Occupational Health

History of Occupational Health

Dr. Ivonne Y. Santiago Santiago
MPH 7470
August 11, 2014
Overview
 What is occupational health?
 Historical figures in occupational health
What is it?
 Occupational health is:
 Part of public health
 Assuring people are safe at work
 Preserving and protecting human resources
 Multidisciplinary approach to recognition,
diagnosis, treatment and prevention and
control of work-related diseases, injuries and
other conditions
What is it?
 The bottom line – making sure people go
home from work will all their fingers and
toes, and that they have not been exposed
to anything that will adversely affect their
health
 Your job should NOT make you sick!
Occupational Health?

Health problems arising from or pertaining to work

Health of people at work
The Health of the gainfully employed
Relationship between Occupation (work) & Health

Environment

Occupation (work) Health

Accidents
 OCCUPATIONAL HEALTH
 The modern definition of Occupational
Health (ILO and WHO) is:

“The promotion and maintenance of the

highest degree of physical, mental and
social well-being of workers in all
occupations – total health of all at work”
 ILO - WHO

 The prevention among workers of departures from

health caused by their working conditions
 The protection of workers in their employment from
risks resulting from factors adverse to health
 Placing and maintenance of a worker in an
occupational environment adapted to his/her
physiological and psychological characteristics.
 To summarize, the adaption of work to people
and of each person to their job.
 According to ILO reports

 About 45% of the world’s population and 58% of

the population over 10 years of age belong to
the global workforce.
 Importance:
 Health
 Productivity
 Socioeconomic issues
 Sustainable development
 According to the principles of the United
Nations, WHO and ILO, every citizen of the
world has a RIGHT to healthy and safe work
and to a work environment that enables him
or her to live a socially and economically
productive life.
 Occupational Health

 Work Health
(occupational disease/work related illness)

 Health Work
(medical fitness for work)
 Occupational Health

The definition of occupational health has been a

transition from the strict concept of “prevention
of occupational injuries and diseases”
to
“Overall protection and promotion of workers’
general health and health of their families, and
communities ”
What is occupational medicine ?

 Occupational Medicine is a new branch of

clinical medicine most active in the field of
Occupational Health.
 Its principal role is the provision of health
advice to organizations and individuals to
ensure that the highest standards of
Health and Safety at Work can be
achieved and maintained.
Historical Figures in
Occupational Health
History
 Occupational Health:
The Beginnings – Ancient Times
The history of occupational medicine can be traced
into antiquity. Observations of increased rates of
illnesses and mortality among miners date back to
Greek and Roman times.

15
PREHISTORIC
 Defensive weaponry
 Silicosis from hard quartz
 Mining for flint

BABYLONIANS
 2000 B.C. – 6th Ruler, Hammurabi
 Code of Hammurabi
 Set precedent for the an early form of worker’s
compensation insurance
 “If a man has caused the loss of a gentleman’s
eye, his own eye shall be caused to be lost”
 Code of Hammurabi
 2000 B.C. ancient Babylonians
 Contains clauses for dealing with injuries, and
monetary damages for those who injured others
 “If a man has caused the loss of a gentleman’s eye,
his own eye shall be caused to be lost.”
 LaDou, J. (1986). Introduction to Occupational safety and
Health. Chicago: National Safety Council, p.28.
EGYPTIANS
 Organized construction of temples, pyramids and tombs
 Rameses II ( 1500 B.C.)
 Canal from Mediterranean to Red Sea
 Constructed huge temple “Ramesseum”
 Provided medical services for workers to maintain a “healthy”
workforce

GREEKS
 Nicander, poet & physician
 Wrote poem, “Alexipharmaca” describing lead poisoning
 Hippocrates, Father of Medicine
 Described effects of tetanus
 Hippocratic Oath
ROMANS
 Built extensive aqueducts, sewage systems, public
baths, latrines and ventilated houses
 Poets and philosophers wrote about ills of certain
occupations, toxic substances, plague etc.
 Alexander the Great – first medical services for the
army
 Pliny the Elder – first respirators made of ox
bladders for workers exposed to mercury
6TH – 17TH CENTURY
 Construction and world exploration
 Some power-driven factories
 Start of textile industry
 Poor living conditions and plague
18th CENTURY
 Ramazzini “ Father of Occupational
Medicine”
 WroteDiscourse on Disease of Workers
 Suggested physicians ask: “What is your
occupation?”
 Mass manufacturing textiles cotton & wool
followed by metal, wood and leather goods
The Industrial Revolution
 Steam Power
 Machines
 New Ways of Raw Material Conversion
 A Division of Labor
These factors created a need to focus on the safety and health of workers.
The introduction of steam power created the potential for life threatening
injuries as did all machines. The new methods introduced for converting raw
materials also created risks and new ways to get hurt or sick. Specialization of
labor increased boredom and, therefore, the possibility of inattentiveness which
promotes a more dangerous work environment.
19th century
 Statutory medical service for factory workers
 Factory Inspectors

 Medical certification for children

 Certifying Surgeons

 Workers with exposure to lead, white

phosphorus, explosives, rubber – periodic
exams
 Notification of industrial disease – lead,
phosphorus, arsenic, anthrax
 1898 – Thomas Legge – Medical Inspector of
Factories
20th century
 Workers’ compensation
 Quickly moved from wage loss to clinical
ratings, “meat chart”
 Many enquiries
 Continual modifications, additional benefits
& coverage
 Occupational disease
 1913 – industrial disease – 6 listed in Schedule 3
 1926 – silicosis, pneumoconiosis
 1932 – cancer
 1944 – exposure length removed
 WCB could add to Schedule 3
 1947 – generic definition of industrial disease
Mid 20 th century
 Occupational Health and Safety legislation
 EU directive
 General duty
 Evaluation of risk
 Program of prevention
 Establishment of preventive services
 Worker rights
 Knowledge

 Participation

 Refuse unsafe work and freedom from reprisals

Late 20 th Century
 WHO – 1985 – Identification and control
of work-related diseases
 Musculoskeletal, chronic non specific
respiratory, behavioural
 Adverse psychological factors at work,
ergonomics, other environmental hazards
2000’s
 ILO – Recording & notification of
occupational accidents and diseases
and ILO list of occupational diseases
 ILO Global Strategy on Occupational
Health & Safety 2003
21st century
 Burden of occupational disease –
ILO/WHO
 Worldwide
 1.9-2.3 million deaths attributed to occupation
 1.6 million deaths attributed to work-related
diseases
 217 million cases of occupational disease
Most Important Contributors
of Occupational Health
 Work Related Disease Issues Have
Been Identified For A Long Time
 Hippocrates (460-377 BC)
 Described symptoms of lead poisoning among miners and
metallurgists.
 Pliny the Elder (23-70 AD)
 Roman senator who wrote about workers who protected
themselves from dust by tying animal bladders over their mouths.
 He also noted hazards of asbestos and cinnabar (mercury ore)

 Ulrich Ellenborg (1473)

 A German physician, he recognized the dangers of metal fumes,
described symptoms and preventive measures.
Hippocrates (470 to 410 B.C.)
 Greek physician
 Father of Medicine
(Hippocratic oath)
 Believed in rest, good
diet, exercise and
cleanliness
 Observed lead
poisoning among
miners
Pliny the Elder (23 – 79 A.D.)
 Roman senator, writer
and scientist
 Dangers related to
zinc and sulfur
 First to recommend
respiratory protection
 Miners should cover
their mouths with an
animal bladder
Influential People
 Paracelsus (1493-1541)
 Known by several names
 Born Phillip von Hohenheim

 A Swiss physician, he wrote a treatise on occupational

diseases
 Described lung diseases among miners and attributed the
cause to vapors and emanation from metals
 Paracelsus is best known today as the “Father of Toxicology”
because of his observations of dose and response:
“All substances are poisons; there is none which is not a
poison. The right dose differentiates a poison and a
remedy.”
 Established concepts of acute and chronic toxicity
Observant People
 Agricola (1494-1555)
 Born Georg Bauer, he was a physician appointed to the mining
town of Jochimstral in the Swiss mountains
 Wrote De Re Metallica, a comprehensive discourse addressing
every aspect of mining, smelting and refining.
 Need for ventilation and fresh air in mines

 Environmental contamination

 Management techniques (shift work)

 Ergonomics, mechanical lift processes

 Butter is antidote for lead toxicity

 Goat’s bladder is used as respiratory protection

 He noted the need to provide ventilation for miners, and

described “asthma” among workers who toiled in dusty mines
Perceptive People
 Bernardino Ramazzini (1633-1714)
 Italianphysician, known as the “patron saint of
industrial medicine”.
 His book De Morbis Artificium Diatriba (The
Diseases of Workmen) described the symptoms of
mercury and lead poisoning and other occupational
diseases.
 He wrote about the pathology of silicosis and
recommended precautions to avoid hazards
 Advised physicians to learn about occupational
diseases by studying the work environment, and
exhorted them to always ask their patients “Of
what trade are you?”
Bernardino Ramazzini (1633-1714)

 Wrote Diseases of Workers

 Urged physicians to ask “Of
what trade are you?” as part
of medical evaluation
 Related occupational
diseases to handling of
harmful materials or unnatural
movements of the body
 Father of Occupational
Medicine
 Bernardino Ramazzini (1633-1714)
``De Morbis Artificum Diatriba``
First book on occupational diseases – 1700 in Italy
Investigative People
 Sir George Baker (1722-1809)
 Discovered that “Devonshire colic” was caused by
lead contamination in cider.
 Percival Pott (1714-1788)
 A London physician, he was the first to link
occupational exposure to cancer.
 Scrotal cancer among chimney sweeps,
caused by soot
 Later linked to Polycyclic Aromatic
Hydrocarbons in Coal Soot
 Sir Humphrey Davy (1788-1829)
 Investigated problems of mine explosions and
developed the first miner’s safety lamp.
Percival Pott (1713-1788)
 Identified relationship
between an
occupation (chimney
sweep), a toxin (poly-
aromatic
hydrocarbons) and
malignancy (testicular
cancer).
Chimney Sweeps
American People
 Dr. Alice Hamilton (1869-1970)
 First woman faculty member at Harvard
University (1919).
 A social activist who worked to improve
occupational health and safety.
 Her autobiography “Exploring the
Dangerous Trades” details her experiences
in the mines and mills across America
Alice Hamilton
 Champion of social responsibility
 Investigated the cause and effect of
worker illness
 Interviewed workers in their homes
and at their dangerous jobs
 Reviewed the evaluation and control
of industrial hazards such as lead and
silica
 Founder of Industrial Hygiene
 Wrote Exploring the Dangerous
Trades
 First woman named to Harvard
Medical School staff
Tragedies Stimulated Change
 Workplace Disasters of the early 1900s led to outrage and
subsequently to legislation to protect workers
 The Triangle Shirtwaist Fire probably was the most
important event leading to the regulation of
occupational safety
 The Triangle Shirtwaist Company was a New York City
“sweatshop” where dozens of mostly young female
immigrant workers crowded together to cut and sew
shirtwaists
 Shirtwaists were a popular ladies garment of the time,
especially for working women
 Sweatshops workers are paid low wages as they work
excessively long hours in unsanitary and unsafe
conditions
Triangle Shirtwaist Company
• 1911 - The Triangle Shirtwaist Company
Caught Fire
– 146 workers died from fire in the upper floors of this
“fireproof” building
• Fire exits were inadequate or locked to keep the
workers at their work stations
• Unable to flee, many victims jumped from the
windows to their deaths
• The tragedy led to 36 laws reforming the state
labor codes
I’ll Take Any Job That Pays…
 1930 - Gauley Bridge Disaster

 Also known as the Hawks Nest tragedy, this was America’s

worst industrial disaster
 Construction of the Hawks Nest tunnel near Gauley Bridge, West
Virginia, caused massive exposures to silica dust
 At least 476 men died and 1500 disabled by silicosis. Silica
exposures were so high men were dying from acute silicosis
from only two months of exposure
 Pneumatic drilling equipment and rock high in silica content
magnified the risk
 Economic factors of the Great Depression forced the men to
work in unhealthy conditions
 Everyday Tragedies

It took a tragedy to get attention, since death on the job was a normal every-day
event. In this single Pennsylvania county, 524 workers died in one year.

MMWR, June 11, 1999 / Vol. 48 / No. 22

 US Laws and Regulations
 Early U.S. Laws and Regulations
 United States Bureau of Labor established in 1884 to
study employment and labor
 Laws and regulations to protect US workers first began
to appear in the early 1900s
 1911- New York and New Jersey passed workmen’s
compensation laws.
 1913 - New York State Department of Labor
 Established a Division of Industrial Hygiene
 1916 - 1930 Forty-seven states enacted workmen’s
compensation laws to guarantee wages and medical
care for injured workers
More US Laws and Regulations
 1935 - The Social Security Act
 Made funds available for public health programs.
 1936 - The Walsh Healey Public Contracts Act
 Required organizations supplying goods or services to the
U.S. government to maintain a safe and healthful working
environment
 1948 - All states had workers compensation laws
 1970 - The Occupational Safety and Health Act
 Established NIOSH and OSHA to carry out its mandate to ensure
a workplaces free of recognized hazards.
 1977 - The Federal Mine Safety & Health Act
 Consolidated all federal health and safety regulations of the
mining industry, strengthened and expanded the rights of miners,
established the Mine Safety and Health Administration (MSHA).
What About Medical Care For
Workers?
 By the 1930s, a medical specialty was
formed: Industrial Medicine
 Physicians in this area of practice were
generally self-taught or taught on the job
until the late 1940s when specialty
training, testing, and board certification
were developed and the resulting new
specialty was renamed Occupational
Medicine
Occupational Medicine

 Recognized Specialty For

Over 50 Years,
certification is under the
American Board of
Preventive Medicine
 Combines Clinical Skills
With Toxicology,
Epidemiology, Safety,
Rehabilitation, and
Business Operations
Occupational Health Services
 Detecting, Evaluating,  Disability Management
and Treating Medical and Accommodation
Conditions  Employee Assistance
 Emergency Response and Advocacy
 Medical Surveillance  Absence Management
 Chronic Disease  Training
Management  Consultant to Workers,
 Fitness and Wellness Managers, Unions, and
 Work-Life Management the Community
Why a Special Practice Model?

 Occupational Diseases are Hard to

Distinguish From Ones Unrelated to
the Workplace

 Absences from Work Have Multiple

Causes (not all are medical)

 Economic Implications of
Maintaining a Healthy Workforce
are Large

Source: USA Today

Since It Is Hard To Differentiate Occupational
Diseases From Naturally Occurring Diseases,
How Do You Know For Sure That The Disorder
Is Or Is Not Associated To The Work
Environment Or Activities?