Occupational Health Policy Research Articles

Non-Decision Making in Occupational Health Policies in Developing Countries

Developing countries have no significant policies for occupational health. This analysis identifies four broad mechanisms through which state- and enterprise-level decision makers in developing countries diffuse attemps to instigate improvements in occupational health: inaction or stifling of such efforts during policy implementation; exercise of power; appeal to the existing bias (norms, rules, procedures) of the system; and prevailing dominant ideology. Addressing these limiting factors requires initiating a process of raising the occupational health policy profile that recognizes the importance of empowering workers' organizations, and enabling professionals to play an active role in the generation of occupational health knowledge required to improve occupational health in the developing countries.

Are Separate Standards for Occupational and Environmental Exposures Good Public Health Policy?

Occupational and environmental exposures are treated as distinct entities for the purpose of public health protection. Yet workers and community members may experience the same exposures simultaneously or within a very narrow time frame. Agricultural chemicals applied by workers in the field drift into residential communities. Chemicals may be carried from a work site, with or without physical boundaries, into the home and delivered to household members. Meteorological conditions transport agricultural chemicals or stored ashes to residential communities during and after the work day. Occupational standards generally allow a higher level of exposure to workers than environmental standards allow for community exposures. For some chemicals, standards exist for only one exposure group, thus leaving the other exposed group without protection. The distinction between occupational and environmental exposures assumes the identification of specific human activities as work or non-work. However, not all human activity falls clearly into one specific category. The strict separation of occupational and environmental exposures therefore renders public health protection of all exposed people difficult to achieve. An in-depth discussion about the factors and assumptions that are used when occupational and environmental standards are separately applied to exposed populations is needed to enhance the public health of all people.

Commentary on Nilsson R, Björdal C, Andersson M, Björdal J, Nyberg A, Welin B & Wilman A (2005) Health risks and occupational exposure to volatile anaesthetics: a review with a systematic approach. Journal of Clinical Nursing 14, 173–186

Commentary on Nilsson R, Björdal C, Andersson M, Björdal J, Nyberg A, Welin B &amp; Wilman A (2005) Health risks and occupational exposure to volatile anaesthetics: a review with a systematic approach. <i>Journal of Clinical Nursing</i> 14, 173–186

Estimation of Burden of Lead for Offspring of Female Lead Workers: A Quality-Adjusted Life Year (QALY) Assessment

This study demonstrates an empirical example that uses quality-adjusted life year (QALY) as a common metric for occupational health assessment to measure the utility loss of potential lead-exposed children delivered by female lead-battery-exposed workers. A set of nationwide health examination data was used for 1726 lead workers. Among them, there were 649 female workers. The numbers of offspring from female lead workers were estimated by multiplying the age-specific fertility rate (ASFR) by the number of workers in each age stratum. The quality of life assessment for these offspring was assumed impaired by increased absorption of lead using a measure of utility for quality of life that was adapted from Rosser’s index of health-related quality of life. The total utility loss was calculated by summing up the loss of QALY for these expected offspring. Dose-response and exposure assessments were based on their mothers’ blood lead levels. It was estimated that more than 38 babies were delivered in 1 yr. There would be 19 babies born with blood lead levels over 30 µg/dl, and about 17 babies with blood lead between 10 and 29 µg/dl. The expected utility loss of the babies was estimated to be about 216 QALY, of which 51.6 QALY was attributed to the babies with moderate blood lead level, while that of high blood lead was 164.4 QALY. An effective industrial hygiene program to reduce blood lead to 5, 10, and 15 µg/dl in female lead-exposed workers would decrease the utility loss to 169.5, 126.8, and 92.3 QALY, respectively, in the offspring. An alternative policy of raising the age of female workers by 5 or 10 yr before employment would also reduce the loss to 174.6 or 107.4 QALY. Data suggest that an effective industrial hygiene program should be implemented, and the use of QALY as a common metric for comparative assessment of occupational health policy may be feasible.

Dangerous Illusions: Cautionary Tales In The History Of Medicine

The recent deaths from avian influenza in Vietnam, Cambodia, and Thailand have generated much concern that avian flu could be the world’s next great pandemic. As of this writing, forty-eight people have died and tens of millions of birds have been slaughtered. Microbiologists fear that if the current strain, which has been passed from bird to bird and from bird to human, were to evolve to allow human to human passage, it could quickly kill millions. What does this mean for our faith in modern medicine? Gerald Grob’s expansive history, spanning the centuries from colonial America to the present, seems ever more relevant as we contemplate this latest epidemiological threat. Grob shatters the comfortable assumption that the future of medicine is one of unlimited progress. Documenting the experience of disease in America, from smallpox to AIDS, he explores the many variables that have shaped epidemics and the role of medicine in containing them. After presenting extensive and detailed evidence, he argues that increased natural immunity, reduced pathogen virulence, improvements in nutrition, and broad public health policies have been much more important influences on declining mortality from infectious diseases than have medical discoveries or treatments. The continuing belief that medicine has played a larger role, and that further progress is inevitable and infinite, provides a false sense of security and may have had a deleterious effect on the design of research studies, funding allocations, and environmental and occupational health policy. As Grob concludes, “the faith that disease can be completely conquered is at best a harmless and at worst a dangerous utopian illusion” (p. 274). Beginning with the early colonization of America, Grob focuses on the major threats to health in each era for different groups of the population. Class, race, and gender are not central categories of his analysis; instead he concentrates attention on the biological “realities” of specific diseases and the population factors that nurture their spread. In meticulous detail, using a vast array of examples from across the country, he documents the terrible toll of contagious diseases on America’s indigenous Indian populations and the early colonists. He clearly establishes the role of previous exposure in creating immunity, as well as the broad array of variables that influence the impact of epidemics—so that the same disease has had different effects in various geographic locations and social environments and on older or younger populations. Grob then turns to the major epidemiological shift of the late nineteenth and early twentieth centuries, in which chronic illnesses overtook infectious diseases as the strongest driver of the country’s mortality rates. He explores various explanations for the declining significance of infectious diseases and draws particular attention to the epidemics of ill

The Impact of Work-related Risk on Nurses During the SARS Outbreak in Hong Kong

Severe acute respiratory syndrome (SARS) is a highly infectious disease, with high potential for transmission to close contacts, particularly among healthcare workers. This is the first systematic study investigating hospital nurses' physical and psychological health status and the kinds of healthcare used-stratified by the level of contact with SARS patients-during the 2003 outbreak in Hong Kong. Nurses in moderate-risk areas appeared to have more stress symptoms than those working in high-risk areas. It is essential to design hospital support systems and occupational health policy to promote the psychological well-being of nurses during future outbreaks of emerging infections.

Web based degrees.

Cardiff University College of Medicine has recently launched a web based master's degree in occupational health policy and practice, giving nurses in Wales the opportunity to study from home.

Commentary: The Rôle of Toxicology in Prevention and Precaution

Advocates of the Precautionary Principle have recently called for a “new science” to support the goals of precaution-based environmental and occupational health policy. While much attention has been given to epidemiology, the evidentiary science most relevant to precaution, or prevention, is toxicology. Opportunities for enhancing the rôle of toxicology in public policy must consider current biases in the field. Thus, rather than a “new science,” advocates for change should focus upon ensuring that current scientific methods are appropriate and that interpretations of scientific data are accurate.

Activism and The Making of Occupational Health and Safety Law in Ontario, 1960s-1980

During the 1970s and 1980s, workers and unions in advanced capitalist nations were successful in their efforts to have their respective governments pass occupational health and safety policies and laws that established, albeit in varying degrees, legislative frameworks which statutorily enshrined workers’ rights to participate in regulatory processes. The purpose of this paper is to outline and analyse how this process took place in Ontario, Canada’s most populous, most industrial, and most economically powerful province. From the late 1960s to the late 1970s, rank-and-file miners and industrial workers, their unions, and a sprinkling of middle-class political activists, forged a vibrant ‘movement’ that forced the Ontario government and the province’s manufacturers to concede to legislation giving Ontario workers unprecedented rights to know about the substances with which they worked, to participate in improving the health and safety of their workplaces, and to refuse work they considered unsafe. As the paper will outline, while the impetus for activism varied for rank-and-file workers, union leaders and political activists, they found common ground in their outrage at how industrial processes were making workplaces both unsafe and, more importantly, unhealthy. Indeed, it was the spectre of widespread occupational disease that ultimately galvanised the Ontario occupational health and safety movement in the mid-1970s. From that moment forward, all demands for health and safety legislation were framed under the compelling phrase: ‘Our health is not for sale’.

An Epidemiologic Review on Occupational Sleep Research among Japanese Workers

Epidemiologic sleep research on Japanese workers has been increasing in recent years. It is timely to give an overview of the sleep issues facing the Japanese working population by reviewing the accumulated epidemiological evidence, which will contribute to the promotion of a sound occupational health policy and the development of occupational sleep research in epidemiology. This paper reviews 24 studies, 13 for non-shift and 11 for shift Japanese workers, identified by using MEDLINE and Japan Cetra Revuo Medicina. The results reviewed are as follows: 1) the prevalence of insomnia and other sleep problems is substantially varied, 5 to 45% for non-shift and 29 to 38% for shift workers, 2) poor sleep quality is related to health, occupational activities and personal relations, 3) the risk or associated factors are identified in pathophysiology (e.g., hypertension), lifestyle behaviors (e.g., diet, alcohol, tobacco), job-related conditions (e.g., job stress, social support, job dissatisfaction, workload, shift schedules) and psychopathology (e.g., depressed mood). The methodological limitations found in the studies and the strategies of future epidemiologic sleep research in workers are discussed.

The Price of Preparing for War

Located a few miles from Anchorage, Alaska’s Eagle River Flats is a coastal saltwater marsh teeming with fish, wildlife—and unexploded mortar and artillery shells. The marsh lies on the Department of Defense’s (DOD) 62,000-acre training facility at Fort Richardson, headquarters to the Army’s Alaskan command and control units. Since World War II, Eagle River Flats has been Fort Richardson’s primary “ordnance impact zone,” where soldiers stationed at the fort come to train with live munitions. Environmental assessments undertaken at the Flats by the Army have revealed high levels of contaminants including heavy metals, explosive compounds, and white phosphorus, a toxic agent used to generate smoke cover on the battlefield. It was this contamination with white phosphorus, which can damage bones and major internal organs, that in 1994 landed Eagle River Flats on the Superfund National Priorities List, a U.S. Environmental Protection Agency (EPA) compilation of the nation’s most polluted properties. Since then, the Army has been conducting an EPA-approved effort to clean up the white phosphorus. But in April 2002 the DOD was sued by a citizens’ coalition urging the Army to address remaining contamination problems at the Flats. Among the plaintiffs were the indigenous Chickaloon Indians, who claimed the Army’s use of live munitions was polluting traditional hunting and fishing grounds. The suit also charged that unexploded mortar rounds and artillery shells in the area were leaching toxic chemicals that were migrating to nearby Cook Inlet. The plaintiffs’ attorney, Scott Allen of the San Francisco, California–based law firm Cox and Moyer, says the suit requested that the Army remove some 10,000 unexploded mortar rounds and artillery shells from the area (the number estimated in the Army’s 1998 proposed Superfund cleanup plan), remediate toxic contamination, and abstain from using the range for bombing exercises until a Clean Water Act permit had been obtained for munitions discharges. When confronted with the lawsuit, the DOD took its case to Congress. There, it argued that the laws on the books were not intended to be applied to operational military ranges in this way, citing long-standing past state and federal regulatory interpretation and practice. The DOD further argued that suits like those brought at Eagle River Flats, if successful, could set a legal precedent whereby environmental litigants could halt military training and thus undermine troop readiness on the battlefield. Before the 2002 lawsuit even arose, the DOD had proposed new legislation called the Readiness and Range Preservation Initiative (RRPI) to prevent just such lawsuits attempting to use hazardous waste laws to limit training. The RRPI calls for exemptions from a number of environmental laws on more than 8,000 operational DOD training ranges, a land area equal to roughly 24 million acres. Under this proposed new legislation, munitions would not be subject to hazardous waste permitting or cleanup requirements as long as they remain on operational ranges.

Story of benzene and leukemia: epidemiologic approach of Muzaffer Aksoy.

In 1974, Professor Muzaffer Aksoy established a link to leukemia in humans as a result of occupational exposure to benzene. The aim of this study is to evaluate his epidemiological approach for his investigation on the effects of benzene and to bring attention to the benzene problem in Turkey. Dr. Aksoy observed that a large group of leukemic patients were shoemakers, or they worked in leather manufacturing. In the 1960s, benzene was a popular solvent in the leather industry. Dr. Aksoy conducted a field investigation in Gedikpasa- Istanbul, where the shoemakers worked so that he could draw his key observations from actual environmental conditions. With a gas detector, he found the concentration of benzene in these work places to be 150-210 ppm and up to 650 ppm on rare occasions. He performed an epidemiological study and health education among 28,500 shoe, slipper and handbag workers during the period from 1967 to 1974. He published these data, establishing an association between benzene and leukemia. The incidence of leukemia among the shoe workers was decreased by screening, health education, and legislative actions in Turkey, but it began to increase again because of lack of an occupational health policy and underestimation of the problem. These results suggest the importance of primary prevention of occupational cancers. Dr. Aksoy's epidemiologic approach may highlight the necessity for detailed investigations of the occupational status of patients who need medical aid in order to diagnose the real underlying factor.

Occupational lung disease in China.

Occupational lung disease has been a major public health problem in China. The recently transformed industrial structure and expansion of the industrial labor force, accompanying the rapid industrialization and economic growth, pose both tremendous challenges and opportunities for occupational health policy and research. New occupational health problems are emerging, while the traditional occupational lung disease continued to occur. Simultaneously, relevant scientific research and professional activities have accelerated notably. The progress and achievement in occupational health research are creating more powerful forces in eliminating industrial hazards and protecting workers' health in China.

The State of Occupational Health in Community Europe: From Top-Down Reform to a Renewal of Trade Union Action?

Working conditions in Europe are getting worse, due to changes in work organization, including intensification and increasing insecurity. A critical assessment of the state of prevention in Europe remains essential. Trade union organizations on the Luxembourg Advisory Committee on Safety, Hygiene and Health Protection at Work drafted a document on what Community occupational health policy should seek to achieve. In June 2001, the ETUC Executive Committee adopted a resolution based on the document. This article discusses the trade union strategy. The first step is to critique the few existing indicators. To a considerable extent, they actually conceal the health problems of work. The statistics on occupational disease reflect, above all, characteristics of the various national systems of benefits but say little about the real state of workers' health. "Traditional" risks still cause tens of thousands of deaths and injuries every year. Risks associated with work organization are increasing steadily. The intensification of work is an important aspect of the reorganization of production processes and is associated with major changes in work management and organization. At the same time, the spread of Taylorized work procedures in certain sectors (probably correlating strongly with work performed by women in both services and some branches of industry) and the introduction of management methods may be summarized in the phrase "controlled autonomy." It involves shifting some of the supervisory burden to the level of the team, which destroys collective solidarity and detracts from the conditions under which work can contribute to mental health. Labor insecurity has been facilitated by the reappearance of mass unemployment and technological changes. Work has become increasingly less "sustainable" and companies are swamping society with the real social costs of their appetite for profit. In seeking harmonization, we must ensure consistent legislation based on the fundamental principles of the Framework Directive. Thus, trade unions demand that all risk factors be covered by directives based on effective preventive approaches. The new language of risk assessment and broadened approach to occupational health may initiate a process that (i) makes the invisible visible; (ii) moves on from observing individual complaints to collective analysis; and (iii) formulates a collective strategy based on identifying what "can be tolerated no longer."

Current scientific, ethical and social issues of biomonitoring in the European Union

Occupational health regulations and practices in EU Member States have been directed, to a large extent, by the principle of social protection, aiming to protect both the health and the employment of every (candidate) worker. Medical and biomonitoring practices have played a major role in identifying health problems at work and also in establishing preventive measures. Lately, a new tendency is occurring that reduces health protection to compliance with a limited set of standards for workplaces and individuals. According to this approach, ‘predictive’ medical tests might be used for the selection of the fittest workers. At a time when the labor market is evolving towards less stable forms of work, such a ‘standardization approach’ may lead to an unequal occupational health policy: the better off being more protected, the more exposed being less protected and the more susceptible being excluded. Instead, biomonitoring tools should only be developed as part of medical surveillance and used for those who need it most.

Workers' liberty, workers' welfare: the Supreme Court speaks on the rights of disabled employees.

On June 10, 2002, a unanimous US Supreme Court rejected the claim by Mario Echazabal that he had been denied his rights under the Americans with Disabilities Act when Chevron USA had refused to employ him because he had hepatitis C. Chevron believed that Echazabal's exposure to hepatotoxic chemicals in its refinery would pose a grave risk to his health. This case poses critical questions about the ethics of public health: When, if ever, is paternalism justified? Must choice always trump other values? What ought to be the balance between welfare and liberty? Strikingly, the groups that came to Echazabal's defense adopted an antipaternalistic posture fundamentally at odds with the ethical foundations of occupational health and safety policy.

Towards a New Community Strategy on Health and Safety at Work? Caught in the Institutional Web of Soft Procedures

Abstract: During the 1990s, Community occupational health and safety policy shifted from a strong regulatory approach to more persuasive policy-making. However, while it is entirely justified to stress the importance of good implementation of occupational health and safety standards, the Community’s post ‘regulatory boom’ in policy in this area still looks largely like a ‘testing out’ of various soft procedures, the effectiveness of which still needs to be proven. The new occupational health and safety strategy proposed by the Commission in March 2002 does not manage to provide a coherent and efficient institutional framework. As long as the Member States do not consider occupational health and safety a political priority, the small occupational health and safety division of the Commission – which lacks the instruments and power to ensure inspection of implementation, and which has seen a good part of its resources disappearing into an Agency over which it has little control – will have a hard time to respond to the challenges of the sector.

Inequity in occupational health services for government hospital workers in South Africa.

South Africa's inequitable public health system is mainly delivered by provincial health departments, and exemplifies the potential and problems of occupational health services in middle-income countries. The occupational health services for 153 265 employees in all of South Africa's 370 provincial hospitals were described and compared. Information was obtained from 303 (82%) hospitals, using a self-completed questionnaire and telephone interviews. Thirty-two per cent of hospitals had an occupational health clinic, but 61% of employees worked in hospitals with a clinic. Occupational health clinics were more likely to be present in larger hospitals, and were strongly associated with provision of primary care and chronic disease services to workers. Thirty-nine per cent of hospitals had a safety officer, 41% had access to an industrial hygienist or environmental health officer, and 80% had health and safety committees, as required by law. While occupational health services were more likely in larger hospitals, workforce size did not explain the marked differences between provinces. The study shows that substantial occupational health services exist, but that important gaps persist, even in wealthier provinces and especially in provinces without coherent occupational health policies.

Health and safety hazards in Northwest agriculture: setting an occupational research agenda.

Agriculture is among the most hazardous occupations in the United States. Research can provide new insights about disease and injury and serve as the foundation for occupational health and safety policies. The determination of research priorities can be problematic. Public participation approaches offer opportunities to identify and integrate various perspectives. The agenda process was modeled on the NIOSH National Occupational Research Agenda. Center staff contacted representatives of producer groups, labor, health care, academia, and public agencies to participate in telephone interviews and a daylong workshop. Twelve research priorities were identified: musculoskeletal disorders; respiratory disease; skin disease; traumatic injuries; chemical exposures; special populations at risk; social and economic foundations of workplace safety; risk communication barriers; diagnostic approaches; hazard control technology; intervention effectiveness; and surveillance research methods. The agenda process engaged stakeholders in priority setting. The resulting document is a useful guide for occupational safety and health in agriculture.

Commentary

At the beginning of the 21st century, the emergence of new forms of work organization are transforming what had become standard types of work arrangements in industrialized countries. In this new labor market environment, new firms, types of workers, and risk factors are powerfully emerging. Contrary to common belief, emergent occupational health hazards should not be approached only as "technical" or "economic" value-free problems. Instead, many of the challenges faced by occupational health policy makers are predominantly related to professional values and to the political ideologies and economic interests of key stakeholders in the decision-making process. In this paper some of the key principles leading to efficient and equitable occupational health policies in the new work environment are discussed. An alternative is also proposed for dealing with the conditions and settings needed to meet the new challenges related to establishing an effective occupational health policy.