We would like to thank Wegman and Davis for their response to our article and congratulate them and their coleagues on the recent report from the National Academies of Science, Engineering, and Medicine: A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century (NAS report).1 We share Wegman and Davis’s optimism that this moment offers an opportunity for developing systems that generate better, more comprehensive data to improve our understanding of the social determinants that drive health inequities and empower society to eliminate health inequities. Whether arguing for a greater recognition for the influence of work on population health or a greater accounting for the role social structures play in health inequalities manifest in the workplace, the need for a more inclusive, social determinant approach to health inequity2 is a central theme of both documents.
One way social determinants are rendered invisible is that relevant data are simply not collected. Including work-related items in public health data collection instruments and ensuring occupational safety and health (OSH) surveillance systems capture additional sociodemographic variables are essential steps to integrating a social determinants of health approach into health inequity research. The NAS report emphasizes the need to better account for race and ethnicity as well as employment arrangement in OSH systems. Two additional variables that are mentioned but warrant more attention are nativity and business size, as both are associated with elevated rates of occupational injury.3 These two variables, together with race/ethnicity and work arrangement, should be designated as core variables collected in OSH surveillance systems. Research should also explore how the combination and interaction of these risk factors contribute to increased vulnerability.4
National Institute for Occupational Safety and Health work with the Mexican consulates5 and business associations6 demonstrates how partnerships with nontraditional stakeholders are essential to promoting health equity. The proposed flexible “systems of systems” approach1 highlights minimally invasive ways to use existing data collection systems of partner organizations to gather better, more in-depth data on individuals from underrepresented groups. Research findings on social determinants of health inequity can lead to greater use and further integration of health equity concerns into the policies and practices of these stakeholders. Engaging nontraditional partners also provides an opportunity to educate them on the importance of OSH and the relationship between work and health. These efforts can lead to innovative approaches that capitalize on the existing infrastructure, programs, and resources to promote health equity.7
Acknowledgments
Note. The findings and conclusions in this letter are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.
Contributor Information
Michael A. Flynn, Occupational Health Equity Program, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH..
Thomas R. Cunningham, Training Research and Evaluation Branch, Education and Information Division, NIOSH..
Emily Q. Ahonen, Departments of Environmental Health Science and Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis..
Kaori Fujishiro, Division of Surveillance, Hazard Evaluations, and Field Studies, NIOSH..
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