The loss of CDC’s occupational health office will have dire consequences

In a single day, 10,000 federal workers at the Centers for Disease Control and Prevention and the Food and Drug Administration were laid off, including 90% or more of those at the CDC’s National Institute for Occupational Safety and Health (NIOSH). The office may be little-known outside of public health circles, but it is of critical importance. The near-evisceration of the office is particularly horrifying because it’s happening during one of the largest avian influenza outbreaks ever to threaten the safety of the U.S. food supply and its workers. As leaders of NIOSH-funded centers focused on occupational safety and health, we worry that the loss of occupational health expertise will have irreparable consequences for H5N1 bird flu response, consumers, and communities.

NIOSH has been the premier agency to research and recommend occupational practices to maintain the health and well-being of the nation’s workforce for more than 50 years. Supported by just over 1,500 federal workers (at least, it was until April 1) and 40 academic centers, NIOSH operates across the many dimensions of work, conducting surveillance of worker health outcomes, addressing major health outcomes (including a variety of chronic diseases and acute hazards), offering resources for small businesses, and focusing particular attention to specific high-risk industries like mining, construction, and agriculture. Risks to worker health are broad and include physical hazards such as extreme heat, injuries, chemical exposures, and infections from biological agents.

For example, consider H5N1 bird flu, which continues to loom over the U.S. Poultry and dairy workers make up the vast majority of people infected with H5N1 in the United States. During last summer’s high heat, H5N1 bird flu was rampant in Colorado, leading to the culling of millions of poultry. When there was a cluster of H5N1 cases in the workers performing the cull, Colorado requested the CDC include a NIOSH industrial hygienist with the team sent to investigate. They found that gigantic fans had been brought into the barns to address the sweltering heat, and the resulting high air velocity was implicated in the workers’ exposures to the virus. This conclusion was only possible because the team included experts who understood how personal protective equipment such as masks might fare under such conditions — expertise that CDC-NIOSH fosters and supports.

The agricultural workforce ensures the adequacy and safety of our nation’s food supply, so NIOSH has (or had!) critical programs, including support of 12 centers that focus on agricultural safety and health. The centers’ efforts go well beyond technical expertise and emerging issue response. Efforts include cost-sharing programs that enable farmers to install tractor rollover protection bars that address a frequent cause of death, key research on the links between high heat exposure and chronic kidney disease among farmworkers, and efforts to reduce farmers’ exposure to hazardous pesticides.

NIOSH also works to protect the almost 900,000 farm youth, half of whom have jobs to do on the farm, in one of the few U.S. industries where children are allowed to participate. The agriculture, forestry, and fishing program is one of many at NIOSH; others focus on construction, health care, manufacturing, mining, and oil and gas extraction — workforces central to national and economic security and competitiveness, as stated in recent White House orders. NIOSH also supports the education of the next generation of nation’s occupational health professionals through 18 centers across the nation that confer graduate degrees in occupational safety and health, provide continuing education for professionals, and research training at the cutting edge of occupational health.

Without NIOSH, these activities, including the work of the centers, will stop.

The programs within NIOSH and their academic center partners and affiliates ensure a healthy and reliable workforce, including through the Total Worker Health program, an integrated approach to harm prevention and health promotion. These centers focus on many work-related health and safety issues, such as mental health. Three-quarters of workers in the U.S. report having at least one mental health challenge sometimes or often over the past year, with more than a third reporting struggling often with mental health issues. A systematic review found that in the U.S., mental health conditions were linked to a 7% to 18% higher likelihood of unemployment, and poor mental health was associated with increases in unemployment and self-employment. Suicide risk among agricultural workers and veterinarians is higher than among the general population.

The H5N1 bird flu outbreak has been a major stressor to farmers and the agricultural workforce generally, driving devastating losses, food prices and economic uncertainty and has put some producers out of business. Mental health problems impact the workers themselves, as well as their families and communities, and can both affect and be influenced by economic conditions. Total Worker Health approaches address well-being across a broad range of workforces through design of interventions that target both worker and enterprise outcomes. What this means is that strategies to improve the health and mental health outcomes of workers are designed to simultaneously benefit industry goals, leading to initiatives that often improve productivity, enhance product quality, and reduce turnover, absenteeism and presenteeism—factors that have direct and indirect economic benefit to businesses. Injuries, chronic diseases, and mental health outcomes are estimated to cost U.S. businesses hundreds of millions to trillions of dollars annually, with individual cases that suggest a strong value on investment in such approaches. In comparison, the cost of NIOSH programs equal approximately $2 per U.S. worker annually.

When you remove a keystone from an arch, the whole thing will collapse. The same is true for key federal agencies that provide support resulting in benefits well in excess of the investment in them.

To use just an agricultural example, the assault on NIOSH halts services and stops activities critical to the function of the workforce, from pesticide exposure risk to heat-related illness to protective measures enhanced through respirator testing and approval. NIOSH’s facilities to test and approve masks is tied to the competitive advantage of industries, such as 3M, which make N95 masks and other personal protective equipment. The loss of NIOSH impacts initiatives in construction and manufacturing that include the workforce that provides key equipment to the agricultural, forestry, and fisheries sectors. Ultimately, without NIOSH experts to recommend worker protection standards and best practices, it is likely that injuries (already a leading cause of death, disability and health care utilization in the workforce) and other health effects will rise, putting additional stress on a threadbare rural healthcare system.

Industry is unlikely to be able to stand up efforts that often require collaboration and information sharing among different companies — exactly the reason these efforts have been publicly supported to date rather than privatized.

Further, there are no state workforce agencies the way there are state health departments or state departments of agriculture — the latter meant to keep the livestock healthy and defend our food supply. At best, a few scattered occupational health functions may be located within environmental health divisions at departments of health, and a few states may shine in their abilities to assist workers, but at a national scale, no state can offer leadership in the field in the same way that NIOSH has.

Cutting NIOSH will not save money. In fact, it likely will end up being costly to industry, the health care system, and society. However you examine it — from a business perspective, a worker perspective, a community perspective — and under H5N1 conditions or not, NIOSH is worth saving. It’s one of the best deals any federal agency will give you. There are no substitutes, and many states can’t support an alternative. Once (irrevocably) gone, we may not be able to resurrect what NIOSH does for agriculture, for workers writ large, and for the business community.

Meghan Davis, D.V.M., Ph.D., is associate professor of environmental health and engineering and directs the Johns Hopkins P.O.E. Total Worker Health Center in Mental Health. Kirsten Koehler, Ph.D., is professor of environmental health and engineering and deputy director of the JHU Education and Research Center on Occupational Health. Judy Bass, Ph.D., M.P.H., is professor of public mental health at Johns Hopkins and deputy director of the POE Center. Julie Sorensen, Ph.D., is director of the Northeast Center for Occupational Health and Safety: Agriculture, Forestry and Fishing. Gurumurthy Ramachandran, Ph.D., is professor of environmental health and engineering and director of the JHU Education and Research Center on Occupational Health.