opportunities exist in ensuring that worker health is optimized through integrating health protection (the traditional OSH professional’s role) and health promotion programs. Industrial hygienists, working with allied health professionals, may play a pivotal role in aligning programs for work force protection and health promotion with corporate strategies to find shared value such as reduced healthcare costs, improved worker efficiencies, and healthier workers. ADAPTING PROFESSIONAL PRACTICE To effectively address these and other challenges, industrial hygienists will have to continue to draw on their professional competencies to do the following:
Expertly synthesize and interpret imperfect information. In the future, industrial hygienists will have to integrate in meaningful ways large amounts of information from diverse data streams such as Tox21, new sensors, and “omics” data. Making sense of this information in ways that provide a more comprehensive exposure history and applying it to reduce the risks for disease will be valuable for better protecting workers and communities.
Create connections with other professionals and stakeholders who share their interest in protecting worker health and the environment, such as healthcare and human resources professionals, insurers, and government. Effectively communicating and collaborating with allied professionals will convey an advantage for industrial hygienists to accomplish their mission. At times, they can be the glue that pulls it all together.
Effectively contribute to the development of participatory solutions that focus on shared value. Solutions have to be holistic to be effective. Total Worker Health (TWH) is an example of a holistic approach that is needed moving into the future. TWH focuses on integrating health protection and health promotion, but also examines spillover effects to families and the community, which is within the IH’s realm of activities.
These are but a few of the challenges and forces that grow and shrink, create and destroy, while never remaining the same for a single millisecond, and which industrial hygienists will need to take on in the future. How it turns out remains to be seen. PAUL J. MIDDENDORF, PhD, CIH, is a senior scientist with CDC/NIOSH in Atlanta. He can be reached at (404) 498-6439 or pkm2@cdc.gov. JOHN PIACENTINO, MD, is the associate director for science with CDC/NIOSH in Washington, D.C. He can be reached at (202) 245-0634 or gjt4@cdc.gov. RENE PANA-CRYAN, PhD, is director of the Economic Research and Support Office at NIOSH in Washington, D.C. She can be reached at rfp2@cdc.gov. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the National Institute for Occupational Safety and Health (NIOSH).
RESOURCES American Journal of Industrial Medicine: “Prevalence Rates of Work Organization Characteristics among Workers in the U.S.: Data From the 2010 National Health Interview Survey,” June 2013.
Bureau of Labor Statistics: “Education and occupations of the foreign born in 2011,” June 2012. 
Bureau of Labor Statistics: “More seniors working full time,” August 2008.
Bureau of Labor Statistics: “Projected growth in labor force participation of seniors, 2006-2016,” July 2008.
Harvard Business Review: “Creating Shared Value,” January 2011.
National Institutes of Health: Toxicology in the 21st Century.
Science: “Environment and Disease Risks,” October 2010.
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