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CENTERS FOR DISEASE CONTROL AND PREVENTION

NATIONAL INSTITUTE FOR OCCUPATIONAL

SAFETY AND HEALTH

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### lst INTERNATIONAL SYMPOSIUM ON TOTAL WORKER HEALTH

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### SESSION 6.1 TOWN HALL FORUM: SHARE YOUR INPUT TO THE NATIONAL AGENDA FOR TOTAL

WORKER HEALTH

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### TUESDAY OCTOBER 7, 2014

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### 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 i4 6 414=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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### Page 30

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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### Page 3]

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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### Page 33

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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### Page 34

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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### Page 35

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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### Page 36

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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### Page 38

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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### Page 39

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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### Page 40

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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### Page 4]

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.)

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

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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