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CENTERS FOR DISEASE CONTROL AND PREVENTION 

NATIONAL INSTITUTE FOR OCCUPATIONAL 

SAFETY AND HEALTH 

+ + + + + 

lst INTERNATIONAL SYMPOSIUM ON 

TOTAL WORKER HEALTH 

+ + + + + 

SESSION 6.1 TOWN HALL FORUM: SHARE YOUR 

INPUT TO THE NATIONAL AGENDA FOR TOTAL 

WORKER HEALTH 

+ + + + + 

TUESDAY 

OCTOBER 7, 2014 

+ + + + + 

The Town Hall met in the 

Auditorium, Natcher Building, National 

Institutes of Health, 9000 Rockville Pike, 

Bethesda, Maryland, at 5:00 p.m., Sara L.` 

Tamers, PhD, MPH, Health Research 

Scientist/Coordinator for Research Program 

Development and Collaboration, NIOSH, CDC, 

facilitating. 

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T-A-B-L-E O-F C-O-N-T-E-N-T-S 

PAGE 

Opening Comments: 

by Dr. Sara Tamers . . . . . . . . . . . . 

Strategic Goal 1: Research . . . . . . . 4 

Strategic Goal 2: Practice . . . . . . . 4 

Strategic Goal 3: Policy . . . . . . . . 5 

Strategic Goal 4: Capacity Building. .. 5 

Oral Comments: 

Christina Banks, Director 

Interdisciplinary Center for Healthy 

Workplaces, University of California 

Berkeley . . . . . . . . . . . . . . . .10 

Luann Miller, St. Genevieve County 

Memorial Hospital. . . . . . . . . . . .14 

Jim Merchant, Healthcare Workforce 

Center for Excellence University 

of Iowa . . . . . . . . . . . . . . . . .19 

Diane Rohlman, University of Iowa. ...23 

Allison Heller-Ono, Ergonomist .... . .28 

Manuel Cifuentes, University of 

Massachusetts Lowell . . . . . . . . . .30 

Daryl Risinger, Concentra 

Healthcare . . . . . . . . . . . ~ . . . .32 

Lili Tenney, School of Public Health, 

Colorado, and Center for Worker 

Health and Environment . . . . . . . . .34 

Pouran Faghri, University of 

Connecticut, Investigator for 

CPH-NEW and Centers of Excellence. ...37 

Closing Comments by Dr. Sara Tamers. .....39 

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1 P-R-O-C-E-E-D-I-N-G-S 

2 (5:13 p.m.) 

3 DR. TAMERS: A11 right, good 

4 evening, everyone. We'11 get started. Thanks 

5 for your patience. So we are here for the 

6 Town Hall for the proposed National Total 

7 Worker Health Agenda. 

8 And, hopefully, everybody's gotten 

9 a chance to look at the Agenda. You should 

10 have gotten a copy at registration, at our 

11 NIOSH table. If not, there are copies in the 

12 back, so please help yourself. 

13 We are here to hear from you, our 

14 stakeholders, on how we might develop the most 

15 appropriate, relevant National Total Worker 

16 Health Agenda, so we really thank you. I am 

17 here on behalf of the Office for Total Worker 

18 Health. 

19 So I'm not going to go over all 

20 the ins and outs of the proposed Agenda, but 

21 simply to say that it includes four strategic 

22 goals and several sub-goals for each of those 

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1 categories. So let's just review those four 

2 strategic goals here. 

3 So our first one relates to 

4 research and that is to advance and conduct 

5 etiologic surveillance and intervention 

6 research that builds the evidence base for 

7 effectively integrating health protection and 

8 health promotion activities in the workplace. 

9 Next, Strategic Goal 2, relates to 

10 practice. And that is to increase the 

11 awareness and adoption of effective integrated 

12 occupational safety and health protection and 

13 health promotion activities in the workplace. 

14 Strategic Goal 3 relates to I 

15 policy. And that is to create guidance for 

16 policies that promote integration of 

17 occupational safety and health protection and 

18 health promotion activities in the workplace. 

19 And last, but not least, Strategic 

20 Goal 4 relates to capacity building. And that 

21 is to build professional capacity to 

22 strengthen the Total worker Health workforce 

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1 and Total Worker Health field, to support the 

2 development, growth, and maintenance of 

3 integrated occupational safety and health 

4 protection and health promotion activities in 

5 the workplace. 

6 Now for those of you who will be 

7 providing oral comment today, as well as those 

8 of you who will be providing written comment 

9 later on, and I'11 explain how to do so 

10 momentarily, we ask that you keep in mind 

il three questions, in particular. 

12 The first one is really trying to 

13 get a sense of what your take is on the 

14 current draft, the goals, the elements, and so 

15 forth. 

16 The second is, really, it's 

17 similarly, but trying to get at the linkages, 

18 the bridges between the work that you're 

19 doing, the priorities that you have, and what 

20 is currently reflected in the proposed Agenda. 

21 And the third one is really, 

22 simply, to get a sense from you, are there any 

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1 major missing components, or gaps, or 

2 potential places of consideration that we 

3 should think about, as we continue to develop 

4 this Agenda. 

5 On that note, I would just like to I 

6 very briefly highlight one of those potential 

7 areas of consideration that we have already 

8 self-identified at NIOSH, with the help of 

9 stakeholders, and that is that, currently, the 

10 draft does not include a, sort of, suitability 

11 criteria, if you will, for employers to meet 

12 in order to engage with us, at NIOSH, in Total 

13 Worker Health-related activities. So that is 

14 something that we are aware of and we are 

15 working on. 

16 One model that was recently put 

17 forth that we might consider, is the OSHA VPP 

18 criteria, but certainly there are other ones 

19 that we will be considering, as well. So just 

20 to give you a sense of one of those additional 

21 points of consideration. 

22 A11 right, so now let's move to 

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1 the rules for the Town Hall oral comments. So i 

2 we've asked those of you who will be 

3 commenting today, to first begin by 

4 introducing yourself, with your name and 

5 affiliation, this is for transcription 

6 purposes. 

7 We also ask that you please limit 

8 your comments to a maximum of five minutes. 

9 Included in that please node is, are any 

10 questions that you might have for us at NIOSH, 

11 and so because of that, we respectfully 

12 request that you actually not pose any 

13 comments. We really want this to be a forum 

14 to hear from you, rather than a discourse with 

15 us. 

16 That said, I will certainly make 

17 myself available, as will, I'm sure, some of 

18 my colleagues, after the Town Hall, to go over 

19 any questions you might have. 

20 I would like to just briefly touch 

21 on the time allotment here, the timekeepings 

22 of Jessica, standing before you here. First, 

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1 a green folder will indicate your start time. 

2 A yellow folder, thank you, Jessica, will 

3 indicate that you have one minute left. And, 

4 hopefully, it's understood that a red folder 

5 means it's really time to stop. Actually, if 

6 you hear a bell, then it's really, really time 

7 to stop, so we won't introduce that here. 

8 We ask that, in addition to the 

9 three questions that we just reviewed, that 

10 you really use this time to please highlight 

11 the most critical salient points to be 

12 included in the Agenda, and that any other 

13 remaining points, you may do so by submitting 

14 to the docket and I'11 over that slide in just 

15 a bit. And keep in mind, all oral comments 

16 today are being transcribed and recorded and 

17 will be included in the docket. 

18 So written comment. There are two 

19 ways, two methods, by which you may do so, via 

20 the Internet through regulations.gov , or if 

21 you'd prefer, you can mail in a copy, 

22 certainly. 

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1 And you needn't write this 

2 information down, there should be a one page 

3 handout in the back, also included in 

4 registration materials. 

5 Keep in mind that there is a 

6 deadline. That the docket will close December 

7 22nd, so all comments have to go in at that 

8 time. And at that time, we will be reviewing 

9 the oral comments, as well as the written 

10 ones, and responded to them accordingly. 

il A11 right, so we have, let's see, 

12 six people, lucky winners, to speak today. 

13 Should we have additional time, which we 

14 should, if everybody keeps to the five-minute 

15 allotment. We certainly will open it up, a 

16 first come first serve. 

17 So we are going to go in order, 

18 it's from Number 27 to 32. So if you have 

19 your ticket, it should say, the last two 

20 digits, that's what we're looking for. 

21 So we will begin, please, with 

22 Number 27. Thank you. And there are, yes, 

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1 two mics, on both sides. And again, if you 

2 could, please, introduce yourself, name and 

3 affiliation. 

4 DR. BANKS: My name is Christina 

5 Banks. I'm the Director of the 

6 Interdisciplinary Center for Healthy 

7 workplaces, at the University of California 

8 Berkeley. 

9 I would like to make three points, 

10 mostly referring to the gaps that I see in the 

11 Agenda, which I hope will be very helpful, and 

12 maybe the definition of the strategic goals 

13 might be flexible enough to incorporate the 

14 items that I would like to add to the list of 

15 things that you might want to consider 

16 researching in this particular Agenda. 

17 The first is, my understanding, 

18 from reading the Agenda, that there are three 

19 areas that weren't mentioned, and I would like 

20 to suggest that it be incorporated into the 

21 research agenda. 

22 The first is an analysis of the 

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1 built environment. This comes from 

2 environmental design and from real estate, 

3 actually, in the actual creation of buildings, 

4 and the building materials, and all of the 

5 indoor air quality aspects of the building, 

6 and the time in which, excuse me, the space in 

7 which people are performing that work. 

8 There's a lot of research in the 

9 built environment literature that suggests 

10 that it has a pretty significant impact on 

11 individuals' well-being, job satisfaction, 

12 productivity, et cetera. 

13 We could add significantly to that. 

14 literature, to help them understand the 

15 dynamics better, and that literature could 

16 inform better health practitioners and 

17 consultants and practitioners of various kind 

18 in this area to address those issues. 

19 The second area that I would like 

20 to add is technology, as an enabler of, 

21 basically, healthy work habits and greater 

22 knowledge of how to improve one's health. 

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1 The health tech area is huge, 

2 growing faster day-by-day, and I, personally, 

3 would like to see how it becomes, not merely 

4 a device that one can learn health 

5 information, but frankly will be in the 

6 infrastructure of how people work and how they 

7 experience work, and it can include sensors 

8 and various devices, which will report on how 

9 people are feeling, their emotions and their 

10 comfort. 

11 Third area that I didn't see much 

12 information on, was on wages and how wages 

13 might affect health and well-being of 

14 employees. 

15 And I know that's a very hot topic 

16 right now, and I don't know whether you want 

17 to get into the fray, politically, but to me 

18 that's an important area. 

19 So those are ones where I see that 

20 there are missing pieces in the Agenda. The 

21 other comment I would like to make is that we 

22 are focusing on programs and activities, 

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1 things that are external to the place in which 

2 people are working. 

3 And I would like to make a 

4 distinction between the things that, the 

5 factors that will affect how people work and 

6 how they feel about the work, and external 

7 things they could do, external to themselves, 

8 in order to promote their health and well9 being. 

10 So I'm looking at things that are 

11 baked in to the way they work versus 

12 discretionary activities that they make a 

13 decision to engage in, or not engage in: I 

14 think the former had less attention than the 

15 later, and I would just like to add that as a 

16 way of thinking about some of these factors 

17 that we want to investigate. 

18 And the last thing that I would 

19 like to add is that, I would like to see more 

20 multi-disciplinary research designs, as 

21 opposed to single, or double factor research 

22 studies. 

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1 And what I mean by multi2 disciplinary, I mean, where we invite people, 

3 who are from different disciplines, like 

4 technology, public policy, public health, 

5 psychology, business, and so on, to form a 

6 multi-disciplinary teams to plan research 

7 projects, to do demonstration projects, so we 

8 can study this concept holistically. Thank 

9 you. 

10 DR. TAMERS: Thank you, very much. 

11 And next we'11 hear from Number 28, please. 

12 MS. MILLER: Hi. My name is Luann 

13 Miller. I'm an Advanced Practice Nurse from 

14 rural Missouri, St. Genevieve County Memorial 

15 Hospital, a 25 bed critical access. 

16 I am here, mostly, to say thank 

17 you for the wonderful research that I see you 

18 all doing. Number 2, I'm here, also to say, 

19 my impact in this, and how this affects me, is 

20 from a whole different perspective than from 

21 what I have seen here. 

IOWA So what I'm going to start doing 

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1 is talking about the things that come from the I 

2 provider's point of view, covering the 17 

3 percent of the population that works in rural 

4 areas. 

5 When you look at Goal Number 2, 

6 under practice, I think that there is a real 

7 gap there in not identifying a relationship 

8 with traditional health care. 

9 Those of you in the urban areas do 

10 have the opportunity to put your own clinics 

11 on corners. out in the health provider areas 

12 where we have a shortage, the HPSA shortages, 

13 we don't have an occupational health provider. 

14 In the State of Missouri, rural_ 

15 areas, I am the, actually, only experienced 

16 occupational health provider in rural 

17 Missouri. So we don't have that opportunity. 

18 So what I worry about is, there's 

19 a gap here between traditional medicine. 

20 You're going to miss that 17 percent of the 

21 population that lives in rural areas, because 

22 there's not occupational health providers 

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11 there. 

2 The other thing you're going to 

3 find with these individuals is, if you do have 

4 physicians in the area, who are not doing 

5 occupational health, as it should be done. 

6 Companies don't go into those areas, because 

7 they can't, they don't have the services they 

8 need, and the physicians are very, very 

9 resistant to occupational health. 

10 At a meeting with two physicians 

11 in rural Missouri last Friday, 2 was told that 

12 my job was to take care of those difficult 

13 patients from the work side. That was my job, 

14 as an occupational health provider. They 

15 didn't like dealing with them. 

16 So we need to bridge this gap, 

17 because there are areas that are not 

18 represented. And nowhere in Number 2 does it 

19 say anything about bridging the gap between 

20 traditional medicine, and we do need to bridge 

21 that gap. 

22 2 want to move on to capacity 

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1 building. When you go to the urban areas, 

2 maybe here on the East Coast, and maybe on the 

3 Fiest Coast, when they teach health care, as an 

4 advanced practice nurse, I went to St. Louis 

5 University, it's considered a very well6 respected program for advanced practice 

7 i46 414=I 7=fM 

8 But I was told, after my first 

9 clinical semester that I had to do some 

10 clinicals in rural medicine, because I did 

11 2,000 physicals at Chrysler, that was not real 

12 medicine. 

13 Our health care education has a 

14 division between occupational health and a 

15 division between traditional health. None of 

16 the nursing programs in my area, they sent 

17 clinical students to our hospital to get 

18 experience, but none of them come to me, 

19 because I don't do real healthcare. 

20 They don't understand anything 

21 about chemical exposures. They don't 

22 understand anything about risks on the farm, 

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1 because those things are not approached, 

2 because no one's comfortable with them. 

3 So in capacity building I'm having 

4 to say educate, educate, educate, because 

5 that's missing. We have to start at the base 

6 and move up. 

7 This is a wonderful idealistic 

8 idea. And I have been researching it, since 

9 I started in occupational health in 1990. In 

10 1995 I was finding anything I could possibly 

11 find on it. 

12 Sut the concern for me is, this is 

13 very academic, but is it able to be 

14 implemented? And those are my concerns, 

15 because I want to see it happen. My employees 

16 deserve this. So that's my comment. 

17 DR. TAMERS: Thank you, very much. 

18 Next, we'11 hear from Number 29, please. 

19 Number 29? 

20 (No response.) 

21 DR. TAMERS: Maybe Number 29 went 

22 on a bathroom break. How about we skip to 

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1 Number 30, we'11 come back to Number 29. 

2 DR. MERCHANT: Jim Merchant, 

3 Healthcare Workforce Center for Excellence 

4 University of Iowa. First I'd like to 

5 congratulate Casey and Anita and the whole 

6 Total Worker Health team for this extravaganza 

7 of Total Worker Health. And, a lot of work, 

8 but I think a terrific, terrific effort, and 

9 I think, really, an important milestone in 

10 this program. 

11 My comments regarding the NORA 

12 Agenda for Total Worker Health are really 

13 based on my experience. I work with the Board 

14 of Scientific Counselors and Linda Rosenstock,- 

15 when she was Director of NIOSH, and really 

16 implemented, conceived and implemented NORA. 

17 And, although, it was to define in 

18 various areas, strategies to deal with 

19 exposures and sectors, the real reason behind 

20 it was to leverage resources, okay, out of the 

21 private sector, the public sector, 

22 particularly, out of agencies that had a lot 

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1 more money than NIOSH, like the NIH. 

2 And Linda worked at that and she 

3 had, I think, a certain amount of success with 

4 partnering with the National Institutes of 

5 Health on particular programs. 

6 Now Total Worker Health, if 

7 there's one that is ready made for 

8 collaboration with the NIH and numerous other 

9 agencies, and it's not as though it's not 

10 happening, but the goal is to really generate 

11 money for this program. Very tough to 

12 generate money out of the Congress, as we all 

13 know, particularly, in this environment. So 

14 that is a, I think, a strategy. You may say 

15 it's a tactic, I think it really is a 

16 strategy. 

17 The other strategy is to try to 

18 utilize the legislation, the Accountable Care 

19 Act, that requires insurance companies to pay 

20 for prevention cost that have been found by 

21 the Prevention Task Force, Community 

22 Prevention Task Force, to be, you know, 

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1 effective and evidenced-based prevention 

2 tools, or interventions, more specifically. 

3 So I think it's a, if we need to 

4 think in terms of Total Worker Health, about 

5 how we can really address that to generate all 

6 of the, you know, billions of dollars that 

7 could go into prevention, as a result of that 

8 legislation. 

9 A very important strategy that Tom ' 

10 Harkin, Iowa's Junior Senator, about to 

11 retire, unfortunately, who is the author of 

12 Title IV of the Accountable Care Act, put in. 

13 there to really generate support for 

14 prevention. 

15 Total Worker Health can seek to 

16 take advantage of that, and I think that is a 

17 real strategy as to, how do you use policy to 

18 advance this Agenda? And that is a specific 

19 proposal. I think there are, probably, other 

20 areas, in terms of policy, that could be used 

21 to strengthen this. 

22 If this program is to really 

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1 advance over time, it is going to have to 

2 generate support in the form of funds, and 

3 those are, I think, two ways that I don't 

4 really see addressed in what is now a pretty 

5 generic document. 

6 And, I mean, I see a certain 

7 advantage of having a generic strategy, 

8 however, if it's generic, it's not very 

9 strategic. 

10 So I think I would encourage NIOSH 

11 to think more specifically in ways that can 

12 not only implement some of the couple of 

13 things that I've talked about, but really 

14 sustain this program over time. 

15 DR. TAMERS: Thank you. Did we 

16 get Number 29 back? 

17 (No response.) 

18 DR. TAMERS: No? A11 right, then 

19 Number 31. Number 31? 

20 (No response.) 

21 DR. TAMERS: A11 right, how about 

22 Number 32? 

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1 DR. ROHLMAN: Such a, you know, 

2 late afternoon, sort of, session here, 

3 everybody's a little quiet. I'm Diane Rohlman 

4 from the University of Iowa, with Jim at the 

5 Healthier Workforce Center for Excellence. 

6 And I just have a couple of 

7 comments here. And I have not spent a lot of 

8 time looking at this, so my comments, really, 

9 are more on, I think, things are not well10 defined, and I think that's important to think 

11 about that. 

12 I see that the word effectiveness 

13 is used throughout, and how is that going to 

14 be operationalized, what does that mean when 

15 you think about that? And is that a word that 

16 you want to include in this document, or not? 

17 So that's one comment, as well. 

18 I think that for the strategical 

19 3, where you're talking about policies there, 

20 one of the first bullet points is develop 

21 policy guidance and Total Worker Health best 

22 practices, what does that mean? What shape is 

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1 that going to take? 

2 So if the NORA is used 

3 strategically, as Dr. Merchant suggested, how 

4 can that be translated into something that has 

5 an impact? And then, from my personal 

6 perspective, as a researcher, how do I write 

7 a grant to address this? 

8 So thinking about it from both 

9 perspectives, I think, and as a mechanism to 

10 keep the funding for this program to be 

11 constant, or increasing, to be able to talk to 

12 our stakeholders, is another component, as 

13 well, we need to be thoughtful in describing 

14 those. And also, as researchers, who we want 

15 to generate some of this evidence, it's very 

16 important. 

17 The second bullet, again, under 

18 the Strategic Goal 3, talks about to promcte 

19 corporate Total Worker Health responsibility 

20 and sustainability. What does it mean to be 

21 a Total Florker Health responsible employer? 

22 Is there a way to operationalize that, you F 

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1 know, how do we recognize it? 

2 And that leads me to another, 

3 perhaps, goal we should strive for, and that's 

4 the need to have common tools. So common 

5 measures that can used in multiple work sites 

6 and multiple situations that we can measure 

7 the same thing. 

8 And, perhaps, removing that. I 

9 know the centers are looking at other 

10 activities, across centers, and trying to get 

11 those together, but that might be a mechanism 

12 there, as well. 

13 As far as Strategic Goal 1, -. 

14 talking about intervention research, there's 

15 a very great bullet that says we want to 

16 investigate the merits of integrated 

17 interventions, relative to comprehensive, but 

18 parallel work site health promotion and 

19 occupational safety and health protection 

20 interventions in the unilateral worker health 

21 promotion, occupational safety and health 

22 interventions. That's great. 

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1 2 would love to design a study to 

2 look at those three components, but the 

3 resources to carry out such a project are 

4 huge. 

5 And if you want me to develop 

6 effective, whatever that means, integrations, 

7 you really have to think about the funding and 

8 the ability of people to carry out these types 

9 of projects. So I think it's great to have 

10 big goals, but thinking realistically about we 

11 can accomplish, with the budgets we have, is 

12 hard. 

13 There's also a comment there 

14 about, this is again under Strategic Goal 1, 

15 giving further attention to the theoretical 

16 underpinnings of Total Worker Health. And 2 

17 think that's a good starting point here. 

18 And there was another comment 

19 about integrating or a multi-disciplinary 

20 approach, and maybe the theories can come from 

21 that, but you want to have a mechanism to sort 

22 through and not just fit a theory, you want to 

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1 be thoughtful in that process. 

2 And, I guess, my last comment 

3 here, and perhaps it's because I do work with 

4 young workers and immigrant populations, is I 

5 don't see any language about these populations 

6 with special characteristics. 

7 Often times, I think, one 

8 criticism I have heard about Total Worker 

9 Health programs is it's a middle class, or 

10 upper class situation. 

11 That when you're dealing with a 

12 workforce that is struggling to survive, to 

13 have a living wage, to maybe have one job, or 

14 multiple jobs, the luxury of being able to 

15 exercise or buy organic food is, you know, far 

16 outweighed by the need to feed your family, or 

17 find childcare. So that's an issue, 

18 certainly, with low income populations, but -_ 

19 immigrant populations. 

20 Again, you have a cultural issues, 

21 as well as training. You know, we've talked 

22 a lot about, in the past, about training for 

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1 immigrant populations that, I think, can be 

2 applied when you think about health 

3 proportion, as well as occupational safety and 

4 health. 

5 DR. TAMERS: Thank you. So let's 

6 check, did we get Number 29, or 31, back in 

7 the room? 

8 (No response.) 

9 DR. TAMERS: A11 right. Then, 

10 Number 30, 26, excuse me, Number 26. 

11 MS. HELLER-ONO: Thank you. My 

12 name is Allison Heller-Ono, and I'm an 

13 Ergonomist in private industry, consulting to 

14 business. _ 

15 Recently, I had an opportunity to 

16 participate in the CDC's program work@Health, 

17 as a trainer. The CDC Work@Health Program 

18 recruited trainers across the country, I don't 

19 know, maybe, in four different areas, maybe 

20 600 trainers. 

21 And those trainers were asked to 

22 recruit five employers in small business to 

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1 train them in the CDC's Work@Health Program on 

2 how to launch a health promotion wellness 

3 program in the workplace. 

4 And it was modular-based, and 

5 there was some minor funding behind it, to 

6 just pay for materials, but not for the 

7 person, the trainer's time and effort, in 

8 recruiting those employers. 

9 I completed the training, but I 

10 was not able to complete the recruitment, 

11 because of my need to earn a living, and so I 

12 stopped at that point. 

13 But my point is today, is that I 

14 think that the goal of that program, the 

15 Work@Health Program, was to complete the one 

16 day training with those employers, but there 

17 was no further obligation from_the trainer to 

18 support the employer with the ongoing creation 

19 of the health promotion team and the efforts 

20 behind that team. 

21 And so I think partnering in that 

22 role, NIOSH support, as well as those 

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1 companies that do proceed with that program, 

2 to measure and monitor their performance and 

3 the outcomes that they get. So that's my 

4 suggestion. 

5 DR. TAMERS: Thank you. So at 

6 this time, we do have some remaining time. 

7 I'd like to invite anybody else who would like 

8 to make a comment, first come first serve. 

9 (Off microphone discussion) 

10 DR. TAMERS: Please. 

11 DR. CIFUENTES: Thank you. My 

12 name is Manuel Cifuentes from the University 

13 of Massachusetts Lowell. I also felt for a 

~ 

14 long time that the trademark Total Worker 

15 Health is very misleading, because it's an 

16 incomplete approach to the health of the 

17 person that is working. 

18 And the limitation of Total Worker 

19 Health to health protection and health 

20 promotion limits also the employer to really 

21 take care and express his/her total concern 

22 for the health and work abilities of the 

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11 workers. 

2 I am not going to propose a change 

3 of the name, I was trying to be creative, but 

4 the idea is, with this issue of structural 

5 determinants of health that was mentioned by 

6 a previous person here, poor people, people 

7 with different backgrounds, people that are 

8 having very difficult health issues in a 

9 relative than they have no money for anything. 

10 Then we are asking them to exercise, to eat 

11 well. 

12 And I cannot see how an employer 

13 can take care of that, right? Then, how can 

14 the employer can seriously design a plan for 

15 health protection, away from that, or health 

16 promotion, in somebody who's having through a 

17 crisis that is due to external factors, or 

18 somebody who is poor, non-educated, has 

19 problems with language? 

20 Then I would like just to add that 

21 in Strategic Goal 1, in advance and conduct 

22 etiologic surveillance, we are effectively 

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1 integrating health protection, health 

2 promotion, and health advocacy. I don't know 

3 how to pronounce that in English, very sorry. 

4 (off microphone discussion) 

5 DR. CIFUENTES: Yes, advocacy. 

6 Giving the employers and the workers the 

7 possibility of joining force, to express their 

8 disappointment for that society that bring 

9 inside the workplace a workforce that has a 

10 lot of problems that are a way from the 

11 employee possibility of solving and away from 

12 the employer possibility of solving. 

13 But if we introduce the issue of 

14 health advocacy, we give them some political 

15 power to work on this, and that would fit 

16 nicely with providing them with information 

17 about how instructing Total Worker Health, or 

18 how non-work related issues affect their 

19 health. Thank you. 

20 DR. TAMERS: Thank you. Anyone 

21 else? 

22 MR. RISINGER: Hi, good afternoon. 

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1 My name is Daryl Risinger. I'm with Concentra 

2 Healthcare. We're a national provider 

3 organization, with almost 700 physicians. And 

4 wanted to call out a concern that I'm seeing 

5 just based on our perspective. 

6 And if you think of us as, really, 

7 kind of the boots on the ground, or the feet 

8 on the street, if you will, interacting day9 to-day with each of these employers. We have 

10 current relationships with approximately 150 

11 employers across the U.S. 

12 The concern is really around 

13 ownership of the wellness, or the health 

14 promotion piece of this. Because, in our 

15 conversations with risk and safety, their 

16 perspective is that health and workplace 

17 health promotion is owned by benefits, and it 

18 is owned by HR. 

19 Most fully-insured plans 

20 incorporate EAP, incorporate health coaching, 

21 incorporate even incentive and rewards 

22 programs. And so I think there's a risk here 

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1 in, I'11 say, muddying the waters, in terms of 

2 the ownership that, kind of, the day-to-day 

3 ownership of who it is that's driving 

4 workplace health. 

5 I'm not saying that it can't be 

6 worked through, but I think that's one of 

7 those where, if we don't understand that 

8 there's a pretty firm partition between those 

9 two constituencies and the employer's 

10 viewpoint, I'm a little fearful that you're 

11 not going to get the traction and the adoption 

12 that everybody really is interested in 

13 obtaining. 

14 DR. TAMERS: Thank you. Any other 

15 comments? Yes, please. 

16 MS. TENNEY: Well, hello, NIOSH 

17 Total Worker Health Gods. My name's Lili 

18 Tenney. I'm with the School of.Public Health 

19 in Colorado and the Center for Worker Health 

20 and Environment. 

21 And thank you, Anita and Casey, 

22 for having this first, very successful 

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1 symposium. And this, just reviewing this, 

2 briefly, is very exciting, and I'm thankful 

3 for the opportunity to comment. 

4 So I have a lot of comments, but I 

5 boiled them down to my top three, and the 

6 first one is around the practice Goal 2, and 

7 has really been based on what we're learning 

8 in Colorado for implementing and, well really, 

9 around the translation and dissemination of 

10 Total Worker Health. 

11 And I think there is really an 

12 opportunity to either expand, or include more 

13 detail around how this could really coordinate 

14 with a lot of the existing efforts that are 

15 going on. 

16 So to mirror what you were saying, 

17 from Concentra, there's a lot of other groups 

18 that are focused around engaging employer 

19 groups. 

20 And so my concern is that we're 

21 all working really hard, and I'm seeing a lot 

22 of replication, or repetitive efforts, and 

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1 lack of coordination, so I think there's an 

2 opportunity to put something in both research, I 

3 or really across all the goals, around how 

4 these programs and research projects can 

5 really be coordinated better. 

6 I also think there's an 

7 opportunity, and this is in line with not 

8 replicating efforts, around the point of 

9 developing an internet-based opened source 

10 system for disseminating these practices. 

11 And that's where, I think, your 

12 additional point around engaging stake 

13 employer groups to be here, to sit at this 

14 table, so we can start being more flexible in 

15 our research approaches, to include 

16 stakeholder input, and really encouraging in 

17 the field experiments for implementing Total 

18 Worker Health, could really be insightful into 

19 how this is happening and how complex the 

20 issue is. 

21 And then, my last point is around 

22 your footnote for, really, coming up with a 

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1 business case for prevention. And, I think, 

2 that has been the common theme I've heard in 

3 all the presentations, over the last couple of 

4 days, is that ranging from, we know Total 

5 Worker Health works in companies, but we don't 

6 know how to get them to engage, or we don't 

7 know how to present this idea to them. 

8 If we could invest an effort 

9 explicitly around marketing Total Worker 

10 Health and trying to brand it and incorporate 

11 into other employer groups and their programs, 

12 I think, we could have significant impact. So 

13 those are my comments. Thank you. 

14 DR. TAMERS: Thank you. Any other 

15 comments? 

16 DR. FAGHRI: Hi. My name is 

17 Pouran Faghri. I am from University of 

18 Connecticut, and one of the investigator with 

19 the CPH-NEW, and one of the Centers of 

20 Excellence. And I wish to echo my colleague's 

21 comments on Casey and Anita, thank you, very 

22 much, for a great conference. It was awesome. 

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1 One thing that I noticed 

2 throughout all of these goals is that, to me, 

3 it appears that you're proposing a, kind of, 

4 one size fits all approach. 

5 And we do know that a small and 

6 medium size companies have different issues, 

7 and they are the one that burden the major 

8 healthcare cost, due to some of the 

9 limitations they have as far as their 

10 resources that larger companies may not have. 

11 So what I would like to see in 

12 these goals and in these strategies, some 

13 naming, or some components, as far as 

14 research, practice and policy, how to 

15 incorporate Total Worker Health for a small to 

16 mid-size companies. 

17 And maybe, encourage different 

18 levels, different phases, meaning Total Worker 

19 Health, I don't know what you're going to call 

20 it, but I think we should be careful in 

21 proposing that these strategies may work for 

22 every company. And I wish to see that 

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1 components in all of these goals. 

2 DR. TAMERS: Thank you. Anyone 

3 else? 

4 (No response.) 

5 DR. TAMERS: Going once, going 

6 twice. Did we get back Number 29, or 31? 

7 (No response.) 

8 DR. TAMERS: Okay. Well, I would 

9 also invite anyone who's already provided 

10 comment to provide some more, should you want 

11 to, at this time. 

12 (Off microphone discussion) 

13 DR. TAMERS: Okay. 

14 (Off microphone discussion) 

15 DR. ROHLMAN: Sorry, guys. I know 

16 it's the end of the day. Again, this is Diane 

17 Rohlman from the University of Iowa. Just two 

18 points that I think, and I don't know if these 

19 have been made, but I feel they're really 

20 important. 

21 One is, we need to make sure we 

22 don't shift the responsibility of a safe and 

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1 healthy workplace from the employer to the 

2 employee. 

3 I think it's very important that 

4 some of the comments that I heard from people 

5 representing employees, so we need to be very 

6 careful that we keep the responsibility where 

7 it should be. 

8 And also, I think we need to 

9 really look for rigorous research methods. 

10 And we need to make sure that the research is 

11 incorporating methodological designs that 

12 allow us draw accurate conclusions. 

13 So we need to have a high standard 

14 for that, as we go ahead and try to come up 

15 with methods to implement Total Worker Health 

1'6 in businesses. That's it. 

17 DR. TAMERS: Thanks very much. 

18 A11 right, well, if anybody is attending our 

19 Healthier Federal Workers Conference, 

20 beginning tomorrow, there will be a final 

21 opportunity to comment, during a Town Hall 

22 that we're having on Thursday. 

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1 A11 the wise, again, we welcome 

2 any written comments to the docket by December 

3 22nd. Thank you all, and enjoy the rest of 

4 your evening. 

5 (whereupon, the meeting in the 

6 above-entitled matter was concluded at 5:54 

7 p.m.) 

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abilities 30:22 

ability 26:8 

able 18:13 24:11 

27:1429:10 

above-entitled 41:6 

academic 18:13 

access14:15 

accomplish 26:11 

Accountable20:18 

21:12 

accurate 40:12 

Act20:19 21:12 

activities 4:8,13,18 

5:4 6:13 12:22 

13:12 25:10 

actual 11:3 

add 10:14 11:13,20 

13:15,19 31:20 

addition 8:8 

additiona16:20 

9:13 36:12 

address 11:18 21:5 

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addressed 22:4 

adoption 4:11 

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advance 4:4 21:18 

22:1 31:21 

advanced14:13 

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advantage 21:16 

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advocacy 32:2,5,14 

affect 12:13 13:5 

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affiliation 7:5 10:3 

afternoon 23:2 

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agencies 19:22 20:9 

agenda 1:7 3:719,16 

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10:21 12:20 19:12 

21:18 

ahead 40:14 

air 11:5 

Allison 2:14 28:12 

allotment 7:21 9:15 

allow 40:12 

amount 20:3 

analysis 10:22 

Anita 19:5 34:21 

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anybody 30:7 

40:18 

appears 38:3 

applied 28:2 

approach 26:20 

30:16 38:4 

approached 18:1 

approaches 36:15 

appropriate 3:15 

approximately 

33:10 

area 11:18,19 12:1 

12:11,18 16:4 

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areas 6:7 10:19 

15:4,9,11,15,21 

16:6,17 17:1 

19:18 21:20 28:19 

asked 7:2 28:21 

asking 3 1: 10 

aspects11:5 

attending 40:18 

attention 13:14 

26:15 

Auditorium 1:13 

author21:11 

available 7:17 

aware 6:14 

awareness 4:11 

awesome 37:22 

r-i 

back 3:12 9:3 19:1 

22:16 28:6 39:6 

backgrounds31:7 

baked 13:11 

Banks 2:7 10:4,5 

base4:6 18:5 

based 19:13 33:5 

35:7 

basically 11:21 

bathroom 18:22 

bed 14:15 

beginning 40:20 

behalf 3:17 

bell 8:6 

benefits 33:17 

Berkeley 2:9 10:8 

best23:21 

Bethesda 1:14 

better 11:15,16 

36:5 

big 26:10 

billions 21:6 

bit 8:15 

Board 19:13 

bofled 35:5 

boots 33:7 

brand 37:10 

break 18:22 

bridge 16:16,20 

bridges 5:18 

bridging 16:19 

briefly 6:6 7:20 

35:2 

bring 32:8 

budgets 26:11 

build 4:21 

building 1:13 2:5 

4:20 11:4,5 17:1 

18:3 

buildings 11:3 

builds 4:6 

built 11:1,9 

bullet 23:20 24:17 

25:15 

burden 38:7 

business 14:5 28:14 

28:22 37:1 

businesses 40:16 

buy 27:15 

C-O-N-T-E-N-T-S 

2:1 

California 2:8 10:7 

call 33:4 38:19 

capacity 2:5 4:20 

4:21 16:22 18:3 

care 15:8 16:12 

17:3,13 20:18 

21:12 30:21 31:13 

carefu138:20 40:6 

carry 26:3,8 

case 37:1 

Casey 19:5 34:21 

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categories 4:1 

CDC 1:15 28:17 

CDC's 28:16 29:1 

Center 2:8,12,19 

10:6 19:3 23:5 

34:19 

centersl:l 2:21 

25:9,10 37:19 

certain 20:3 22:6 

certainly 6:18 7:16 

8:22 9:15 27:18 

cetera 11:12 

chance 3:9 

change 31:2 

characteristics 

27:6 

check 28:6 

chemica117:21 

childcare 27:17 

Christina 2:7 10:4 

Chrysler 17:11 

Cifuentes 2:15 

30:11,12 32:5 

class 27:9,10 

clinical 17:9,17 

clinicals 17:10 

clinics 15:10 

close 9:6 

Closing 2:22 

coaching 33:20 

Coast 17:2,3 

collaboration 1:15 

20:8 

colleague's 37:20 

colleagues 7:18 

Colorado 2:19 

34:19 35:8 

come 9:16 15:1 

17:18 19:1 26:20 I 

30:8 40:14 

comes 11:1 

comfort 12:10 

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comment 5:7,8 

8:18 12:21 18:16 

23:1726:13,18 

27:2 30:8 35:3 

39:10 40:21 

commenting 7:3 

comments 2:2,6,22 

7:1,8,13 8:15 9:7 

9:9 19:11 23:7,8 

34:15 35:4 37:13 

37:15,21 40:4 

41:2 

common 25:4,4 

37:2 

Community 20:21 

companies 16:6 

20:19 30:1 37:5 

38:6,10,16 

company 38:22 

complete 29:10,15 

completed 29:9 

complex 36:19 

component24:12 

components 6:1 

26:2 38:13 39:1 

comprehensive 

25:17 

conceived 19:16 

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33:1 35:17 

concept14:8 

concern 18:12 

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concerns18:14 

concluded 41:6 

conclusione 40:12 

conduct4:4 31:21 

conference 37:22 

40:19 

congratulate 19:5 

Congress 20:12 

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Connecticut2:21 

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consider 6:17 

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consideration 6:2,7 

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considered 17:5 

considering 6:19 

constant24:11 

constituencies 34:9 

consultants 11:17 

consulting 28:13 

continue 6:3 

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conversations 

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coordinate 35:13 

coordinated 36:5 

coordination 36:1 

copies 3:11 

copy 3:10 8:21 

corners 15:11 

corporate 24:19 

cost 20:20 38:8 

Counselors 19:14 

 country 28:18 

County 2:10 14:14 

couple 22:12 23:6 

37:3 

covering 15:2 

CPH-NEW 2:21 

37:19 

create 4:15 

creation 11:3 29:18 

creative 31:3 

crisis 31:17 

criteria 6:11,18 

critical 8:11 14:15 

criticism 27:8 

cultura127:20 

current5:14 33:10 

currently 5:20 6:9 

Daryl2:17 33:1 

day 29:16 33:8 

39:16 

day-by-day 12:2 

day-to-day 34:2 

days 37:4 

deadline 9:6 

deal 19:18 

dealing 16:15 

27:11 

December 9:6 41:2 

decision 13:13 

detine 19:17 

defined 23:10 

detinition 10:12 

demonstration 

14:7 

describing 24:13 

deserve 18:16 

design 11:2 26:1 

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designs 13:20 

40:11 

detail 35:13 

determinants 31:5 

develop 3:14 6:3 

23:20 26:5 

developing 36:9 

development 1:15 

5:2 

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devices 12:8 

Diane 2:13 23:3 

39:16 

different 14:3,20 

28:19 31:7 38:6 

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difficult 16:12 31:8 

digits 9:20 

Director 2:7 10:5 

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disciplinary 14:2 

disciplines 14:3 

discourse 7:14 

discretionary 

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discussion 30:9 

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DISEASE 1:1 

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dissemination 35:9 

distinction 13:4 

division 17:14,15 

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document 22:5 

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doing 5:19 14:18 

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dollars 21:6 

double 13:21 

Dr 2:3,22 3:3 10:4 

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23:1 24:3 28:5,9 

30:5,10,11 32:5 

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draft 5:14 6:10 

draw 40:12 

driving 34:3 

due 31:17 38:8 

dynamics 11:15 

EAP 33:20 

earn 29:11 

East 17:2 

eat 31:10 

echo 37:20 

educate 18:4,4,4 

education 17:13 

effective 4:11 21:1 

26:6 

effectively 4:7 

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effectiveness 23:12 

effort 19:8 29:7 

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efforts 29:19 35:14 

35:22 36:8 

either 35:12 

elements 5:14 

emotions 12:9 

employee 32:11 

40:2 

employees 12:14 

18:15 40:5 

employer 24:21 

29:18 30:20 31:12 

31:14 32:12 35:18 

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employer's 34:9 

employers 6:11 

28:22 29:8,16 

32:6 33:9,11 

enabler 11:20 

encourage 22:10 

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encouraging 36:16 

engage 6:12 13:13 

13:13 37:6 

engaging 35:18 

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English 32:3 

enjoy 41:3 

environment 2:19 

11:1,920:13 

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environmental 

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Ergonomist 2:14 

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estate 11:2 

et 11:12 

etiologic 4:5 31:22 

evening 3:4 41:4 

everybody 9:14 

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everybody's 3:8 

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evidence 4:6 24:15 

evidenced-based 

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Excellence 2:12,21 

19:3 23:5 37:20 

exciting 35:2 

excuse 11:6 28:10 

exercise 27:15 

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existing 35:14 

expand 35:12 

experience 12:7 

17:18 19:13 

experienced 15:15 

experiments 36:17 

explain 5:9 

explicitly 37:9 

exposures17:21 

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express 30:21 32:7 

external 13:1,6,7 

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extravaganza 19:6 

facilitating 1:16 

factor 13:21 

factors 13:5,16 

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Faghri 2:20 37:16 

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family 27:16 

far 25:13 27:15 

38:9,13 

farm 17:22 

faster 12:2 

fearfu134:10 

Federa140:19 

feed 27:16 

feel 13:6 39:19 

feeling 12:9 

feet 33:7 

felt 30:13 

field 5:1 36:17 

final 40:20 

find 16:3 18:11 

27:17 

finding 18:10 

flrm 34:8 

first4:3 5:12 7:3,22 

9:16,16 10:17,22 

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30:8,8 34:22 35:6 

fit26:22 32:15 

fits 38:4 

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five-minute 9:14 

flexible 10:13 

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folder 8:1,2,4 

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footnote 36:22 

force 20:21,22 32:7 

form 14:5 22:2 

former 13:14 

forth 5:15 6:17 

forum 1:7 7:13 

found 20:20 

four 3:21 4:1 28:19 

frankly 12:5 

fray 12:17 

Friday 16:11 

fully-insured 33:19 

funding 24:10 26:7 

29:5 

funds22:2 

further 26:15 

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gap 15:7,19 16:16 

16:19,21 

gaps 6:1 10:10 

generate 20:10,12 

21:5,13 22:2 

24:15 

generic 22:5,7,8 

Genevieve 2:10 

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give 6:20 32:14 

giving 26:15 32:6 

go 3:19 7:18 9:7,17 

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goa12:4,4,5,5 4:9 

4:14,20 15:5 

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25:13 26:14 29:14 

31:21 35:6 

goals 3:22 4:2 5:14 

] 0:12 26:10 36:3 

38:2,12 39:1 

Gods 34:17 

going 3:19 9:17 

14:22 15:20 16:2 

22:1 23:13 24:1 

31:2 34:11 35:15 

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good 3:3 26:17 

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gotten 3:8,10 

grant24:7 

great25:15,22 26:9 

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greater11:21 

green 8:1 

ground 33:7 

groups 35:17,19 

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growing 12:2 

growth 5:2 

guess 27:2 

guidance 4:15 

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guys39:15 

habits 11:21 

Hall 1:7,12 3:6 7:1 

7:18 40:21 

handout 9:3 

happen 18:15 

happening 20:10 

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hard 26:12 35:21 

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health 1:2,5,8,13 

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healthcare 2:11,17 

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Healthier 23:5 

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healthy 2:8 10:6 

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hear 3:13 7:14 8:6 

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heard 27:8 37:2 

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Heller-Ono 2:14 

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hello 34:16 

help 3:12 6:8 11:14 

helpfu110:11 

Hi 14:12 32:22 

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high 40:13 

highlight 6:6 8:10 

his/her 30:21 

holistically 14:8 

hope 10:11 

hopefully 3:8 8:4 

hospita12:10 14:15 

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hot 12:15 

HPSA 15:12 

HR 33:18 

huge 12:1 26:4 

idea 18:8 31:4 37:7 

idealis6c 18:7 

identifying 15:7 

immigrant27:4,19 

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impact I 1:10 14:19 

24:5 37:12 

implement 22:12 

40:15 

implemented 18:14 

19:16,16 

implementing 35:8 

36:17 

important 12:18 

19:9 21:9 23:10 

24:16 39:20 40:3 

improve 11:22 

incentive 33:21 

include 6:10 12:7 

23:16 35:12 36:15 

included 7:9 8:12 

8:17 9:3 

includes 3:21 

income 27:18 

incomplete 30:16 

incorporate10:13 

33:20,20,21 37: ] 0 

38:15 

incorporated 10:20 

incorporating 

40:11 

increase 4:10 

increasing 24:11 

indicate 8:1,3 

individuals 11:11 

16:3 

indoor11:5 

industry 28:13 

inform 11:16 

information 9:2 

12:5,12 32:16 

infrastructure 12:6 

input 1:7 36:16 

ins 3:20 

inside 32:9 

insightful 36:18 

INSTITUTE 1:2 

Institutes 1:13 20:4 

instructing 32:17 

insurance20:19 

integrated 4:11 5:3 

25:16 

integrating 4:7 

26:19 32:1 

integration 4:16 

integrations26:6 

interacting 33:8 

Interdisciplinary 

2:8 10:6 

interested 34:12 

INTERNATION... 

1:4 

Internet 8:20 

internet-based 

36:9 

intervention 4:5 

25:14 

interventions 21:2 

25:17,20,22 

introduce 8:7 10:2 

32:13 

introducing 7:4 

invest37:8 

investigate 13:17 

25:16 

investigator 2:21 

37:18 

invite 14:2 30:7 

39:9 

Iowa 2:12,13 19:4 

23:4 39:17 

Iowa's 2 1: 10 

issue 27:17 31:4 

32:13 36:20 

issues 11:18 27:20 

31:8 32:18 38:6 

iteme 10:14 

IV 21:12 

Jessica 7:22 8:2 

Jim 2:11 19:2 23:4 

job 11:11 16:12,13 

27:13 

jobs 27:14 

joining 32:7 

Junior 2 1: 10 

keep 5:10 8:15 9:5 

24:10 40:6 

keeps 9:14 

kind 11:17 33:7 

Neal R. Gross and Co., Inc. 

202-234-4433 Washington DC www.nealrgross.com 
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34:2 38:3 

know 12:15,16 

20:13,22 21:6 

23:1 25:1,9 27:15 

27:21 28:19 32:2 

37:4,6,7 38:5,19 

39:15,18 

knowledge 11:22 

L 

L 1:14 

lack 36:1 

language 27:5 

31:19 

larger 38:10 

late 23:2 

launch 29:2 

leads25:2 

learn 12:4 

learning 35:7 

left 8:3 

legislation 20:18 

21:8 

let's 4:1 6:22 9:11 

28:5 

levels 38:18 

Ieverage19:20 

Lili 2:18 34:17 

limit 7:7 

limitation 30:18 

limitations 38:9 

limits 30:20 

Linda 19:14 20:2 

line 36:7 

linkages 5:17 

list 10:14 

literature 11:9,14 

11:15 

little 23:3 34:10 

lives 15:21 

living 27:13 29:11 

long 30:14 

look 3:9 15:5 26:2 

40:9 

looking 9:20 13:10 

23:8 25:9 

1ot11:8 19:7,22 

23:7 27:22 32:10 

35:4,14,17,21 

Louis 17:4 

love 26:1 

low 27:18 

Lowell2:16 30:13 

Luann 2:10 14:12 

lucky 9:12 

luxury 27:14 

mail 8:21 

maintenance 5:2 

major 6:1 38:7 

Manuel 2:15 30:12 

marketing 37:9 

Maryland 1:14 

Massachusetts 

2:16 30:13 

materials 9:4 11:4 

29:6 

matter 41:6 

maximum 7:8 

mean 14:1,2 22:6 

23:14,22 24:20 

meaning 38:18 

means 8:5 26:6 

measure 25:6 30:2 

measures 25:5 

mechanism 24:9 

25:11 26:21 

medicine 15:19 

16:20 17:10,12 

medium 38:6 

meet 6:11 

meeting 16:10 41:5 

Memoria12:10 

14:14 

mentioned 10:19 

31:5 

Merchant2:11 

19:2,2 24:3 

merely 12:3 

merits 25:16 

met 1:12 

methodological 

40:11 

methods 8:19 40:9 

40:15 

microphone 30:9 

32:4 39:12,14 

mics 10:1 

mid-size 38:16 

middle 27:9 

milestone 19:9 

Miller 2:10 14:12 

14:13 

mind 5:10 8:15 9:5 

minor 29:5 

minute 8:3 

minutes 7:8 

mirror 35:16 

misleading 30:15 

missing 6:1 12:20 

18:5 

Missouri 14:14 

15:14,17 16:11 

model 6:16 

modular-based 

29:4 

momentarily 5:10 

money 20:1,11,12 

31:9 

monitor 30:2 

move 6:22 16:22 

18:6 

MPH 1:14 

muddying 34:1 

multi 14:1 

multi-disciplinary 

13:20 14:6 26:19 

multiple 25:5,6 

27:14 

name 7:4 10:2,4 

14:12 28:12 30:12 

31:3 33:1 37:16 

name's 34:17 

naming 38:13 

Natcher 1:13 

national 1:2,7,13 

3:6,15 20:4 33:2 

need 16:8,16,20 

21:3 24:13 25:4 

27:16 29:11 39:21 

40:5,8,10,13 

needn't 9:1 

nicely 32:16 

NIH 2O:1,8 

NIOSH 1:15 3:11 

6:8,12 7:10 19:15 

20:1 22:10 29:22 

34:16 

node 7:9 

non-educated 

31:18 

non-work 32:18 

NORA 19:11,16 

24:2 

note 6:5 

noticed 38:1 

Number 9:18,22 

14:11,18 15:5 

16:18 18:18,19,21 

19:1,1 22:16,19 

22:19,22 28:6,10 

28:10 39:6 

numerous 20:8 

nurse 14:13 17:4 

nurses 17:7 

nursing 17:16 

O 

O-F 2:1 

obligation 29:17 

obtaining 34:13 

occupational 1:2 

4:12,17 5:3 15:13 

15:16,22 16:5,9 

16:14 17:14 18:9 

25:19,21 28:3 

OCTOBER 1:10 

Office 3:17 

okay 19:20 39:8,13 

once 39:5 

one's 11:22 18:2 

ones 6:18 9:10 

12:19 

ongoing 29:18 

open 9:15 

opened 36:9 

Opening 2:2 

operationalize 

24:22 

operationalized 

23:14 

opportunity 15:10 

15:17 28:15 35:3 

35:12 36:2,7 

40:21 

opposed 13:21 

oral2:6 5:7 7:1 

8:15 9:9 

order 6:12 9:17 

13:8 

organic27:15 

organization 33:3 

OSHA 6:17 

outcomes 30:3 

outs 3:20 

outweighed 27:16 

owned 33:17,18 

ownership 33:13 

34:2,3 

P-R-O-C-E-E-D-... 

3:1 

p.m 1:14 3:2 41:7 

page 2:2 9:2 

paralle125:18 

participate 28:16 

particular 5:11 

] 0:16 20:5 

particularly 19:22 

20:13 

partition 34:8 

partnering 20:4 

29:21 

patience 3:5 

patients 16:13 

pay 20:19 29:6 

people 9:12 11:7 

12:6,9 13:2,5 14:2 

26:8 31:6,6,7 40:4 

percent 15:3,20 

performance 30:2 

performing 11:7 

person 29:7 30:17 

31:6 

personal 24:5 

personally 12:2 

Neal R. Gross and Co., Inc. 

202-234-4433 Washington DC www.nealrgross.com 
Page 46 

perspective 14:20 

24:6 33:5,16 

perspectives 24:9 

phases 38:18 

PhD 1:14 

physicals 17:11 

physicians 16:4,8 

16:10 33:3 

piece 33:14 

pieces 12:20 

Pike 1:13 

place 13:1 

places 6:2 

plan 14:6 31:14 

plans 33:19 

please 3:12 7:7,9 

8:109:21 10:2 

14:11 18:18 30:10 

34:15 

point 15:2 26:17 

29:12,13 36:8,12 

36:21 

points 6:21 8:11,13 

10:9 23:20 39:18 

policies 4:16 23:19 

policy 2:5 4:15 14:4 

21:17,20 23:21 

38:14 

politica132:14 

politically 12:17 

poor 31:6,18 

population 15:3,21 

populations 27:4,5 

27:18,19 28:1 

pose 7:12 

possibility 32:7,11 

32:12 

possibly 18:10 

potential 6:2,6 

Pouran 2:20 37:17 

power 32:15 

practice 2:4 4:10 

14:13 15:6 17:4,6 

35:6 38:14 

practices 23:22 

36:10 

practitioners 11:16 

11:17 

prefer 8:21 

present37:7 

presentations 37:3 

pretty 11:10 22:4 

34:8 

prevention 1:1 

20:20,21,22 21:1 

21:7,14 37:1 

previous31:6 

priorities 5:19 

private 19:21 28:13 

probably 21:19 

problems 31:19 

32:10 

proceed 30:1 

process 27:1 

productivity 11:12 

professiona14:21 

program 1:15 17:6 

19:1020:11 21:22 

22:14 24:10 28:16 

28:17 29:1,3,14 

29:15 30:1 

programs 12:22 

17:16 20:5 27:9 

33:22 36:4 37:11 

project 26:3 

projects 14:7,7 

26:9 36:4 

promote 4:16 13:8 

24:18 

promotion 4:8,13 

4:18 5:4 25:18,21 

29:2,19 30:20 

31:16 32:2 33:14 

33:17 

pronounce32:3 

proportion 28:3 

proposal 21:19 

propose 31:2 

proposed 3:6,20 

5:20 

proposing 38:3,21 

protection 4:7,12 

4:17 5:4 25:19 

30:19 31:15 32:1 

provide 3 9: 10 

provided 39:9 

provider 15:11,13 

15:16 16:14 33:2 

provider's15:2 

providers15:22 

providing 5:7,8 

32:16 

psychology14:5 

public2:18 14:4,4 

19:21 34:18 

purposes 7:6 

put6:16 15:10 

21:12 36:2 

quality 11:5 

questions 5:11 7:10 

7:19 8:9 

quiet23:3 

ranging 37:4 

reading 10:18 

ready 20:7 

real 11:2 15:6 

17:11,19 19:19 

21:17 

realistically 26:10 

really 3:16 5:12,16 

5:21 7:13 8:5,6,6 

8:10 19:9,12,15 

20:10,15 21:5,13 

21:22 22:4,13 

23:8 26:7 30:20 

33:6,12 34:12 

35:7,8,11,13,21 

36:3,5,16,18,22 

39:19 40:9 

reason 19:19 

recognize 25:1 

recorded 8:16 

recruit 28:22 

recruited 28:18 

recruiting 29:8 

recruitment 29:10 

red 8:4 

referring 10:10 

reflected 5:20 

regarding 19:11 

registration 3:10 

9:4 

regulations.gov 

8:20 

related 32:18 

relates 4:3,9,14,20 

relationship 15:7 

relationships 3 3: 10 

relative 25:17 31:9 

relevant3:15 

remaining 8:13 

30:6 

removing 25:8 

repetitive 35:22 

replicating 36:8 

replication 35:22 

report12:8 

represented 16:18 

representing 40:5 

request 7:12 

requires 20:19 

research 1:14,15 

2:4 4:4,6 10:21 

11:8 13:20,21 

14:6,17 25:14 

36:2,4,15 38:14 

40:9,10 

researcher 24:6 

researchers24:14 

researching 10:16 

18:8 

resistant 16:9 

resources 19:20 

26:3 38:10 

respected 17:6 

respectfully 7:11 

responded 9:10 

response 18:20 

22:17,20 28:8 

39:4,7 

responsibility 

24:19 39:22 40:6 

responsible 24:21 

rest 41:3 

result21:7 

retire 21:11 

review 4:1 

reviewed 8:9 

reviewing 9:8 35:1 

rewards 33:21 

right 3:3 6:22 9:11 

12:16 22:18,21 

28:9 31:13 40:18 

rigorous40:9 

Risinger 2:17 

32:22 33:1 

risk 33:15,22 

risks 17:22 

Rockville 1:13 

Rohlman 2:13 23:1 

23:3 39:15,17 

role 29:22 

room 28:7 

Rosenstock 19:14 

rules 7:1 

rural 14:14 15:3,14 

15:16,21 16:11 

17:10 

safe 39:22 

safety 1:2 4:12,17 

5:3 25:19,21 28:3 

33:15 

salient 8:11 

Sara 1:14 2:3,22 

satisfaction 11:11 

saying34:5 35:16 

says25:15 

School2:18 34:18 

Scientiflc 19:14 

Scientist/Coordi... 

1:15 

second 5:16 11:19 

24:17 

sector 19:21,21 

sectors 19:19 

sce9:11 10:10 12:3 

12:11,19 13:19 

14:17 18:15 22:4 

22:6 23:12 27:5 

31:12 38:11,22 

seeing 33:4 35:21 

Neal R. Gross and Co., Inc. 

202-234-4433 Washington DC www.nealrgross.com 
Page 47 

seek 21:15 

seen 14:21 

self-identified 6:8 

semester 17:9 

Senator 2 1: 10 

sense 5:13,22 6:20 

sensors12:7 

sent17:16 

seriously 31:14 

serve 9:16 30:8 

services 16:7 

session 1:7 23:2 

shape 23:22 

SHARE 1:7 

shift 39:22 

shortage15:12 

shortages 15:12 

side 16:13 

sides 10:1 

significant 11:10 

37:12 

significantly 11:13 

similarly 5:17 

simply 3:21 5:22 

single 13:21 

sit 36:13 

site 25:18 

sites 25:5 

situation 27:10 

situations 25:6 

six 9:12 

size 38:4,6 

skip 18:22 

slide 8:14 

small28:22 38:5,15 

society 32:8 

solving 32:11,12 

somebody 31:16,18 

sorry 32:3 39:15 

sort 6:10 23:2 

26:21 

source 36:9 

space 11:6 

speak 9:12 

special 27:6 

specific 21:18 

specifically 21:2 

22:11 

spent23:7 

St2:10 14:14 17:4 

stake 36:12 

stakeholder 36:16 

stakeholders3:14 

6:9 24:12 

standard 40:13 

standing 7:22 

start 8:1 14:22 18:5 

36:14 

started 3:4 18:9 

starting 26:17 

State 15:14 

stop 8:5,7 

stopped 29:12 

strategic 2:4,4,5,5 

3:21 4:2,9,14,19 

10:12 22:9 24:18 

25:13 26:14 31:21 

strategical 23:18 

strategically 24:3 

strategies 19:18 

38:12,21 

strategy 20:14,16 

20:17 21:9,17 

22:7 

street 33:8 

strengthen 4:22 

21:21 

strive 25:3 

structural 31:4 

struggling 27:12 

students 17:17 

studies 13:22 

study 14:8 26:1 

sub-goals 3:22 

submitting 8:13 

success 20:3 

successful 34:22 

suggest 10:20 

suggested 24:3 

suggestion 30:4 

suggests 11:9 

suitability 6:10 

support 5:1 21:13 

22:2 29:18,22 

sure 7:17 39:21 

40:10 

surveillance 4:5 

31:22 

survive 27:12 

sustain 22:14 

sustainability 

24:20 

symposium 1:4 

35:1 

system 36:10 

T 

T-A-B-L-E 2:1 

table 3:11 36:14 

tactic 20:15 

take 5:13 16:12 

21:16 24:1 30:21 

31:13 

talk 24:11 

talked 22:13 27:21 

talking 15:1 23:19 

25:14 

talks 24:18 

Tamers 1:14 2:3,22 

3:3 14:10 18:17 

18:21 22:15,18,21 

28:5,9 30:5,10 

32:20 34:14 37:14 

39:2,5,8,13 40:17 

Task 20:21,22 

teach 17:3 

team 19:6 29:19,20 

teams 14:6 

tech 12:1 

technology 11: 20 

14:4 

Tenney 2:18 34:16 

34:18 

terms 21:4,20 34:1 

terrific 19:8,8 

thank 3:16 8:2 9:22 

14:8,10,16 18:17 

22:15 28:5,11 

30:5,11 32:19,20 

34:14,21 37:13,14 

37:21 39:2 41:3 

thankful 35:2 

Thanks 3:4 40:17 

theme 37:2 

theoretical26:15 

theories 26:20 

theory 26:22 

thing 13:18 16:2 

25:7 38:1 

things 10:15 13:1,4 

13:7,10 15:1 18:1 

22:13 23:9 

think 6:3 13:14 

15:6 19:8,9 20:3 

20:14,15 21:3,4 

21:16,19 22:3,10 

22:11 23:9,10,10 

23:15,18 24:9 

26:7,9,17 27:7 

28:1,2 29:14,21 

33:6,22 34:6 

35:11 36:1,6,11 

37:1,12 38:20 

39:18 40:3,8 

thinking 13:16 

24:8 26:10 

third 5:21 12:11 

thoughtful 24:13 

27:1 

three 5:11 8:9 10:9 

10:18 26:2 35:5 

Thursday 40:22 

ticket 9:19 

time 7:21 8:1,5,6 

8:10 9:8,8,13 11:6 

22:1,14 23:8 29:7 

30:6,6,14 39:11 

tlmekeepings 7:21 

times 27:7 

Title 21:12 

to-day 33:9 

today 5:7 7:3 8:16 

9:12 29:13 

told 16:11 17:8 

Tom 21:9 

tomorrow 40:20 

tools 21:2 25:4 

top 35:5 

topic 12:15 

total 1:5,7 3:6,15 

3:17 4:22 5:1 

6:12 19:6,7,12 

20:6 21:4,15 

23:21 24:19,21 

26:16 27:8 30:14 

30:18,21 32:17 

34:17 35:10 36:17 

37:4,9 38:15,18 

40:15 

touch 7:20 

tough 20:11 

Town 1:7,12 3:6 

7:1,18 40:21 

traction 34:11 

trademark 30:14 

traditional 15:8,19 

16:20 17:15 

train 29:1 

trainer 28:17 29:17 

trainer's 29:7 

trainers 28:18,20 

28:21 

training 27:21,22 

29:9,16 

transcribed 8:16 

transcription 7:5 

translated 24:4 

translation 35:9 

try 20:17 40:14 

trying 5:12,17 

25:10 31:3 37:10 

TUESDAY 1:10 

twice 39:6 

two 8:18,19 9:19 

10:1 16:10 22:3 

34:9 39:17 

types 26:8 

U.S 33:11 

underpinnings 

26:16 

understand 11:14 

17:20,22 34:7 

understanding 

]0:17 

understood 8:4 

Neal R. Gross and Co., Inc. 

202-234-4433 Washington DC www.nealrgross.com 
Page 48 

unfortunately 

21:11 

unilatera125:20 

University 2:8,12 

2:13,15,20 10:7 

17:5 19:4 23:4 

30:12 37:17 39:17 

upper 27:10 

urtian 15:9 17:1 

use 8:10 21:17 

utllize 20:18 

various 11:17 12:8 

19:18 

versus13:11 

view 15:2 

viewpoint 34:10 

VPP 6:17 

W 

wage 27:13 

wages 12:12,12 

want 7:13 10:15 

12:16 13:17 16:22 

18:15 23:16 24:14 

25:15 26:5,21,22 

39:10 

wanted 33:4 

waters 34:1 

way 13:11,16 24:22 

32:10 

ways 8:19 22:3,11 

we'113:4 14:11 

18:18 19:1 

we're 9:20 33:2 

35:7,20 40:22 

we've 7:2 27:21 

welcome 41:1 

well-being 11:11 

12:13 

wellness 29:2 33:13 

went 17:4 18:21 

weren't 10:19 

West 17:3 

winners 9:12 

wise 41:1 

wish 37:20 38:22 

wonderful 14:17 

18:7 

word 23:12,15 

work 5:18 11:7,21 

12:6,7 13:5,6,11 

16:13 19:7,13 

25:5,18 27:3 

30:22 32:15 38:21 

Work@Health 

28:16,17 29:1,15 

worked 20:2 34:6 

worker 1:5,8 2:19 

3:7,15,17 4:22 5:1 

6:13 19:6,7,12 

20:6 21:4,15 

23:21 24:19,21 

25:20 26:16 27:8 

30:14,18 32:17 

34:17,19 35:10 

36:18 37:5,9 

38:15,18 40:15 

workers 27:4 3 1: 1 

32:6 40:19 

workforce 2:11 

4:22 19:3 23:5 

27:12 32:9 

working 6:15 13:2 

30:17 35:21 

workplace 4:8,13 

4:18 5:5 29:3 

32:9 33:16 34:4 

40:1 

Workplaces 2:8 

10:7 

works 15:3 37:5 

worry 15:18 

write 9:1 24:6 

written 5:8 8:18 

9:9 41:2 

yellow 8:2 

young 27:4 

1 

12:4 25:13 26:14 

31:21 

10 2:9 

14 2:10 

150 33:10 

1715:2,20 

19 2:12 

1990 18:9 

1995 18:10 

lst 1:4 

22:4 4:9 14:18 15:5 

16:18 35:6 

2,00017:11 

20141:10 

22nd 9:7 41:3 

23 2:13 

2514:15 

26 28:10,10 

27 9:18,22 

28 2:14 14:11 

2918:18,19,21 19:1 

22:16 28:6 39:6 

3 

3 2:5 4:14 23:19 

24:18 

302:16 19:1 28:10 

3122:19,19 28:6 

39:6 

32 2:17 9:18 22:22 

34 2:19 

37 2:21 

39 2:22 

4 2:4,4,5 4:20 

5 2:5,5 

5:00 1:14 

5:13 3:2 

5:54 41:6 

6.1 1:7 

600 28:20 

7 

71:10 

700 33:3 

Neal R. Gross and Co., Inc. 

202-234-4433 Washington DC www.nealrgross.com 
49 

C E R T I F I C A T E 

This is to certify that the foregoing transcript 

In the matter of: Town Hall Forum - Evening Session 

Before: CDC and NIOSH 

Date: 10-07-14 

Place: Bethesda, MD 

was duly recorded and accurately transcribed under 

my direction; further, that said transcript is a 

true and accurate record of the proceedings. 

Court Reporter __. _. 

NEAL R. GROSS 

COURT REPORTERS AND TRANSCRIBERS 

1323 RHODE ISLAND AVE., N.W. 

(202)234-0433 WASHINGTON, D.C. 20005-3701 vraw.nealigross.com