| Occupational Public Health |
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Defining occupational public health 1--more than the sum of its parts?
- pub•lic \pə-blik\ (adjective) “of or relating to people in general”
- health \helth\ (noun) “the condition of being sound in body, mind, or spirit; especially: freedom from physical disease or pain”
- oc•cu•pa•tion•al \ä-kyə-pā-shə-nl\ (adjective) “An activity in which one engages; the principal business of one’s life.”1
Using these definitions, we might literally define occupational public health as "the condition of people being in sound mind and body in the principal business of one's life."
What does this actually mean? To explain, a short primer on public health is needed.
What is public health?
The Institute of Medicine (IOM) defines public health as "fulfilling society's interest in assuring conditions in which people can be healthy."2
Public health is a multidisciplinary field with the goal of promoting the health of populations through community efforts. Bernard Turnock, a leading public health researcher, says public health is "a broad social enterprise, more akin to a movement, that seeks to extend the benefits of current knowledge in ways that will have the maximum impact on the health status of a population. It does so by identifying problems that call for collective action to protect, promote, and improve health, primarily through preventive strategies."3
Key activities essential to public health include:
- assessing the health status of a population;
- diagnosing its problems;
- searching for the cases to those problems;
- and designing solutions to control or prevent those problems.4
Public health's focus on prevention and community health stands in contrast to the field of medicine, which focuses on treating illness in separate individuals. Public health achievements are imperative to reduce disease, disability, and death; however, the field has been given much less attention and funds than medicine. Why should this be so? It is not easy to identify a person who has been spared disease, disability, or death.4
Most people are familiar with public health, although they may not have considered it thus (e.g. vaccinations, food poisoning investigations). And while these are vital components to ensuring the health of the public, there is much more to public health. Environmental, social, behavioral, and occupational public health are all important subfields of public health.
Defining occupational public health 2--the big picture
We might adapt the IOM definition from above to reflect the occupational slant to public health: "Fulfilling society's interest in assuring conditions in which people can be healthy at work."
Therefore, occupational public health is a branch of public health that assures the health and well-being of people at work or affected by work. This broad group includes workers, of course, but also includes co-workers, family members, customers, suppliers, employers, nearby communities, and any other members of the public who are impacted by the workplace environment. In other words, just about everyone! Occupational injuries and illnesses are preventable, and public health’s prevention-based approach is critical to identify problems, implement prevention strategies, and evaluate programs. In addition, public health has the ability to impact groups that may fall outside the jurisdiction of regulatory agencies (e.g. Occupational Safety and Health Administration or OSHA).5
Occupational safety and health--a related field
Occupational safety and health is a related but different field, in which public health plays a role along with industrial hygiene, safety engineering, ergonomics, environmental health, occupational health psychology, sociology, and other fields. The International Labour Organization (ILO) and the World Health Organization (WHO) revised their 1950 definition of occupational health in 1995 to read “Occupational health should aim at: the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; the prevention amongst 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; the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological capabilities; and, to summarize, the adaptation of work to man and of each man to his job."6
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| A brief history of occupational safety and health |
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United States
At the beginning of this century, workers faced incredibly high health and safety risks on the job. Through a group effort involving unions, workers, employers, government agencies, scientists, and others, considerable progress has been made in improving working conditions. However, there is still a great deal of work to be done, with the "goal for all workers being a productive and safe working life and a retirement free from long-term consequences of occupational disease and injury."7
Although a full history of occupational safety and health is beyond the scope of this article, some of the main points are highlighted, and the reader is referred to other sources for more information.
(Adapted from Wikipedia)
- 1893: Congress passes Safety Appliance Act (applies only to railroads)
- 1910: Congress establishes federal Bureau of Mines (no regulatory authority)
- Early-mid 1900s: States begin establishing workers' compensation laws (Oregon: 1913)
- World-War II: Industrial production soars, along with industrial accidents
- Mid-1960s: Growing awareness of environmental impact of chemicals
- January 1968: President Johnson submits comprehensive occupational safety and health bill to Congress (bill dies in committee)
- December 1970: President Nixon signs the Occuptional Safety and Health Act (OSHA)
- April 28, 1971: OSHA goes into effect (now celebrated as Workers' Memorial Day by American Labor Unions)
More information on the history of U.S. workplace safety:
Economic History Services: History of Worklace Safety in the United States, 1880-1970
More information on OSHA:
Frequently asked questions about the OSH Act
Passage of the OSH Act:
The Job Safety Law of 1970: Its Passage was Perilous
History of the OSH Act, 1971-1984:
OSHA: A History of its First Thirteen Years
Oregon
The 1913 Oregon Legislative Assembly gave Oregon its first workers’ compensation law; it became effective July 1, 1914. The law set up the State Industrial Accident Commission, consisting of three trustees, to oversee the Industrial Accident Fund. Employers in hazardous occupations had to decide whether to be part of the fund. Contributors to the fund could not be sued; instead, suits were brought against the commission. Employers who did not contribute had no common-law defenses, and the Employer Liability Act made them vulnerable to unlimited damages for worker injuries or illnesses. Employers in nonhazardous occupations also could contribute to the fund and get the benefits.
In 1965, the Legislature overhauled the law. Most employers came under the Workmen’s Compensation Law, effective Jan. 1, 1966. Two years later, all employers that employed subject workers came under this law. Employers could buy the commission’s insurance, self-insure, or insure with private companies. The State Industrial Accident Commission was renamed the Workmen’s Compensation Board, and its insurance function was given to the State Compensation Department, the forerunner of SAIF Corporation. The federal Occupational Safety and Health Act of 1970 gave rise to the Oregon Safe Employment Act in 1973. Its purpose was to ensure safe and healthful working conditions and to reduce the burden — in terms of lost production, lost wages, medical expenses, disability compensation payments, and human suffering — caused by occupational injury and disease. Oregon Occupational Safety and Health Division (Oregon OSHA) was created in 1973 under an agreement with the Federal Department of Labor, Occupational Safety and Health Administration. That agreement enabled Oregon OSHA to enforce federal laws concerning worker environment and safety.
The 1977 Legislature created the Workers’ Compensation Department, which took on the administrative functions previously under the Workmen’s Compensation Board. The board continued supervising the Hearings Division, functioning as an appellate body. Today, the Workers’ Compensation Division is part of the Department of Consumer and Business Services. The department also contains other divisions involved in workers’ compensation and workplace safety: Oregon OSHA, the Insurance Division, the Ombudsman for Injured Workers, and the Small Business Ombudsman. The Workers’ Compensation Board is an independent agency that relies on DCBS for administrative support.8,9
OPHP's history
Oregon has been involved in Occupational Public Health surveillance since 1988. Pesticide-related illness was the first occupational condition tracked in a series of NIOSH-funded activities. These included cooperative agreements for Sentinel Event Notification System for Occupational Risk (SENSOR) programs to address pesticides, burns and dermatitis, a State Occupational Surveillance Consortium (SOSC) grant, and the current Consortium of Occupational State-Based Surveillance (COSS) Fundamental and Expanded grants. We have also received funding from NIOSH through cooperative agreements, contracts and grants to conduct occupational blood lead surveillance and to investigate occupational blood-borne pathogen exposure. Also funded were a Community Partners for Healthy Farming project and a surveillance research project through the National Occupational Research Agenda (NORA) program.
In 2005, OPHP was established to improve upon state-based occupational health surveillance by strengthening and expanding existing surveillance and prevention partnerships in the public and private sectors to ensure that priority health conditions are more fully characterized.
How does public health fit into the realm of occupational safety and health?
The Federal Occupational Safety and Health Administration (OSHA), state OSHA programs, and the Mine Safety and Health Administration (MSHA), which enforce workplace health and safety standards, have long been viewed by the public as the government agencies with primary responsibility for worker safety and health at the state and local levels. These regulatory agencies play a central and essential function in protecting worker health.5
Enforcement of workplace safety and health regulations are only one component of a comprehensive, integrated public health approach to workplace health and safety. State public health agencies have a critical and complementary role in the prevention of occupational illnesses and injuries. They do this by applying public health surveillance tools to identify problems, target interventions, and evaluate programs to reduce occupational illness and injury morbidity and mortality, and by applying public health approaches to protect the health of working populations. The public health approach to the prevention of work-related illnesses, injuries, and fatalities rests on the scientific rigors of epidemiology and medicine and related public health disciplines including program evaluation and culturally sensitive health communications. The statutory, regulatory, and philosophical commitment of public health to protect and promote the health of the public, especially vulnerable groups that may fall outside the jurisdiction of state or federal OSHA or MSHA, is accomplished not only by the actions of public health agencies but also by collaborations with other agencies and by mobilization of other sectors of society.5
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| References |
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1 Merriam-Webster Dictionary. Available at URL: http://www.merriam-webster.com/
2 Institute of Medicine (IOM). The Future of Public Health (1988). National Academies Press, Washington, D.C. Available at URL: http://www.nap.edu/openbook.php?isbn=0309038308&page=7
3 Turnock, Bernard. Public Health, Fourth Edition: What It Is and How It Works (2008). Jones and Bartlett Publishers, Sudbury, Mass.
4 Aschengrau Ann and Seage III, George R. Essentials of Epidemiology in Public Health (2003). Jones and Bartlett Publishers, Sudbury, Mass.
5 Council of State and Territorial Epidemiologists (CSTE) Occupational Health Surveillance Work Group (2008). Guidelines for minimum and comprehensive state-based public health activities in occupational safety and health. NIOSH Publication No. 2008-148. Available at URL: http://www.cdc.gov/niosh/docs/2008-148/
6 International Labour Office (ILO). Technical Guidelines For Workers’ Health Surveillance (1998). Available at URL: http://www.ilo.org/public/english/protection/safework/cops/english/download/e000017.pdf
7 Centers for Disease Control and Prevention. 1999. Achievements in Public Helath, 1900-1999: Improvements in Workplace Safety--United States, 1900-1999. MMWR 48(22):461-469. Available at URL: http://www.cdc.gov/mmWR/preview/mmwrhtml/mm4822a1.htm
8 Oregon Department of Consumer and Business Services. 2008. Biennial Report on the Oregon Workers' Compensation System. Available at URL: http://www4.cbs.state.or.us/ex/imd/reports/rpt/index.cfm?fuseaction=version_view&version_tk=181462&ProgID=FEARA006
9 Oregon Department of Consumer and Business Services. 2007. Administrative Overview. Available at URL: http://arcweb.sos.state.or.us/recmgmt/sched/special/state/overview/20060013dcbsadov.pdf
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