One thing I dislike about developments in the health system over the last twenty years is the rise of consumer as a synonym for citizen. Consumer means to me someone who buys, eats, digests, uses up … consumes. That’s hardly an adequate reflection of our lives, lives in which we parent, teach, learn, recreate, sleep, ponder, act politically, commune with our neighbors. The rise of this consumer orientation has, I think, narrowed our view of individual interests, behaviors, and motivations. And in so doing, it has displaced the more holistic—and complex—notion of citizen, a term that encompasses both individual rights and responsibilities to the community and embraces the many roles we play, only one of which is as a user of goods or services in a market place.

Like citizenship, public health is a complex notion. The 1988 Institute of Medicine’s The Future of Public Health (and C.E.A. Winslow long before that) says that public health involves “society’s interest in assuring the conditions in which people can be healthy” and that this requires “organized community effort.” If we accept that view, then nearly all aspects of human life could be considered part of public health. After all, research and practice over the past hundred years have established strong links between health and sanitation, land use, education, income distribution, work, environmental degradation, housing, highway speeds, diet, and so on.

If this wide array of factors affects health, then rather than separate health, environment, and labor agencies, we should have a single, all-encompassing public health agency that grants building permits, protects wild rivers and streams, cleans up toxic dumps, inspects restaurants, organizes anti-tobacco campaigns, finances K-12 education, and gives out tickets for speeding.

Right! (Just imagine the training curriculum for that job!)

It would be unrealistic to expect a single regulatory agent to govern all of these sectors; the managerial, budgetary, legal, political, and human resource challenges would be overwhelming. So, at federal, state, and local levels, responsibilities for these various health-affecting sectors have long been divided among separate health departments, zoning and building divisions, environmental protection agencies, workers compensation programs, and employment departments. This division of labor may make sense on a practical level, but it creates some (at least potential) barriers to public health efforts. For example, half of our waking hours are spent at work, yet the bulk of our public health expertise is vested in health departments that have no direct oversight of workplaces.

The articles in this issue of Northwest Public Health highlight the need to overcome these jurisdictional barriers for at least two reasons. First, some work entails inherent threats to health—consider health care (see Silverstein and Howard, and Beaton), commercial fishing (see Mode), aviation (see Mode), and work performed by youth (see Miller) or people with disabilities (see Jones). Rates of workplace injuries for selected industries can be seen in the Northwest Region at a Glance. Second, some threats to health transcend the divisions between work and home, including children’s exposure to farm pesticides (see Thompson and Coronado), intimate partner violence (see Doherty), and obesity, lack of exercise, and poor diet (see the series of articles on wellness programs).

We hope that this issue’s focus on the health and safety of workers will add a little to efforts to better coordinate the strategies and practices of public health and occupational safety and health.

Aaron Katz, Editor-in-Chief
Director, UW Packard-Gates Population Leadership Program