Editor’s note: This article is the third in a series about the need for industrial hygienists to expand their perspective regarding matters of risk. Other articles in the series include “Shifting the Conversation” in the April 2015 issue and “Characterizing Risk” in the September 2015 issue.
Much of our professional perspective on risk is rooted in a historical approach involving assessment of exposures against an array of exposure limits. These limits include occupational (PELs, RELs, DNELs, exposure banding), non-occupational (NAAQS, ASHRAE, AHERA), and other levels such as Acute Exposure Guideline Levels (AEGLs) and AIHA’s Emergency Response Planning Guidelines (ERPGs). We are finding, however, that simply answering the question “Are we above or below the limit?” is no longer enough to meet our employers’ and clients’ risk management needs. AIHA’s Content Portfolio Management Team recognizes this problem and has acknowledged that the topic of risk is much broader than exposure. A session at AIHA’s Fall Conference in October explored the improvement of worker health, both on and off the job, and our professional role and challenges with such a mission. Key points in the previous articles in this Synergist series were developed further in the kick-off presentation, namely that expanding the profession’s risk perspective will require new language and context. This need was reinforced in a case study from Johnson & Johnson about its success incorporating elements of the NIOSH Total Worker Health (TWH) initiative, and presentations that discussed NIOSH’s Cumulative Risk Assessment (CRA) efforts and the risk assessment challenges facing small businesses. The session demonstrated that risk is multifaceted and complex, and spans every aspect of human activity. TOWARD A NEW RISK MODEL Such a broad and forward-looking view of risk is seen in the NIOSH TWH and CRA initiatives. The concept of TWH embodies a holistic approach to the well-being of workers. It acknowledges that health problems unrelated to work, such as those from smoking, have tremendous impact on workplace health and costs, and TWH engages individual workers to care about their own health and safety by offering integrated systems and programs at the employer’s expense. CRA is the practice of examining multiple contributions to exposure when we make decisions about risk. To date, most work on CRA has focused on environmental risk assessments; EPA, for example, uses CRA to address the effects of multiple environmental chemical exposures occurring simultaneously. NIOSH is working to integrate all risk factors—personal, environmental, and occupational—into CRA. Both TWH and CRA stem from the understanding that the health of workers on the job and the public off the job are inextricably intertwined. Worldwide trends are making the boundaries between the workplace and the community less distinct; NIOSH and EPA, together with labor, academics, and consultants, have responded by seeking to replace conventional siloed models of risk (Figure 1) with an integrated risk model (Figure 2) that focuses on the well-being of the individual and recognizes the interactions of occupational, environmental, individual, and societal risks. To that end, NIOSH is leading an effort to publish peer-reviewed journal articles that address occupational risk factors (ORF) in aggregate (cumulative) risk assessments.
Total Worker Health and Cumulative Risk Assessment: A Vision for the Future
• Focuses on well-being • Recognizes the impact of interactions