Lecture 1: Introduction to Occupational H ealth

1. Lecture 1: Introduction to Occupational Health Occupational Health EOH3202 Environmental & Occupational Health Faculty of Medicine and Health Sciences University Putra of Malaysia

2. Objectives • After this class session, students should be able to: • Understand changes in approach to occupational safety and health throughout history • Be aware of some of the important people, events and laws affecting occupational health and safety

3. Content • Occupational health • Historical perspective of OH • Occupational Health tragedies - US • Social changes and other factors • Occupational Health Organisations • Other related organisations • United Kingdom • United States of America • Recent tragedies • Current perspectives of OH • Customer-driven OH • References

4. Occupational Health • Observation of the relation between occupational hazards and poor health dates back several centuries • Stone age was the first age of occupational risk – flint knapping – the process of making stone tools • Hunter-gatherers • Iron age – smelting of iron • Ancient Egyptians recognised the hazardous effects of mining and restricted such work to slaves and criminals • Agricultural age • Industrial revolution – UK – poor sanitation and a lot of rural populations moved to town to work – employers were not concerned and was profit-oriented • Information technology and K-economy

5. Historical perspective of oh • Hippocrates (c. 460-377 b.c.) described a case of lead poisoning plus its symptoms • The first recorded observation due to occupational disease • Pliny (23–70 a.d.) spoke of the poisonous nature of lead, mercury, and sulphur, but nothing was done to protect the workers • Described how lead refiners used membranes as masks, very inadequate form of protection • However, medical care was provided to the upper classes and to those who entertained, such as the gladiators, but never to manual labourers • At the end of the 15th century, literature began to be devoted to occupational diseases

6. Historical perspective of oh cont. • Increase in trade had stimulated a demand for gold and silver • Firearms were being developed, creating a demand for iron, copper, and lead • In 1473, a German physician, Ulrich Ellenbog, wrote a short treatise, • On the Poisonous Wicked Fumes and Smokes, referring to fumes from coal, nitric acid, lead, mercury encountered by goldsmiths and other metal workers

7. Historical perspective of oh cont. • Agricola (Georg Bauer, 1494–1553) German mineralogist and scholar - physician and practiced in a mining town • 1526, published De Re Metallica, a book on metallurgy • described the diseases and accidents prevalent among miners, and recommendations for prevention • He says dust “. . . eats away the lungs, and implants consumption ... ; • In the Carpathean mountains women have married seven husbands . . .”

8. Historical perspective of oh cont. • In 1587, Paracelsus (1493–1541), a Swiss • Published the first monograph on the diseases of mine and smelter workers (disease of metallurgists) • Described the “lung sickness” of miners, which he attributed to the climate and vapor of the mines • Mercurialism or mad hatter’s disease • Father of toxicology – all substances are poison • BernadinoRamazinni (1633-1714) who is an Italian Professor in Padua in 1700 wrote Diseases of Workers or De MorbisArtificumDiatriba • Conducted Comprehensive Studies of Diseases and Their Relationship to Occupations • De MorbisArtificumDiatriba was the first comprehensive work on occupational disease- Father of Occupational Medicine

10. Historical perspective of oh cont. • Among those at risk were miners, chemists, potters, tinsmiths, glassmakers, painters, tobacco workers, lime-workers, tanners, weavers, coppersmiths, and printers • idea for his treatise - attention was attracted by the speed with which a sewage worker emptied the sewer at Ramazzini’s house • When questioned the man answered that too long a stay in such a place would cause blindness • Ramazzini found that sewage workers showed severe reddening of the eyes and that many of them, after years of such work, became blind • Linked the pathology to acidic substances (ammonia vapours) present in the sewer

11. Historical perspective of oh cont. • Ramazzini applied his approach of • inspecting the workplace, questioning the workers • advising on remedies to outline the health hazards that labourers may encounter in their daily routine • 1775 - Percivall Pott published a work on the diseases of chimney sweeps – associate soot from chimney with scrotal cancer

12. Historical perspective of oh cont. • Charles Turner Thackrah published an extensive study of industrial illnesses and poverty in 1831 • Sir Thomas Legge (1863-1932) First Medical Inspector of Factories – England – Lead poisoning • Under Legge’s influence, lead poisoning was made a nationally notifiable disease in Britain in 1899 • Amanda Hamilton (1869-1970) First women Professor at Harvard and expert in occupational health • Pioneer in the field of toxicology studying occupational illnesses and the dangerous effects of industrial metals and chemical compounds

13. Occupational health tragedies - US • Workplace disaster in the early 1990s • Outrage over catastrophic events often lead to legislation to protect workers • America • Triangle shirtwaist company in 1911 - Workers are paid low wages and work in unsafe and unsanitary conditions – 146 died in a fire • Gauley Bridge Disaster in 1930 – construction of tunnel caused massive exposure to silica dust – 500 (silicosis) and 1500 disabled African American men

14. Social changes and other factors • Organised labour • Labour unions influence improvements in workplace health and safety by influencing legislations as well as forcing concessions from management • Studies on worker’s health • In 1914 in the US, studies found workers living in unsanitary conditions have tuberculosis – abolished sweat shops • 1923, development of industrial hygiene sampling equipment for studies of the dusty trades • Professional organisations • American Industrial Hygiene Association, 1939

15. Social changes and other factors (cont.) • Economic factors • The Great Depression, 1929 ke 1930s • Government in the US established labour standards • World War II • Started a period of industrial growth in the US and Great Britain

16. Occupational health organisations - ilo • Play a big role in occupational health • International Labour Organisation or ILO 1919 • League of Nations (since WW1) • Tripartite – government, employers, workers • Come out with conventions and recommendations • ILO encylopedia • ILO classification of penumoconiosis

17. Other related organisations • World Health Organisation under the UN • Occupational health unit (workers health) • Health settings (workplaces) approach • International agency for research in cancer or IARC in Lyon, France • IARC classification of carcinogens • American Conference of Governmental Industrial Hygienists (ACGIH) • Come out with threshold limit values or TLV

18. United kingdom • Factories Act 1833 • Inspectorate system • Medical Inspector of Factories • Medical surveillance – 1895 for lead and phosphorus • Health and Safety at Work Act 1974 – Robens Commission – safety and health responsibility of those who create the risks and those who work with risks • COSHH – 1986 – Risk Assessment • European directives – six pack regulations in 1992 – PPE, DSE, Workplace, Management, Work equipment, manual handling • http://www.unitetheunion.org/member_services/health_and_safety/health_and_safety_resources/the_six_pack.aspx

19. United states of america • 1914 – USPHS – Office of Industrial Hygiene and Sanitation – NIOSH • 1916 – American Association of Industrial Physicians and Surgeons – ACOEM • 1939 – American Industrial Hygiene Association • 1946 – American Academy of Occupational Medicine • 1955 – American Board of Preventive Medicine (Occupational Medicine) • 1970 – Occupational safety and Health Act

20. Recent tragedies • Chernobyl nuclear disaster, Kiev, Ukraine • April 26, 1986, a reactor at the Chernobyl nuclear power plant experienced a catastrophic failure • Resulted in the worst nuclear power disaster in history • due to a flawed reactor design and poorly trained plant personnel • Amount of radiation released was at least 100 X that of the Hiroshima and Nagasaki atomic bombs combined

21. Chernobyl

22. Recent tragedies • Bhopal tragedy, India • December 1984, a highly toxic gas was leaked from a pesticide plant in city • Winds spread the poison through a densely populated area • Many died instantly, others as they tried to flee, more than 20,000 people died in total in the aftermath of the leak

23. Bhopal and union carbide

24. bright sparklers fireworks explosion at sungaibuloh • Tragedy happened in 7th May, 1991 • Fireworks factory and fire killed 22 people and injured 103 others • Bright Sparklers Sdn. Bhd violated many laws to carry out dangerous operation • Commission found that legislations pertaining to siting, construction, maintenance and operations of the factory were not adhered to

25. Current perspective of oh • Chemicals • Gasses • Dusts • Particles • Light • Heat • Noise • Vibration • Slips, trips, falls • Radiation • Information Technology and K-economy • Working hours • Stress • Ergonomics

26. Customer-driven OH • Example 1: Fairtradeorganisation • Fairtrade is an alternative approach to conventional trade • Fairtrade Standards applies to workers - employers pay decent wages, guarantee the right to join trade unions, ensure health and safety standards and provide adequate housing where relevant • Other examples are Nike and Apple iPhone (n-hexane) • Prolonged over-exposure to n-hexane can cause extensive damage to the peripheral nervous system and ultimately the spinal cord, leading to muscular weakness and atrophy and even paralysis

27. Child labour in the 21st century? • Chocolate and child slavery • Ivory coast, West Africa – cocoa exporter almost 50% of the world • In 2001, BBC investigation found cocoa farmers employ thousands of children to work • Mali, Burkina Faso, and Togo • Children were trafficked and sold to work • Usually 12-to-14-years-old or younger, forced to do hard manual labour 80 to 100 hours a week. • Hershey’s and M&M Mars, ADM Cocoa, Ben & Jerry’s, Cadbury Ltd., Kraft, Nestle, See’s Candies, The Chocolate Vault, Toblerone etc

28. references • "Bernardino Ramazzini." Encyclopedia of World Biography. 2004. Encyclopedia.com. (July 15, 2012). http://www.encyclopedia.com/doc/1G2-3404707887.html • Ramazinni and worker’s health. The Lancet, 1999. • http://www.johnrobbins.info/blog/is-there-slavery-in-your-chocolate/ • http://www.unionlearn.org.uk/extrasUL/Education/OccupationalHealth.pdf

29. discussion • What “forces” led to the creation of worker protection laws early in this century? • Are these forces still in effect? • What forces drive occupational safety and health in today’s world?