SUPPLEMENT TWO: Occupational Health: Issues and priorities || To Work Safely in a Healthy Environment: a Right and a Responsibility: THE WORKING ENVIRONMENT: A PATH TO HEALTH AND A

To Work Safely in a Healthy Environment: a Right and a Responsibility: THE WORKINGENVIRONMENT: A PATH TO HEALTH AND A PATH TO POWERAuthor(s): CLIVE A.R. DENNISSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 67,SUPPLEMENT TWO: Occupational Health: Issues and priorities (SEPTEMBER/OCTOBER 1976),pp. 61-64Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41987527 .

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To Work Safely in a Healthy Environment:

a Right and a Responsibility

THE WORKING ENVIRONMENT: A PATH TO HEALTH AND A PATH TO POWER

CLIVE A.R. DENNIS1

The causes of concern for the quality of our environment are wrapped up with the causes of stress in our society. An appreciation of those causes insofar as the working environment is con- cerned is a necessity for those who wish to contribute in this area.

The very fact that a critical number of people are appreciating their personal involvement in environmental issues - how environmental problems can affect them - has created a receptive and sensitive group who say: "Well, if that is what pollution can do outside a plant, whatever must it be doing to those inside that plant?" Or again, "If noise from a factory half a mile away is causing us to be annoyed when we wish to relax in our back-yards, what must it be doing in those places of work from where it comes?" "If chemicals used in our places of work can pollute our waterways, what effects must these same chemicals be having on persons handling them inside our places of work?" "And if dust and gases can tarnish the buildings of our cities, can cause a decrease in visibility, even make our eyes smart, what must this dust and these gases be doing to those inside the workplaces?"

Perhaps this group, sensitive to environmental issues outside the workplace and now aware that these problems are likely magnified inside the workplace are also now becoming aware that the reason they value their external environment more and more is

1. Executive Director, The Prairie Institute of Environ- mental Health, 2220 Lome Street, Regina, Saskat- chewan.

because they need it to escape the ever increasing rate of change within our society. Perhaps they now begin to associate these problems with their workplaces, with increasing demands for higher production, greater effi- ciency, with stressful situations.

When this group has identified itself with these work-related problems it then becomes more aware of the vehicle pile-ups it sees on the highways, of accident stories in our newspapers, and the interplay of environmental hazards and life activities develop greater signi- ficance.

GENERAL CONSIDERATIONS

Occupational Health When we wish to discuss a problem it

is as well if we all understand what we mean. The World Health Organization defines Occupational Health in the following manner: - The promotion and maintenance of

the highest degree of physical, mental and social well-being of workers;

- The prevention among workers of ill-health caused by their working conditions;

- The protection of workers in their employment from risks resulting from factors adverse to health;

- The placing and maintenance of workers in an occupational environment adapted to their physiological and psychological condition.

Note that the definition of occupa-

tional health can and should include both health and safety work problems. As safety is usually associated with protective guards and protective cloth- ing whereas health is a very personal characteristic associated with people it is especially advantageous to use the term occupational health (rather than occupational safety) if one wishes to accentuate a people-orientated program.

Note that the definition includes the "maintenance of the highest degree of physical, mental and social wellbeing of workers" - in other words, if work is so boring that we start taking pep pills or so frustrating that we take tranquil- lizers, or so stressful that we get an ulcer - then this is all a part of occupational health.

Occupational health then, relates to health and safety promotion at work, to the prevention of compensable work accidents and occupational diseases, to any factor which unnecessarily impairs the quality of life at work and to the wide areas of individual concern in- volving occupational health services and occupational rehabilitation.

Needs of Workers Before any responsibilities for occu-

pational health can be discussed or specific programs defined, the needs of people who work with respect to occupational health must at first be identified.

The following are the needs that Dr. John Markham and I identified prior to

Canadian Journal of Public Health Supplement two to Vol. 67, September/October 1976 61



drafting the Saskatchewan Occupa- tional Health Act:

1. A place of work which is designed to ensure that accident and health hazards are designed out of that workplace and not into it;

2. A way of work which does not present an uncontrollable hazard to health or safety;

3. Information of potential health and safety hazards in the workplace;

4. Knowledge that continuing re- search is being carried out into possible adverse affects of new substances or new work methods introduced into the workplace;

5. Protection from health and safety hazards;

6. Provision of health services, either in or out of the workplace, which can provide effective treatment of injuries accidentally caused and which enables the early symptoms of occupational disease to be recognized and treatment initiated;

7. A place to go with health and safety concerns;

8. Services that assist workers to return to work following injury or disease and assist persons suffer- ing from the disabling effects of injury, disease or congenital de- formity in obtaining and main- taining employment.

Responsibility for Health and Safety in the Workplace

At the practical level the essence of occupational health is its implications of participatory responsibility in the workplace: if to prevent a certain type of accident workers must work in a certain way, then the involvement of those workers is necessary to avoid such accidents. And if to prevent a certain type of health effect certain environmental conditions have to be provided, then the involvement of management is necessary to provide those conditions.

The role of government in occupational health can be overstated. No one would disagree that government has a responsibility to ensure that work does not present a serious hazard to life and limb; and government can have a

capability in this area to match its responsibility. But if you said that government should assume direct responsibility for optimal quality of life in the workplace, I would disagree with you because government could never have the capability to match that responsibility even if it wanted to. But if government can provide services or, better still, facilitate others in achieving optimal quality of life in the workplace, then I think that government has a role and a responsibility to make such provisions.

SPECIAL PROBLEMS

Politics and Participatory Responsibility

The Saskatchewan Occuptional Health Act was, I believe, the first occasion where the joint responsibility of employees and employer with regard to health and safety at work was recognized in a legal statute.

Section 20 of the Act states that, "In every place of employment in which ten or more persons are employed the person in charge of the operation of the place of employment shall cause a committee to be established to be known as an Occupational Health Committee". The Act then further out- lines the composition and make-up of the committee and its duties.

This section of the Act was never intended to be a panacea for all ills in the workplace, but it was intended that it should recognize the joint responsibility of employees and employer and provide the framework by which this joint responsibility might be exercised.

For those of you with responsibility for administering occupational health or safety programs, I would not pretend that the path of participatory responsibility is universally accepted. Some managers believe that safety will only be achieved by strict enforcement of rules defined by management; some groups of workers believe that safety will only be achieved through worker control in the workplace.

For participatory responsibility to work it is necessary for management to delegate some of the responsibility which in the past has been considered its

own; unions must allow individual workplaces to have a chance of working out their own solutions.

One of the major early achievements in the development of the occupational health program within the framework of the new Act was the accord worked out by which management and unions agreed to support the principle of participatory responsibility as envis- aged in the occupational health committee concept. For the first time, it seemed, health-and-safety-at-work issues could be largely removed from the bargaining arena and both employer and employee could work together with a common purpose with regard to health and safety issues.

However, a small radical group was successfully able to project their beliefs that only after the attainment of worker control would the committees be able to deal successfully with health and safety issues and that the newly found accord was not in the interests of workers or government. It is noteworthy that the group had been previously successful in projecting the concept of patient control over physicians in one of Saskat- chewan's community clinics which sub- sequently led to its break-up.

For those with a belief in the demo- cratic process, it is reassuring to note that, by and large, the call to assume worker power through occupational health committees has been largely ignored at the plant level in spite of a vigorous educational program to achieve that objective.

Ignoring for a moment the potential role of labour/ management confronta- tion as a cause of work accidents, there are two important side-effects of an occupational health program oriented towards the promotion of worker power. The first is that professionals employed in the workplace for the purpose of promoting health and safety are automatically crucified as stooges of management for the purpose of ex- ploiting the worker, be they physician, nurse, safety director, first-aid worker, occupational hygienist, safety engineer or rehabilitation counsellor. The second is that programs not directly associated with the assumption of worker power

62 Canadian Journal of Public Health Supplement two to V ol. 67



are regarded as of secondary impor- tance, e.g., agricultural health and safety programs, occupational health services, occupational rehabilitation programs, and health and safety provisions for small working concerns.

Health Departments and Preventive Health Programs

There can be few administrators specializing in environmental and occupational health in Canada who have been particularly enthused about the support that their departments have given to their programs and who have not at the same time given serious thought as to why they have been largely unsuccessful in getting their message across. It seems to me, also a practising physician, that until responsibility for health insurance can be separated from responsibility for health that preventive health programs will lack the drive and will lack the em- phasis, that comes from a major com- mitment. My reasoning is that preventive health programs (and occupational health is a preventive health program) will never achieve their objec- tives unless and until those programs can involve the primary health care team. Because health care delivery costs paid for by health insurance programs indirectly involve physicians there is a tendency to regard physicians and those with whom they are associated as enemies of the state at worst, or, at best, a group with whom to avoid contact. Yet, as Sir Richard Doll pointed out at the CPHA annual conference in Edmonton last year, 80 percent of occupational cancers were brought to light through the observations of family physicians, while an extensive survey in Regina in 1974 indicated that the family physician was most often responsible for the placement of partially disabled persons in employment. Until the health agencies can find ways of working with physicians and allied health professionals, both in and out of the workplace, to promote health, preventive health programs will never achieve the success they deserve.

In my opinion, occupational health is an integral and inseparable part of

environmental health which broadly includes the interactions of the human environment and health including general accident prevention. I believe that whilst it is beneficial for health-and- safety-at-work legislation to be admin- istered by one government agency, this is not inconsistent with the health personnel being within the Department of Health (the Saskatchewan Occupa- tional Health Act allows for this even- tuality).

Manpower Needs An occupational health administra-

tor needs three basic types of experts: 1. environmental inspectors -

health, safety; 2. environmental specialists - occu-

pational hygienist, safety engineer;

3. health service personnel - physician, nurse, rehabilitation offi- cer.

While special training programs can provide in one and the same individual a person doubly qualified in environmental inspection with regard to both health and safety concerns, in practice such individuals do not exist in Canada. The Workers' Compensation Board safety inspector fits the safety slot, but the environmental inspector with pro- ficiency in health-hazard appraisal in the workplace is not immediately forth- coming. I wish to emphasize the potential value of public health inspectors (environmental health officers) coming on stream from the recently revamped training program for public health inspectors: such persons are of high calibre and in my opinion would make excellent environmental health inspectors in most workplaces. I believe it is quite logical to have two types of inspector in the workplace: the environmental safety inspector (the traditional safety inspector) with his back-up expert the safety engineer, and the environmental health inspector (the newly trained public health inspector) with the occupational hygienist as his back-up expert. I feel very strongly that the public health inspector could find a new purpose in the role I have outlined.

We have a small cadre of highly

qualified and effective occupational hygienists but they are few in number; their counterpart in safety, the safety engineer, is almost a non-existent species except in the mines where the engineer is also his own safety inspector.

Definition of Problem Areas The last special problem I wish to

identify is our need to develop a system which can identify problem areas in occupational health so that occupational health administrators can plan their programs according to need rather than have them dictated by crises. Let me give two examples:

1. Accident Statistics: because an accident results from an interaction of a person, some external agent and environment, parameters which shed light on this interaction must be recorded if accident statistics are to shed light on cause and prevention. Such parameters include occupation and actual physical activity at the time of the accident, the purpose of that activity, etc. Much of our accident data come to us in the form of so many head injuries, so many hand injuries, so many foot injuries, with the result that we translate this into so many hard hats, so many protective gloves, so many protective boots, all of which might reduce the effect of accidents but which cannot in itself reduce their incidence; whereas by recording parameters of the interaction perhaps the incidence of accidents themselves might be favorably affected.

2. Occupationally influenced health effects: Canada has a unique col- lection of health data unrivalled in any other country which can be used to identify occupationally influenced health effects. I refer to Medicare Data which are the computerized records of all physician- patient contacts including the diagnosis. These data may be utilized to identify specific environmental influences on health, e.g., respiratory disease and ex- posure to grain dust, noise-in-

September/ October 1976 63



duced hearing loss and tractor driving, and the incidence of agricultural poisoning.

If Departments of Health are sincere in wishing to give priority to occupational health then I challenge them to demonstrate that sincerity by facilita- ting the utilization of the computerized physician-generated data in defining the effects of the environment on health. I believe that this is one of the keys to establishing priority in preventive

health programs because the use of Medicare Data provides a tool by which the health economist can measure the effectiveness of programs of interven- tion.

CONCLUSION I wish to conclude by acknowledging

a document to which I have frequently referred in clarifying my ideas of occupational health programming needs: I refer to the working document A New

Perspective on the Health of Cana- dians. This, with its counterpart pro- duced by the Science Council, is truly an outstanding exposition of health needs and no occupational health specialist should fail to digest this document and apply its concept to occupational health. Each characteristic of the health field concept - human biology, environment, lifestyle and health care organization - is intimately related to health and safety in the workplace, and this study will be amply rewarded.

64 Canadian Journal of Public Health Supplement two to Vol.67



Documents

SUPPLEMENT TWO: Occupational Health: Issues and priorities || To Work Safely in a Healthy Environment: a Right and a Responsibility: THE WORKING ENVIRONMENT: A PATH TO HEALTH AND A