file: hph_lec4f.mp3
A History of Modern Public Health: Surveillance - The World of
Work
So in this section, let's draw together some of the main points
of our class on work and public health and the case studies that
we've had a look at in relation to match-making and asbestos
mining.
First of all, there is a history that work place legislation has
been both poorly implemented and understaffed. So for example in
the factory legislation in Britain, there were only two chief
inspectors of factories, one in London, one in Birmingham. These
inspectors plus their staff were barely adequate for the 110,000
factories and workshops that were under their control during the
19th century. And by the 20th century, there were only 107
inspectors of factories employed in Britain. So this tended to be
a trend of work place legislation internationally.
There was also a question of vague terminology that was open to
interpretation. So for example in the 1911 Mines Act in South
Africa, asbestos mining managed to extricate itself from that
particular legislation and wasn't subjected to the constraints
that were placed on other forms of mining in the country.
There were other aspects of terminology that were also
contentious. So for example, when legislation states that it was
to render harmless so far as is practical particular hazards or
to regulate processes of manufacture that were injurious to
health, these particular forms of terminology were contentious.
Who knows what "injurious to health" actually means? How do you
render something harmless? So on the one hand, you have poor
implementation and understaffing, on another hand, you have vague
terminology that is open to interpretation.
Another point to draw your attention to is the fact that most of
the early legislation tended to focus on women and children. And
this is particularly the case of the factory acts and legislation
that concentrated on cotton mills and factories in western
industrialized Europe.
What they also did was concentrate on dangerous trades rather
than overall health. So much of the research on epidemiological
studies that related to particular hazardous materials such as
phosphorus and asbestos mining concentrated on particular sectors
of industry. Where there was a general shortfall was the idea
that overall health could be impacted by the working process. The
very fact of going to work, stress levels that related with long
hours of work, standing at machinery, jobs that are very physical
in nature such as mining, this relationship between that sort of
work and overall health tended to be underexplored in comparison
with specific processes and specific trades that caused specific
diseases.
And there has been an argument that the involvement of medicine
and public health in the work place has actually been a failure.
Certainly throughout the second half of the 19th century and the
beginning of the 20th century, medical inspection brought
relatively many more benefits to health for the reasons that I
outlined previously in relation to the fact that there was a
concentration on specific diseases and specific processes rather
than the overall impact of work. And this is partly because
medicine tended to concentrate on individualistic solutions,
solutions such as match-makers having to wash their hands between
touching the phosphorus, individualistic solutions relating to
prevention and worker safety in factories and work places,
whereas what should have been the focus of attention were the
working conditions and the collective problems of industry. So
medicine in a sense was replicating its general focus and
ideology of an individualistic-based knowledge and
individualistic-based policies. And this tended to work through
into work place legislation.
So what you have are interventions that weed out the
constitutionally unfit for work. So for example, it was possible
for the mining companies in South Africa to dismiss a worker if
they found evidence of insipient lung disease or asbestosis once
they performed an x-ray in a medical examination. So workers who
were constitutionally unfit were in effect excluded from the work
force, and the side effect of this is that much larger questions
such as the prohibition of exposure to hazardous materials, the
effects of long hours, the overall constitutional effects on the
body, for example of standing at machinery for long periods of
time were unscathed. These questions were not addressed, and they
were not discussed in the public health debates around the
relationship between health and work.
And ultimately the result of this was that public health and
health intervention was relatively unsuccessful in combating the
interests of big business, this balance between economy and
profit and competition and health. It was unsuccessful in
weighing the balance down in favor of health for many years.
What this class has shown us is that frequently the interests of
big business tend to win out over the interests of health. And
that is why the relationship of work and of occupation to ill
health and disease remains an important area for public health
today and in the years to come.
