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The role of community groups and the voluntary sector in occupational health and safety has grown rapidly during the past twenty years. Hundreds of groups spread across at least 30 nations act as advocates for workers and sufferers from occupational diseases, concentrating on those whose needs are not met within workplace, trade union or state structures. Health and safety at work forms part of the brief of many more organizations which fight for workers’ rights, or on broader health or gender-based issues.
Sometimes the life-span of these organizations is short because, in part as a result of their work, the needs to which they respond become recognized by more formal organizations. However, many community and voluntary sector organizations have now been in existence for 10 or 20 years, altering their priorities and methods in response to changes in the world of work and the needs of their constituency.
Such organizations are not new. An early example was the Health Care Association of the Berlin Workers Union, an organization of doctors and workers which provided medical care for 10,000 Berlin workers in the mid-nineteenth century. Before the rise of industrial trade unions in the nineteenth century, many informal organizations fought for a shorter working week and the rights of young workers. The lack of compensation for certain occupational diseases formed the basis for organizations of workers and their relatives in the United States in the mid-1960s.
However, the recent growth of community and voluntary sector groups can be traced to the political changes of the late 1960s and 1970s. Increasing conflict between workers and employers focused on working conditions as well as pay.
New legislation on health and safety in the industrialized countries arose from an increased concern with health and safety at work amongst workers and trade unions, and these laws in turn led to further increases in public awareness. While the opportunities offered by this legislation have seen health and safety become an area for direct negotiation between employers, trade unions and government in most countries, workers and others suffering from occupational disease and injury have frequently chosen to exert pressure from outside these tripartite discussions, believing that there should be no negotiation over fundamental human rights to health and safety at work.
Many of the voluntary sector groups formed since that time have also taken advantage of cultural changes in the role of science in society: an increasing awareness amongst scientists of the need for science to meet the needs of workers and communities, and an increase in the scientific skills of workers. Several organizations recognize this alliance of interest in their title: the Academics and Workers Action (AAA) in Denmark, or the Society for Participatory Research in Asia, based in India.
Strengths and Weaknesses
The voluntary sector identifies as its strengths an immediacy of response to emerging problems in occupational health and safety, open organizational structures, the inclusion of marginalized workers and sufferers from occupational disease and injury, and a freedom from institutional constraints on action and utterance. The problems of the voluntary sector are uncertain income, difficulties in marrying the styles of voluntary and paid staff, and difficulties in coping with the overwhelming unmet needs of workers and sufferers from occupational ill-health.
The transient character of many of these organizations has already been mentioned. Of 16 such organizations known in the UK in 1985, only seven were still in existence in 1995. In the meantime, 25 more had come into existence. This is characteristic of voluntary organizations of all kinds. Internally they are frequently non-hierarchically organized, with delegates or affiliates from trade unions and other organizations as well as others suffering from work-related health problems. While links with trade unions, political parties and governmental bodies are essential to their effectiveness in improving conditions at work, most have chosen to keep such relationships indirect, and to be funded from several sources—typically, a mixture of statutory, labour movement, commercial or charitable sources. Many more organizations are entirely voluntary or produce a publication from subscriptions which cover printing and distribution costs only.
The activities of these voluntary sector bodies can be broadly categorized as based on single hazards (illnesses, multinational companies, employment sectors, ethnic groups or gender); advice centres; occupational health services; newsletter and magazine production; research and educational bodies; and supranational networks.
Some of the longest-established bodies fight for the interests of sufferers from occupational diseases, as shown in the following list, which summarizes the principal concerns of community groups around the world: multiple chemical sensitivity, white lung, black lung, brown lung, Karoshi (sudden death through overwork), repetitive strain injury, accident victims, electrical sensitivity, women’s occupational health, Black and ethnic minority occupational health, white lung (asbestos), pesticides, artificial mineral fibres, microwaves, visual display units, art hazards, construction work, Bayer, Union Carbide, Rio Tinto Zinc.
Concentration of efforts in this way can be particularly effective; the publications of the Center for Art Hazards in New York City were models of their kind, and projects drawing attention to the special needs of migrant minority ethnic workers have had successes in the United Kingdom, the United States, Japan and elsewhere.
A dozen organizations around the world fight for the particular health problems of ethnic minority workers: Latino workers in the United States; Pakistani, Bengali and Yemeni workers in England; Moroccan and Algerian workers in France; and South-East Asian workers in Japan among others. Because of the severity of the injuries and illnesses suffered by these workers, adequate compensation, which often means recognition of their legal status, is a first demand. But an end to the practice of double standards in which ethnic minority workers are employed in conditions which majority groups will not tolerate is the main issue. A great deal has been achieved by these groups, in part through securing better provision of information in minority languages on health and safety and employment rights.
The work of the Pesticides Action Network and its sister organizations, especially the campaign to get certain pesticides banned (the Dirty Dozen Campaign) has been notably successful. Each of these problems and the systematic abuse of the working and external environments by certain multinational companies are intractable problems, and the organizations dedicated to resolving them have in many cases won partial victories but have set themselves new goals.
The complexity of the world of work, the weakness of trade unions in some countries, and the inadequacy of statutory provision of health and safety advice at work, have resulted in the setting up of advice centres in many countries. The most highly developed networks in English-speaking countries deal with tens of thousands of enquiries each year. They are largely reactive, responding to needs as reflected by those who contact them. Recognized changes in the structure of advanced economies, towards a reduction in the size of workplaces, casualization, and an increase in informal and part-time work (each of which creates problems for the regulation of working conditions) have enabled advice centres to obtain funding from state or local government sources. The European Work Hazards Network, a network of workers and workers’ health and safety advisers, has recently received European Union funding. The South African advice centres network received EU development funding, and community-based COSH groups in the United States at one time received funds through the New Directions programme of the US Occupational Safety and Health Administration.
Occupational Health Services
Some of the clearest successes of the voluntary sector have been in improving the standard of occupational health service provision. Organizations of medically and technically trained staff and workers have demonstrated the need for such provision and pioneered novel methods of delivering occupational health care. The sectoral occupational health services which have been brought into existence progressively over the last 15 years in Denmark received powerful advocacy from the AAA particularly for the role of workers’ representatives in management of the services. The development of primary-care-based services in the UK and of specific services for sufferers from work-related upper limb disorders in response to the experience of workers’ health centres in Australia are further examples.
Changes within science during the 1960s and 1970s have lead to experimentation with new methods of investigation described as action research, participatory research or lay epidemiology. The definition of research needs by workers and their trade unions has created an opportunity for a number of centres specializing in carrying out research for them; the network of Science Shops in the Netherlands, DIESAT, the Brazilian trade union health and safety resource centre, SPRIA (the Society for Participatory Research in Asia) in India, and the network of centres in the Republic of South Africa are amongst the longest established. Research carried out by these bodies acts as a route by which workers’ perceptions of hazards and their health become recognized by mainstream occupational medicine.
Many voluntary sector groups produce periodicals, the largest of which sell thousands of copies, appear up to 20 times a year and are read widely within statutory, regulatory and trade union bodies as well as by their target audience amongst workers. These are effective networking tools within countries (Hazards bulletin in the United Kingdom; Arbeit und Ökologie (Work and the Environment) in Germany). The priorities for action promoted by these periodicals may initially reflect cultural differences from other organizations, but frequently become the priorities of trades unions and political parties; the advocacy of stiffer penalties for breaking health and safety law and for causing injury to, or the death of, workers are recurrent themes.
The rapid globalization of the economy has been reflected in trade unions through the increasing importance of the international trade secretariats, area-based trade union affiliations like the Organization of African Trade Union Unity (OATUU), and meetings of workers employed in particular sectors. These new bodies frequently take up health and safety concerns, the African Charter on Occupational Health and Safety produced by OATUU being a good example. In the voluntary sector international links have been formalized by groups which concentrate on the activities of particular multinational companies (contrasting the safety practices and health and safety record of constituent businesses in different parts of the world, or the health and safety record in particular industries, such as cocoa production or tyre manufacture), and by networks across the major free trade areas: NAFTA, EU, MERCOSUR and East Asia. All these international networks call for the harmonization of standards of worker protection, the recognition of, and compensation for, occupational disease and injury, and worker participation in health and safety structures at work. Upward harmonization, to the best extant standard, is a consistent demand.
Many of these international networks have grown up in a different political culture from the organizations of the 1970s, and see direct links between the working environment and the environment outside the workplace. They call for higher standards of environmental protection and make alliances between workers in companies and those who are affected by the companies’ activities; consumers, indigenous people in the vicinity of mining operations, and other residents. The international outcry following the Bhopal disaster has been channelled through the Permanent People’s Tribunal on Industrial Hazards and Human Rights, which has made a series of demands for the regulation of the activities of international business.
The effectiveness of voluntary sector organizations can be assessed in different ways: in terms of their services to individuals and groups of workers, or in terms of their effectiveness in bringing about changes in working practice and the law. Policy making is an inclusive process, and policy proposals rarely originate from one individual or organization. However, the voluntary sector has been able to reiterate demands which were at first unthinkable until they have become acceptable.
Some recurrent demands of voluntary and community groups include:
The voluntary sector in occupational health and safety exists because of the high cost of providing a healthy working environment and appropriate services and compensation for the victims of poor working conditions. Even the most extensive systems of provision, like those in Scandinavia, leave gaps which the voluntary sector attempts to fill. The increasing pressure for deregulation of health and safety in the long-industrialized countries in response to competitive pressures from transitional economies has created a new campaign theme: the maintenance of high standards and upward harmonization of standards in different nations’ legislation.
While they can be seen as performing an essential role in the process of initiating legislation and regulation, they are necessarily impatient about the speed with which their demands are accepted. They will continue to grow in importance wherever workers find that state provisions fall short of what is needed.
In the context of occupational health and safety, “right to know” refers generally to laws, rules and regulations requiring that workers be informed about health hazards related to their employment. Under right-to-know mandates, workers who handle a potentially harmful chemical substance in the course of their job duties cannot be left unaware of the risk. Their employer is legally obligated to tell them exactly what the substance is chemically, and what kind of health damage it can cause. In some cases, the warning must also include advice on how to avoid exposure and must state the recommended treatment in case exposure does occur. This policy contrasts sharply with the situation it was meant to replace, unfortunately still prevailing in many workplaces, in which workers knew the chemicals they used only by trade names or generic names such as “Cleaner Number Nine” and had no way to judge whether their health was being endangered.
Under right-to-know mandates, hazard information is usually conveyed through warning labels on workplace containers and equipment, supplemented by worker health and safety training. In the United States, the major vehicle for worker right to know is the Occupational Safety and Health Administration’s Hazard Communication Standard, finalized in 1986. This federal regulatory standard requires labelling of hazardous chemicals in all private-sector workplaces. Employers must also provide workers access to a detailed Materials Safety Data Sheet (MSDS) on each labelled chemical, and provide worker training in safe chemical handling. Figure 1 shows a typical US right-to-know warning label.
Figure 1. Right-to-know chemical warning label
It should be noted that as a policy direction, the provision of hazard information differs greatly from direct regulatory control of the hazard itself. The labelling strategy reflects a philosophical commitment to individual responsibility, informed choice and free market forces. Once armed with knowledge, workers are in theory supposed to act in their own best interests, demanding safe working conditions or finding different work if necessary. Direct regulatory control of occupational hazards, by contrast, assumes a need for more active state interventions to counter the power imbalances in society that prevent some workers from making meaningful use of hazard information on their own. Because labelling implies that the informed workers bear ultimate responsibility for their own occupational safety, right-to-know policies occupy a somewhat ambiguous status politically. On the one hand, they are cheered by labour advocates as a victory enabling workers to protect themselves more effectively. On the other hand, they can threaten workers’ interests if right to know is allowed to replace or weaken other occupational safety and health regulations. As activists are quick to point out, the “right to know” is a starting point that needs to be complemented with the “right to understand” and the “right to act”, as well as with continued effort to control work hazards directly.
Local organizations play a number of important roles in shaping the real-world significance of worker right-to-know laws and regulations. First and foremost, these rights often owe their very existence to public interest groups, many of them community based. For example, “COSH groups” (grass-roots Committees on Occupational Safety and Health) were central participants in the lengthy rule-making and litigation that went into establishing the Hazard Communication Standard in the United States. See box for a more detailed description of COSH groups and their activities.
Organizations in the local community also play a second critical role: assisting workers to make more effective use of their legal rights to hazard information. For example, COSH groups advise and assist workers who feel they may suffer retaliation for seeking hazard information; raise consciousness about reading and observing warning labels; and help bring to light employer violations of right-to-know requirements. This help is particularly important to workers who feel intimidated in using their rights due to low education levels, low job security, or lack of a supportive trade union. COSH groups also assist workers in interpreting the information contained on labels and in Material Safety Data Sheets. This kind of support is badly needed for workers with limited literacy. It can also help workers with good reading skills but insufficient technical background to understand the MSDSs, which are often written in scientific language confusing to an untrained reader.
Worker right to know is not only a matter of transmitting factual information; it also has an emotional side. Through right to know, workers may learn for the first time that their jobs are dangerous in ways they had not realized. This disclosure can stir up feelings of betrayal, outrage, dread and helplessness—sometimes with great intensity. Accordingly, a third important role that some community-based organizations play in worker right to know is to provide emotional support for workers struggling to deal with the personal implications of hazard information. Through self-help support groups, workers receive validation, a chance to express their feelings, a sense of collective support, and practical advice. In addition to COSH groups, examples of this kind of self-help organization in the United States include Injured Workers, a national network of support groups that provides a newsletter and locally available support meetings for individuals contemplating or involved in workers’ compensation claims; the National Center for Environmental Health Strategies, an advocacy organization located in New Jersey, serving those at risk of or suffering from multiple chemical sensitivity; and Asbestos Victims of America, a national network centred in San Francisco that offers information, counselling, and advocacy for workers exposed to asbestos.
A special case of right to know involves locating workers known to have been exposed to occupational hazards in the past, and informing them of their elevated health risk. In the United States, this kind of intervention is called “high-risk worker notification”. Numerous state and federal agencies in the United States have developed programmes of worker notification, as have some unions and a number of large corporations. The federal government agency most actively involved with worker notification at present is the National Institute for Occupational Safety and Health (NIOSH). This agency carried out several ambitious community-based pilot programmes of worker notification in the early 1980s, and now includes worker notification as a routine part of its epidemiological research studies.
NIOSH’s experience with this kind of information provision is instructive. In its pilot programmes, NIOSH undertook to develop accurate lists of workers with probable exposure to hazardous chemicals in a particular plant; to send personal letters to all workers on the list, informing them of the possibility of health risk; and, where indicated and feasible, to provide or encourage medical screening. It immediately became obvious, however, that the notification did not remain a private matter between the agency and each individual worker. On the contrary, at every step the agency found its work affected by community-based organizations and local institutions.
NIOSH’s most controversial notification took place in the early 1980s in Augusta, Georgia, with 1,385 chemical workers who had been exposed to a potent carcinogen (β-naphthylamine). The workers involved, predominantly African-American males, were unrepresented by a union and lacked resources and formal education. The community’s social climate was, in the words of programme staff, “highly polarized by racial discrimination, poverty, and substantial lack of understanding of toxic hazards”. NIOSH helped establish a local advisory group to encourage community involvement, which quickly took on a life of its own as more militant grass-roots organizations and individual worker advocates joined the effort. Some of the workers sued the company, adding to the controversies already surrounding the programme. Local organizations such as the Chamber of Commerce and the county Medical Society also became involved. Even many years later, echoes can still be heard of the conflicts among local organizations involved in the notification. In the end, the programme did succeed in informing the exposed workers of their life-long risk for bladder cancer, a highly treatable disease if caught early. Over 500 of them were medically screened through the programme, and a number of possibly life-saving medical interventions resulted.
A striking feature of the Augusta notification is the central role played by the news media. Local news coverage of the programme was extremely heavy, including over 50 newspaper articles and a documentary film about the chemical exposures (“Lethal Labour”) shown on local TV. This publicity reached a wide audience and had enormous impact on the notified workers and the community as a whole, leading the NIOSH project director to observe that “in actuality, the news media perform the real notification”. In some situations, it may be useful to regard local journalists as an intrinsic part of right to know and plan a formal role for them in the notification process to encourage more accurate and constructive reporting.
While the examples here are drawn from the United States, the same issues arise worldwide. Worker access to hazard information represents a step forward in basic human rights, and has properly become a focal point of political and service effort for pro-worker community-based organizations in many countries. In nations with weak legal protections for workers and/or weak labour movements, community-based organizations are all the more important in terms of the three roles discussed here—advocating for stronger right-to-know (and right-to-act) laws; assisting workers to use right-to-know information effectively; and providing social and emotional support for those who learn they are at risk from work hazards.
Formed in the wake of the US Occupational Safety and Health Act of 1970, committees on occupational safety and health initially emerged as local coalitions of public health advocates, concerned professionals, and rank-and-file activists meeting to deal with problems resulting from toxics in the workplace. Early COSH groups started in Chicago, Boston, Philadelphia and New York. In the south, they evolved in conjunction with grass roots organizations such as Carolina Brown Lung, representing textile mill workers suffering from byssinosis. Currently there are 25 COSH groups around the country, at various stages of development and funded through a wide variety of methods. Many COSH groups have made a strategic decision to work with and through organized labor, recognizing that union-empowered workers are the best equipped to fight for safe working conditions.
COSH groups bring together a broad coalition of organizations and individuals from unions, the public health community and environmental interests, including rank-and-file safety and health activists, academics, lawyers, doctors, public health professionals, social workers and so on. They provide a forum in which interest groups that do not normally work together can communicate about workplace safety and health problems. In the COSH, workers have a chance to discuss the safety and health issues they confront on the shop floor with academics and medical experts. Through such discussions, academic and medical research can get translated for use by working people.
COSH groups have been highly active politically, both through traditional means (such as lobbying campaigns) and through more colorful methods (such as picketing and carrying coffins past the homes of anti-labor elected officials). COSH groups played a key role in the struggles for local and state right-to-know legislation, building broad-based coalitions of union, environmental and public interest organizations to support this cause. For example, the Philadelphia area COSH group (PHILAPOSH) ran a campaign which resulted in the first city right-to-know law passed in the country. The campaign climaxed when PHILAPOSH members dramatized the need for hazard information by opening an unmarked pressurized canister at a public hearing, sending members of the City Council literally diving under tables as the gas (oxygen) escaped.
Local right-to-know campaigns eventually yielded more than 23 local and state right-to-know laws. The diversity of requirements was so great that chemical corporations ultimately demanded a national standard, so they would not have to comply with so many differing local regulations. What happened with COSH groups and right to know is an excellent example of how the efforts of labor and community coalitions working at the local level can combine to have a powerful national impact on occupational safety and health policy.