What is occupational health?

Science and Profession

The discovery that eighteenth-century chimney sweeps were prone to developing testicular cancer is often cited as the first example of an acknowledged occupational illness. In fact, physicians and other health care professionals had been aware for many centuries that certain jobs were linked to particular medical disorders: millers developed coughs, and hat makers became mentally unbalanced. Textbooks urged physicians to consider a patient’s occupation both in diagnosing and in treating illness. The emergence of occupational health as a distinct specialty within the medical professions is, however, a relatively recent phenomenon.

The Industrial Revolution brought with it not only the separation of one’s home life from one’s work life but also an increased risk of injury from factory machinery. Spinning jennies, power looms, mill wheels and belts, and early assembly line processes all carried the risk of accidental amputations, mangled limbs, and other permanently crippling injuries. Not surprisingly, much of the early emphasis of occupational health focused on safety. While company doctors treated the injured workers, engineers sought ways to reduce the job hazards.

By the twentieth century, several different but related specialties had evolved that focused on different aspects of occupational health. Industrial hygienists combine training in engineering and public health and attempt to improve safety in the workplace by providing education and training for workers and by redesigning the work area to eliminate hazards. Doctors of occupational medicine are employed by both government and industry to diagnose and to treat occupational illnesses and work-related disabilities. In addition to diagnosing and treating work-related injuries and illnesses, occupational health care providers may provide preemployment physical examinations, health screenings, and health promotion education and risk management programs based on occupational hazards and outcomes of trends of injuries or risks identified in the workplace. Public awareness of occupational health issues has led to the passage of legislation creating such agencies as the United States Occupational Safety and Health Administration (OSHA). All occupational health specialists in the United States must work within guidelines established by OSHA. There is a high cost to society from such disabilities as the black lung disease suffered by coal miners and the toxic or radioactive exposure experienced by workers ranging from hospital laboratory technicians to pipefitters and welders. As a result, occupational health has become an ever-expanding, complex, and important medical specialty.

Diagnostic and Treatment Techniques

Because occupational health problems can affect any part of the human anatomy, their diagnostic and treatment techniques are drawn from all areas of medical science. If a worker is injured on the job or suffers from an easily recognizable problem, such as a repetitive motion disorder, diagnosis and treatment can be quite straightforward. In the case of repetitive motion, problems such as carpal tunnel syndrome, which is sometimes experienced by word processing operators, might be treated by advising patients to change their work posture, providing them with splints to align the wrists and hands properly, employing corrective surgery to alleviate pain, and redesigning the work site to prevent future problems. The treatment for many on-the-job injuries will also include an extensive course of physical and rehabilitative therapy to allow the worker to return to work eventually, either at the old job or at a new one.

Many occupational health problems, however, are not as readily diagnosed as carpal tunnel syndrome. The industrial hygienist and the doctor of occupational medicine often must rely on the expertise of epidemiologists and toxicologists to determine the substances to which occupational exposure may be responsible for a worker’s ill health. In cases in which workers complain of vague symptoms such as chronic fatigue, nausea, or neuropathy (loss of nerve function), an accurate diagnosis can prove elusive. The medical literature contains numerous examples of occupational illnesses that mimicked other common disorders. For example, doctors misdiagnosed a cosmetologist as suffering from multiple sclerosis (a degenerative disease of the central nervous system) when she was actually experiencing nerve damage caused by many years of exposure to the chemical solvents used to apply and remove artificial fingernails. Because many occupational illnesses can take years or even decades to appear, in some cases an accurate diagnosis may never be achieved. Once a diagnosis is made, treatment for an occupational illness caused by exposure to chemicals, for example, can be as simple as assigning the worker to tasks that eliminate exposure or as technologically sophisticated as using dialysis or chemical chelation to remove toxins from a patient’s blood.

Perspective and Prospects

Occupational health is one of the most challenging specialties in modern medicine. Practitioners must combine skills and knowledge gleaned from a wide spectrum of related skills. The proliferation of technologically complex methods and materials in the workplace has resulted in occupational exposures and illnesses that were unknown until the twentieth century. At the time that occupational health first emerged as a distinct concern in the medical community, industrial hygiene focused almost exclusively on safety in the workplace. If the factory could be designed so that workers did not risk losing a limb whenever they operated machinery, the hygienist could feel a sense of accomplishment.

Workplace safety remains a concern in occupational health, but obvious hazards such as poorly lit work areas or exposed moving parts on machines have been joined by a host of subtler threats to workers’ well-being. Epidemiologists and toxicologists have linked on-the-job exposure to dust, heavy metals, radiation, solvents and other chemicals, and even blood-borne pathogens to a host of cancers, disabling diseases, reproductive problems, and other concerns. Yet, not only must the industrial hygienist and doctor of occupational medicine worry about protecting workers from these physical hazards, but the modern occupational health specialist must also be concerned with the long-term effects of repetitive motions, noise exposures, and even emotional stress. As the influence of workers’ jobs on those workers’ health and on the health of their families is recognized as a major factor in a family’s overall well-being, the importance of the occupational health specialist becomes increasingly obvious within modern society. Occupational health specialists employed in government, industry, and private practice, each approaching the question of worker wellness from a slightly different perspective, all fill a vital and expanding niche in modern medical practice.

The regulatory agency OSHA was created by Congress with the Occupational Safety and Health Act of 1970 to ensure safe work environments free of hazards that could cause death or serious physical harm to employees. It has the authority to fine or charge employers who do not follow safety regulations. The National Institute of Occupational Safety and Health (NIOSH), also created in 1970, conducts research and advises OSHA on issues related to hazards in the workplace.

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