Development of Occupational Health Measures for the National Health Security Preparedness Index

The 2001 World Trade Center and 2005 Hurricane disasters, and the 2014 Ebola outbreak were major events that tasked the United States' public health emergency preparedness and response apparatus. The health and economic cost of these events is huge including over 4000 deaths and damages to infrastructure worth hundreds of billions of dollars. Unfortunately, the U.S. labor force was disproportionately affected (1–4). Similar public health impact of other disasters on workers has also been reported. In the immediate aftermath of the Gulf of Mexico oil spill, for instance, approximately 75% of those who developed acute health effects and sought medical care were clean-up workers (5). The United States civilian labor force is large (ranks third globally), with approximately 160 million people, and most disasters tend to occur during work hours (6–8). Hence, we believe health security strategies that are customized to the needs of workers are critical. Additionally, we believe future evaluation of national preparedness and response level should consider objective occupational health and safety metrics. recently completed its first quadrennial evaluation of the progress made in achieving its national health security goals – the National Health Security Review 2010–2014 (12). Despite the progress that has been made in achieving its goals, the review recognizes that " the science of evaluation in this emerging area of expertise is still relatively new. " However, evidence-based evaluation of national public health programs is critical to their future success (13). Hence, the collaboratively developed National Health Security Preparedness Index (NHSPI), inspired by the Centers for Disease Control and Prevention, is welcomed (14). To the best of our knowledge, the NHSPI is the only tool currently available to measure the preparedness of each of the states in the U.S. The index is calculated based on values assigned to 194 measures that are believed to influence six broad domains of national health security (15, 16). The domains are (i) incident and information management, (ii) health-care delivery, (iii) environmental and occupational health, (iv) countermeasure management, (v) community planning and engagement, and (vi) health security surveillance. On reviewing the environmental and occupational health domain of the index, we found that only measures of environmental health were included; there are no indicators of occupational health and safety (17). As the NHSPI gets revised in the future, we hope objective measures of occupational health and safety would be considered. We believe collaboration with government and academic institutions that have …