Industry's Challenge to MedicineAuthor(s): T. H. PATTERSONSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 58, No.5 (MAY 1967), pp. 193-196Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41984039 .

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Canadian Journal of

PUBLIC HEALTH

VOLUME 58 MAY 1967 NUMBER 5

Industry's Challenge to Medicine1

T. H. PATTERSON,2 M.D., C.M., D.P.H., M.P.H.

CINCE ancient times, industry and the ^ diseases of workmen have presented a challenge to the doctor and his co-workers. In Ramazzini's time, fundamental work was carried out in this field and yet in these days of specialization the diseases recognized then are still frequently encountered.

Although working places have continued to present health problems through the centuries, medicine has not always kept pace. Only during the last fifty years here in North America has there been an active interest in the health of workers. In this short span of years, however, interest has been fanned from a spark to a flame which now kindles and holds the attention of leaders not only in the health professions but also of leaders in our industries, unions, and governments.

Published reports of certain occupational diseases were responsible for arousing attention and interest in workers' health on this continent almost fifty years ago. Rife at that time were blindness and mortality from methyl alcohol, mercurialism in the felt hat industry, and lead poisoning. Awakened concern for the workers' health subsequently led to the enactment of Workmen's Compensation in the United States and Canada. With it came the be- ginning of what was then known as "compensation medicine". Presented at the 57th annual meeting of the Canadian Public Health Association held in Quebec City, May 31-June 2, 1966. 2Chief, Occupational Health Division, Department of National Health and Welfare, Ottawa, Ontario.

In the early 1920's, "industrial medicine" first appeared in Canada. Since that time, the terms "occupational health" and "occupational medicine" have replaced "industrial hygiene" and "industrial medi- cine". The area of health concern has been broadened to include not just the manufacturing industries but also the occupations of office, store, factory, mines, construction, and agriculture.

In 1955, "occupational medicine" was recognized as a specialty along with "aviation medicine" and "public health administration".

Nine years ago, with the launching of Sputnik, aviation medicine was expanded to include special problems of Zero G, baro-pressure, and supersonic flight prob- lems of ozone and radioactivity at high altitudes.

The terms "submarine medicine" and "nuclear medicine" have now evolved. Although not yet formally recognized as specialties, they have special interest in the hazards posed by atomic energy.

Air and water pollution have, in the last few years, been increasingly brought to our attention as environmental health problems crying out for more attention by health workers.

Beginning in 1921, several of Canada's provincial governments and the federal government started programs for the identification and control of occupational health and other environmental hazards. Our country's large industries have also

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194 CANADIAN JOURNAL OF PUBLIC HEALTH Vol 58

developed health services for their em- ployees.

In the span of a comparatively few years we have come a long way, but only a small proportion of our workers derive the full benefit of an effective environ- mental health service.

The technological developments of science in industry are creating new haz- ards to health at a faster rate than we can develop the ways and means to identify and control them.

Environmental health authorities in the United States have already stated that they will never catch up and will have to run very fast just to remain where they are at present. If our position is any better than this, it is only because our problems are not yet as great.

This, then, is the challenge presented to medicine and all the allied health pro- fessions.

In the federal government, we have accepted the fact that we must concern ourselves with the total ecological system of man or the man-environment relation- ship.

The recognition of hazards and their control on one hand and their biological effects on the other, regardless of cause or place of occurrence, are part of the total concept of environmental health.

This concept has recently led to the con- struction of the new Environmental Health Centre in Ottawa, which houses the major divisions concerned with air pollution, water pollution, occupational health, and aerospace medicine. This Centre can, at best, be considered as only one of the stepping stones towards organizing our health facilities to meet the challenge which we face.

Provincial governments, local health services, industry, and universities must also plan to meet this challenge if we are not to fall behind.

In planning to meet any problem we must look ahead and attempt to foresee what the future will bring. The key, how- ever, to our future may frequently be found by looking first to our past to see what changes have been occurring.

With little observation, we know indus- try is changing drastically as is the meaning of work, the composition of our work force, the incidence of occupational and other diseases, the trend toward urbani-

zation, and the growth of our public health and medical care programs.

Industry - Beginning with the so-called Industrial Revolution of over one hundred years ago, industry has become more and more mechanized to increase its capacity for work previously done by human labour. More recently automation has provided yet another step to further mechanization with the computer taking its place in present production lines.

The cottage-type industry of seventy years ago has given way to the highly complex industry of today. Some large industries, such as the petrochemical in- dustry, are now on the verge of becoming fully automated.

In the wake of these changes, we have experienced a large migration of popula- tion, particularly from rural to urban areas; housing shortages; unemployment; and in- creased pollution of our soil, air, and water resources.

As an example, in the United States there are now an estimated four pounds of garbage per capita per day, exclusive of body and other wastes, to be disposed of in some manner which will avoid further pollution of air and water. I am not sug- gesting that this is a challenge to medicine, but it is certainly one for our engineers and other technical workers.

Work - With the transition taking place in industry, the meaning of work has also changed. The man on the assembly line does not have the satisfaction of completing a job to the stage where he can take full credit for a finished product.

With machines taking over more of the labours of man, the demand for physical exertion in many jobs is now far below the optimum for the worker. This separa- tion from physical work and fragmentation of job bring about a loss of sense of in- volvement and perhaps a feeling of aim- lessness for the worker.

At the same time the work week is diminishing, providing the worker with more and more time to do as he wishes. Many of us, however, don't really know how best to use this additional free time, adding further to our sense of frustration with life.

Work Force - Aside from the individual worker's problem, we also need to look at

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May 1967 INDUSTRY'S CHALLENGE 195

what is happening to the total work force. Mechanization in the manufacturing in-

dustries has brought about a reduction of unskilled and semi-skilled jobs to the extent that, although in the past fifty years pro- duction has increased twelvefold, the num- ber of employees has barely doubled.

In the last ten years, professional occupa- tions have increased by 75%, while the semi- and unskilled jobs rose only by 19%. By 1975 only an estimated 12% of jobs will require unskilled or semi-skilled workers.

The introduction of the computer con- tinues to dislocate workers from their old jobs, while many new, more skilled jobs are being created. The older and essen- tially unretrainable worker is the one who suffers most from this change. This further increases the economic burden on our young, employable group, for the depen- dency ratio is changing substantially, with many more people living to an older age.

Another striking change in our work force may be seen with the increased num- ber of female workers, from about 14% fifty years ago to an expected 35% by 1970.

Occupational Diseases - Many of the old or previously recognized occupational diseases or accidents are still with us, de- spite substantial reductions made through the co-operative efforts of physicians, nurses, safety engineers, and industrial hygienists.

Today, disease accounts for only about 3% of occupationally caused disability. The remainder falls into the category of accidental injury.

In fifty years, the record reduction in accidents at work has made workplaces much safer than the home.

We cannot, however, afford to be com- placent in the light of this experience, for new and more complex hazards are being presented by numerous new toxic chemi- cals and industrial uses of such physical agents as radiation, laser, and microwaves. Increased use of vibrating tools and higher working noise levels are other examples of growing health hazards.

With the reduction in acute disease inci- dence in early life, we have seen a corre- sponding increase in the incidence of chronic disease among our working popu- lation.

Cardiovascular diseases and malignant neoplasms now loom large as occupational health problems, and the effects of our environment on these diseases are not yet fully understood.

Necessary changes in the working en- vironment have brought further aberration to the type of diseases we encounter. For instance, through improved dust control, we have seen a reduction in the incidence of pneumoconiosis attributable to employ- ment. Clinical concern over asbestosis, for example, has given way to concern over the increased incidence of lung cancer among asbestos workers. Tumours are re- ported to develop following minimal or even non-occupational exposure to asbes- tos dust, but usually this occurs after a latent period of forty or more years.

The Changing Role of the Industrial Physician

The physician in industry now serves a much different function than he did at the turn of the century. He is now charged primarily with maintaining the worker's health. To do this, he has to use increas- ingly more refined indices of deviation from the so-called normal health status to recognize and prevent illness before it be- comes incapacitating.

In the industrial setting, physicians are ideally situated to develop and use the newer and more sophisticated techniques for detecting early health change. Tele- metering equipment used in the rigid and well-defined environmental conditions of industry is yielding meaningful results. Tachometers measuring heart rate are equated with physiological reserve or strain under such environmental conditions as heat stress.

Telemetry has been used to demonstrate evidence of angina under actual stressful working conditions, yet this evidence did not appear in electrocardiographic tracings following use of the Master Step test in the doctor's office.

The industrial physician is called upon to be far more than a clinical diagnostician. As the need arises, he has to be toxicolo- gist, hygienist, rehabilitator, and educator, among other things. Perhaps his greatest contribution to medicine may lie in his ability to conduct epidemiological studies.

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196 CANADIAN JOURNAL OF PUBLIC HEALTH Vol. 58

Felton has stressed that industrial health departments have access to the best source of human measurement data available to- day; data which can lead to the develop- ment of new analytical and diagnostic techniques for the general use of medicine.

Industrial health services continue to play an outstanding role in the identifica- tion of carcinogenic effects of physical and chemical agents. Potts' description of scro- tal cancer among chimney sweeps is well known. Gradually, from his time to the present there evolved studies on the effects of nickel, chromium, asbestos, arsenic, and radioactivity.

Mental health in industry, particularly with the rapid changes of working de- mands, poses a special challenge to the physician. The early detection of deviation from normal behaviour as a result of stresses inherent in modern industry is exceedingly difficult and requires special psychophysiological skills.

The recognized need to conserve and maintain human resources, as well as the equipment and other assets of industry, has tended to involve the physician more and more in management functions.

The doctor's professional contribution also extends beyond the confines of indus- try as he may be called upon to solve problems resulting from the impact of industry on the community, as well as co-ordinate his services with other health and social services of the surrounding area.

Many physicians have already recognized their unique position with respect to re- search and have made notable contribu-

tions to the medical literature as a result of this work.

We are, therefore, seeing the evolution of a sort of psycho-social scientist executive in place of the former unsophisticated doctor who concerned himself only with diagnosis and treatment of frank disease and injury.

No one, however, is capable of becoming a specialist in all aspects of such a broad field. At best, the physician can become the directing and co-ordinating factor in the specialized team required to manage the health problems relating to our work- ing environment.

Existing occupational health programs in industry and government generally work well together, but there is no question that we are a long way from being able to meet the challenges presented by our rapidly changing industrial and social structure.

Professor T. Hatch of Pittsburgh has stated that, to meet these challenges, there is a need to develop highly effective, joint programs between the community and oc- cupational health services. Programs must be undertaken jointly because the complex nature of the man-environment relationship affects the community as a whole and not just the industrial situation.

We have the potential for developing this co-operation here in Canada. Its de- velopment will, however, depend upon health planners at every level in the pro- fessions, universities, industries, and com- munities recognizing this need and work- ing together to meet these emerging health problems while they are still manageable.

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