Education and Training Program in Occupational Health Services and Policy

Introduction to the Program

The Division of Environmental and Occupational Health (EOH), and the Division of Health Services Research and Policy (HSRP) in the School of Public Health at the University of Minnesota have established a collaborative doctoral-level education and training program in occupational health services research and policy. This new program builds on existing doctoral programs offered by both divisions. Students may enter through either division. All students will take a rigorous two year program in statistics, research design, sampling, survey methodology, econometrics, health economics, occupational and environmental epidemiology and toxicology, exposure assessment and policy. Doctoral students in EOH will obtain a minor in health services research, policy and administration. Doctoral students in HSRP will complete supporting course work in environmental and occupational health.

Two important trends are generating increased demand for researchers trained in both occupational health and health services research and policy. First, the scope of occupational health is expanding. Health and safety issues in the workplace now include access to care for occupational illness and injury, evaluation of the cost and quality of care, and utilization patterns in occupational health services. Occupational health concerns also include the supply of, and demand for, occupational health and safety professionals. Second, policy-makers are demanding more detailed and rigorous evaluation of proposed workplace regulations. Increasingly, proposed regulations must be supported by cost-benefit and cost-effectiveness analyses, including estimated effects of the proposed regulation on employee and community health risks and health outcomes.

In the future, many important areas of research in occupational health and safety will focus on the organization, financing and delivery of health care services (including clinical and preventive practice guidelines). This is the traditional domain of health services research. Health services researchers have addressed questions regarding cost, access, and quality of preventive, acute, and long-term care services in both public and private health care delivery systems. However, relatively little is known about health services for work-related conditions whether delivered by occupational health providers, private clinics, or workers' compensation managed care systems.

Key questions warranting investigation include:

• What is the role of the public versus private sector in improving health and safety in the workplace?
• Who will design new interventions to improve the work environment?
• Who will oversee evaluation of those interventions and be responsible for public dissemination of information about successful results?
• What are the appropriate statistical approaches to evaluation, particularly when subjects cannot be assigned randomly to treatment and control groups?
• Do successful interventions pay for themselves through improvements in productivity, or do they require additional financing.
• If additional financing is required, who should pay: the government, the employer, the employee, or some combination?
• Who will be responsible for managing the delivery of services under those programs?

These questions all are within the realm of health services research, but require a thorough understanding of the substantive context of occupational health and safety. Currently, we believe that the best way to address these questions is through collaborative research between experts in occupational health and safety and health services research and policy. In the future, however, we believe that research and training efforts in this area can be expedited by training a cohort of doctoral students who have expertise in both areas.

To facilitate this training effort the National Institute for Occupational Safety and Health (NIOSH) is providing grant support to the University of Minnesota to provide tuition and stipend support to doctoral students accepted into the program. In addition, NIOSH has begun to identify a research agenda for occupational health services research as part of its National Occupational Research Agenda (NORA). We anticipate that graduates of this new doctoral program will assume leadership roles that enable them to contribute to the scientific knowledge base and policy evaluation efforts identified by NORA.