In the Western world, the first time that the general public probably focused attention on workers’ health issues was in the early 1800s, when activists in the UK raised the issue of child chimney sweeps. The fact that these children faced health risks became evident – with complications such as respiratory problems, deformed limbs and cancer of the scrotum being some of the most common long-term risks. This was true in cases wherein children may have survived the short-term risks that included the risk of death arising from suffocating, falling, or burning while working in the chimney. However, despite the widespread awareness about these risks, the country still took more than 6 decades to enact the legislation that banned use of children. Even more difficult was the task of enforcing the legislation, primarily due to cost factors. Since the cost associated with mechanical alternatives for chimney sweeps was a lot more than child chimney sweeps, enforcement was clearly not effective until the 1860s. At that time, heavy fines were imposed that made the cost of noncompliance greater than the cost of compliance.

One of the major drivers of occupational medicine, as demonstrated by the chimney sweeps example, has been the basic idea of social justice. Its rivaling force, i.e. the short-term costs that employers have to bear in order to protect workers, is a persistent factor today. International organizations, (for example, the International Labour Organisation [ILO, http://www.ilo.org/], an agency of the United Nations), along with national organizations (for example, the Occupational Safety and Health Administration [OSHA, http://www.osha.gov/] in the US, and the Health and Safety Executive [http://www.hse.gov.uk/] in the UK) have been in existence for relatively shorter periods. Even in the developed world, these organizations have had a rather checkered success at convincing governments and employers that protecting employees is financially beneficial in the long-term. However, work-related accidents are the primary cause of disability and death. According to ILO estimates, more than 2 million individuals die every year due to work-related diseases and accidents and more than 160 million people become ill due to workplace hazards.

In several countries, legislation required to protect workers is either nonexistent or is not enforced. Statistically, around 1.7 billion workers in the developing world have limited or no protection. The worst affected of all are the migrant workers, (especially those that do not have legal status) who often cross borders in search of work. A number of migrant Hispanic workers have to continuously deal with inappropriate work conditions, poor health care and biased attitudes that are rampant in the western United States. There are many migrant workers in Europe also and as it usually happens, it was not before a tragedy occurred that the poor work conditions of these workers were highlighted, which eventually prompted the government to take appropriate action. In 2004, when 23 Chinese cockle pickers died due to drowning in the UK, the government had to introduce appropriate legislation to regulate the work conditions in which these workers, under the supervision of “gangmasters”, could work and live (refer to the Gangmasters Licensing Authority [http://www.gla.gov.uk/. ]). It is difficult to tell whether or not this specific legislation has been effective. In a recent journalistic investigation that focused on understanding the work conditions of low-paid Lithuanian workers living and working in East Anglia revealed unsafe living and working conditions.

Occupational health cannot be treated as minority interest, but it should rather involve the entire society. On both national and international levels, the health of larger populations is inseparable from the health interests of workers. Two more examples, one related to the developing world and the other related to the developed world, demonstrate this unavoidable link. The first example relates to traffic injury, which has been researched by another paper and which documents the growing incidence of traffic injury in Africa. The growing migratory work force comprising of unprotected and illegal workers is disproportionately predisposed to bear the burden of traffic injury as it takes to the roads in search of work.

The second example is relevant to a specific region in the developed world, wherein workers’ health issues have become a part of political agenda due to the widespread health interests associated with the politically charged issue of smoking. It was in July 2007 that England became the last of the countries in Europe to impose a ban on smoking in enclosed public places. This is a good example of public health legislation, but apart from that it is also a good example of occupational health legislation since the beneficiaries are most likely to be individuals working in the hospitality industry. It is important to note that during the period when the Act was being publicly debated, professional bodies comprising of occupational health physicians lobbied successfully to impose complete coverage of the ban, even when initially the Act had intended to exclude specific work places. This example demonstrates the best that occupational medicine can be and shows the way into the future of this particular profession.

Complexities in the labor market are increasing, and as demonstrated by the adult film industry, it is bringing about new and unforeseen challenges that both health professionals and society at large should be able to deal with. The most important thing to remember is that occupational medicine should not be used only by a specific group of workers or those residing in the developed world. To work in safe work conditions is a basic human right, and protecting workers’ health will eventually benefit the entire society.

 

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