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A discussion of national priority setting systems
In recent decades far-reaching national efforts to set priorities for research in the sector of occupational safety and health (OSH) have led to redefinitions and shifts in national policies and priorities, with wide-scale involvement of all concerned—public and social bodies, occupational health and safety experts, companies, trade unions, public and private insurance agencies. The benefit of establishing national priorities in the OSH sector is clear from the success of several national stakeholder efforts to focus research and funding in key topical areas of occupational health, based on judgements that indicate the likelihood of addressing serious occupational health and safety problems. Here we describe the methods, results, and impact of national priority setting systems created by the National Institute for Occupational Safety and Health (NIOSH) in the USA, the National Institute for Occupational Safety and Prevention (ISPESL) in Italy, the British Occupational Health Research Foundation (BOHRF) in the United Kingdom, the European Agency for Safety and Health at Work for Europe, the University of Amsterdam in the Netherlands, the National Institute for Industrial Health in Japan, and the National Institute for Occupational Safety and Health in Malaysia.1–7 We focus mainly on European and North American studies, analysing their approaches to bringing together the concerned parties, looking at the measures taken to implement the priority decisions, and assessing the impact of the efforts.
Most national systems used the Delphi technique—pure or modified—which involves an iterative process of two or more cycles of discussions or questionnaires, until the personal assessments of a panel of experts converge in a group consensus. The various countries selected their experts differently, reflecting the intrinsically multidisciplinary character of the OSH sector. In general, with a view to future impact, the countries included among the stakeholders were those likely to be affected by the research, as well as the researchers themselves. This approach contributed to substantial impact in the American and Italian efforts, and led to success in the Netherlands as well. The selection of different groups of stakeholders in the individual countries was influenced by national sociocultural factors and resulted in different choices of priorities to be emphasised. Some national efforts focused on research; others were dedicated to transferability of research into widespread use in practice in the country.
In the first round of questionnaires or discussions, the Delphi technique leaves the participants free to list what they consider priority research areas. However, the European Agency provided countries with a standard form and chose as its priorities the topics most frequently listed in the National Reports from the Member States. The participants were not free to select the areas where they considered it necessary to extend knowledge in order to safeguard workers’ health. Despite attempts to unify the data, the National Reports showed substantial differences among the Member States: different subjects were involved in the projects, different degrees of agreement were reached, and the proposed EU outline was followed closely by some, less closely by others. Some EU countries contacted only a limited number of institutions, and completed the data with information from their files, not adhering closely to the standard classification suggested by the European Agency.
Other national priority setting activities also diverged from the usual Delphi system: not all the systems gave a ranking for each topic; in some cases priority was established for sub-items in relation to their macro-area. One macro-area designated for attention in four of the seven national efforts is the incidence and prevalence of selected occupational diseases, identified as needing research by the UK, USA, Italy, and Malaysia. All four of these systems listed these three sub-items as priorities: occupational asthma, dermatitis, and accidents in the workplace. Differences in national choices reflected the degree of development of research in a sector. For example, occupational carcinogenesis was assigned top priority in the Italian system, whereas the US National Occupational Research Agenda (NORA) restricted the priority area to cancer research methods. Musculoskeletal disorders, psychosocial/work organisation/stress, and special vulnerable work populations are reflected in all seven national research agendas. Injuries, dermatological disorders, and respiratory diseases are included in six national systems, and hearing loss is found in five of these.
Substantial impact has been achieved in several countries through creation and implementation of national priority setting systems. In 1996 NIOSH convened a series of national meetings to bring together all OSH stakeholders to create the National Occupational Research Agenda (NORA) which would guide OSH research into the next decade in the United States.8 To ensure that research in the 21 priority areas identified by the stakeholders would be encouraged, NIOSH established a NORA team for each priority area, consisting of about 15 members, with about half from outside NIOSH. These teams developed national research agendas for the particular priority areas, organised national conferences, stimulated research, and produced useful information (http://www2a.cdc.gov/NORA/default.html). NORA has been successful in stimulating funding and partnerships for new research needed to address the problems of workplace injuries and illnesses: from 1996, when NORA was set up, to 2003, NIOSH investment in the 21 priority areas increased from 15.4 to 94.3 million dollars. Besides the NIOSH investments, other partnering US federal agencies have awarded research funding to competitive academic scientific proposals in the NORA areas, reaching more than 30 million dollars in 2003.
The national stakeholder effort conducted by ISPESL in Italy in 2000 has also had considerable impact. It extensively involved the scientific community, the national health service, and various “social” bodies, and helped redefine the Institute’s plans for further investigation of topics related to emerging risk. This led the Ministry of Health to give absolute priority to financing research into occupational carcinogenesis, allocating 33% of the budget to this topic in 2002. Next in line are themes related to low dose and multiple exposure (23%), the quality of air and the indoor environment (17%), biological agents (14%), and the healthcare and hospital sector (13%).
The European Agency has set aside funds for further work on the topics assigned priority in the 1998 priority setting effort. Since 2000, each year’s European Week—the information campaign designed to promote health and safety at work in the 15 EU Member States—has focused on the priority topics identified. The European Week’s themes have been musculoskeletal disorders (2000), accidents at work (2001), stress at work (2002), and handling dangerous substances (2003).
In the United Kingdom, the British Occupational Health Research Foundation has assigned a large part of its research budget to the topics that were given priority. Current research at the BOHRF is focused on musculoskeletal disorders and rehabilitation techniques, aimed at restoring workers’ health in the shortest possible time so they can return to work, and on intervention techniques for acute cases to prevent chronic illness. Numerous other projects are nearing completion, regarding, for example, methods to reduce stress by reorganising work, and strategies to eliminate occupational asthma and its causes.
The successes of these seven national agendas may encourage occupational safety and health institutions in other countries to sponsor broad stakeholder efforts to identify national priority topics for which focused funding and research efforts could make substantial contributions to reduce occupational illness and injury.
A discussion of national priority setting systems