Impactful partnerships: an occupational health perspective
In my discipline of occupational health, we aim to improve the health of workers by identifying workplace hazards and developing strategies to reduce exposure. Some strategies are more effective than others. Ideally, hazards are eliminated from the process completely, or perhaps replaced with a safer alternative. Engineering controls can isolate workers from the hazard or administrative controls used to change behavior. Ultimately, personal protective equipment serves as a last line of defense.
Of course, a tricky thing about workers is that they tend to have employers. Any effort on our part to improve conditions for workers, if it is to be successful, ultimately needs to involve the company. To even conduct the investigation, we typically need permission to access the workplace and talk to workers. Most importantly, once our work is complete, we want our recommendations to be implemented. This is best achieved by building a relationship of trust with the company during each stage of the process.
Understanding a suspected cancer risk
As an example, our group has worked to investigate exposure to polycyclic aromatic hydrocarbons (PAHs) among asphalt paving workers. PAHs are a complex mixture of hundreds of chemicals, many of which are either known of suspected to cause cancer. We all have at least low levels of exposure to PAHs from diesel exhaust, cigarette smoke, grilled food, and even some dandruff shampoos. But because the composition of asphalt is about 10% PAHs, and it is applied at high temperatures when paving roads, asphalt workers have higher levels of exposure while on the job.
Early studies showed an increased risk of cancer among asphalt workers but there was very limited information about the exposure details. What jobs or tasks had the highest exposures? Does most of the exposure occur from inhalation or from absorption through the skin? What changes could we make that would be accepted by the workers, supported by the company, and effectively reduce exposure? This information was necessary for us to make useful recommendations.
Working with all parties
To ensure our work had the maximum benefit for workers, we engaged in a multi-sector partnership that included representatives from government, industry, and labor, working with the National Institute for Occupational Safety and Health and the Centers for Disease Control and Prevention, the National Asphalt Paving Association, the Laborers’ International Union of North America, and the International Union of Operating Engineers).
To be clear, an approach like this is hard. Everyone at the table represented a set of particular positions and interests that did not always align. However, there were two key factors that made it successful:
- We shared the goal of improving the health of workers. This common mission was our North Star and the group came back to this point repeatedly, particularly during disagreements about peripheral details.
- Everyone agreed that the researchers from academia and government would make all decisions related to the investigation and would have no restrictions on the ability to publish the work. The input of all stakeholders was important at every stage of the project, but in the end, it was critical that we had the freedom to conduct our work and communicate our findings without interference.
Ultimately, our research found that asphalt paving workers primarily absorb PAHs through their skin. We then developed exposure reduction strategies that have now been implemented by the asphalt industry, to the benefit of workers and the industry. For example, by reducing the application temperature of the asphalt significantly, it lowered exposure for workers. This change not only reduces exposure, but is also less expensive for the industry.
As another example, we found that substituting biodiesel fuel for diesel fuel as a cleaning agent led to further reductions in exposure. This change was especially welcomed by workers because the biodiesel proved to be more effective at cleaning their equipment. The science itself was of course important, but it was the partnership approach that positioned us to maximize our impact on worker health.
Using research to enact change
While this example is in the field of occupational health, I believe the approach is relevant more broadly to our work in all domains of population health research. We always seek to maximize the real-world benefits of our work, extending beyond the publication of a journal article or presentation at a professional meeting. But it is difficult to achieve this goal when academics only partner with other academics. If we aim to change the world by journal article alone, progress will be slow.
Many companies are developing new technologies and products that are designed to improve population health. Their missions are well aligned with our mission as public health professionals. They don’t know how to design and conduct research studies and I don’t know how to engineer innovative gizmos, so there are ways we can each contribute our expertise to accelerate progress.
Again, compared to traditional academic research, this approach is hard. And we must take steps to ensure that we maximize the benefits while avoiding the potential pitfalls. But if academic public health can become better at seeking out opportunities to find these matches and develop new partnerships, guided by a shared mission to improve population health, there is potential for us to significantly expand our reach and have a real-world impact in ways that otherwise would not be possible.
Michael McClean, ScD is the Associate Dean for Research and Faculty Advancement and a Professor of Environmental Health at the Boston University School of Public Health.