The US Workplace-"The Forgotten Environment"
Well more importantly is the state of the specialty of Occupational Medicine, as I perceived it through the conference and in the hallways or over coffee with my colleagues. The biggest shift in the field is a sea change in the American College of Occupational and Environmental Medicine (ACOEM) www.acoem.org membership demographics from company and government employed occupational doctors in the 1970s (over 80 % of the membership) who actually collaborated with Safety, Industrial Hygiene, Toxicologists and Epidemiologists to seek to understand and mitigate workplace safety and health hazard to most Occupational Docs now working in for profit clinics (over 80%) mostly attempting to “manage” (i.e. reduce) workers compensation costs for mostly musculoskeletal "injury" cases. Hence, Dr. Joseph LaDou, an academic leader in Occupational Medicine from California himself, has written about “The Rise and Fall of Occupational Medicine in the United States ” and calls for radical reform including a public health model of Occupational Medicine and the dismantling of the US workers compensation system as two means to save the profession
Beginning with Clinton admin and accelerated by the Bush admin the enabling law and regulatory agency for Occupational Medicine –OSHA- has almost been completely gutted giving corporate America little incentive to retain or hire occupational health professionals. Instead companies are “encouraged” to engage in voluntary partnerships with OSHA -reminding me of faith based volunteerism that Mr. Bush believes should replace other government funded or regulated social safety net programs in other fields.
Alas published data reveals that recent trends in workplace related injuries and illnesses are not good (see http://www.hillnews.com/thehill/export/TheHill/Comment/OpEd/092105.html).
And I for one believe that work stress and depression remain at epidemic proportions due to either layoffs-“you cant have occupational heath without an occupation” and the fear of layoffs re downsizing and outsourcing trends. Although I must admit things seem a bit brighter in recent months regarding these trends. I wrote a piece in 2004 on US worker use of antidepressants in www.medicationsense.com which I still believe remains excessive.
In 2004 I also wrote a review of sociologist Elaine Draper’s book called The Company Doctor: Risk, Responsibility, And Corporate Professionalism wherein I basically agreed with Draper that the US must adopt an independent tripartite model of Occupational Medicine funded by Industry, Government and labor which is the working model in many European nations. This model might save US Occupational Medicine?
A few bright spots of the conference were the opening key-note address by Dr. Paul Brandt-Rauf from Columbia University and Editor of ACOEM’s journal JOEM who urged occupational doctors to sign up now for work in environmental medicine in third world nations like Bangladesh where Brandt-Rauf and his colleagues from Columbia are doing quite remarkable work on lowering arsenic in drinking water which is a huge environmental health problem in many countries including parts of the US. My professional association to its credit had the vision to add Environmental Medicine to its worker health field in 1992 recognizing the magnitude and the importance of the global environmental moment yet not long after prompting organized labor to correctly call the workplace “the forgotten environment” hence the title of this blog piece.
Also a seed of social conscience has become manifest in ACOEM called the Section on Underserved Populations was founded just two years ago. This small section is correctly focusing on preparing migrant clinic based primary care docs in occupational medicine basics who will absorb the estimated 11-12 million soon to be legalized workers who are now working “undercover” on farms, in landscaping, hotels, garment factories, construction etc. These workers don’t currently dare call any attention to themselves by reporting an occupational injury or illness less they be arrested and deported for illegal immigrant status. Go to www.migrantclinician.org
Finally, if progressive dems or independents win US congressional elections in November of this year and capture the White House in 08 look for a long overdue stronger OSHA and increased activities in Occupational Health no matter what delivery model prevails.
I have practiced Occupational Medicine for over 30 years and it always occurred to me that the term “worker health” was inherently a liberal concept where workers might be viewed as assets and not expendable costs on the balance sheet despite the inherent power dominion that empoyers have over employees and the classical business definition of efficiency.
But I have always been a dreamer- I know of no other way to live?
My view of Occupational Medicine romantically goes beyond the avoidance of work related pathology which I would die very happy to see come to pass. My view is that work, being so central to human existence, is actually a prerequisite to good heath. I hold the view that job satisfaction is grossly understudied and under appreciated as a determinant of human health. One of my mentors Dr. Lennart Levi from the Karolinska Institute in Stockholm, Sweden said it well many years ago when he said-
“Work should be designed by man for man. Work should serve human needs- not vice versa. Good and healthy work should give meaning to life. This is not what work looks like to millions of workers all over the globe. Work should become man’s servant-not his master”
Dr. Rick Lippin ("Blake")