Table 6 Interview Respondents’ Recommendations for Building Organizational and Leadership Support for OSH and WHP

Benefits of integration

For the Health Department

• Including OSH/WHP expertise on teams brings a specialist perspective that improves program outcomes: “…if you are trying to address infection control or Ebola…the people who know the most about personal protective equipment (PPE) are occupational health and safety people, and those are the people that need to be at the table when you’re talking about PPE requirements…so you need to have more of a team approach.” (OSH1)

• Using WHP to coordinate chronic disease efforts at the worksite fosters a more strategic approach and allows chronic disease programs to expand reach: “…there must be some sort of worksite objective or goal that, the money that goes to the chronic disease program, can go to that. Because that’s where so much of their reach needs to be is in the worksite and they’re not taking advantage of it…or if they do work with the worksite, it’s very limited. Maybe just something on blood pressure or something on diabetes. So they miss the big picture piece where we go in there with the CDC Health ScoreCard and we do an assessment and then we figure out what does this worksite really need to focus on.” (WHP3)

For OSH/WHP programs, specifically

• Integration boosts leadership awareness of the contributions of OSH/WHP to health department goals: “You know, occupation is not listed over there as the agency priority. But we can say through occupational health surveillance…what kind of mother in what kind of occupation, what kind of industry is more likely to have a pre-term or very low-birthweight baby...So through this link…the agency says ‘Oh! Occupational surveillance can help the agency to achieve the agency’s goal…’” (OSH2)

• Integration provides access to other funding streams coming into the department (especially important when existing OSH/WHP capacity precludes applying for targeted funding): “…since we’re not likely to start from scratch and establish [OSH] as a new program area…I think that CDC looking at ways that OSH can be incorporated into other programs…kind of more of a “one health” approach is probably gonna be more successful…for example there’s a lot of money that gets funneled into health care associated infections. And that’s a program we have here. So if there are tools and resources and funding towards expanding HIE surveillance programs to also include some aspects of occupational health and safety, I think that would be the most successful way to go.” (OSH3)

Strategies for promoting integration

• CDC can fund integration by specifying that a certain amount of existing awards be applied to OSH/WHP activities, make collaboration with OSH/WHP a requirement to receive funding, or require integrated teams.

Barriers to recognizing OSH/WHP as core public health

• NIOSH funding only half of states for OSH surveillance perpetuates view that OSH is optional/elective: “There’s no consistent model for occupational safety and health in a public health department, that you can reliably expect to be there for every single state in the country…like half the states in the country don’t have anybody in the public health department!…it’s a real shame…that there is no consistent, core funding or expectation for occupational safety and health in public health.” (OSH8)

• OSH not viewed as public health’s responsibility because of other state agencies (e.g., Department of Labor) that work in this field: “I’m asked all the time ‘What do you need more resources for in Occupational Health, doesn’t OSHA take care of that?’” (OSH4)

Strategies for promoting OSH/WHP as core disciplines in public health

• NIOSH fund all SHDs for basic OSH surveillance: “I think it should be essential funding, by the federal government…because there is no clear commitment from CDC, OSHA, or federal government…the locals don’t see it as a problem.” (OSH5)

• Add industry and occupation indicators to all major public health data sets (e.g., BRFSS)

• CDC encourage inclusion of occupational and environmental objectives in State Healthy People objectives

• Increased federal funding for WHP

• CDC release more WHP-focused tools (e.g., CDC Worksite Health ScoreCard) and training: “…we haven’t had that coming from CDC saying this is important and we’re going to have a conference...But I think those kind of things are what gets the SHD leaders and staff thinking ‘Oh so this matters too, and it’s a part of all that we do’” (WHP3)