Public Health Occupational Safety and Health
by
Arthur L. Frank
  • LAST REVIEWED: 05 May 2017
  • LAST MODIFIED: 23 February 2011
  • DOI: 10.1093/obo/9780199756797-0058

Introduction

Occupational safety and health is the discipline that collectively looks after the regulation, inspection, and surveillance of workplaces and workers and uses scientific information to prevent injuries and illnesses in workplace settings. It is the part of public health that focuses on workers and their exposures as populations and provides diagnosis and care to individuals. Included in this field are the administrative measures to set and oversee exposure limits in workplaces and the policies to deal with workers who may have suffered an injury or illness caused by their work or work conditions. This is a broad-based field that uses professionals of varied backgrounds, all with the ultimate goal of disease and injury prevention.

General Overviews

Given the many scientific disciplines that come together in this field, one may need to look into various sources of information to cover all aspects. Several textbooks give comprehensive overviews of the field, including Wallace 2008, Rosenstock, et al. 2005, Rom 2007, LaDou 2007, and Levy et al. 2006. Each of these multiauthored texts takes on the wide scope of the field with sometimes differing assessments of the same potential hazards.

  • LaDou, Joseph, ed. 2007. Current occupational and environmental medicine. 4th ed. New York: McGraw Hill.

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    A paperback book written at an introductory level in the field but comprehensive in its approach. The editor has long experience in educating physicians in occupational medicine and was a journal editor for many years.

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  • Levy, Barry S., David H. Wegman, Sherry L. Baron, and Rosemary K. Sokas. 2006. Occupational and environmental health: Recognizing and preventing disease and injury. 5th ed. Philadelphia: Lippincott, Williams, and Wilkins.

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    One of the earliest widely used texts in the field. The paperback has undergone frequent updates to keep it current and relevant. Good for an understandable introduction to the field.

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  • Rom, William N., ed. 2007. Environmental and occupational medicine. 4th ed. Philadelphia: Lippincott, Williams, and Wilkins.

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    One of the first texts to focus on environmental as well as occupational exposures. Edited by a physician trained in occupational medicine who specializes in pulmonary diseases.

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  • Rosenstock, Linda, Mark R. Cullen, Carl A. Brodkin, and Carrie A. Redlich. 2005. Textbook of clinical occupational and environmental medicine. London: Elsevier.

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    A comprehensive text focusing on the clinical aspects of occupational medicine. Edited by an experienced group, including a former director of the National Institute for Occupational Safety and Health (NIOSH).

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  • Wallace, Robert B., ed. 2008. Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. New York: McGraw Hill.

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    Perhaps the standard text in all of public health, first published in 1914. This edition keeps the tradition of having one-third of the book devoted to occupational and environmental issues. All areas are covered except for occupational health nursing and safety.

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Historical Background

The field of occupational medicine was first recognized in 1700 due to the efforts of an Italian physician, Bernardino Ramazzini of Carpi. As described in Ramazzini 1940, Ramazzini was professor of medicine in Padua when he published his first edition of De mortis artificum diatriba (Diseases of workers). Known as the “father of occupational medicine,” Ramazzini added a question to the list generally asked by physicians since the days of Hippocrates: What is the occupation of the patient? An organization named after Ramazzini, Collegium Ramazzini, addresses issues of occupational and environmental health. In the United States the name most associated with the origins of occupational medicine in North America is Alice Hamilton. She was an early female physician active in the Woman Suffrage movement, and in 1918 she became the first female appointed to a faculty position at Harvard, in its School of Public Health. Hamilton 1943 is fascinating reading about the historical development of the field in the United States.

  • Collegium Ramazzini.

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    This is the website of a major international body of physicians and scientists following in the path of Bernardino Ramazzini. With its international headquarters in his hometown of Carpi, in northern Italy, this group presents scientific information and advocates for workplace safety and health. Its membership comes from all over the world.

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  • Hamilton, Alice. 1943. Exploring the dangerous trades. Boston: Little Brown.

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    Hamilton wrote her autobiography after a distinguished career in occupational medicine and public health that included teaching, inspecting factories, and publishing an early American textbook in the field. She noted that the field was seen as lagging in the United States compared to how it was viewed in Europe.

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  • Ramazzini, Bernardino. 1940. Diseases of workers. Translated by Wilmer Cave Wright. Chicago: Univ. of Chicago Press.

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    An early translation of Ramazzini’s classic text of 1713. He listed many diseases still seen in scores of workers in the early 21st century.

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Related Disciplines

Many scientific disciplines contribute to the field of occupational safety and health. They often work together and draw upon the expertise of each. These areas include occupational medicine, occupational health nursing, industrial hygiene, safety, ergonomics, health physics and radiation safety, toxicology, and occupational health psychology. Traditionally the largest number of these practitioners is in the field of occupational health nursing. More workplaces include personnel from that field than from any other. Such nurses also do some workplace assessments and may manage the care of injured workers in addition to providing frontline care. Occupational physicians make up one of the smallest branches of medicine, with less than 4,000 certified as specialists in the late 20th century. Levy 1980 documents that most medical students get little training in occupational medicine. Industrial hygiene is the field that assesses exposures to chemical and physical hazards in workplaces and recommends preventive strategies, as reviewed in Roelfs, et al. 2003. Safety considers the roles and behaviors of both workers and managers, as noted in Thompson, et al. 1998. Ergonomics traditionally looks at man–machine interactions, but in the late 20th century, as highlighted in Bohr 2000, ergonomics moved into the office environment. Radiation safety largely focuses on radiation hazards in medicine but also looks at sources in industrial settings, for example, sterilization of medical equipment and foods. Toxicology looks at the biological response to hazardous materials that may be found in workplaces. Huang, et al. 2006 reports on outstanding work in occupational health psychology, and one of the authors, Peter Y. Chen, is recognized as a leader in this field.

  • Bohr, Paula C. 2000. Efficiency of office ergonomics education. Journal of Occupational Rehabilitation 10:243–255.

    DOI: 10.1023/A:1009464315358Save Citation »Export Citation » Share Citation »

    The fastest-growing area of injuries to workers is office ergonomics, which this paper addresses.

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  • Huang, Yueng-Hsiang, Michael Ho, Gordon S. Smith, and Peter Y. Chen. 2006. Safety climate and self-reported injury: Assessing the mediating role of employee safety control. Accident Analysis and Prevention 38:425–433.

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    Chen has been a leader in this small field that looks at the role psychology plays to keep workers safe in workplaces.

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  • Levy, Barry S. 1980. The teaching of occupational health in American medical schools. Journal of Medical Education 55:18–22.

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    Levy did the earliest work documenting how little training medical students receive in occupational medicine, a situation that changed little by the early 21st century.

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  • Roelfs, Cora R., Elizabeth M. Barbeau, Michael J. Ellenbecker, and Rafael Moure-Eraso. 2003. Preventive strategies in industrial hygiene. American Industrial Hygiene Association Journal 64:62–67.

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    This paper speaks to how prevention strategies are used by industrial hygienists. The basic methods of substitution of materials and production processes, engineering controls for exposure reduction, and administrative controls and personal protective equipment, in that order, outline the structure used by industrial hygienists to protect workers.

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  • Thompson, Richard C., Thomas F. Hilton, and L. Alan Witt. 1998. Where the safety rubber meets the shop floor: A confirmatory model of management influence on workplace safety. Journal of Safety Research 29:15–24.

    DOI: 10.1016/S0022-4375(97)00025-XSave Citation »Export Citation » Share Citation »

    This paper points out the important role of management in setting a good corporate culture for safety. The DuPont Company has been a leader in this field for many years.

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Drug Testing in the Workplace

A sometimes controversial practice in occupational safety and health is testing for drug use in workplace settings. Drug testing may be a part of the preemployment evaluation; may be done among workers on a random basis; may be required in some settings, such as transportation; and may be required after an accident. Drug-free workplaces are mandated under some federal regulations. There is conflicting information regarding the value of drug-related testing with regard to hiring or use after employment. Joseph Rowntree Foundation 2004 is a fine, unbiased report on the value of drug testing and findings associated with such programs. A positive test by one method needs to be confirmed by another. Miller, et al. 1990 reviews ethical issues regarding drug testing. Much government information about drug testing is at the website of the Substance Abuse and Mental Health Services Administration.

Ergonomics

This is the field sometimes described as man–machine interactions, also called human factors. The goal of this field is to protect health and help maximize productivity in the workplace. Ergonomics can be applied in many diverse settings that range from office work to manufacturing equipment to the cockpit design in jet aircraft. Even the ancients knew about maximizing the use of tools in the workplace, as discussed by Marmaros, et al. 1999. Leading centers for academic work in the United States are at New York University and the University of Michigan (Violante, et al. 2000). The biggest concern of ergonomics in the early 21st century in the American workplace is related to computer use in offices, as reviewed in the US Department of Defense Workplace Ergonomics Reference Guide, a useful document developed by the military and published under its TRICARE Management Activity program. Many workers’ compensation complaints come from the area of office ergonomics.

Exposures to Chemicals

Traditionally a major area of concern in occupational safety and health has been the matter of workers being exposed to chemicals. There are tens of thousands of chemicals in commerce. By looking at groups of chemicals and some representative examples, one can gain some understanding of the hazards of exposures to chemicals. Many organs of the body can be affected by such exposures, but chief among them are the skin, lungs, liver, and nervous system. Obviously other organs can also be affected. Some chemicals are made in the millions of pounds each year, and hundreds of thousands of workers can be affected. The wide range of chemicals used in workplace settings exposes many workers. Many textbooks have sections on chemicals, but one comprehensive source for a review of them is the 15th edition of Maxcy-Rosenau-Last Public Health and Preventive Medicine, especially the Levin and Lilis 2008 piece on organic chemicals. Hazards and recommended exposure limits are in American Conference of Governmental Industrial Hygienists 2010 and National Institute for Occupational Safety and Health 2005. These two documents are useful guides to important potentially hazardous chemicals.

  • American Conference of Governmental Industrial Hygienists. 2010. 2010 guide to occupational exposure values. American Conference of Governmental Industrial Hygienists publication no. 0388. Cincinnati, OH: American Conference of Governmental Industrial Hygienists.

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    The American Conference of Governmental Industrial Hygienists guide, updated annually, has been around for decades and gives recommended exposure limits, known as threshold limit values (TLVs), for many hundreds of potentially harmful workplace chemicals.

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  • Levin, Stephen, and Ruth Lilis. 2008. Diseases associated with exposure to chemical substances: Organic compounds. In Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. Edited by Robert B. Wallace, 619–674. New York: McGraw Hill.

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    A comprehensive review of many important chemicals, their uses, the populations exposed, and health effects of exposures.

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  • National Institute for Occupational Safety and Health (NIOSH). 2005. NIOSH pocket guide to chemical hazards.

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    A useful guide that gives thumbnail sketches of chemical names, synonyms, Chemical Abstracts Registry Service (CAS) numbers, recommended exposure limits, and typical health effects. Available in hard copy or online.

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Organic Solvents

Organic solvents make up a large group of compounds, including alcohols, ethers, esters, ketones, aromatics, aliphatics, halogenated hydrocarbons, and others. They affect especially the liver, kidney, hematologic system, and nervous system. In addition to significant toxic effects in various organs are some common nonspecific effects, such as a depressant effect on the nervous system, which if severe enough can lead to unconsciousness or even death. Many effects are reversible following cessation of exposure, but some effects may be long-lasting, even after exposure ceases, as reviewed in Levin and Lilis 2008. These types of chemicals are often measured by industrial hygienists in a workplace. These hazardous materials have been known for many decades to cause diseases in workers and therefore have been of great concern. A comprehensive resource for access to many kinds of information is Organic Chemistry Resources Worldwide.

Aromatic Compounds

Aromatic compounds can be simple molecules, and perhaps the one of greatest importance is benzene. The particular hazard of benzene is its effect on blood-forming organs of the body. While compounds can be relatively pure, commercial-grade chemicals of aromatic solvents, such as toluene, zylene, and mineral spirits, almost always contain some level of benzene. Benzene is an extremely widely used material, and more than two million workers are exposed. Used for many purposes (basic chemical stock, pharmaceuticals, plastics, and more), benzene is especially known for its toxic effect on the bone marrow, as noted in Levin and Lilis 2008 and Smith 1996.

  • Levin, Stephen, and Ruth Lilis. 2008. Diseases associated with exposure to chemical substances: Organic compounds. In Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. Edited by Robert B. Wallace, 619–674. New York: McGraw Hill.

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    A comprehensive review of these important chemicals. See pp. 623–628.

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  • Smith, Martyn T. 1996. The mechanism of benzene-induced leukemia. Environmental Health Perspectives 104:1219–1225.

    DOI: 10.2307/3433166Save Citation »Export Citation » Share Citation »

    This is an article by a leading researcher on the topic of benzene-induced cancers, especially leukemias, although lymphomas and other conditions have also been reported.

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Aliphatics

The structure of this class of hydrocarbons, made primarily from petroleum, is a simple chain of carbon atoms and hydrogen atoms. Included in this group of hydrocarbons are gasoline, jet fuel, and solvents. Very-low-chain carbon compounds are gases and are used for heating and cooking (e.g., propane and butane). Neurotoxicity is the main hazard of theses materials. Clearly these are common materials, and many workers are exposed. They are flammable and must be handled carefully in the workplace and other settings. Levin and Lilis 2008 notes the health hazards.

  • Levin, Stephen, and Ruth Lilis. 2008. Diseases associated with exposure to chemical substances: Organic compounds. In Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. Edited by Robert B. Wallace, 619–674. New York: McGraw Hill.

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    A comprehensive review of health concerns related to this class of materials. See pp. 620–622.

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Halogenated Hydrocarbons

These hydrocarbons have at their core the carbon-hydrogen structure of many other organic compounds, but included in the structure as substitutes for hydrogen atoms are various halogens, such as bromine and chlorine. These compounds are solvents and are widely used to make rubber, pigments, and paints. While not as widely used as before the early 21st century, they account for more than half a trillion pounds of chemicals produced each year. Halogenated hydrocarbons have been well studied and are reported in Levin and Lilis 2008. They have many past and current uses. The carcinogenic potential of these compounds is reported in International Agency for Research on Cancer 1979.

  • International Agency for Research on Cancer. 1979. Some halogenated hydrocarbons. International Agency for Research on Cancer Monographs 20. Geneva, Switzerland: World Health Organization.

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    The International Agency for Research on Cancer (IARC) uses panels of international scientists to evaluate many chemicals and workplace processes for their potential to cause cancer. Published for decades, the reports classify substances according to how likely they are to be cancer-causing chemicals. The IARC is a well-respected agency.

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  • Levin, Stephen, and Ruth Lilis. 2008. Diseases associated with exposure to chemical substances: Organic compounds. In Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. Edited by Robert B. Wallace, 619–674. New York: McGraw Hill.

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    A good overview of these varied chemicals and their toxicity. These are among the most ubiquitous chemicals. See pp. 629–640.

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Exposure to Metals

Modern industrial society would not operate without the widespread use of many metals. First used for rare objects and weaponry, metals have become ubiquitous in our lives. Workplace exposures to metals are extensive, from extraction and processing to being made into products for human use. Fortunately not all metals have significant toxicity, but some metals and their processing have caused much occupational disease over the centuries. The historical assessment of the hazards of mining and smelting go as far back as 1556, and Agricola 1950 discusses the hazards of these activities. The toxic effects of metals are well reviewed in an almost encyclopedic manner in Grandjean 2008, and some of the specific hazards are reviewed in sections of this entry. While most hazards from metals do occur in workplaces, some, like lead, can poison individuals in other settings, including children affected by dusts derived from paint pigments in homes, as reviewed in Needleman 1992.

  • Agricola, Georg. 1950. De re metallica. Translated by Herbert Clark Hoover and Lou Harry Hoover. New York: Dover.

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    An ancient text translated into English that speaks to the hazards of mining and smelting, with a series of excellent woodcut illustrations making plain the author’s intent. Originally published in 1556.

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  • Grandjean, Philippe. 2008. Health significance of metal exposures. In Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. Edited by Robert B. Wallace, 603–617. New York: McGraw Hill.

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    An encyclopedic chapter reviewing the uses of, groups exposed to, and toxic effects of many commonly used industrial metals.

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  • Needleman, Herbert L., ed. 1992. Human lead exposure. Boca Raton, FL: CRC Press.

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    A book by the leading US authority on lead poisoning, especially its effects on children. Needleman has been a leader in eliminating lead from both gasoline and paint.

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Aluminum

Aluminum is a commonly found material, largely extracted from bauxite ore. There is no known role for aluminum in the body, and little is absorbed from the gastrointestinal tract under most circumstances. The toxicity of aluminum is noted from the development of spontaneous pneumothorax among workers exposed to aluminum dust. Aluminum may also cause neurotoxicity, as discussed in Grandjean 2008, especially in patients undergoing kidney dialysis. When neurotoxicity occurs, it appears to be irreversible. World Health Organization 1997 more fully outlines the hazards.

  • Grandjean, Philippe. 2008. Health significance of metal exposures. In Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. Edited by Robert B. Wallace, 603–617. New York: McGraw Hill.

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    See pages 604–605. A brief but good summary of aluminum toxicity.

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  • World Health Organization. 1997. Aluminum. International Programme on Chemical Safety, Environmental Health Criteria 194. Geneva, Switzerland: World Health Organization.

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    A volume put out by the World Health Organization regarding the specific health issues related to aluminum exposures.

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Arsenic

Found in relatively small quantities in nature, occupational exposures occur mainly in connection with metal smelting and specific products. In some parts of the world (India, Taiwan, and parts of South America), arsenic at toxic levels has been found in drinking water. Arsenic has both acute and chronic effects, as outlined in Grandjean 2008. Acutely, at sufficient doses it can cause rapid death. The chronic issues with arsenic are several distinct kinds of cancer, including in the skin and the lungs, and hemangiosarcomas of the liver. Both occupational and environmental exposures to arsenic have given rise to cancers, as noted in World Health Organization 2001.

  • Grandjean, Philippe. 2008. Health significance of metal exposures. In Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. Edited by Robert B. Wallace, 603–617. New York: McGraw Hill.

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    A review of sources, uses, and toxic effects of arsenic in workplaces and elsewhere. Also discussed are allowable levels of exposure and preventive methods. See pp. 605–606.

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  • World Health Organization. 2001. Arsenic and arsenic compounds. 2d ed. International Program on Chemical Safety, Environmental Health Criteria 224. Geneva, Switzerland: World Health Organization.

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    A volume from the World Health Organization that specifically looks at the hazards of arsenic.

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Beryllium

Used to give strength and lightness to metal alloys, beryllium has been used on spacecraft and in other settings where weight is an important issue. It is not a common element, nor does there appear to be any biological need for beryllium. Extremely low levels of beryllium can cause disease, and high enough levels will cause death. Acutely, beryllium can cause death by severely damaging the lungs. The chronic disease gives rise to granulomatous changes in the lungs. Newman, et al. 1989 discusses beryllium disease, and L. S. Newman has published extensively on the disease. World Health Organization 1990 reviews this topic also. While most disease has occurred in workplace settings, environmental exposures at very low levels have caused disease as well.

  • Newman, L. S., K. Kreiss, T. E. King Jr., S. Seay, and P. A. Campbell. 1989. Pathologic and immunologic alterations in early stages of beryllium disease: Re-examination of disease definition and natural history. American Review of Respiratory Disease 139:1479–1486.

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    Newman and Kreiss are leading researchers on the problems of beryllium. This article looks at the development of the disease.

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  • World Health Organization. 1990. Beryllium. International Programme on Chemical Safety, Environmental Health Criteria 106. Geneva, Switzerland: World Health Organization.

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    The World Health Organization published this volume that focuses on the health hazards related to exposure to beryllium.

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Chromium

Chromium compounds exist in several valence states, and toxicity may differ depending on the state. Chromium in very small amounts is an essential trace element for humans involved with glucose metabolism. The form with a six valence is clearly a carcinogen. It is unclear if chromium-3 is also carcinogenic, but the three form may metabolize in part to the six form inside the human body. Chromates have been known as a health hazard for centuries, the original issue being perforation of the nasal septum. Occupational Safety and Health Administration 2006 is a good fact sheet on the hazards of chromium. International Agency for Research on Cancer 1990 reviews the carcinogenicity of chromium. Katz and Salem 1993 is a full review of the toxicity of this material, focusing on the differences between the species.

Lead

A soft, easily worked metal, lead has been used for centuries, and its health hazards have been recognized for that long as well. Its major health effect is as a neurotoxin, but other organ systems can be affected also. Needleman, et al. 1990 discusses the health effects of lead on children, in whom it causes drops in IQ, hematologic effects, and other hazards. Adult exposures to lead, which often cause elevations in blood pressure and other health problems, come from lead paint and other sources, as discussed in Lustberg and Silbergeld 2002, and previously from lead-based gasoline additives, as reviewed in Lewis 1985.

  • Lewis, Jack. 1985. Lead poisoning: A historical perspective. EPA Journal.

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    This review of lead poisoning on the Environmental Protection Agency website is an excellent summation of what has been known and done about lead since ancient times and the positive impact from the reduction in the use of lead in modern society.

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  • Lustberg, Mark, and Ellen Silbergeld. 2002. Blood lead levels and mortality. Archives of Internal Medicine 162:2443–2449.

    DOI: 10.1001/archinte.162.21.2443Save Citation »Export Citation » Share Citation »

    Silbergeld is one of the most thoughtful and prolific writers about the many hazards of lead and its effects on children, pregnant women, and workers.

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  • Needleman, Herbert L., Alan Schell, David Bellinger, Alan Leviton, and Elizabeth N. Allred. 1990. The long-term effects of exposure to low doses of lead in childhood: An 11-year follow-up report. New England Journal of Medicine 322:83–88.

    DOI: 10.1056/NEJM199001113220203Save Citation »Export Citation » Share Citation »

    Needleman has been a leader in the study of lead poisoning, especially among children, but it should be noted that there is a connection with adult workplaces, since family members working in a leaded environment can contaminate households by bringing dust home.

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Manganese

Used in the making of many alloys, especially stainless steel, manganese is a component also found in many welding rods. It is an essential element for humans, functioning in several enzyme systems in the body. It has been used as a gasoline additive with detrimental effects. Neurotoxicity is the major adverse health effect of exposure to manganese. There is no doubt that in some settings, such as mining, exposure to manganese has deleterious health effects, especially on the nervous system. There is still some controversy regarding the exposure to manganese that occurs from the use of welding rods, a topic well reviewed in Antonini 2003. The use of manganese gasoline additives is addressed in Frumkin and Solomon 1997. The hazards of manganese should not be a surprise following the pioneering work reported in Couper 1837. J. Couper reported on the hazards early, and much has been written since then.

  • Antonini, James M. 2003. Health effects of welding. Critical Reviews in Toxicology 33:61–103.

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    A long and detailed discussion of the possible health hazards of manganese from welding rods. This author does not yet adopt the view of others that there is a definitive hazard, and he calls for more research.

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  • Couper, J. 1837. On the effects of the black oxide of manganese when inhaled into the lungs. British Annals of Medicine and Pharmacology 1:41–42.

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    This is the first written documentation of the health hazards of manganese, and it points out that the most serious source of exposure is by inhalation, a fact still appreciated.

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  • Frumkin, Howard, and Gina Solomon. 1997. Manganese in the U.S. gasoline supply. American Journal of Industrial Medicine 31:107–115.

    DOI: 10.1002/(SICI)1097-0274(199701)31:1<107::AID-AJIM16>3.0.CO;2-6Save Citation »Export Citation » Share Citation »

    This is an early paper pointing out the significant use and potential toxicity of a manganese-based gasoline additive that was subsequently shown to be quite toxic, with great effects on animals in the general environment, giving concern about the potential health effects on humans.

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Mercury

Mercury is an extremely toxic material and is generally well regulated in workplaces. It does, however, still get out into the general environment and can concentrate in sea life, with levels growing higher the further one goes up the food chain of fish. Spills can be hazardous, and as a liquid it can also sublime and become gaseous without any clear evidence of its presence. Grandjean, et al. 2005 discusses mercury, and Philippe Grandjean is especially well known for his work on mercury in many world settings. Governmental agencies have produced documents especially on the form of mercury found in the food chain, including World Health Organization 1991. Severe outbreaks of mercury poisoning have occurred following dumping of industrial sources of mercury, such as in Minamata Bay, Japan, as documented by the Japanese National Institute for Minamata Disease.

  • Grandjean, Philippe, Sylvaine Cordier, Tord Kjellström, Pál Weche, and Esben Budtz Jørgensen. 2005. Health effects and risk assessments. In Dynamics of mercury pollution on regional and global scales: Atmospheric processes and human exposures around the world. Edited by Niccola Pirrone and Kathryn R. Mahaffey, 511–539. New York: Springer.

    DOI: 10.1007/b105709Save Citation »Export Citation » Share Citation »

    Grandjean is a recognized expert on the health effects of mercury, and from his base in Denmark he has studied this problem all over the world.

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  • National Institute for Minamata Disease.

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    A fine documentation of the major problem that occurred in Minamata Bay, Japan, from ingesting contaminated seafood after mercury was released into the bay.

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  • World Health Organization. 1991. Inorganic mercury. International Programme on Chemical Safety, Environmental Health Criteria 118. Geneva, Switzerland: World Health Organization.

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    A comprehensive review and documentation of inorganic mercury, its health effects, and how and where it enters into humans.

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Nickel

Known for centuries, nickel was first isolated in the 18th century, and subsequently a technique was developed to make large quantities of pure nickel. Nickel is extracted from various ores. It is an allergen, and certain compounds are known to be carcinogenic. Many individuals find they cannot wear some earrings or watchbands because of the nickel content and the development of allergic changes, as discussed in Nielsen, et al. 1990. The Mond process of making pure nickel involves exposure to nickel carbonyl, known to be a carcinogen, which is reviewed in Grandjean 2008.

  • Grandjean, Philippe. 2008. Health significance of metal exposures. In Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. Edited by Robert B. Wallace, 603–617. New York: McGraw Hill.

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    A section written by a scientist especially well known for his work on many metals. See pp. 613–614.

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  • Nielsen, G. D., L. V. Jepsen, P. J. Jørgensen, P. Grandjean, and F. Brandrup. 1990. Nickel-sensitive patients with vesicular hand eczema: Oral challenge with a diet naturally high in nickel. British Journal of Dermatology 122:299–308.

    DOI: 10.1111/j.1365-2133.1990.tb08277.xSave Citation »Export Citation » Share Citation »

    A review of nickel sensitivity and the role diet may play as well.

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Uranium

Uranium is a radioactive element that comes in several isotopes, though over 99 percent is U-238. U-235 is more readily fissionable and is used for electric power and bombs. Ores with as little as 1 percent uranium are used for extraction. Exposure to uranium can cause kidney toxicity in humans, where it does damage to tubules. The toxicity of uranium ores for humans also comes from the inhalation of radon and daughters, leading to lung cancer. The toxicity of uranium is well reviewed by the Agency for Toxic Substances and Disease Registry.

Zinc

Zinc is a common metal essential to human life with low toxicity for forms other than freshly generated zinc oxide. It is involved with various enzymes, and it is also involved with the sense of smell. Zinc is used in paints, deodorants, and shampoos. Heating zinc, such as occurs in welding galvanized steel, releases zinc fumes that can cause metal fume fever. Treatment, as reviewed in Mueller and Seger 1985, is mostly supportive, although prevention is important in regard to this disease. The Agency for Toxic Substances and Disease Registry has a whole volume on zinc, including discussions of prevention and disease entities.

Governmental Agencies

Prior to 1971 there was a hodgepodge of state-level regulations regarding workplace exposure limits and enforcement. In that year, after Congress passed the Williams-Steigers Act, both the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health came into being. The Occupational Safety and Health Administration, located in the Department of Labor, sets legal limits for exposures and does workplace inspections. The National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention, is mandated to undertake scientific research in workplace safety and health, make scientific recommendations to the Occupational Safety and Health Administration for setting limits on workplace exposures, and provide training of occupational safety and health personnel. Originally in the Department of the Interior, the Mine Safety and Health Administration was moved into the Department of Labor to provide support for worker well-being in the mining industry through standard setting and inspections. In truth all federal governmental programs in workplace safety and health have for years been financially starved and unable to fully do what they were intended to accomplish. As each of the websites for these organizations notes, there is an organizational structure in place, but the lack of resources to operate is not well appreciated by those outside the field.

Legal Issues

In addition to legally allowable exposures in workplaces established by the Occupational Safety and Health Administration (OSHA), there are other legal aspects that can affect workers. Modern workers’ compensation started in the 1800s in Germany and began in the early 20th century in the United States, as reviewed in Guyton 1999. It is basically operated as a no-fault system. Workers’ medical bills are covered, and their lost wages are replaced in whole or in part. The issue of asbestos exposure has been especially contentious and is well reviewed in Tweedale 2000.

  • Guyton, Gregory P. 1999. A brief history of workers’ compensation. Iowa Orthopaedic Journal 19:106–110.

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    A comprehensive history of compensation and commentary about the difficulties in operating such programs.

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  • Tweedale, Geoffrey. 2000. Magic mineral to killer dust: Turner and Newall and the asbestos hazard. Oxford: Oxford Univ. Press.

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    This book is a detailed account of the hazards of asbestos, the role of an important company in the field, and the contentiousness of legal issues surrounding this material.

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Pneumoconiosis

In 1867 a German pathologist coined this term, which means “dust disease of the lung.” There are dozens of exposures that can give rise to the development of scar tissue in the lung or surrounding tissue. The development of this scar tissue can lead to death if severe enough, and some of the dusts, especially asbestos fibers, can also lead to the development of several forms of cancer. The dusts of special importance include asbestos, coal, and silica, though some others, like kaolin or talc, can also produce disease in workers. Although the name is relatively recent, the hazards of the dusts have been known for millennia. The three special dusts mentioned will be discussed in further detail. It should be noted that the pneumoconioses, as they are collectively called, are all entirely preventable illnesses with appropriate limits in exposures or the use of personal protective equipment. This is reviewed by the National Institute for Occupational Safety and Health.

Asbestos

The term “asbestos” refers to six naturally occurring minerals. All six fiber types cause all asbestos-related diseases. Asbestos affects both the lung parenchyma and pleura. What makes asbestos especially important is that it can cause a wide variety of cancers. Selikoff and Lee 1978 is a comprehensive treatise on the hazards of asbestos.

  • Selikoff, Irving J., and Douglas H. K. Lee. 1978. Asbestos and disease. New York: Academic Press.

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    While not a new book, it is still quite comprehensive and correct, written by a master in the field.

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Coal Dust

Coal mining can generate considerable amounts of dust, and “black lung,” also known as coal worker’s pneumonconiosis, is the scarring that results from the inhalation of this dust. The federal government operates a compensation program for coal miners to address the needs of this group when it develops this lung disease. It is one of only two disease-specific programs run by the government (the other being a program for dialysis patients). Coal dust is not known to produce cancer. Attfield and Seixas 1995 is an extensive study of this issue.

  • Attfield, Michael D., and Noah S. Seixas. 1995. Prevalence of pneumoconiosis and its relationship to dust exposure in a cohort of U.S. bituminous coal miners and ex-miners. American Journal of Industrial Medicine 27:137–151.

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    Attfield is a leading researcher at the National Institute for Occupational Safety and Health (NIOSH) who has done extensive research on coal worker’s pneumoconiosis.

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Silica

Silica exposure, leading to the disease silicosis, has been known for millennia. It comes in two forms, acute silicosis, which can kill within a few months, arising with very heavy exposure, and the more normal, indolent, and chronic form that may take decades to develop. Exposure to silica causes scarring in the lungs and lung cancer, kidney disease, and autoimmune phenomena. Rosenman, et al. 2003 reports on the health hazards of silica.

  • Rosenman, Kenneth D., Mary Jo Reilly, and Paul K. Henneberger. 2003. Estimating the total number of newly-recognized silicosis cases in the United States. American Journal of Industrial Medicine 44:141–147.

    DOI: 10.1002/ajim.10243Save Citation »Export Citation » Share Citation »

    A comprehensive review of silica-related disease patterns in the United States. Rosenman is well-known for his work on this topic.

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Manmade Materials

In addition to minerals found in nature, humans have created a number of similar materials that have proven useful. Among these are nanoparticles. Nanoparticles are useful in many ways but may also carry risks. Nanoparticles are of a size that has been shown to have deleterious health effects, such as small particles in polluted air, the PM 2.5s, which can cause lung and cardiovascular problems. Takagi, et al. 2008 raises an issue of special concern, showing that one form of these can give rise to cancer.

  • Takagi, Atsaya, A. Hirose, T. Nishimura, N. Fukumori, A. Ogata, N. Ohashi, S. Kitajima, and J. Kanno. 2008. Induction of mesothelioma in p53+/- mouse by intraperitoneal application of multi-wall carbon nanotube. Journal of Toxicological Sciences 33:105–116.

    DOI: 10.2131/jts.33.105Save Citation »Export Citation » Share Citation »

    This paper points out that scientific uses often get ahead of biologic concerns related to new materials. That these artificial tubes can cause mesothelioma should be of great concern.

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Physical Hazards in the Workplace

Workers are exposed to several significant physical hazards. These include noise, radiation, temperature and pressure extremes, and low lighting. Excessive noise has been linked to hearing loss and to other medical issues, such as elevated blood pressure. Ionizing radiation, well reviewed in Upton 1986, comes as a form of high-energy exposures, like X-rays. Lower-energy exposures are often called nonionizing radiation. Frank and Slesin 2008 reviews lower-energy nonionizing radiation. Temperatures can be either too hot or too cold; those hazards are reviewed in Kilbourne 2008. Noise-induced hearing loss is nicely reviewed and outlined in Rabinowitz 2000. Sataloff and Sataloff 2001 discusses noise-induced hearing loss and hearing loss prevention.

  • Frank, Arthur L., and Louis Slesin. 2008. Nonionizing radiation. In Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. Edited by Robert B. Wallace, 743–754. New York: McGraw Hill.

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    A review of nonionizing radiation, including lighting, radio-frequency, and microwave energy.

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  • Kilbourne, Edwin M. 2008. Temperature and health. In Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. Edited by Robert B. Wallace, 725–734. New York: McGraw Hill.

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    A thorough review of temperature extremes outcomes.

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  • Rabinowitz, Peter M. 2000. Noise-induced hearing loss. American Family Physician 61:2749–2756, 2759–2760.

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    A well-illustrated and easily understood review of what causes hearing loss, how it is graphed, and potential protective measures.

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  • Sataloff, Robert, and Joseph Sataloff. 2001. Differential diagnosis of occupational hearing loss. Occupational Health and Safety 70:126–129.

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    This father and son team publishes widely on noise-induced hearing loss and preventive measures and procedures that should be followed in workplaces.

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  • Upton, Arthur C. 1986. Historical perspectives on radiation carcinogenesis. In Radiation carcinogenesis. Edited by Arthur C. Upton, Roy E. Albert, Frederic J. Burns, and Roy E. Shore, 1–10. New York: Elsevier Scientific.

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    An excellent review of the hazards of ionizing radiation by a leader in the field.

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Special Environments

In the field of occupational safety and health, work done in special environments must sometimes be considered. A special field called aerospace medicine deals with flight crews of all kinds and considers many of the same basic issues as do occupational physicians. Those working under pressure, such as caisson workers or deep-sea divers, also have special needs that must be considered. Davis, et al. 2008, a standard text in aerospace medicine, updates the classic work of Roy DeHart. Bove 2004 is a similar text for undersea work.

Special Populations

Although over 130 million Americans work, within the workforce are groups of workers who merit special consideration. These include workers with disabilities, both mental and physical, pregnant workers, older workers, child laborers, and farm laborers. Pregnant woman deserve special attention. Paul and Himmelstein 1988 discusses workplace hazards and risks to female reproduction. Pollack, et al. 1990 discusses child labor. Villaréjo and Schenker 2008 studies farmworkers. As the workforce grows and becomes more complex, all of these issues take on special importance.

  • Paul, Maureen, and Jay Himmelstein. 1988. Reproductive hazards in the workplace: What the practitioner needs to know about chemical exposures. Obstetrics and Gynecology 71:921–938.

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    Paul is a leading researcher in the hazards of workplace exposures for pregnant women.

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  • Pollack, Susan H., Philip J. Landrigan, and D. L. Mallino. 1990. Child labor in 1990: Prevalence and health hazards. Annual Review of Public Health 11:359–375.

    DOI: 10.1146/annurev.pu.11.050190.002043Save Citation »Export Citation » Share Citation »

    This is a comprehensive review of health hazards for children and adolescents in workplace settings.

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  • Villaréjo, Don, and Marc B. Schenker. 2008. The health of hired farmworkers. In Maxcy-Rosenau-Last public health and preventive medicine. 15th ed. Edited by Robert B. Wallace, 819–834. New York: McGraw Hill.

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    Farmworkers have special health issues related to their work and their mobility, which are well reviewed here.

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Safety

The concept of safety means keeping people from harm. In the workplace it refers to making the work environment as free from risk of injury for workers as possible. The Occupational Safety and Health Administration has a major responsibility related to worker safety. Smith, et al. 2006 addresses the importance of a proper safety climate, which has been shown to decrease injuries.

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