Evolution of attitudes toward occupational health in the U.S.A.

Abstract

Attitudes toward ill-health associated with the workplace are inevitably closely linked to attitudes toward disease occurring generally, and these have evolved remarkably slowly since the Middle Ages. By the nineteenth century in western countries, at least, people considered disease as a retribution for sins against God, or as a result of bad luck. Certainly this attitude was a factor in why the advent of the germ theory was followed only very slowly by measures aimed at preventing infections brought about from water, food, or airborne sources, even when methods for doing so were well understood. Today, attention is directed toward chronic degenerative diseases and cancer, with their long periods of development, and preventive approaches to these diseases are similarly slow to be applied. In part because the U.S.A. is a relatively young country, with a rapid influx of immigrant labor in this century, the contribution of occupations to injury, ill health and disease has been too seldom recognized. Doctors or nurses working in industries have usually focussed their attention on traditional health care techniques. In the U. S. A. there has recently been, however, a change toward recognizing the importance of prevention of disease. In the context of work-related illness, this recognition has been accelerated by recent legislation which makes employers legally responsible for detecting adverse effects on health of workers and the general public arising from their operations. Paradoxically the Occupational Safety and Health Act of 1970 has been less effective in bringing about a change of awareness of occupational disease than has the Toxic Substances Control Act of 1977. As a result of well-publicized situations in which serious effects of new chemical agents on workers have been discovered, the public and its representatives have led the way in these changes. But attitudes toward workplace diseases and injuries have been slow to change, as it is commonly said that worker protection is in conflict with economic viability of industries. Nevertheless, at least in large companies managers have recognized their vulnerability to huge compensation losses, and the role of occupational health professionals has become much more significant. Social, political and economic forces still act to delay application of knowledge of occupational disease causation and prevention of workplace diseases and injuries.