(over)

In April 1996, The National Institute for Occupational

Safety and Health (NIOSH) and its partners unveiled

the National Occupational Research Agenda (NORA),

a framework to guide occupational safety and health

research into the next decade. NORA is a tool not

only for NIOSH but for the entire occupational safety

and health community. Approximately 500

organizations and individuals outside NIOSH provided

input into the development of the Agenda. Prior to

NORA, there had been no national research agenda in

the field of occupational safety and health (and no

research agenda in any field) which had captured such

broad input and consensus. This unique process

resulted in remarkable agreement about the top 21

research priorities (see below).

NORA arose out of a need to address the changes in

the U.S. workplace as well as the increasingly

diversified workforce. The distribution of jobs in the

U.S. economy continues to shift from manufacturing to

services. Longer hours, compressed workweeks,

shiftwork, reduced job security, and part-time and

temporary work are realities of the modern workplace.

The U.S. workforce will grow to an estimated 147

million by the year 2005, with minorities representing

28% of the workforce and women approximately 48%.

NORA also provides a means to target research in

areas with the highest likelihood of reducing the still

significant toll of workplace illness and injury. Each

day, an average of 9,000 workers sustain disabling

injuries on the job, 16 workers die from a workplace

injury and 137 workers die from work-related diseases.

These injuries and deaths continue to inflict a

tremendous toll in both human and economic costs. A

NIOSH-funded study published in 1997 showed that in

1992, indirect and direct costs (including

administrative costs) of occupational injuries and

illnesses totaled $171 billion ($145 billion for injuries

and $26 billion for diseases). These costs compare to

$33 billion for AIDS, $67 billion for Alzheimer’s

Disease, $164 billion for circulatory diseases, and

$171 billion for cancer.

These numbers alone point to the need for continued

occupational safety and health research. However,

research efforts in both the public and private sector

face increasing fiscal constraints. Through NORA and

its collaborative structure the nation is better

positioned to address the toll of workplace injury,

illness and death.

Implementation

The development of NORA was only the first step in

the effort between NIOSH and its many partners to

guide and promote occupational safety and health

research. Since NORA was announced, there has been

a common commitment to implement the Agenda

primarily by increasing activities and resources in the

21 priority areas.

NORA Priority Research Areas

Disease and Injury

Allergic and Irritant Dermatitis

Asthma and Chronic Obstructive Pulmonary Disease

Fertility and Pregnancy Abnormalities

Hearing Loss

Infectious Diseases

Low Back Disorders

Musculoskeletal Disorders of the Upper Extremities

Traumatic Injuries

Work Environment and Workforce

Emerging Technologies

Indoor Environment

Mixed Exposures

Organization of Work

Special Populations at Risk

Research Tools and Approaches

Cancer Research Methods

Control Technology and Personal Protective

 Equipment

Exposure Assessment Methods

Health Services Research

Intervention Effectiveness Research

Risk Assessment Methods

Social and Economic Consequences of Workplace

 Illness and Injury

Surveillance Research Methods

November 1998
Twenty Partnership Teams (the two musculoskeletal

priority research areas are being addressed by one

team) were formed to assist in the implementation of

the agenda. Each team consists of a team leader,

NIOSH researchers, and external partners. The 20

Partnership Teams have brought together 120 NIOSH

researchers and 150 external members including

representatives from academia, labor, industry, health

and safety organizations, the insurance industry and

other government organizations.

A NORA Liaison Committee and a Federal Liaison

Committee also have important roles in the

implementation of NORA. Both committees provide

outreach and help guide the progress and direction of

NORA implementation.

A Broad-Based Partnership

NORA has been successful on many levels. In March

1998, NIOSH, in partnership with three Institutes of

the National Institutes of Health (the National Institute

of Arthritis and Musculoskeletal and Skin Diseases,

the National Institute of Environmental Health

Sciences, and the National Heart, Lung, and Blood

Institute) announced an $8 million investment in

investigator-initiated occupational safety and health

research (the largest single infusion of funding ever).

The investment will support grants for studies in

selected NORA high priority areas and represents a

three-year commitment of $24 million.

Early in the NORA process, NIOSH made a

commitment to redirect some of its resources to the 21

NORA priority areas. Out of an overall operating

budget in FY 96 of $165.3 million, the NIOSH

baseline investment in the NORA priority areas was

$15.4 million (approximately 9% of the budget). Of

this, $8.7 million was devoted to intramural research

(NIOSH-conducted) and cooperative agreements

(NIOSH-funded extramural research that NIOSH

initiates and participates in) and $6.7 million for

research grants (extramural investigator-initiated

projects). A redirection of resources in FY 97 nearly

doubled this investment to $28.1 million.

A new $5 million special Congressional appropriation

to NIOSH in FY 98 for NORA, coupled with

additional reinvestment of baseline monies into NORA

priority areas, resulted in an estimated $46.9 million of

To obtain a copy of the National

Occupational Research

Agenda (No. 96-115),

the NORA Update 1998 (No. 98-141)

or Partnership Team products call:

1-800-35- NIOSH

(1-800-356-4674)

or visit the NORA site on the

NIOSH Home Page at:

http://www.cdc.gov/niosh/norhmpg.html

research (about 25% of the budget) in NORA priority

areas for FY 98. Such an increase is tangible evidence

of NIOSH’s commitment to NORA. This shift is

particularly notable given existing Congressional

mandates and obligations that limit how much of the

budget can be redirected.

The Federal Liaison Committee was instrumental in

conducting the first-ever Federal survey of occupational

safety and health research. The survey identified a total

of only $204 million for all occupational safety and

health research from all Federal sources. The FY 96

baseline for NORA from non-NIOSH Federal sources

was about $15 million. Federal partners have agreed

to perform the survey biannually. The next survey will

assess FY 98 expenditures.

The Partnership Teams have also had much success in

collaborating with key stakeholders, defining research

needs and leveraging resources for research. The teams

have published white papers, held conferences and

workshops, developed surveys, established graduatelevel training programs, participated in continuing

medical education workshops and developed

documents.

Further successes for NORA include NORA’s selection

as a semifinalists for the prestigious Innovations in

American Government Award sponsored by the Ford

Foundation and administered by Harvard University’s

John F. Kennedy School of Government. The number

of organizations using NORA as a model for creating

research agendas or other types of partnership and

planning is also noteworthy. Examples include the

Italian National Institute for Occupational Safety and

Health, the Department of Defense and the Chemical

Industry Institute of Toxicology.

DHHS (NIOSH) Publication No. 99-108