Special Report on Health at Work

The great success of the Clean Air Act, and the many health benefits it brought, are taken for granted by a generation which has never experienced the death-dealing pea-souper fogs that used to enshroud our major cities.

Today the focus has narrowed from environmental pollution of the atmosphere to the health hazards of the workplace. For the workplace is a microcosm of the environment, says Dr. Geoffrey Brown, secretary of the Society of Occupational Medicine, which commemorates its golden jubilee this year.

The factories and offices, the farmlands and oil rigs and shops, the hospitals and public utilities, the schools and print rooms and lorries and laboratories – where millions spend most of their waking hours – are no less in need of being free from hazard to health than the air we breathe.

The importance of health at work, established in legislation by the Health and Safety at Work Act, 1974, and by thousands of regulations since, was acknowledged by the Prime Minister earlier this year.

Mrs. Thatcher was visiting the occupational and hygiene laboratories of the Health and Safety Executive, the large but impressively energetic and expert quango which is the Government’s watchdog on health at work. Commenting on their ‘meticulous’ research, she emphasized that for British industry to remain at the top level, it must not only be efficient, it must also be safe.

The need for controls has been recognized since the earliest days of the industrial revolution.

In 1775, Percival Pott pointed to the high incidence of scrotal cancer among chimney sweeps. The Factory Inspectorate began its work more than 150 years ago, in the same year, 1832, as the Great Reform Act. Later legislation effectively established the world’s first national industrial medical service.

Towards the end of the 19th century, an industrial disease notification scheme was begun and in 1898 Thomas Morrison Legge became the first medical inspector of factories.

Illness and death among munition workers in the First World War made the nation aware that both for humanitarian reasons and to preserve human resources, medical services at the workplace were essential. Even during the interwar slump, many businesses set up health facilities.

More recently, bodies such as Nuclear and Agriculture Inspectorates have done much to maintain and improve health standards among workers in those vital industries. Contrary to widespread belief, incidentally, farming is much more hazardous to health, through noise, dust, pesticides, machinery and animals, than atomic power.

For the past 50 years, the now 2,000-strong Society of Occupational Medicine has greatly advanced the cause of health at work, through scientific meetings, education and training, consultations on new measures and in forming a faculty in occupational medicine within the Royal College of Physicians.

It has, says Dr. Tim Carter, its official historian and director of medical services for the Health and Safety Executive, an ‘evangelical’ role. That has not always made it friends.

Its prime work has been to encourage and respond to government initiatives, its members trying to tread the path between state intervention and voluntary action. Unfortunately, doctors in industry have tended, unjustly, to be identified with the employers’ sectional interests, and their integrity has been questioned.

But with both employers and trade unions lukewarm at first about occupational health, many services might well not have come into existence when they did but for the Society’s proselytizing.

As Dr. Carter points out, Britain differs from most European countries in not imposing statutory obligations upon employers to seek occupational health guidance, but relies on voluntary action. The government’s involvement is chiefly regulatory and supervisory.

Nor, of course, does it provide a treatment service.

The National Health Service, which does, is not specifically concerned with health at work. The Robens Committee in 1972 thought occupational health services might wastefully duplicate the NHS.

It was against this background that the House of Lords select committee on science and technology last year, while calling for a major expansion of occupational health services to cover millions in smaller companies, favored voluntary codes of practice for employers to follow rather than compulsion.

The conflict between the advisory and enforcement roles of government agencies is not easy to resolve. Dr. Tim Carter, believes that employers and trade unions sometimes want occupational health advice to bolster some essentially political position rather than to solve a health problem or help remove a hazard.

As a result, the field services of the Employment Advisory Medical Service of the Health and Safety Executive act more as arbitrators than advisers. Scares about the supposed dangers of visual display units, alarmist talk about asbestos in situ, needless fears about occupationally related cancers, distract the service from the real problems.

That is not to say, of course, that asbestos is not dangerous or that some of the 30,000 or so hazardous substances in industry are not, carcinogenic. But the real challenge is different.

Though facilities in many major companies are first-rate-concerns like Esso, Shell, Marks & Spencer, Rank Hovis McDougall and Kodak are among the most notable – such companies form a mere 20 percent minority.

For the majority, however, mostly medium and small companies, to provide such services requires venture capital which they do not have or do not want to provide.

This means that the 60 doctors and 30 nurses of Dr. Carter’s medical advisory service act as troubleshooters and crisis managers with health problems that need never have occurred. Meanwhile, important new problems – and new technology means these constantly arise – are not being adequately researched.

Ensuring health at work has a further difficult dimension. Safety at work is one thing – it is easy enough to identify dangerous equipment or the need to reduce noise (about a million workers have noise-related hearing defects, often severe and distressing). But it may not be so easy to do something about it.

If work causes you to lose an arm, the issue are clear. But what if it causes you to lose your reason? How to pin responsibility for the ‘sick building syndrome’, the vague but disturbing malaise which afflicts so many who work in modern buildings? How even to know for sure when it is or is not manifest?

However, Dr. John Cullen, the former industrialist who now heads the Health and Safety Commission, which advises the Government and develops the policies which the executive puts into practice, points out that the British system is being used as a model by other countries.

The way it involves both sides of industry in forming its policies and executing regulations in detail certainly ensures that measures are workable and realistic. ‘We don’t tell people how to run their show’, Dr. Cullen says. ‘We are not seeking to be over-protective.

‘But a decade ago, health at work was peripheral. Today, it is part and parcel of management. It is considered at the highest level in companies’.

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