Friday, 11 February 2011 20:24

Occupational Health Services in the United States: Introduction

Rate this item
(0 votes)

History

Occupational health services in the United States have always been divided in function and control. The extent to which government at any level should make rules affecting working conditions has been a matter of continuing controversy. Furthermore, there has been an uneasy tension between the state and federal governments about which should take primary responsibility for preventive services based primarily upon laws governing workplace safety and health. Monetary compensation for workplace injury and illness has primarily been the responsibility of private insurance companies, and safety and health education, with only recent changes, has been left largely to unions and corporations.

It was at the state level that the first governmental effort to regulate working conditions took place. Occupational safety and health laws began to be enacted by states in the 1800s when increasing levels of industrial production began to be accompanied by high accident rates. Pennsylvania enacted the first coal mine inspection act in 1869, and Massachusetts was the first state to pass a factory inspection law in 1877.

By 1900 the more industrialized states had some laws in place regulating some workplace hazards. Early in the twentieth century, New York and Wisconsin led the nation in developing more comprehensive occupational safety and health programmes.

Most states adopted worker’s compensation laws mandating private no-fault insurance between 1910 and 1920. A few states, such as Washington, provide a state-run system allowing the collection of data and the targeting of research goals. The compensation laws varied widely from state to state, were generally not well enforced, and omitted many workers, such as agricultural workers, from coverage. Only railway, longshore and harbour workers, and federal employees have national worker’s compensation systems.

In the first decades of the twentieth century, the federal role in occupational safety and health was largely restricted to research and consultation. In 1910 the Federal Bureau of Mines was established in the Department of the Interior to investigate accidents; consult with industry; conduct safety and production research; and provide training in accident prevention, first aid and mine rescue. The Office of Industrial Hygiene and Sanitation was created in the Public Health Service in 1914 to conduct research and assist states in solving occupational safety and health problems. It was located in Pittsburgh because of its close association with the Bureau of Mines and its focus on injuries and illnesses in the mining and steel industries.

In 1913 a separate Department of Labor was established; the Bureau of Labor Standards and the Interdepartmental Safety Council were organized in 1934. In 1936, the Department of Labor began to assume a regulatory role under the Walsh-Healey Public Contracts Act, which required certain federal contractors to meet minimum safety and health standards. Enforcement of these standards was often carried out by the states with varying degrees of effectiveness, under cooperative agreements with the Department of Labor. There were many who felt that this patchwork of state and federal laws was not effective in preventing workplace injuries and illnesses.

The Modern Era

The first comprehensive federal occupational safety and health laws were passed in 1969 and 1970. In November 1968, an explosion in Farmington, West Virginia, killed 78 coalminers, providing impetus to the demands of the miners for tougher federal legislation. In 1969, the Federal Coal Mine Health and Safety Act was passed, which set mandatory health and safety standards for underground coal mines. The Federal Mine Safety and Health Act of 1977 combined and expanded the 1969 Coal Mine Act with other earlier mining laws and created the Mine Safety and Health Administration (MSHA) to establish and enforce safety and health standards for all mines in the United States.

It was not a single disaster, but a steady rise in injury rates during the 1960s that helped spur passage of the Occupational Safety and Health Act of 1970. An emerging environmental consciousness and a decade of progressive legislation secured the new omnibus act. The law covers the majority of workplaces in the United States. It established the Occupational Safety and Health Administration (OSHA) in the Department of Labor to set and enforce federal workplace safety and health standards. The law was not a complete break from the past in that it contained a mechanism by which states could administer their own OSHA programmes. The Act also established the National Institute for Occupational Safety and Health (NIOSH), in what is now the Department of Health and Human Services, to conduct research, train safety and health professionals and develop recommended safety and health standards.

In the United States today, occupational safety and health services are the divided responsibility of a number of different sectors. In large companies, services for treatment, prevention and education are primarily provided by corporate medical departments. In smaller companies, these services are usually provided by hospitals, clinics or physicians’ offices.

Toxicological and independent medical evaluations are provided by individual practitioners as well as academic and public sector clinics. Finally, governmental entities provide for the enforcement, research funding, education and standard setting mandated by occupational safety and health laws.

This complex system is described in the following articles. Drs. Bunn and McCunney from the Mobil Oil Corporation and the Massachusetts Institute of Technology, respectively, report on corporate services. Penny Higgins, RN, BS, of Northwest Community Healthcare in Arlington Heights, Illinois, delineates the hospital-based programmes. The academic clinic activities are reviewed by Dean Baker, MD, MPH, the Director of the University of California, Irvine’s Centre for Occupational and Environmental Health. Dr. Linda Rosenstock, Director of the National Institute for Occupational Safety and Health, and Sharon L. Morris, Assistant Chair for Community Outreach of the University of Washington’s Department of Environmental Health, summarize government activities at the federal, state and local levels. LaMont Byrd, the Director of Health and Safety for the International Brotherhood of Teamsters, AFL-CIO, describes the various activities provided to the membership of this international union by his office.

This division of responsibilities in occupational health often leads to overlapping, and in the case of workers’ compensation, inconsistent requirements and services. This pluralistic approach is both the strength and weakness of the system in the United States. It promotes multiple approaches to problems, but it can confuse all but the most sophisticated user. It is a system that often is in flux, with the balance of power shifting back and forth among the key players—private industry, labour unions, and state or federal governments.

 

Back

Read 7452 times Last modified on Thursday, 08 September 2022 19:27

" DISCLAIMER: The ILO does not take responsibility for content presented on this web portal that is presented in any language other than English, which is the language used for the initial production and peer-review of original content. Certain statistics have not been updated since the production of the 4th edition of the Encyclopaedia (1998)."

Contents

Occupational Health Services References

Association of Occupational and Environmental Clinics (AOEC). 1995. Membership Directory. Washington, DC: AOEC.

Basic law on labour protection. 1993. Rossijskaja Gazeta (Moscow), 1 September.

Bencko, V and G Ungváry. 1994. Risk assessment and environmental concerns of industrialization: A central European experience. In Occupational Health and National Development, edited by J Jeyaratnam and KS Chia. Singapore: World Science.

Bird, FE and GL Germain. 1990. Practical Loss Control Leadership. Georgia: Institute Publishing Division of the International Loss Control Institute.

Bunn, WB. 1985. Industrial Medical Surveillance Programmes. Atlanta: Centers for Disease Control (CDC).

—. 1995. The scope of international occupational medical practice. Occup Med . In press.

Bureau of National Affairs (BNA). 1991. Workers’ Compensation Report. Vol. 2. Washington, DC: BNA.

—. 1994. Workers’ Compensation Report. Vol. 5. Washington, DC: BNA.
China Daily. 1994a. New sectors opened to lure foreign investment. 18 May.

—. 1994b. Foreign investors reap advantages of policy changes. 18 May.

Council of the European Communities (CEC). 1989. Council Directive On the Introduction of Measures to Encourage Improvements in the Safety and Health of Workers At Work. Brussels: CEC.

Constitution of the Russian Federation. 1993. Izvestija (Moscow), No. 215, 10 November.

Czech and Slovak Federal Republic. 1991a. The health sector: Issues and priorities. Human Resources Operations Division, Central and Eastern European Department. Europe, Middle East and North Africa Region, World Bank.

—. 1991b. Joint environmental study.

Equal Employment Opportunity Commission (EEOC) and Department of Justice. 1991. Americans with Disabilities Act Handbook. EEOC-BK-19, P.1. 1, 2, October.

European Commission (EC). 1994. Europe for Safety and Health At Work. Luxembourg: EC.

Felton, JS. 1976. 200 years of occupational medicine in the US. J Occup Med 18:800.

Goelzer, B. 1993. Guidelines on control of chemical and physical hazards in small industries. Working document for the Inter-Regional Task Group on health protection and health promotion of workers in small-scale enterprises, 1-3 November, Bangkok, Thailand. Bangkok: ILO.

Hasle, P, S Samathakorn, C Veeradejkriengkrai, C Chavalitnitikul, and J Takala. 1986. Survey of working conditions and environment in small-scale enterprises in Thailand, NICE project. Technical Report, No. 12. Bangkok: NICE/UNDP/ILO.

Hauss, F. 1992. Health promotion for the crafts. Dortmund: Forschung FB 656.

He, JS. 1993. Working report on national occupational health. Speech on the National Occupational Health Conference. Beijing, China: Ministry of Public Health (MOPH).

Health Standards Office.1993. Proceedings of National Diagnostic Criteria and Principles of Management of Occupational Diseases. Beijing, China: Chinese Standardization Press.

Huuskonen, M and K Rantala. 1985. Work Environment in Small Enterprises in 1981. Helsinki: Kansaneläkelaitos.

Improving working conditions and environment: An International Programme (PIACT). The evaluation of the International Programme for the Improvement of Working Conditions and Environment (PIACT). 1984. Report to the 70th session of the International Labour Conference. Geneva: ILO.

Institute of Medicine (IOM). 1993. Environmental Medicine and the Medical School Curriculum. Washington, DC: National Academy Press.

Institute of Occupational Health (IOH). 1979. Translation of the Occupational Health Care Act and the Council of the State Decree No. 1009, Finland. Finland: IOH.

Institute of Occupational Medicine.1987. Methods for Monitoring and Analysis of Chemical Hazards in Air of Workplace. Beijing, China: People’s Health Press.

International Commission on Occupational Health (ICOH). 1992. International Code of Ethics for Occupational Health Professionals. Geneva: ICOH.

International Labour Organization (ILO). 1959. Occupational Health Services Recommendation, 1959 (No. 112). Geneva: ILO.

—. 1964. Employment Injury Benefits Convention, 1964 (No.121). Geneva: ILO.

—. 1981a. Occupational Safety and Health Convention, 1981 (No. 155). Geneva: ILO.

—. 1981b. Occupational Safety and Health Recommendation, 1981 (No. 164). Geneva: ILO.

—. 1984. Resolution Concerning Improvement of Working Conditions and Environment. Geneva: ILO.

—. 1985a. Occupational Health Services Convention, 1985 (No. 161). Geneva: ILO

—. 1985b. Occupational Health Services Recommendation, 1985 (No. 171). Geneva: ILO.

—. 1986. The Promotion of Small and Medium-Sized Enterprises. International Labour Conference, 72nd session. Report VI. Geneva: ILO.

International Social Security Association (ISSA). 1995. Prevention Concept “Safety Worldwide”. Geneva: ILO.

Jeyaratnam, J. 1992. Occupational health services and developing nations. In Occupational Health in Developing Countries, edited by J Jeyaratnam. Oxford: OUP.

—. and KS Chia (eds.). 1994. Occupational Health and National Development. Singapore: World Science.

Joint ILO/WHO Committee on Occupational Health. 1950. Report of the First Meeting, 28 August-2 September 1950. Geneva: ILO.

—. 1992. Eleventh Session, Document No. GB.254/11/11. Geneva: ILO.

—. 1995a. Definition of Occupational Health. Geneva: ILO.

—. 1995b. Twelfth Session, Document No. GB.264/STM/11. Geneva: ILO.

Kalimo, E, A Karisto, T Klaukkla, R Lehtonen, K Nyman, and R Raitasalo. 1989. Occupational Health Services in Finland in the Mid-1980s. Helsinki: Kansaneläkelaitos.

Kogi, K, WO Phoon, and JE Thurman. 1988. Low Cost Ways of Improving Working Conditions: 100 Examples from Asia. Geneva: ILO.

Kroon, PJ and MA Overeynder. 1991. Occupational Health Services in Six Member States of the EC. Amsterdam: Studiecentrum Arbeid & Gezonheid, Univ. of Amsterdam.

Labour Code of the Russian Federation. 1993. Zakon, Suppl. to Izvestija (Moscow), June: 5-41.

McCunney, RJ. 1994. Occupational medical services. In A Practical Guide to Occupational and Environmental Medicine, edited by RJ McCunney. Boston: Little, Brown & Co.

—. 1995. A Manager’s Guide to Occupational Health Services. Boston: OEM Press and American College of Occupational and Environmental Medicine.

Ministry of Health of the Czech Republic. 1992. The National Programme of Health Restoration and Promotion in the Czech Republic. Prague: National Centre for Health Promotion.

Ministry of Public Health (MOPH). 1957. Recommendation on Establishing and Staffing Medical and Health Institutions in Industrial Enterprises. Beijing, China: MOPH.

—. 1979. State Committee of Construction, State Planning Committee, State Economic Committee, Ministry of Labour: The Hygienic Standards for Design of Industrial Premises. Beijing, China: MOPH.

—. 1984. Administrative Rule of Occupational Disease Diagnosis. Document No. 16. Beijing, China: MOPH.

—. 1985. Methods of Airborne Dust Measurement in Workplace. Document No. GB5748-85. Beijing, China: MOPH.

—. 1987. Ministry of Public Health, Ministry of Labour, Ministry of Finance, All-China Federation of Trade Union: Administrative Rule of Occupational Disease List and Care of the Sufferers. Document No. l60. Beijing, China: MOPH.

—. 1991a. Administrative Rule of Health Inspection Statistics. Document No. 25. Beijing, China: MOPH.

—. 1991b. Guideline of Occupational Health Service and Inspection. Beijing, China: MOPH.

—. 1992. Proceedings of National Survey on Pneumoconioses. Beijing, China: Beijing Medical Univ Press.

—. 1994 Annual Statistic Reports of Health Inspection in 1988-1994. Beijing, China: Department of Health Inspection, MOPH.

Ministry of Social Affairs and Employment. 1994. Measures to Reduce Sick Leave and Improve Labour Conditions. Den Haag, The Netherlands: Ministry of Social Affairs and Employment.

National Centre of Occupational Health Reporting (NCOHR). 1994. Annual Reports of Occupational Health Situation in 1987-1994. Beijing, China: NCOHR.

National Health Systems. 1992. Market and Feasibility Study. Oak Brook, Ill: National Health Systems.

National Statistics Bureau. 1993. National Statistics Yearbook of the People’s Republic of China. Beijing, China: National Statistic Bureau.

Neal, AC and FB Wright. 1992. The European Communities’ Health and Safety Legislation. London: Chapman & Hall.

Newkirk, WL. 1993. Occupational Health Services. Chicago: American Hospital Publishing.

Niemi, J and V Notkola. 1991. Occupational health and safety in small enterprises: Attitudes, knowledge and behaviour of the entrepreneurs. Työ ja ihminen 5:345-360.

Niemi, J, J Heikkonen, V Notkola, and K Husman. 1991. An intervention programme to promote improvements of the work environment in small enterprises: Functional adequacy and effectiveness of the intervention model. Työ ja ihminen 5:361-379.

Paoli, P. First European Survey On the Work Environment, 1991-1992. Dublin: European Foundation for the Improvement of Living and Working Conditions.

Pelclová, D, CH Weinstein, and J Vejlupková. 1994. Occupational Health in the Czech Republic: Old and New Solutions.

Pokrovsky, VI. 1993. The environment, occupational conditions and their effect on the health of the population of Russia. Presented at International Conference Human Health and the Environment in Eastern and Central Europe, April 1993, Prague.

Rantanen, J. 1989. Guidelines on organization and operation of occupation health services. Paper presented at ILO Asian subregional seminar on the Organization of Occupational Health Services, 2-5 May, Manila.

—. 1990. Occupational Health Services. European Series, No. 26. Copenhagen: WHO Regional Publications

—. 1991. Guidelines on the organization and operation of occupational health services in the light of the ILO Occupational Health Services Convention No. 161 and Recommendation No. 171. Paper presented at the African sub-regional workshop on occupational health services, 23-26 April, Mombasa.

—. 1992. How to organize plant-level collaboration for workplace actions. Afr Newslttr Occup Health Safety 2 Suppl. 2:80-87.

—. 1994. Health Protection and Health Promotion in Small-Scale Enterprises. Helsinki: Finnish Institute of Occupational Health.

—, S Lehtinen, and M Mikheev. 1994. Health Promotion and Health Protection in Small-Scale Enterprises. Geneva: WHO.

—,—, R Kalimo, H Nordman, E Vainio, and Viikari-Juntura. 1994. New epidemics in occupational health. People and Work. Research reports No. l. Helsinki: Finnish Institute of Occupational Health.

Resnick, R. 1992. Managed care comes to Workers’ Compensation. Bus Health (September):34.

Reverente, BR. 1992. Occupational health services for small-scale industries. In Occupational Health in Developing Countries, edited by J Jeyaratnam. Oxford: OUP.

Rosenstock, L, W Daniell, and S Barnhart. 1992. The 10-year experience of an academically affiliated occupational and environmental medicine clinic. Western J Med 157:425-429.

—. and N Heyer. 1982. Emergence of occupational medical services outside the workplace. Am J Ind Med 3:217-223.

Statistical Abstract of the United States. 1994. 114th edition:438.

Tweed, V. 1994. Moving toward 24-hour care. Bus Health (September):55.

United Nations Conference on Environment and Development (UNCED). 1992. Rio De Janeiro.

Urban, P, L Hamsová, and R. Nemecek. 1993. Overview of Occupational Diseases Acknowledged in the Czech Republic in the Year 1992. Prague: National Institute of Public Health.

US Department of Labor. 1995. Employment and Earnings. 42(1):214.

World Health Organization (WHO). 1981. Global Strategy for Health for All by Year 2000.
Health for All, No. 3. Geneva: WHO.

—. 1982. Evaluation of Occupational Health and Industrial Hygiene Services. Report of the Working Group. EURO Reports and Studies No. 56. Copenhagen: WHO Regional Office for Europe.

—. 1987. Eighth General Programme of Work Covering the Period 1990-1995. Health for All, No.10. Geneva: WHO.

—. 1989a. Consultation On Occupational Health Services, Helsinki, 22-24 May 1989. Geneva: WHO.

—. 1989b. Final Report of Consultation On Occupational Health Services, Helsinki 22-24 May 1989. Publication No. ICP/OCH 134. Copenhagen: WHO Regional Office for Europe.

—. 1989c. Report of the WHO Planning Meeting On the Development of Supporting Model Legislation for Primary Health Care in the Workplace. 7 October 1989, Helsinki, Finland. Geneva: WHO.

—. 1990. Occupational Health Services. Country reports. EUR/HFA target 25. Copenhagen: WHO Regional Office for Europe.

—. 1992. Our Planet: Our Health. Geneva: WHO.

—. 1993. WHO Global Strategy for Health and Environment. Geneva: WHO.

—. 1995a. Concern for Europe’s tomorrow. Chap. 15 in Occupational Health. Copenhagen: WHO Regional Office for Europe.

—. 1995b. Global Strategy On Occupational Health for All. The Way to Health At Work: Recommendation of the Second Meeting of the WHO Collaborating Centres in Occupational Health, 11-14 October 1994 Beijing, China. Geneva: WHO.

—. 1995c. Reviewing the Health-For-All Strategy. Geneva: WHO.

World Summit for Social Development. 1995. Declaration and Programme of Action. Copenhagen: World Summit for Social Development.

Zaldman, B. 1990. Industrial strength medicine. J Worker Comp :21.
Zhu, G. 1990. Historical Experiences of Preventive Medical Practice in New China. Beijing, China: People’s Health Press.