Dr. Paul Schulte was the Director of the Division of Science Integration and Co-Manager of the Nanotechnology Research Center at the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC). He currently is a consultant with Advanced Technologies and Laboratories International, Inc. Dr. Schulte has 47 years of experience in conducting and developing guidance on occupational cancer, nanomaterials, risk communication, workplace well-being, and genetics. He also has examined the convergence of occupational safety and health and green chemistry and sustainability.
He is the co-editor of the textbook, Molecular Epidemiology: Principles and Practices. Dr. Schulte has served as guest editor of the Journal of Occupational Medicine and the American Journal of Industrial Medicine and was on the initial editorial board of Cancer Epidemiology, Biomarkers and Prevention. He is currently on the International Advisory Board of the Annals of Occupational Hygiene. Dr. Schulte has developed various frameworks for addressing the aging workforce, burden of occupational disease and injury, well-being of the workforce, and translation research and synthetic biology and occupational risk.
Episode Description
Some important milestones have passed during the pandemic blur of the last few years. The 50th anniversary of the National Institute for Occupational Safety and Health (NIOSH) was one. Created by the Occupational Safety and Health (OSH) Act of 1970. NIOSH, one of the Centers for Disease Control and Prevention (CDC), was established as a “separate and independent research program to create objective scientific research findings in the field of occupational safety and health.” Today’s episode of Stats+Stories with guest Paul Schulte
+Full Transcript
John Bailer
Some important milestones have passed during the pandemic blur the last few years. The 50th anniversary of the National Institute for Occupational Safety and Health NIOSH was one created by the Occupational Safety and Health at OSHA act of 1970 NIOSH, one of the Centers for Disease Control and Prevention CDC was established as a quote separate and independent research program to create objective scientific research findings in the field of Occupational Safety and Health. Today's episode of stats and stories focuses on using epidemiological, statistical and biological information to protect workers. I'm John Bailer. Stats and Stories is the production of Miami University's Department of Statistics and media journalism and film, as well as the American Statistical Association. Joining me as a panelist is Regina Nuzzo, professor at Gallaudet University and freelance science writer. Rosemary Pennington is away. Our guest today is occupational health researcher Paul Schulte. Schulte was the Director of the Division of science integration and CO manager of the nanotechnology research center at NIOSH, Dr. Schulte has 40 years of experience in conducting and developing guidance on occupational cancer nanomaterials risk communication, workplace wellbeing and genetics. He also has examined the convergence of Occupational Safety and Health and green chemistry and sustainability. He is the CO editor of the textbook molecular epidemiology principles and practices. And he currently serves on the International Advisory Board of the annals of Occupational Hygiene. Dr. Schulte has developed various frameworks for addressing the aging workforce burden of occupational disease and injury, well being of the workforce and translation research and synthetic biology and occupational risk. Paul, thank you so very much for being with us today.
Paul Schulte
Oh, well, it's my pleasure. I really was looking forward to this.
John Bailer
Oh, us too. Well, Paul, to start our conversation off. Could you talk a little bit about the difference between NIOSH and OSHA? I mean, I think a lot of people get those confused. So why don't you help set that straight?
Paul Schulte
Well, you alluded to it in your opening, we were both formed under the Occupational Safety and Health Act of 1970. And around that time, people finally essentially got fed up with the fact that many workers were dying from occupational hazards or made sick or being injured. And it was time to get a concerted national effort to address that. And so they were able to pass the Occupational Safety and Health Act. And then what they did was they divided the responsibilities because, as you well know, Occupational Safety and Health is not just a public health science kind of effort. It's a highly charged political effort. And so to deal with that, they put the science on one side in one entity, and that was called the National Institute for Occupational Safety and Health or NIOSH, and they put the enforcement and the development of regulations on the other side. And that was the Occupational Safety and Health Administration, which is part of the Department of Labor. NIOSH was in the Department of Health and Human Services, or its predecessor. So we're in two separate, we were in two separate Cabinet departments. We work together, but we were separate. Again, just to note, I am now retired from NIOSH, after 47 years. And I'm a consultant now, but I don't speak for NIOSH. And anything I say, is my own opinion.
Regina Nuzzo So Paul, I'm curious, you just said you've retired after 47 years. So were you at NIOSH in the very beginning of its formation?
Paul Schulte
No, I was. I was about five years into its history. In government time. The law passed in 70. The show didn't really get on the road to about 72. So by the time I got there in 75, it was early days, but I have not considered what are called the NIOSH pioneers. I'm just an old timer.
Regina Nuzzo I'm curious how this idea of health and safety has changed since the 70s. What is different, you know, I'm picturing different types of jobs, different people, different environments, what are we dealing with now that we're not dealing with then?
Paul Schulte
Well, it's a good question. Indeed. I did a blog a couple years back, where I depicted five eras of Occupational Safety and Health, but the most and then in the old, old days, you can go back to the Egyptians and the Romans and the Greeks. And then you can go up through the industrial era in Britain. But around 1970, the major concerns were the hard physical hazards, exposure to chemicals, traumatic injuries, and heavy physical affects of those kinds of things. Since then, there has been an evolution to the point that now we're talking about total worker health. So we've evolved to not just talking about physical, chemical and biological hazards, but talking more about psychological hazards, psychosocial hazards, and overarching concepts like wellbeing, and total worker health. So we're taking a more holistic view now. Whereas back in the 70s, and 80s, the problems were so acute, just dealing with those kinds of problems was the high priority.
John Bailer Can I follow up just to drill down a little bit more on the question that Regina raised and that, and Paul, you alluded to some of these hard chemicals, you know, sort of explicit specific exposure to a single chemical in a certain industrial context? Can you give kind of some examples of that, you know, I'm thinking of like benzene or some of these other decisions that were early on with regulation. And then some of the recent stuff when you're talking about psychosocial? Can you talk a little bit more like, you know, how stress plays out in that I mean, all of us that are coming out of the pandemic, I think, have thought the whole work environment was a stressful one as a consequence. So can you talk a little bit about sort of examples of the early types of explorations that were being done in Occupational Safety and Health and some of the more recent ones?
Paul Schulte
Well, indeed, you've identified it, some of the high volume chemicals in in society in commerce, many are known to be a highly toxic and particularly toxic in the area of cancer carcinogenic, it was also in the 1970s, when the whole understanding of chemical carcinogenesis was coming into under into play, and how chemicals could impact the nuclear structure of cells and lead to carcinogenic responses. So early on, if the first recommended standard that NIOSH did was for asbestos. And clearly, asbestos is one of the was one of the big substances in commerce and utilize going back for decades and left in its wake millions of workers with lung disease, both carcinogenic and non carcinogenic, various kinds of lung diseases, there were other major things like benzene, all the solvents pretty much have neurologic problems. So solvents were a big deal. And then certainly traumatic injuries, workers getting arms, cut off limbs, cut off fingers, all that was a serious thing. And, also early on noise was understood to be a serious hazard. So these are the kinds of things that were the emphasis in the 1970s. Okay, then you can progress to where we are today, where there was a body of research started in the 70s harassing work and others about job demands and job control, leading to stressful situations leading to physical and, and psychological impacts. And so that is the progression now to more psychosocial hazards and dealing with them. And then a more whole, as I said before a more holistic view of the well being of workers.
Regina Nuzzo
So it's no longer the case that the dirtiest jobs are the most dangerous, then?
Paul Schulte
Well, I use the concept of a mosaic we're in a mosaic of occupational hazards where we still have the classic ones of the past. And we may have them as they were, or we may have them as old hazards in new situations, but they're still we know about them, but So those still exist, but now we have all kinds of newer hazards. And so the dirty jobs are Still the dirty jobs, but there are new kinds of jobs that may not look dirty, but they can still be quite hazardous to workers.
Regina Nuzzo
So give me some examples of what is a stressful dangerous job that is dangerous because of its psychosocial stressors?
Paul Schulte
Well, people who have to work 24/7, who can be on call by their supervisor by their boss at almost any time, some cases where the boss really expects them to answer some cases where they put, the boss puts out a message and the person feels compelled to answer even though the boss isn't necessarily expecting it. So you get this, you get this stress that can have then physiologic blood pressure effects, other kinds of physical effects, and can lead to anxiety, depression, burnout, in some cases, suicidal ideation, you can see some serious mental health issues. And and one of the things that we've seen with the pandemic is that what we expect to occur increasingly in the future has been accelerated to be happening now with the pandemic, that people working alone under 24/7 type of conditions in many cases,
John Bailer
you know, just that, you said that NIOSH is described, NIOSH is kind of this research entity that's exploring these hazards. And the idea that hazard has evolved over 50 years is seen as a pretty compelling idea. So can you talk a little bit about some of the ways in which, you know, you would explore you not necessarily you explain, but you as well, but how NIOSH has has explored these early hazards that you talked about in the 70s, when when was formed to now it seems like it's gonna be a lot harder to study these, these more complicated cumulative types of milieu of hazards.
Paul Schulte Well, indeed, and in the 70s, and 80s, in the early days of NIOSH, and in Occupational Safety and Health Research, in general, there was essentially a main effect that was looked for and in research, and everything else was considered a confounder, or noise. And so the approaches were to control for those confounders and look at their main effect. We've grown to a point now where where we appreciate their simultaneity of insults to work, some of which are directly related to work, some of which are totally not related to work in another that their origin is outside of work, some of which are and who in 1984, established this concept called Work relatedness, which is where personal factors and outside factors could exacerbate occupational hazards. So we now have a more of an understanding of there's a simultaneity of insults. And and then we have we've seen growing, particularly in the environmental health field, the whole concept of cumulative risk assessment, where you not only look at one hazard, you look at the multiplicity of hazards that are occurring at one time and then over time, so and then I put it back to you all, what are the statistical approaches that we're going to need to sort this out? It's beyond my knowledge level. But what I do know is that I think things like multilevel modeling are going to be one of the tools and departures from that, but there's probably other ways to think about this. And I think that's going to be one of the big challenges for the statistics and epidemiologic areas.
John Bailer
You're listening to Stats and Stories. Our guest today is occupational safety and health researcher Paul Schulte. In a recent commentary, Paul, you and co authors talked about an expansion of this traditional occupational and safety framework to consider both what horizontal things that you've been discussing these personal risk factors and socio economic risk factors as well as vertical components, the idea of pre work, work and post work. Can you talk about why this has been an A very important expansion that is considered in terms of the framework for evaluating Occupational Safety and Health?
Paul Schulte
Well, this is a concept that is not necessarily accepted in the field. This is a concept that I and colleagues are promoting, because this is what we see is needed. Just the discussion we've had thus far. They change from the chemical, physical and biological hazards of the seven days to the psychosocial hazards of more recent years. And the need for holistic approaches to deal with them led us to think that the field has to expand partly for, for defense of the field and for its its stature as a field within society, Occupational Safety and Health has to be able to speak to the problems of the day and their problems of the day or not exposure to one particular chemical, that is a problem not to diminish that. But the problems are that we have a huge mental health crisis in this country, exacerbated by work is accelerated by the pandemic, and and in characteristic of a response to working environments that, as I said, are 24/7 that blur the distinction between work and family, that is, put a intense burden on people such that never before have we seen such prominence of the terms resignation, or burnout, even burnouts been talked about for decades, but not to the extent that it is now. And, and so the Occupational Safety and Health field has to be positioned to talk about all those things and address those things. And since they encompass more than just what's in the workplace, they have to have a broader view. NIOSH, envisioned this 15 or so years ago, and promoted the concept of total worker health, Dr. John Howard, the director of NIOSH envisioned what was going to happen and was a strong proponent of thinking about total worker health, which is another way of packaging all the things we've been talking about. And that is, so the field needs to expand. And it needs to expand in a number of ways. You talk, John. about the model we put out where we talked about what we call the horizontal expansion, where we need to think about personal risk factors, as well as risk factors. And you need to think about social and economic effects, as well as just work related effects. But then we talk about a longitudinal expansion, and that has a number of components. One is that instead of thinking about one job in a person's life, we need to think about their whole working life. So we call that their working life continuum. And within that, well, there's growing data that people in their lives are going to have many jobs, not just one or two, it's not, certainly it's not you worked for one place for 50 years, and you get a gold watch. The last data, which is about 1012 years ago, had people with over 12 jobs in their lives. And that was an underestimate.
They had truncated the data. So it's clearly going to be more. So the time when people work can be thought of as they're at work, and they're going to leave work. So they're either going to do it because of some duress, or stress, or they're afraid to leave because of the precarity of their situation. Then they leave, they're unemployed, and they get another job and so forth. Occupational Safety and Health has to study that whole process. They have to study work under employment, unemployment, precarious work, and overworking lifetime. Also, occupational safety and health needs to focus not only just on a specific worksite, but on the workforce as a whole and talk about the quality of the workforce, and issues within the workforce. And then just the epitome of the model. The top of the arrow is an overarching concept of well being. And everybody uses well being in the conjuncture phrase health and well being, but nobody defines it. And so if we're going to use it as a variable in Occupational Safety and Health Research, or as a target indicator, we have to operationalize it. And that's where that's where we are now. And so that's what we were calling for in the expanded focus.
Regina Nuzzo
So call this sort of thing that you're talking about with stress and across the lifespan. This sounds social, this is more social science and psychology. It also sounds harder to measure than In your exposure to benzene, how are you able to measure these things in a way that you can actually use the data? And just technology healthcare? What? What can you do to get that data?
Paul Schulte
Right? You said the secret word social science. The field of Occupational Safety and Health historically has been made up of physicians, toxicologists, nurses, engineers, industrial hygienists, statisticians, epidemiologists, and lawyers. And eventually psychologists, were calling in the expanded focus papers, the need for more social science to be part of Occupational Safety and Health, maybe even to the point that we have to change the distribution of skill sets within the field to be more predominantly people who can look at psychosocial factors, including economics, particularly, and we need more of those kinds of people. We also need two other things. One is that the whole field needs to adopt Systems Thinking approaches. And you're familiar with the literature on systems thinking. And its it again, is another way of holistically characterizing situations and there's a whole are subsets of systems thinking. And so we're so that's one thing, the other thing is transdisciplinarity, that we've talked for decades about interdisciplinary and multidisciplinary, but we really need to get to transdisciplinary approaches. And that means that different disciplines actually collaborate. They respect each other's paradigms, they learn each other's language, and then they jointly attack a problem using the strengths of their disciplines. Now how we're going to get to your core question of how we're going to analyze the complexities of the world of work, as we've just been describing, it is indeed the challenge of our time. And there are models of how people are starting to approach that. But I'm sure we all want to ratchet them up.
John Bailer
As you were talking about this, Paul, the thing that came to mind for me was, you know, you're in the past that was very much about kind of controlling or setting limits on exposure to it seems like now that I'm in the way you're describing what you're this the system, this framework is more of a positive promotional component, you know, moving from controlling to promoting, you know, controlling exposure, so that to minimize damage, to promoting a context in which the you have this outcome of whether it's well being or health or however you're defining this outcome is being done. Is that on target? Am I missing it? Or am I hitting it?
Paul Schulte
One of my, my colleague of recent years, one of my colleagues is Dr. George DelClose the University of Texas School of Public Health. And so we've been working together on this expanded focus model. And the old paradigm was, we want to bring a worker home from work the same way they went to work. George has stated in a different way, we want to bring a worker home from work better than when they went to work better conceptually, in the sense that we know work is healthy for you, good, decent work, is healthy for you. Decent Work stimulates people, it gives them a sense of dignity, it gives them money, it gives them lots of good things. If it's bad, we know that bad side, we've talked about that. That's what Occupational Safety Health deals with. But work can be made. Total worker health in part is the merging of prevention and promotion work. And I'm not talking about gyms at work. That may be a piece of it, but we're talking about participation in the decision making process of your work autonomy, to have some decision latitude in your work gives the worker a feeling of sufficiency, a feeling of satisfaction with their work, and they enhance are made better by that these are sort of nonspecific terms, but made better than if they were if they were downtrodden.
Regina Nuzzo
So I'm picturing an app; tell me if this is crazy. I'm picturing an app like the old centers That would measure how much radiation I was getting, you know, inside the plant. Now I'm picturing an app that's telling me how much stress I'm getting. Whether it's time to take a break, I'm sitting down too much i All the accumulation of everything that's going on in my life. Is that it or not? What can individual workers be gaining? From all of this research? How will it make a difference in their lives?
Paul Schulte
Well, I don't know if an app is possible, but the concept is good. They take stock of all the stressors that one has in their lives, and especially when they're going to and from work and in their work. And somehow, if you could gauge that, it may be within the App. And then you had some sort of decision making that you could make based on the feedback from that gauging would allow them to make decisions that would avoid some of the more deleterious impacts of all that. So yeah, I think that's right on, right on track. I just wanted to say, though, back to the statement that maybe we wouldn't measure levels of stress the way we would like, say many levels of benzene wouldn't have. But possibly there are tools that will allow us to measure stress or well being certainly, NIOSH has just come out with the well BQ questionnaire. It's a survey, it's a survey, it's been validated, it's publicly available on the website, designed to capture five different domains related to wellbeing that includes both the work related and non work related ones. This is sort of like maybe the precursor of what you're suggesting, Regina, have some sort of app. And there's other ones. Susan Peters, I think at Harvard has the Thrive tool there. I'm sure there are many others. So thinking about how to capture the cumulative insults that people are experiencing. And then the challenge would be, well, what is the risk assessment that you would do with that? And what are the cut points you would make? Or what would be the ways where you say, This is too much? Or this is, this is okay. That's part of the frontier that we're at now?
John Bailer Well, Paul, I'm afraid that's all the time we have for this episode of Stats and Stories. Thank you so much for joining us today.
Paul Schulte Well, this has been really fun, and thanks for going out I think some very important points.
John Bailer
It's our pleasure to have you have you join us. Stats and Stories is a partnership between Miami University’s Departments of Statistics, and Media, Journalism and Film, and the American Statistical Association. You can follow us on Twitter, Apple podcasts, or other places you can find podcasts. If you’d like to share your thoughts on the program send your email to statsandstories@miamioh.edu or check us out at statsandstories.net, and be sure to listen for future editions of Stats and Stories, where we discuss the statistics behind the stories and the stories behind the statistics.