Conference Co-Chairs:

PJ EDINGTON

Executive Director

Center for Office Technology

and

DAVID FELINSKI, Manager

Occupational & Environmental Programs

American Automobile Manufacturers Association

CONFERENCE OPENING SESSION

Welcome:

David Felinski, Manager, Occupational & Environmental Programs, AAMA

Introductions:

Frank Rooney, Manager of Product Stewardship and Ergonomics, Digital Equipment Corp.

Constituency Presentations:

Marc Freedman, National Coalition on Ergonomics

Margaret (Peg) Seminario, Director, Dept. of Occupational Safety & Health, AFL-CIO

Linda Rosenstock, MD, MPH, Director, NIOSH

Keynote Address:

Henry B. Lick, PhD, CIH, CSP, ROH, Manager, Industrial Hygiene, Ford Motor Company

Mr. DAVID FELINSKI, AAMA

Good morning ladies and gentlemen. My name is David Felinski and I am with the American Automobile Manufacturers Association. On behalf of our Conference co-sponsor, the Center for Office Technology, it is both my privilege and pleasure to welcome you all here to this venerable old city on the Ohio River. I should also like to welcome you on behalf of the following organizations who have cooperated with AAMA and COT in planning and making this remarkable science and policy conference happen:

The American Industrial Hygiene Association; The American Petroleum Institute; The American Trucking Association; The Center to Protect Workers’ Rights; Chrysler Corporation; Consultants in Epidemiology and Occupational Health; Ergoweb®; Ford Motor Company; General Motors Corporation; IBM Corporation; The Institute for Ergonomics at Ohio State University; The United Auto Workers Union; The National Association of Manufacturers; The National Coalition on Ergonomics; The National Institute for Occupational Safety & Health; and Organization Resources Counselors.

This conference represents a radical departure from the several previous Managing Ergonomics or "best practices" conferences COT and AAMA have co-sponsored in that it is designed specifically to open the discussion on the scientific issues and in particular, the many policy issues surrounding the subject of ergonomics. The development, format and structure for this conference was derived from and patterned after the very successful symposium on metalworking fluids that our association sponsored and staged in November of 1995 where labor, government, and industry had a common platform and forum to openly discuss the science and the issues involving the use of and exposure to machining fluids. That Symposium represented a landmark cooperative effort between traditional adversaries in opening a constructive dialogue on an issue of mutual concern. We are now attempting to repeat that precedent, this time in the somewhat contentious area of ergonomics.

This entire conference will be conducted in a plenary session format, and contains eight discreet sessions, culminating on Friday morning with presentations by each of the three major constituencies as well as presentations by the Session Moderators on their sense of their Session and their vision of ‘where do we go from here.’. Each plenary session has two session arrangers, one of which will serve as the actual session moderator, and the other who will summarize their session and present their vision of the future on Friday morning.

Each of the eight plenary sessions will contain presentations by noted experts in the field. These presentations will be followed by Discussant’s from various perspectives who will comment on one or more of the presentations made during that session. The conference will then be open for participation and questions or comments from anyone in the general audience. We have established only three ‘rules of engagement’ for the Q&A portion of the Conference, and they are as follows:

1) You must ask your question from one of the three microphones in each of the aisles;

2) You must state your name and affiliation prior to asking your question; and

3) We ask that you be respectful.

This conference is being audio-recorded for the purpose of generating a Conference Proceedings. The Proceedings will be available via the internet, hopefully by the end of this July, and we should like to express our gratitude to Ergoweb® Incorporated for making that possible. In your conference packets is information along with your individual access code and password for accessing and downloading the Conference Proceedings from the Ergoweb® internet site.

And now without further ado, it is my pleasure to introduce our next speaker who will introduce the speakers to follow in this opening session. It is Mr. Frank Rooney and he is Manager of Product Stewardship for Digital Equipment Corporation. Thank you very much ladies and gentlemen, and we hope you enjoy this unique Conference.

Mr. FRANK ROONEY, Digital

Thank you, Dave, and good morning everybody. As Dave mentioned, I am the Manager of Product Stewardship and Ergonomics for Digital Equipment Corporation. But I am also the Chairman of the Center for Office Technology. COT is delighted to be co-sponsoring for the fourth year, a national ergonomics conference with AAMA. This has been a productive and fruitful partnership.

Before introducing our morning speakers, I’d like to take this opportunity to announce the establishment of the outstanding Office Ergonomics Award. This award is being created by the Center for Office Technology to recognize and promote the successful implementation of sound office ergonomic programs. There will be two awards announced in April of 1998 - one recognizing a private sector program, and one recognizing a public sector program. By honoring successful and innovative office ergonomic programs, COT hopes to promote a variety of successful approaches and to encourage peers to emulate outstanding programs. You will find a brochure explaining the award in your conference packet, and there will be brochures available at the COT information table in the exhibitor’s area. And I hope that several of you here today elect to put your programs up for nomination. The pamphlet is the little red one in your brochure. We tried to design it so it would be simple and straightforward, but we think it’s time that some folks get recognized for the good work they’re doing out there.

Now on with the important business at hand. The conference planning committee, which had more than two dozen participants, has designed what we believe is a dynamic, innovative and stimulating conference where we can explore ergonomic science and policy issues in a frank and meaningful way.

This morning we’ll have a conference overview presented by prominent representatives of industry, labor and government who will discuss why they are involved in this important dialogue and what they hope to achieve in this forum. I will introduce the three speakers first, and then they will give us their thoughts.

Our first speaker today will be Mark Freedman, Director of Government Affairs for the Painting and Decorating Contractors of America, and a member of the National Coalition on Ergonomics. We are delighted that Mr. Freedman agreed to substitute for Dr. Martin Reape who had found out only last Friday that he had to go to South America for his company. So, we’re getting a pinch hitter here, but he’s a very good one. Marc has been instrumental in developing his association’s response on legislative and regulatory issues, including OSHA reform, the Americans With Disabilities Act and Workers Compensation. Marc received his law degree from Case Western Reserve University.

The second speaker today will be Peg Seminario, Director of the Department of Occupational Safety and Health for the AFL-CIO. She has worked extensively in a wide range of regulatory initiatives at the Occupational Safety and Health Administration, and legislative initiatives at the federal and state level. Ms. Seminario serves on numerous federal agency and scientific advisory committees, and holds an M.S. degree in industrial hygiene from the Harvard School of Public Health, and a B.A. in biological sciences from Wellsley College.

The last speaker will be Dr. Linda Rosenstock, Director of the National Institute of Occupational Safety and Health. Dr. Rosenstock is also a professor in the Departments of Medicine and Environmental Health at the University of Washington. She received her A.B. in psychology from Brandeis University, and her M.D. and M.P.H. from the Johns Hopkins University. She has written two occupational medicine textbooks, and before coming to NIOSH she chaired the United Auto Workers/General Motors Occupational Health Advisory Board.

So we’ll begin with Mr. Freedman.

Mr. MARC FREEDMAN, National Coalition on Ergonomics

Good morning. My name is Marc Freedman as you just heard. I’m Director of Government Affairs for the Painting and Decorating Contractors of America. We are members of the steering committee of the National Coalition on Ergonomics, one of the sponsors of this important meeting. We are pleased to be involved in this conference. This meeting provides a forum to address key issues regarding the application of ergonomic principles and practices, focusing on the prevention of musculoskeletal injuries or disorders. Protecting the public and employees is a common mission for all of us participating in this conference. There are many issues and uncertainties associated with preventing injury and illness on the job and enhancing employee health. These issues and uncertainties fall into the domains of science, medicine, public policy and the legal arena. By working to identify, explore, research and reduce these uncertainties, we increase our ability to understand how to be effective. This conference can serve to help address these issues and uncertainties and support us in our mission to protect and enhance health, not only the American workforce, but around the world. The National Coalition on Ergonomics was organized in 1994 by private business and trade associations, most of whom were applying ergonomic principles and practices in their health and safety engineering activities. The Coalition was formed to provide industry with an organization to address science and policy related to regulatory initiatives being explored by the Occupational Safety and Health Administration, along with providing a voice and a source of information in an area that affected every sector of private industry. Currently, over 250 organizations belong to the Coalition, including trade associations and individual companies from all sectors of the economy. The Coalition believes that ergonomic principles have application inside and outside the workplace. We are committed to assuring that national regulatory initiatives and actions are based on science which can demonstrate prevention of specific conditions. We support prevention that can actually be achieved through defined risk management actions.

In the fall of 1996, we were invited to participate in developing this conference in cooperation with members of organized labor, other trade associations and private industry organizations, academics, consultants and government representatives. We agreed to participate because we believe the principle issues now before us are scientific, and because we believe that scientific debates should be held in open, scientific meetings, not in a regulatory proceeding. Some have challenged us as to why we oppose the draft ergonomic regulation OSHA circulated in early 1995. We based our initial opposition to a regulatory solution on the proposition that the scientific issues were unsettled. We came to this conclusion after considering a report produced by the American National Standards Institute’s Z365 Committee on Cumulative Trauma Disorders. The report, prepared by a subcommittee, was charged with evaluating the scientific literature and described to us in early 1993 by a committee member suggested that much of the literature dealing with the relationship between activities at work and various injuries, illnesses and complaints of employees could, at best, be described as lacking in adequate scientific rigor. We considered this to be a significant problem, and our concerns were confirmed by scientists in our member organizations. Consequently, the Coalition’s purpose is to assure that whatever action to be taken would be based on sound, scientific data and information, and not on opinion, speculation and conjecture which leads us to our position supporting the use of ergonomic principles in business, but opposing unsound ergonomic regulation. The issues that remain unclear are numerous. Significant among them are those related to the question of public policy that bear most directly on OSHA’s decisions. There are several questions in areas which need to be addressed for any regulatory strategy to be generally effective in the workplace. Some of the questions that occur to us include:

What specific injuries or conditions would a regulation address? That is, what conditions rise to the level of material impairment of health or functional capacity?

How do physicians define and diagnose these conditions? How can the definitions be uniformly and consistently applied in epidemiologic studies?

How should incidence and prevalence be measured? How are the statistics validated and what are the differences between the general and occupational populations?

How can the risks, symptoms and injuries related to work and non-work activities be apportioned and distinguished?

At what point does low back pain become an injury recognized under the OSHA statute, and how does that affect the risk of back injury in a working population?

What is the relative contribution of non-occupational factors to these conditions and how, from a public policy perspective, should OSHA deal with multifactorial causation in defining employer responsibilities?

How should proposed risk factors be measured in a consistent and reliable manner to apply in research studies?

 

These are but a few of the questions that remain to be answered.

Consider recent reports on low back pain. The Department of Health and Human Services suggests that the lifetime prevalence of low back pain is upwards of 80%. Clearly there remains a significant amount of research that needs to be done to identify what kinds of activities contribute to back injury, whether low back pain is a precursor to back injury, what the impact of personal factors is on the overall risk, and what factors and work activities as opposed to general life activities, create a risk, if any, of back injury in the workplace. With other occupational conditions it is easier to justify placing the entire burden on the employer for preventing the injury or disease because the causes are not normally encountered in every day life activities. But the conditions we are discussing here and the causal factors described by current knowledge are common to the general population regardless of occupation. They are ‘activity’ rather than ‘occupationally’ related. Given the uncertainties in the quantitative relationship between the causes and these conditions, allocating responsibility solely to the employer to prevent these conditions is unfair. Workforce changes and turnover rates also raise important issues in regard to determination of whether an employer is in compliance with the law that must be answered by additional research. When employees work multiple jobs, the use of complaints and injuries as the measure of compliance becomes a more difficult problem.

Another issue that has concerned us is the assertion that an epidemic is now occurring. We hear reports of hundreds of thousands of cases each year being related to ergonomics, and that cases have increased by large percentages since the mid 1980’s. While reported illnesses have increased since the early 1980’s, the last reported figures for 1995 showed a decline in total cases of 7%. Meanwhile, the often cited reports of hundreds of thousands of cases can only be reached if back injuries are included in the tally, and it is not clear whether those kinds of cases have increased at all in recent times. Moreover, we believe that there are still significant questions as to the reason for the increase in reported illnesses. The assertion that it is caused by increased pace in the workplace is not entirely credible because, at the same time, job tasks performed today require much less effort. So while the reported numbers can be emphasized to leave an impression that the hundreds of thousands of cases represents a great increase over the last 10 to 15 years, in fact, we all know that this statement cannot be supported by the current data. We await the appropriate research to explain the statistics.

The last issue I want to mention is the passion that has characterized opinions on both sides of the issue because of the absence of clear, scientific, quantitative consensus. One question that the lack of this consensus suggests is that the generally accepted motto of relating the complaints to forced repetition, posture, duration, may not accurately describe the causal relationship. No doubt this motto is intuitive - that does not make it right. Yet we have observed little, if any, research on this fundamental question. Indeed there appears to be a reluctance to involve anyone who does not accept the conventional wisdom in this area either in the debate or to fund their research. Admittedly research dollars are scarce, but unless some funding goes to those who challenge the conventional wisdom … I’m sorry, the conventional approaches … and suggest a different solution to a difficult and contentious problem, we may never have a complete understanding or agreement on this issue.

Finally, the Coalition is concerned that much remains to be learned before these ergonomic principles can be applied in a regulatory scheme to address musculoskeletal disorders in all workplaces. We think it is critical to keep in mind that there is a difference between voluntary actions taken by employers to push the envelope of practical knowledge, and having a mandatory, untested approach imposed on employers by government agencies. Many employers, such as members of my association, would be unable to accomplish the requirements of a large regulatory approach without severe difficulty and financial hardship. We look forward to an active exchange of ideas, perspectives and understanding during the next four days. The program has been constructed to present all views on the various aspects of ergonomics and its application to the control of occupational injuries and illnesses. Our goal in participating is to help develop a path forward that will address the need for a better understanding of the issues in the hope that whatever approach might be adopted will be based on a sound, scientific foundation. Toward that end, we hope that members of the audience will feel free to speak out during the discussion periods and to engage representatives of all sides in serious and challenging discussion about their assumptions and recommendations. In this way, we hope this conference might generate a little light along with the heat that accompanies this subject. Thank you.

Mr. Frank Rooney, Digital

Thank you, Marc. And now we’ll hear from Ms. Seminario.

Ms. PEG SEMINARIO, AFL-CIO

Good morning. It’s good to be here and see so many of you here in this room so interested in these important issues regarding ergonomic injuries and illnesses in the workplace. I want to start by thanking the AAMA and COT for holding this conference on this important subject. And particularly thank Hank Lick who will be our keynote speaker this morning. It was Hank’s idea and thought to have this meeting. He first approached me on this well over a year ago, and I must say that I had some level of skepticism given the heated debate that’s been going on for the last couple years about ergonomics and wondering if indeed it was possible to get everyone in the same room who are on very different sides of this issue and have a constructive dialogue. But again, my thanks to Hank, and indeed he pulled this off. I also want to thank all the members of the planning committee who participated in trying to pull together what we hope will be a good and constructive program. But most of all, thank all of you who have taken four days out of your busy schedule to come here and talk about these issues. I was asked this morning to speak about why we at the AFL-CIO were involved in this process and have come to participate in this meeting, and what we hope will come from it. Simply put, the reason why I am here is because too many workers indeed are being hurt, are suffering, are in pain, are being disabled by musculoskeletal diseases related to their work. And I in my job, and I think most of us in all of our work, are obligated to do all that we can do to prevent these serious injuries and illnesses.

Let me start by telling you about one of these workers. A woman by the name of Shirley Mack who I had the honor and privilege of getting to know well over a year ago when she came to participate in a 25^th anniversary celebration of the Occupational Safety and Health Act, and the AFL-CIO’s Workers Memorial Day activities. Shirley is a single mother of four who lives in a small town in North Carolina where she was employed for several years as a poultry worker. Her job was to split chicken breasts. She made the same cut over and over and over, thousands of times every day. One day her hand started going numb; she reported it to her supervisor. But he ordered her to go back to her job or else she would be fired. Shirley was diagnosed with carpal tunnel syndrome and other forms of nerve damage. After a few days of restricted work activity, she was fired from her job. She wakes up every morning in wrenching pain, she can’t fix meals, she can’t hang clothes, she can’t go to the grocery store - she basically can’t do anything to provide for her family. She’s disabled. She’s had her life entirely changed by a musculoskeletal disorder caused by her job. She was denied workers compensation. She was forced on welfare, public assistance in order to provide for her family. Now all of us in this room who deal with ergonomic problems day in and day out know that she indeed is not alone, that there are thousands of other workers just like Shirley who have been disabled, seriously injured by musculoskeletal disorders caused by their jobs. These workers are women, they are men, they work in meat packing, they work in auto assembly plants, they work in textile mills, they work in nursing homes, they work in the construction industry. They basically work in all sectors of our economy. Many of these workers are in their 30’s and 40’s. They are becoming hurt and disabled when they had many more years left in their lives. And so the reason that I have come to this conference today is with the hope that through the discussion of the next several days that we can come together and really come to some agreement as to ways to move forward to prevent these injuries from occurring.

Now for the last number of years, as many of you here are well aware of, ergonomics has really gotten caught up in the middle of a lot of political fights that have been going on in Washington, particularly the fight about what is the appropriate role of our government, and particularly in this instance, when it comes to worker safety and health. There have been a number of attempts over the last couple of years to stop any government action on an ergonomics standard. There were proposals made, and for a while successful, to prohibit OSHA from developing a rule, developing voluntary guidelines on this issue. Last year there were attempts to stop OSHA from collecting data on ergonomic injuries and illnesses. This year the proposals are somewhat different. They are ones that would say no standards or guidelines could be issued until the National Academy of Sciences conducts a review of the scientific literature. And we expect that that debate and discussion around ergonomics will be coming in the next several weeks and months. And that fight will go on, and it will continue. But while that fight has been going on in the political arena, as all of you here know, there’s been an awful lot of work going on in ergonomics.

Unions have been doing a lot of training, they’ve been working jointly with employers to find solutions to problems. Companies have been identifying problems, taking action at their workplaces. There’s an awful lot of you providing consulting services to try and help employers deal with these kinds of problems. In the academic community, there’s a lot of research going on to answer some of the underlying questions of science, and NIOSH at the federal government level has been conducting research. They came out last year with a primer on effective approaches to ergonomics, and they are about to come out with a comprehensive review of the scientific literature. For a while, unfortunately, the political activity caused the Occupational Safety and Health Administration to go into a deep freeze and hibernation on ergonomics, but there are some signs of life there. OSHA is beginning to restart their initiatives and look at different ways that they can move forward on this issue. But what has happened while the political fight has been going on, there’s been a lot of other activity. That activity has largely taken place independently in isolation. There haven’t been the kind of national forums, the kind of opportunities to come and have a discussion about the issues that we are concerned about. And so, hopefully, this conference will provide us that kind of opportunity to have the discussion around these issues.

So, what I would urge for the next few days is for us to listen to each other - listen to what our experience has been, listen to what our findings have been around these important issues. Let us try to identify those areas where there actually is agreement - agreement about what we can do to identify the kinds of cases that are work related with respect to musculoskeletal disorders, control measures that are working, the appropriate treatment measures, the kind of training, the kind of interventions that are working throughout this country to prevent these kinds of injuries and illnesses. And let’s identify those areas where more research is needed. So the basic message here is to use this week as a way to figure out how to move forward, not to just have a debate for the purpose of debate. The science and policy issues on ergonomics are not going to be resolved by a vote in the United States Congress. They are not going to be answered or resolved by a small group of experts impaneled by NAS going off to study the issue.

So we believe that the problem of ergonomic injuries and illnesses is indeed the major safety and health challenge that we face today. We don’t think we need to resolve every last scientific issue before we move forward to try to prevent these injuries. The problem is simply too big, too important to ignore or deny. And there are indeed too many workers who are suffering. So what I would ask is that we do now what we can in the next several days to have the discussion, to look at what we can do to move forward on this issue, to get back looking at ergonomics as a safety and health issue instead of a political issue, and commit ourselves to finding the path forward. Shirley Mack and the thousands of other workers seriously injured and disabled each year deserve our best effort and our best work. Thank you very much.

Mr. Frank Rooney, Digital

Thank you, Peg. And now we’ll hear from Dr. Rosenstock.

Dr. LINDA ROSENSTOCK, NIOSH

Thanks. I’m walking over here not to distance myself from the previous speakers - although some of my comments may in a moment - but because I’ll need to be able to see this screen. As the academic that I still consider myself to be, I rely on slides.

One of the charges for those of us giving this overview is to try to describe why our organization, or organizations we represent, was participating in this conference. NIOSH was a member of the planning committee, was proud to be so. We think this is an important forum. We also liked the choice of Cincinnati - we think it’s a great city. Many of you know that 500 of our now nearly 1,400 employees work in Cincinnati and they’re delighted to, in some sense, be helping to co-host this event. I’m also intrigued to be a part of any conference where the initial comments invite that anyone coming up to the floor to speak should be respectful. That does suggest a different kind of meeting than most scientific meetings.

I also want to put into context before I tell you a little bit about what NIOSH is doing and turn over the podium to Hank Lick, who I’d also like to congratulate for his efforts in getting this conference together and his overall efforts in trying to keep our eye on the correct ball when it comes to ergonomics. This conference, in my mind, is an important follow-up of one that took place in January that was co-sponsored by NIOSH and OSHA with many other organizations working with us - the Effective Practices Conference. I think that let us, at that point in time, move forward with recognizing that many individuals and companies and associations whatever their perspective might be on some of the science and policy issues that we’re going to be addressing the next few days, were already making great strides in terms of trying to address this very significant, serious, and we would contend, largely preventable problem. For those of you who weren’t able to be with us in January, we were able to draw a record crowd of over 1,000 - we had to turn away many at the end, just for size and problems of capacity - and the proceedings will be available shortly from NIOSH and OSHA. I think there was a consistent message. The consistent message was that there was a need for employee involvement and management support of ergonomics programs, and that there were many examples and many different kinds of work settings of successes of using these kinds of steps to move forward to address the problem. Successes both in terms of reduction in the health burden of musculoskeletal disorders and also successes in the economic burden - a true win-win situation which we would argue is very much going to be the case as we move forward in dealing with these problems. And it’s clear that although research has demonstrated a link between job factors, work-related factors and musculoskeletal disorders of many types, for several decades and that as we heard earlier this morning, there seems to still be considerable debate about the nature, magnitude and causes of these problems. I must say, personally, I’m sometimes stymied by the scope and range of the debates and hope what will become clear in the next few days is that there is actually a mainstream scientific position. And that although there are research gaps, that the mainstream scientific position will demonstrate consistently a real relationship between specific work factors and specific health outcomes. And that we already have, despite these gaps, sufficient knowledge to move forward with a preventive program of many different types. Can I have the first slide, please?

We heard mentioned … this is a slide that’s going to be described in much better detail and with much more finesse by Bill Weber from the Bureau of Labor Statistics who will follow later this morning, the red line going up identifies the illnesses due to repeated trauma reported by employers to the Bureau of Labor Statistics. The red line going up represents a 14-fold increase in the time period, the 25 years or so that these data have been collected. These do exclude low back disorders - largely upper extremity musculoskeletal disorders explaining the main rise in reporting of these conditions. And there is a drop, as you can see, in ’94 to ’95 of about 7%. Now I’d like to point out that this drop which we are delighted about if it is real in terms of a real reduction in these problems, and we hope indeed it continues because of the efforts that are taking place, still puts this problem at a higher level in 1995 than in any previous year before 1994. So the problem is obviously a large one. Now we have lots of information from other conditions in general and specifically for musculoskeletal disorders that will talk about why these are systematic underestimates of the problem. And I know there’ll be more discussion of that in the next few days.

Now another way of looking at this problem, and now here looking at reported injuries and illnesses involving lost work days - again, employer reported - is that in this yellow piece of the pie here, about 30%, over 700,000 cases here, and this does include low back disorders - a very significant problem in scope. So although there may be a debate raging on about what exactly explains in detail the rise, I think there can be no question - and we are the first to admit that perhaps better recognition and reporting explains some of this rise - whatever the debate may be about that, anyone who would argue that this is not a significant work-related problem I think really needs to have more discussion take place if we’re really trying to have an open scientific debate. It is a major problem for workers in this country. It’s a major problem for employers. And that’s one of the reasons that employers, as we’ve heard, are doing a lot to try to deal with it. This was a survey that came out about six months ago now, looking at large companies, those who report over 500 million dollars in revenue a year. And they reported that in even one year, between 1996 and 1995, there was an increase in complaints of repetitive motion injury. And as you can see here, the vast majority are already taking steps to deal with this very real and very significant problem, whether it be modifying equipment and tasks, looking at work jobs, new equipment, referring workers for medical treatment and training and the like, obviously recognizing a problem and recognizing that there are effective approaches to trying to deal with it.

Let me turn to NIOSH to end my overview comments in terms of where we sit in our role in dealing with musculoskeletal disorders. The first thing is, we get a lot of requests. And a lot of our requests come from small and medium business owners and those who work for them trying to get help from us. We have a 1-800 number, the last full year for which we have data available. About 4,000 calls coming in requesting information about how to deal with musculoskeletal disorders, what to recommend for them to prevent these problems. We also get requests at about 10-15 to actually do on-site health hazard evaluations to look at specific work places. In response to those requests, we actually came up with the primer which Peg just mentioned, which we released in draft form in the January Chicago Conference and in final form several months ago. And that’s available to you today as part of your packet. And that was really based on our cumulative experience in performing health hazard evaluations, coming up with this 7-step common sense approach to how to deal with these problems.

Now, on July 1, we will be releasing a document that is, to our knowledge, the most comprehensive review to date of the scientific literature of the epidemiology of musculoskeletal disorders. We focused on upper extremity-specific conditions of concern - carpal tunnel, neck, so on and so forth, wrist tendonitis, elbows and the like. We looked at its specific risk factors, low back disorders as well. This document has gotten a significant amount of attention. It has received the widest external peer review in NIOSH’s history. The peer review comments were extensive and, because of that, it has taken quite a bit of time to be as responsive as we can to the scientific peer reviewers as we have been revising this document, soon to be released to the public. In that document, we will make a qualitative assessment looking at well established epidemiologic principles of the strength of the evidence of relations between specific work factors and select outcomes. And it will become clear, and that’s part of our business indeed, that there is strong evidence for some but not all risk factors and for some risk factors in combination, particularly for some conditions, and that of course research gaps exist. But I, again, think it would defy the mainstream of scientific opinion to challenge that there is not a really extraordinary body of information that already tells us about the significant relationship between workplace factors and these medical problems.

I want to turn now in closing to one other activity - and some you in the room have helped us with this activity and how musculoskeletal disorders fit into it - our National Occupational Research Agenda that was designed as a wide open process with broad partnership of many in industry, labor, the academic community, health professionals and others to help NIOSH and the rest of the occupational safety and health community define the top priorities for research in the next ten years in the United States. As a result of this open process we had remarkable consensus of the priorities that we needed to focus on - 21 priorities - 8 in the disease and injury categories, and the rest in two other categories. And if we look to the issue of ergonomics, I would like to identify that two of the top eight priorities in disease and injury for research for the next ten years are the key ones for low back, the group of low back disorders and musculoskeletal disorders of the upper extremities. And indeed a number of the other research priorities as shown here, such as emerging technologies, organization of work, health services research and so on, have a clear direct relation to this major work place problem.

Let me just give you a sense of the strong consensus that came to this open process. We had five expert working groups using a voting process about priorities. All five identified, for example, for upper extremity musculoskeletal disorders that this was a top research priority. It was similarly endorsed by a corporate liaison committee that was chaired by General Motors. It was also endorsed by a group of international occupational safety and health research institute directors, and by really myriad other individuals and organizations. There was similar strong endorsement of the need for more focused research in low back disorders. So we don’t disagree for a moment of the need for more research and are working actively in implementing the agenda to generate such research activities and awareness. But despite our being the first to recognize and to conduct ourselves and fund significant research portfolio in the area, I would like to close with the message that I hope is strong and clear from NIOSH, and I think is extremely well based in science, is that we have a very large problem in health and economic terms. And that despite the research gaps, there are many ways in which preventive actions can and should be taken now. Thank you.

Mr. Frank Rooney, Digital

Thank you, Linda. Before introducing our keynote speaker, I just want to remind you that immediately following the keynote we will begin our first panel session. And the first break of the morning is scheduled for 10:45.

Our keynote speaker today is Hank Lick, the Manager of Industrial Hygiene at Ford Motor Company. Hank has a doctorate in instructional technology and over 30 years experience as an occupational health, safety and environmental professional. Certified by the American Board of Industrial Hygiene and the Board of Certified Safety Professionals. He serves on the National Advisory Committee on Occupational Safety and Health. In 1996, Dr. Lick was selected Michigan’s Safety Professional of the Year by the Michigan Safety Conference. Dr. Lick.

<Dr. HANK LICK, Ford Motor Company

Okay, we’re going to use this podium - again, not to distance myself from anyone. Good morning. It’s good to be here and to have this meeting, and to finally discuss the science and also the policy issues as they’re related to ergonomics. Before we get started I’d just like to thank Linda and Peg for their kind remarks, but I think you also should recognize that an artist needs a canvas to paint on, and Ford Motor Company gives me that canvas. And my friends at UAW-Ford also give me that canvas too. So, I couldn’t be here without the support of Ford Motor Company and my friends at Ford-UAW.

So, anyhow, a lot of good things have already been said framing the issues, why we should be here. I believe I should thank my fellow symposium organizers for the honor of being selected the keynote speaker. Although I don’t know, that may be a dubious honor when you consider the debate around ergonomics. They told me that people on all sides know that I appreciate their views on ergonomics, and perhaps I have too much of an appreciation of the issues on both sides.

When you’re in the business for 30 years you do see people, like Peg told you about, that are suffering from the results of occupational disease. Ergonomics is a different kind of disease. It’s not like seeing someone with lead poisoning. It’s a different kind of disease. But the tragedy is that you can get people in their 30’s and 40’s that aren’t going to work for the rest of their lives. And not working for the rest of your life is not a good way to go. It’s not good for us.

I’ve thought about this speech since I was asked to give it about six months ago, and how this speech would be different than the one that I gave in Chicago at the Best Practices Conference. At that time I made it perfectly clear that I support ergonomics and its goals. And you know that Ford Motor Company is behind ergonomics. So, I’ve spent a lot of time talking and thinking about what the issues are - researching the issues and thinking about them. I’ve even re-read the Constitution because there are issues of law, as Mark brought up and David Sarvadi, I think, will talk about them later on. There are issues of economics. Ergonomics does go with economics. So I re-read Adam Smith, I re-read Keynes, several Harvard Business Review articles on ethics, organizations, globalization and the changing issues in business. And as you can see from Linda’s slide, things have changed over the last 30 years or so. So there is a lot to say . . . where do we start with this?

What I’d like to do is take a few minutes and just take you back in history. On August 31, 1990, then Secretary of Labor Elizabeth Dole, was interviewed by Charlie Gibson on Good Morning America. That date sticks in our mind at Ford quite a bit because we entered into an agreement with OSHA on a corporate-wide settlement on ergonomics and recordkeeping. So we used that tape, and I’m going to show you that interview in a minute. Mrs. Dole had some interesting remarks especially when considering the issues of ergonomics and the ensuing debate that has come about. And if you take a look at this piece that I’m going to show you, you can see how they apply and how some of the questions continue to haunt us. Her remarks can help frame some of our discussions this week, and where we’re going to go. So, let’s go back seven years and take a look at what Mrs. Dole had to say on Good Morning America. [Videotape excerpt presentation]

Charlie Gibson: All reported occupational illnesses are work-related disorders called repetitive motion injuries. Any job in which a single task is repeated, from working the assembly line in an auto plant to typing at a video display terminal, could subject an employee to the kinds of stress that cause these painful disorders. The symptoms are pain and irritation from damage to nerves, tendons and joints. Well yesterday the Occupational Safety and Health Administration announced its initial guidelines to protect workers from repetitive motion illnesses, and the Secretary of Labor, Elizabeth Dole, is joining us this morning from Washington to talk about these guidelines.

Good morning.

Elizabeth Dole: Good morning, Charlie.

Gibson: You have repetitive motion illnesses in a number of industries. I mean, there’s as many industries that have these things as you can count. And yet I understand that your guidelines only involve one, is that right?

Dole: The guidelines apply to the red meat industry, Charlie, which has about ten times as many repetitive motion illnesses as the workplace generally. But this is just the beginning. We have a national emphasis program. A part of that will be to move toward rulemaking, either by a request for information or an advanced notice of proposed rulemaking in keeping with the President’s regulatory program that will apply to all industries involving ergonomic problems.

Gibson: I always get lost when you talk about guidelines and rules. Explain the difference to me. What are these guidelines going to do? Are they designed to relieve the conditions that cause the illnesses?

Dole: Yes, the guidelines are, really they’re four ‘pillars’ if you will. First of all to identify by job analysis if you, a red meat plant, have problems with repetitive motion illnesses. Secondly, to take steps which are recommended in the guidelines to solve those problems for your employees - to have an effective training program and a medical management program. Now, we’re recommending that employers use these guidelines. They will be very, very effective in reducing or eliminating these kinds of illnesses, which are 48% of workplace illnesses today. There will also be a targeted inspection program which will begin in January for these kinds of illnesses. And if an employer has not signed an agreement to set up a plan using these guidelines, then they will be subject to the targeted program, the inspection program. We will also, as I’ve mentioned, move forward to cover industries overall with regard to ergonomic problems.

Gibson: With all due respect, why has it taken so long? The meat industry here…there have been complaints about these problems literally for years. They exist in other industries as well...that’s been known for a long time. Why has it taken so long to get guidelines in just one industry?

Dole: Charlie, this is a complicated situation in that the illnesses, the ergonomic illnesses, have probably existed for 200 years, but the science has only begun to develop several years ago. And frankly, part of it is because we became more aggressive in requiring employers to keep their records properly. In other words, we’ve had large fines, we’ve aggressively pursued recordkeeping. And as companies have had to record their illnesses and injuries more accurately, it’s certainly produced the higher numbers of ergonomic illnesses. And this has been something which the medical community, the employers, the employees are now discovering as these records are kept more properly because we’ve been aggressive and the fines have been large. But the science of ergonomics has been developing just in recent years. So these guidelines reflect the state-of-the-art, if you will. They’re designed to reduce these illnesses as quickly as possible and as many as possible. In other words, we’re going to move forward aggressively using guidelines, using a targeted inspection program and moving to cover the entire industry across the board.

Gibson: It’s indeed a pleasure to have you here.

Dole: Thanks very much. My pleasure, Charlie.

Gibson: Thanks for being here.

Well, we’re back to 1997. When asked why Charlie Gibson - and Charlie Gibson is probably the same like myself, he’s looking better in 1990 than he is in ’97. But, anyhow, when asked by Charlie Gibson what had taken so long, Mrs. Dole talked about ergonomic injuries going back 200 years. And she said, well only now the science had progressed to the point where ergonomics could be used as an intervention. She also said that 48% of workplace injuries were ergonomics-related. And depending on whose numbers, it’s still a fairly large number. It seems like OSHA made its case; it seems like Mrs. Dole made her case.

Well, so what happened? Ross Perot once told us when he ran for office that the devil’s in the details, and that’s exactly where it’s at. Part of the details are climate and perception and who defines science. I used to think that science was an empirical study. It’s really not. One thing that life teaches you is everything is not just black and white, it’s shades of gray.

So, in 1990 -- let’s take a look at the background here. 1990 - George Bush was President, Iraq invaded Kuwait and George Bush was very popular. Then George Bush and Congress raised taxes, we went into a recession, corporate downsizing accelerated and the U.S. economy moved towards a service economy. Bill Clinton then became President.

After Bill Clinton became President, the Republican revolution and the religious right really crystallized the anti-Washington, anti-regulatory sentiment in this country. It’s said that Americans can’t live with regulation, but they can’t live without it. And if you look at the debate on tobacco and everything else, it depends on whether you like tobacco, whether you like ergonomics . . . everyone can embrace science at one point in their career, in one point in their life as to their perspective.

Anyhow, in business it continued to become leaner and very much meaner, looking for cost reduction at every turn. And with the downsizing and everything else came the advent of small business. Small business became a force to be reckoned with.

So with all of this, why are we here? Well, I’d like to talk about leadership and responsibility. So we’re all health and safety professionals in this room. And, believe it or not, we’re people of privilege. Now you can say, well what makes me privileged? Well, by either education or influence, we’re people of privilege. However, with privilege comes responsibility. This symposium is an exercise in responsibility. It’s not about bitter debate; it’s an exercise in responsibility. We are here to explore the science and to consider the policy issues in ergonomics. Ergonomics gives us a view of the present, and it also gives us a view of the future. The present is a bitter and sometimes a very divisive debate and gridlock. And it’s extending to all of health and safety. The future could be more of the same until we completely destroy occupational health and safety. We destroy the gains that we made.

So why is this debate so bitter? There’s good reason for the debate to be bitter. It’s in the definition of science and who defines it. It’s in basic issues such as management rights and prerogatives, in job design and work organization. It’s in the cost of controls and the ability to retrofit controls in ergonomics. It’s also issues of infrastructure - you just don’t throw equipment away. And if it’s hard to maintain, how do you deal with that?

And finally there’s the ever tightening issues of cost pressures and cost containment and reduction. This is our basic background. But then there’s technical issues. There’s technical issues in substance that impact differently on areas in manufacturing, office and administrative workplaces, construction, warehousing, transportation and shipping, and finally service industries. All of these have different issues that are not necessarily ‘organ specific’ or ‘body part specific’ as they were in other more traditional occupational risk factors in occupational medicine. Further, there’s the evaluative tools and analytical tools that vary in their effectiveness in all of these areas. And finally, injury rates and their validity also vary in these industries.

But, as Peg said, however you cut it, people are still getting hurt. And it’s easy not to personalize that when you don’t see them, but people are still getting hurt. And, yes, we must appreciate that a lot of their injury, they bring to work with them from outside activities. But we like to say there’s no free lunch and we still have to deal with the issue by placing workers and rehabilitating them, either through the occupational health scene or the health care system. With the rising cost of health care, you just can’t push people off to the side and not deal with them.

The science of ergonomics in some areas is very deep - Linda talked about that a little bit. In other areas, such as evaluative tools as they relate to specific issues such as age, physical condition or underlying health issues, the science is much thinner. So, how do you consistently calculate ergonomic risk when a few variables can complicate the probability of an injury occurring?

I’d like to say, if we create standards or regulations or guidelines where the holes in the filter are too large, all jobs will pass through. And with this endpoint, ergonomics loses its credibility. Jobs need to be prioritized and identified. The ergonomic issues must be identified through hard data, and they must also be identified through worker input. This week we must answer some of these questions. We must answer the questions of how do you get people back to work and where do you place them, what is the proper medical management protocol, and shouldn’t medical management and medical treatment fit the worker and not be ‘formula medicine?’

These are among the issues we must confront this week. All the right people are finally here in one place. Now we have the responsibility to review the science and present it. We finally have the opportunity and obligation to rationally consider all of the policy issues. And now it’s time for all of us to get to work, and I thank you.