Program Scoring and Rationale - Agriculture Forestry and Fishing Research at NIOSH - page 158

protective structure [ROPS]) may have been the most efficient approach available,
however creative partnering with other organizations, on items such as the NAWS
survey might have provided additional information to guide program develop-
ment. There are numerous examples beyond surveillance where NIOSH might
reasonably let responsibility for an aspect of worker health and safety rest with
another agency, but it was difficult to find that such a decision was arrived at after
intentional consideration and decisionmaking.
In the 1990s, the AFF Program attempted to conduct surveillance through the
FFHHS program and the OHNAC program. In addition, the AFF Program funded
the National Farm Medicine Center in Wisconsin and the Great Plains Center
for Agricultural Health in Iowa to conduct surveillance in two rural surveillance
catchment areas. More recently, a second phase of the Regional Rural Injury Study
has been funded.
The AFF Program needs to develop its surveillance program by using surveil-
lance results in partnership with other organizations. Examples of some of these
include the Centers for Disease Control and Prevention (CDC) National Center for
Injury Prevention and Control, the National Center for Health Statistics (CDC), the
National Animal Health Monitoring System (USDA), NIOSH Ag Centers, the Na-
tional Children's Center for Rural and Agricultural Health and Safety, agricultural
safety specialists at 1862 land-grant institutions, equipment manufacturers, and
such informal groups as agricultural, fishing, and forestry workers and employer
focus groups. NIOSH program directors and managers have not fully used CDC's
surveillance findings for intervention targeting and development. Injury surveil-
lance in the fishing industry appears to have been undertaken more expertly, at least
for commercial systems of the far North, and health surveillance beyond hazard
surveillance in the forestry industry is in programmatic infancy. Further, the use
of hazard surveillance systems for nonfatal injuries and illnesses holds promise for
being a more cost-effective model for identifying emerging issues. In addition, the
use of sentinel monitoring of occupational illnesses and injuries, first proposed in
1983 (Rutstein et al., 1983) by NIOSH staff has not been actively pursued and may
also be cost-effective.
Stakeholders
On the basis of the information provided by the AFF Program, remarks pro-
vided by stakeholders, and comments submitted by the public, the committee un-
derstands that the AFF Program has not fully engaged its stakeholders. It has had
some remarkable partnerships to reach stakeholders, such as those with the com-
mercial fishing industry in Alaska, but it has struggled to engage other stakeholders.
The program has met the most success when it has understood stakeholder needs
by asking for direct feedback from farm workers, loggers, and fishermen. It has also