Viewpoint. Protecting Workers and Promoting Public Health in the Workplace

Work is where adults spend half if not the majority of their waking life. Thus, the workplace can be seen as a point of entry for the implementation of public health programs to assess and intervene not only to prevent and control occupational hazards but also to promote health.

Public health professionals need to know about workplace hazards and the regulatory functions in occupational health in order to ally with occupational health professionals to take advantage of the opportunities the workplace presents for health interventions.

In 1950, a joint committee of the International Labor Organization (ILO) and the World Health Organization (WHO) adopted the following definition: “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 departure from health caused by their working conditions, the protection of workers in their employment from risks resulting from factors adverse to health, and the placing and maintenance of workers in an occupational environment adapted to his/her physiological and psychological capabilities.” In 1995, this definition was broadened to include the maintenance and promotion of workers’ health and working capacity, and in 2007 the World Health Assembly will consider a resolution for a new Global Plan of Action on Workers’ Health to further expand the concepts of workers’ health to include activities that use the work setting as the site for interventions for health promotion, prevention of illness and injuries, and control of health problems.

Regardless of whether is it is framed as workers’ health or occupational health, the primary goal is to protect workers from occupational hazards by eliminating hazards, controlling exposure to unavoidable risk, and preventing illness or injury resulting from workplace exposures. The current work environment is much different than the industrial workplace imagined in the 1950s and for which the industrial hygiene hierarchy of controls was created, which emphasized the use of engineering controls for occupational hazards. This focus assumed an “acceptable risk” of exposure and had little consideration of infection and disease as occupational hazards. Now, the first priority is applying a precautionary approach to eliminate instead of control hazards and to substitute safer materials and processes.

Tuberculosis, malaria, and HIV/AIDS, the three major killers in the world today, are not generally thought of as occupational hazards, although the workplace is considered an important setting for interventions to prevent and control these infections, and health workers are at risk of exposure and infection from work with these patients.

Other emerging infections such as Severe Acute Respiratory Syndrome (SARS) and avian influenza are more closely linked with occupation and demonstrate the need for close collaboration between occupational and public health. During the 2003 outbreak in Canada, 43 percent of all reported cases of SARS, for example, were among health care workers. In the poultry industry, workers who raise, slaughter, or prepare chickens, as well as veterinarians and others responsible for culling sick birds, are at risk for infection with avian influenza. But children represent half of the total reported human cases of avian influenza with a 50 percent mortality rate. Rural families are at risk when they raise chickens in or close to the home. Addressing the problems of children and their working parents exposed in the informal sector, where there is neither a traditional employer-employee relationship nor a specific work site, requires collaboration between public health and occupational health. The majority of workers in the world are working in the informal sector, and increasingly in the US, cottage industry occurs in home and in non-industrial settings unregulated and unreached by occupational health professionals.

The role of the workplace and occupational hazards are incorporated into a new framework or ecological model for public health described in the 2003 Institute of Medicine report, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, which calls on public health professionals to recognize and address multiple determinants of health. This ecological model of public health requires a heightened awareness of the role of the environment—including the work environment—biological, chemical, physical, ergonomic, social, and economic factors, as well as employment and the built environment in order to improve population health in the next century.

Workplace surveillance provides information about public health hazards that can lead to interventions for the community at large. In this way, workers are like canaries in a coal mine for emerging health problems, and workplace interventions will assist in identifying solutions for the whole community. All public health interventions should take into consideration the work environment and other determinants of health of individuals and populations and promote policies to address them.

Susan Wilburn, MPH, RN, is an occupational health consultant for WHO and for John Snow International.