Occupational health: a world of false promises.

The response of the World Health Organization (WHO) to the Ebola outbreak in West Africa in 2015 demonstrated that the global health system is unprepared to address what should be its primary mission, control of disease epidemics while protecting health workers. Critics blamed WHO politics and its rigid culture for the poor response to the epidemic. We find that United Nations agencies, WHO and the International Labor Organization (ILO), are faced with the global problem of inadequate worker protections and a growing crisis in occupational health. The WHO and ILO are given monumental tasks but only trivial budgets, and funding trends show UN agency dependence on private donations which are far larger than funds contributed by member states. The WHO and ILO have limited capacity to make the necessary changes occupational health and safety demand. The UN could strengthen the national and global civil society voice in WHO and ILO structures, and by keeping conflict of interest out of policy decisions, ensure greater freedom to operate without interference.

The European influence on workers' compensation reform in the United States.

Workers' compensation law in the United States is derived from European models of social insurance introduced in Germany and in England. These two concepts of workers' compensation are found today in the federal and state workers' compensation programs in the United States. All reform proposals in the United States are influenced by the European experience with workers' compensation. In 2006, a reform proposal termed the Public Health Model was made that would abolish the workers' compensation system, and in its place adopt a national disability insurance system for all injuries and illnesses. In the public health model, health and safety professionals would work primarily in public health agencies. The public health model eliminates the physician from any role other than that of privately consulting with the patient and offering advice solely to the patient. The Public Health Model is strongly influenced by the European success with physician consultation with industry and labor.

A World of False Promises: International Labour Organization, World Health Organization, and the Plea of Workers Under Neoliberalism.

Occupational health and safety is poorly served by United Nations agencies designated to protect workers: the World Health Organization (WHO) and the International Labor Organization (ILO). The neoliberal programs initially adopted by the United Nations supported institutions of social protection and regulation and expanded worker protections and union growth. Neoliberalism later became synonymous with globalism and shared in its international success. The fundamental change under neoliberalism was the exchange and accumulation of capital. The major beneficiaries of neoliberalism, at the expense of workers, were large transnational corporations and wealthy investors. During this period, WHO and ILO activities in support of workers declined. As neoliberalism ultimately became neoconservatism, occupational health and safety was purposely ignored, and labor was treated with hostility. Neoliberalism had evolved into a harsh economic system detrimental to labor and labor rights. The United Nations is now in decline, taking with it the trivial WHO and ILO programs. Replacements for the WHO and ILO programs must be developed. It is not enough to call for renewed funding, given the United Nations' failure to direct the global effort to protect workers. A new direction must be found.

Federal Employees' Compensation Act.

The Federal Employees' Compensation Act (FECA) program provides wage loss compensation and payments for medical treatment to federal civilian employees. Administered by the Department of Labor (DOL), FECA covers over 2.7 million federal employees in more than 70 different agencies. FECA costs rose from $1.4 billion in 1990 to $2.6 in 2006, while the federal workforce remained essentially unchanged. While federal civilian employees represent only 2.1% of all workers eligible for workers' compensation benefits, federal programs account for 6% of the benefits paid. Disability benefits under FECA are far greater than those in the state workers' compensation programs. The benefit payments often exceed the former salary of the injured employee. The last congressional hearings on the FECA program were held over thirty years ago. It is unlikely that Congressional review will occur any time soon, as the entrenched bureaucracy that benefits from the FECA program defines and protects its future.

Export of electronics equipment waste.

Electronics equipment waste ("e-waste") includes discarded computers, computer monitors, television sets, and cell phones. Less than 10% of e-waste is currently recycled. The United States and other developed countries export e-waste primarily to Asia, knowing it carries a real harm to the poor communities where it will be discarded. A 2006 directive bans the use of lead, mercury, cadmium, hexavalent chromium, and certain brominated flame retardants in most electronics products sold in the EU. A similar directive facilitates the development and design of clean electronics products with longer lifespans that are safe and easy to repair, upgrade, and recycle, and will not expose workers and the environment to hazardous chemicals. These useful approaches apply only regionally and cover only a fraction of the hazardous substances used in electronics manufacture, however. There is an urgent need for manufacturers of electronics products to take responsibility for their products from production to end-of-life, and for much tighter controls both on the transboundary movement of e-waste and on the manner in which it is recycled. Manufacturers must develop clean products with longer lifespans that are safe and easy to repair, upgrade, and recycle and will not expose workers and the environment to hazardous chemicals.

"Gulf war syndrome" may be related to circadian dysrhythmia.

An Institute of Medicine (IOM) review found that the data obtained from research addressing the health issues of Gulf War veterans do not satisfactorily clarify the origins, extent, and long-term implications of their health problems. The IOM committee concluded that there should have been more screening and medical examinations of deployed personnel before and after service in the Gulf. The many possible causes of the "Gulf War syndrome" examined, however, did not include circadian dysrhythmia or desynchronosis. It would have been possible to determine the level of desynchronosis in the returning Gulf War veterans, and to follow them into their subsequent pursuits to determine whether chronic desynchronosis was present in those who had persistent symptoms. If circadian dysrhythmia is found to be present in veterans now returning from the Gulf, they should receive treatment to correct the problem before they develop chronic desynchronosis.

Aspartame bioassay findings portend human cancer hazards.

The U.S. Food and Drug Administration (FDA) should reevaluate its position on aspartame as being safe under all conditions. Animal bioassay results predict human cancer risks, and a recent animal study confirms that there is a potential aspartame risk to humans. Aspartame is produced and packaged in China for domestic use and global distribution. Japan, France, and the United States are also major producers. No study of long-term adverse occupational health effects on aspartame workers have been conducted. The FDA should consider sponsoring a prospective epidemiologic study of aspartame workers.

Cancer and reproductive risks in the semiconductor industry.

Although many reproductive toxicants and carcinogens are used in the manufacture of semiconductor chips, and worrisome findings have been reported, no broad epidemiologic study has been conducted to define possible risks in a comprehensive way. With few exceptions, the American semiconductor industry has not supported access for independent studies. Older technologies are exported to newly industrialized countries as newer technologies are installed in Japan, the United States, and Europe. Thus there is particular concern about the many workers, mostly in countries that are still industrializing, who have jobs that use chemicals, technologies, and equipment that are no longer in use in developed countries. Since most countries lack cancer registries and have inadequate reproductive and cancer reporting mechanisms, industry efforts to control exposures to carcinogens are of particular importance. Government agencies, the courts, industry, publishers, and academia, on occasion, collude to ignore or to downplay the importance of occupational diseases. Examples of how this happens in the semiconductor industry are presented.

American College of Occupational and Environmental Medicine (ACOEM): a professional association in service to industry.

The American College of Occupational and Environmental Medicine (ACOEM) is a professional association that represents the interests of its company-employed physician members. Fifty years ago the ACOEM began to assert itself in the legislative arena as an advocate of limited regulation and enforcement of occupational health and safety standards and laws, and environmental protection. Today the ACOEM provides a legitimizing professional association for company doctors, and continues to provide a vehicle to advance the agendas of their corporate sponsors. Company doctors in ACOEM recently blocked attempts to have the organization take a stand on global warming. Company doctors employed by the petrochemical industry even blocked the ACOEM from taking a position on particulate air pollution. Industry money and influence pervade every aspect of occupational and environmental medicine. The controlling influence of industry over the ACOEM physicians should cease. The conflict of interests inherent in the practice of occupational and environmental medicine is not resolved by the ineffectual efforts of the ACOEM to establish a pretentious code of conduct. The conflicted interests within the ACOEM have become too deeply embedded to be resolved by merely a self-governing code of conduct. The specialty practice of occupational and environmental medicine has the opportunity and obligation to join the public health movement. If it does, the ACOEM will have no further purpose as it exists, and specialists in occupational and environmental medicine will meet with and be represented by public health associations. This paper chronicles the history of occupational medicine and industry physicians as influenced and even controlled by corporate leaders.

IBM, Elsevier Science, and academic freedom.

Elsevier Science refused to publish a study of IBM workers that IBM sought to keep from public view. Occupational and environmental health (OEH) suffers from the absence of a level playing field on which science can thrive. Industry pays for a substantial portion of OEH research. Studies done by private consulting firms or academic institutions may be published if the results suit the sponsoring companies, or they may be censored. OEH journals often reflect the dominance of industry influence on research in the papers they publish, sometimes withdrawing or modifying papers in line with industry and advertising agendas. Although such practices are widely recognized, no fundamental change is supported by government and industry or by professional organizations.

Printed circuit board industry.

The printed circuit board is the platform upon which microelectronic components such as semiconductor chips and capacitors are mounted. It provides the electrical interconnections between components and is found in virtually all electronics products. Once considered low technology, the printed circuit board is evolving into a high-technology product. Printed circuit board manufacturing is highly complicated, requiring large equipment investments and over 50 process steps. Many of the high-speed, miniaturized printed circuit boards are now manufactured in cleanrooms with the same health and safety problems posed by other microelectronics manufacturing. Asia produces three-fourths of the world's printed circuit boards. In Asian countries, glycol ethers are the major solvents used in the printed circuit board industry. Large quantities of hazardous chemicals such as formaldehyde, dimethylformamide, and lead are used by the printed circuit board industry. For decades, chemically intensive and often sloppy manufacturing processes exposed tens of thousands of workers to a large number of chemicals that are now known to be reproductive toxicants and carcinogens. The printed circuit board industry has exposed workers to high doses of toxic metals, solvents, acids, and photolithographic chemicals. Only recently has there been any serious effort to diminish the quantity of lead distributed worldwide by the printed circuit board industry. Billions of electronics products have been discarded in every region of the world. This paper summarizes recent regulatory and enforcement efforts.

Occupational and environmental medicine in the United States: A proposal to abolish workers' compensation and reestablish the public health model.

The workers' compensation model of occupational and environmental medicine should be converted to a public health model. Occupational and environmental medicine, as a part of the public health infrastructure,could play a much more substantive part in bringing about a national program to deal with occupational and environmental health. The workers' compensation insurance system could be discontinued at any time,but it will be vital to do so when national health insurance is adopted in the United States. Abolishing workers' compensation would remove the perverse incentives that currently undermine the practice of occupational medicine. Medical care for workers should be provided by health care professionals who are not subject to influence by employers or insurers. Eligibility for benefits should not be determined by health and safety professionals. Wage-replacement benefits for workers should be determined by guidelines established by government and industry that prevent manipulation of health and safety professionals by employers and insurers. A nationwide comprehensive system to track work-related injury and illness, superior to the current reliance on records provided by employers and collated by government agencies, should be adopted. When unusually high rates of injuries, illnesses,and fatalities occur, government inspectors ought to respond and regulate the industry accordingly. Occupational health and safety professional strained in public health can and should participate in these activities, but not when they are in the employ of industry or insurers.

FIOH-sponsored newsletter misrepresents asbestos hazards in Zimbabwe.

The Finnish Institute of Occupational Health (FIOH) has received support from the World Health Organization (WHO) and the International Labor Office (ILO) to publish the African Newsletter on Occupational Health and Safety. The African Newsletter on Occupational Health and Safety should not be a medium for industry propaganda, or the source of misinformation among the workers of Africa. Instead, FIOH should provide the same level of scientific information in Africa that it does in Finland and other developed countries.

Occupational medicine: the case for reform.

The specialty of occupational medicine is in peril, in large part because of its reliance on financing by industry, which has powerful incentives to limit costs and to favor physicians who are useful to their employers. Occupational physicians generally practice within the framework of the workers' compensation system. Serious flaws in the incentive structure of workers' compensation constrain objectivity in their practice. Under present law they are unavoidably subject to perverse influences from employers and insurance companies. A fundamental reform of workers' compensation law and practice is urgently needed to separate occupational physicians from the control of employers and workers' compensation insurers, whose interests should not be allowed to override the physicians' integrity or to compromise the specialty.

World Trade Organization, ILO conventions, and workers' compensation.

The World Trade Organization, the World Bank, and the International Monetary Fund can assist in the implementation of ILO Conventions relating to occupational safety and health in developing countries. Most countries that seek to trade globally receive permission to do so from the WTO. If the WTO required member countries to accept the core ILO Conventions relating to occupational safety and health and workers' compensation, it could accomplish something that has eluded international organizations for decades. International workers' compensation standards are seldom discussed, but may at this time be feasible. Acceptance of a minimum workers' compensation insurance system could be a requirement imposed on applicant nations by WTO member states.

The asbestos cancer epidemic.

The asbestos cancer epidemic may take as many as 10 million lives before asbestos is banned worldwide and exposures are brought to an end. In many developed countries, in the most affected age groups, mesothelioma may account for 1% of all deaths. In addition to mesotheliomas, 5-7% of all lung cancers can be attributed to occupational exposures to asbestos. The asbestos cancer epidemic would have been largely preventable if the World Health Organization (WHO) and the International Labor Organization (ILO) had responded early and responsibly. The WHO was late in recognizing the epidemic and failed to act decisively after it was well under way. The WHO and the ILO continue to fail to address the problem of asbestos mining, manufacturing, and use and world trade of a known human carcinogen. Part of the problem is that the WHO and the ILO have allowed organizations such as the International Commission on Occupational Health (ICOH) and other asbestos industry advocates to manipulate them and to distort scientific evidence. The global asbestos cancer epidemic is a story of monumental failure to protect the public health.

The rise and fall of occupational medicine in the United States.

Thirty years ago, occupational medicine was one of the smallest of all the medical specialties, ignored by most physicians and medical schools. Occupational physicians were more likely to have entered the field through career transition than by residency training. In 1970, governmental agencies sought to transform occupational medicine into a major clinical specialty. Influential groups projected a need for large numbers of physicians in the field. Residency training was expanded, as were other teaching programs. However, industry and its workers' compensation insurance partners were not widely included in these plans. For that reason, among others, many physicians entering the field met with disappointment. About half the corporate positions for occupational physicians have disappeared in the last decade. Private practice opportunities turned out to be much more limited than planners had anticipated. Attempts to bring occupational medicine into the curriculum of the medical schools failed. Many of the residency programs that had been created are now closing. The proposal that occupational medicine create a joint specialty with environmental medicine is not widely accepted by the rest of medicine. Because so few physicians obtain board certification, it appears that the specialty of occupational medicine is returning to its former obscurity.

International occupational health.

Working conditions for the majority of the world's workers do not meet the minimum standards and guidelines set by international agencies. Occupational health and safety laws cover only about 10 percent of the population in developing countries, omitting many major hazardous industries and occupations. With rare exception, most countries defer to the United Nations the responsibility for international occupational health. The UN's international agencies have had limited success in bringing occupational health to the industrializing countries. The International Labor Organization (ILO) conventions are intended to guide all countries in the promotion of workplace safety and in managing occupational health and safety programs. ILO conventions and recommendations on occupational safety and health are international agreements that have legal force only if they are ratified by ILO member states. The most important ILO Convention on Occupational Safety and Health has been ratified by only 37 of the 175 ILO member states. Only 23 countries have ratified the ILO Employment Injury Benefits Convention that lists occupational diseases for which compensation should be paid. The World Health Organization (WHO) is responsible for the technical aspects of occupational health and safety, the promotion of medical services and hygienic standards. Limited WHO and ILO funding severely impedes the development of international occupational health. The U.S. reliance on international agencies to promote health and safety in the industrializing countries is not nearly adequate. This is particularly true if occupational health continues to be regarded primarily as an academic exercise by the developed countries, and a budgetary triviality by the international agencies. Occupational health is not a goal achievable in isolation. It should be part of a major institutional development that touches and reforms every level of government in an industrializing country. Occupational health and safety should be brought to industrializing countries by a comprehensive consultative program sponsored by the United States and other countries that are willing to share the burden. Occupational health and safety program development is tied to the economic success of the industrializing country and its industries. Only after the development of a successful legal and economic system in an industrializing country is it possible to incorporate a successful program of occupational health and safety.

Health and safety executive inspection of U.K. semiconductor manufacturers.

Europe plays a major role in the international semiconductor industry, but has conducted few studies of the occupational health of its workers. An exception is in the United Kingdom, where, in two small studies, the Health and Safety Executive (HSE) evaluated some health effects of semiconductor work. Neither of these studies, largely restricted to Scotland, produced definitive results, and both were misused by industry to assert that they demonstrated no adverse health effect on workers. The results of the studies prompted semiconductor industry inspections recently completed by the HSE that included chip manufacturers in Scotland and other U.K. areas. The results of these inspections are disappointing.