Wednesday, 23 February 2011 00:00

Surveillance of the Working Environment

Rate this item
(2 votes)

Since Ramazzini published the seminal text on occupational medicine (Ramazzini 1713), we have come to realize that working at certain jobs can cause specific illnesses. At first, only observational tools were available to survey the work environment. As technology developed, we began to be able to measure the environments in which workers plied their trades. Measuring the workers’ environment has helped identify the sources of workplace stresses. However, this improved knowledge brought with it a need to set exposure limits to protect workers’ health. Indeed, we have found ways to detect the presence of toxic substances at low levels, before they can create health problems. Now we often can predict the results of exposures without waiting for the effects to appear, and thus prevent disease and permanent injury. Good health in the workplace is no accident; it requires surveillance of workers and their environments.

Workplace Exposure Limits

Early workplace exposure limits were set to prevent acute illness and death. Today, with much better information, we try to meet much lower limits in order to prevent chronic illness and subclinical health effects. The most successful systematic attempt to develop occupational exposure limits was the effort of the Committee on Threshold Limits established by the American Conference of Governmental Industrial Hygienists (ACGIH) in 1943. (The ACGIH is a US organization with no formal ties to any government regulatory agency.) The success of this effort is shown by the fact that many countries around the world have adopted the threshold limit values (TLVs) published by ACGIH, which now number more than 600, as workplace exposure standards. Their wide use as enforceable standards has invited critical examination of TLVs and the process by which they were set. Despite their usefulness, TLVs have been criticized from three sectors of the decision-making process: scientific, political and ethical. A brief review of several criticisms follows:

Scientists criticized the fact that the TLVs set on the basis of substantial data are not distinguished from those based on considerably less data.

TLVs were never intended to be “safe” exposure levels for all workers. The TLV Committee recognized that the biological variations among workers, and other factors that could not be calculated, made it impossible to set limits that would guarantee safety for all workers in all environments. Adopting TLVs as enforceable standards creates a political problem, because part of the worker population is not protected. Only zero exposure can provide this guarantee, but zero exposure and zero risk are not practical alternatives.

The data that the TLV Committee worked with were often produced and paid for by industry, and were unavailable to the public. Those protected by this limit-setting process argue that they should have access to the data upon which the limits are based. Industry’s attempts to restrict access to their data, no matter what the reason, are seen by many as unethical and self-serving.

TLVs are still widely respected as guidelines for workers’ exposures to environmental stresses, to be used by professionals who can interpret them properly.

Community Exposure Standards

There is a link between occupational and community exposures. Any adverse health effects seen in workers are a result of their total exposure to environmental contaminants. Total dose is important in selecting appropriate exposure limits. This need is already recognized for poisons that accumulate in the body, such as lead and radioactive substances.

Present exposure limits differ for workers and for the community, in part, because workers’ exposures are intermittent, not continuous. TLVs were set for a five-day work week of eight-hour days, the norm in the United States. TLVs reflect the action of human repair mechanisms. However, many argue that community and occupational exposure limits should not be different.

Without specific information about synergistic or antagonistic effects, exposure limits for both workers and the public reflect only additive interactions between multiple environmental contaminants. When setting limits for a single substance, the complexities of the environments in which we live and work make it impossible to evaluate all potential interactions among environmental contaminants. Instead, we make the following simplifying assumptions: (1) the basic mix of chemicals in our environment has not changed materially; and (2) the epidemiological information and the environmental criteria used to set standards reflect our exposure to this mix of chemicals. By making these assumptions when setting community exposure limits for individual substances, interactions can be ignored. Although it would be useful to apply the same reasoning to setting workplace exposure limits, the logic is questionable because the mix of substances in the various work environments is not uniform when compared with that in our communities.

A part of the political debate is whether to adopt enforceable international exposure standards. Should an individual country set its own priorities, as reflected in its exposure limits, or should international standards be adopted, based on the best data available? Many governments of developing countries take the position that the developed countries should have stricter community exposure standards, because the latter’s industrial and agricultural pollution has created a less healthy environment.

Health Criteria Based on the Type of Risk

Currently, we rely heavily on toxicity testing of animals to set human exposure limits. Today’s sophisticated technology makes it possible to determine both the degree and kind of toxicity that a body will suffer after exposure to a substance. We measure a substance’s ability to cause cancer, to damage a foetus, to cause even benign tumours. We also measure the degree to which that substance can affect somatic systems. Many scientists assume that there is a safe level of exposure, and this has been validated by observations of mankind’s early diseases. However, such an assumption may not be justified today, especially for cancer. Experts still argue both for the existence and absence of a no-effect or “safe” level of exposure.

We co-exist with natural carcinogens in our environment. To deal with them, we must calculate the risk associated with exposure to these substances, and then use the best available technology to reduce that risk to an acceptable level. To think we can achieve zero risk is a misleading idea, and possibly the wrong path to take. Because of the cost and complexity of animal testing, we use mathematical models to predict the risks of exposures to substances at low doses. The best we can do is compute statistically reliable predictions of what are likely to be safe levels of exposure to environmental stresses, assuming a level of risk that the community accepts.

Monitoring the Working Environment

Monitoring of the working environment is the speciality of occupational hygienists. (In North America, they are called industrial hygienists.) These professionals practice the art and science of identification, evaluation and control of occupational stresses. They are schooled in the techniques of measuring the environment in which people work. Because of their obligation to protect the health and well-being of employees and the community, occupational hygienists have a deep concern for ethical issues. As a result, the principal industrial hygiene societies in the United States recently completed a revision to their Code of Ethics, which was originally drafted in 1978 (see also “Canons of Ethical Conduct and Interpretive Guidelines”).

Problems of Secrecy

Data developed from monitoring the work environment are critical to improving exposure limits both for workers and for the community. In order to come up with the best limits, which balance risk, cost and technical feasibility, all data from industry, labour and government must be available to those who set the limits. This consensus approach seems to be growing in popularity in a number of countries, and may become the procedure of choice for setting international standards.

Regarding trade secrets and other proprietary information, the new Code of Ethics provides guidelines for industrial hygienists. As professionals, they are obliged to make sure that all parties who need to know information regarding health risks and exposures are given that information. However, hygienists must keep key business information confidential, except when overriding health and safety considerations require them to reveal it.



Read 8070 times Last modified on Monday, 07 November 2011 22:40

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


Ethical Issues References

Ad hoc Committee on Medical Ethics (AC of P). 1984. Position paper. American College of Physicians ethics manual. Part I. History of medical ethics, the physician and the patient, the physician’s relationship to other physicians, the physician and society. Ann Intern Med 101:129-137.

American College of Occupational and Environmental Medicine. 1994. Code of ethical conduct. J Occup Med 29:28.

American Occupational Medical Association (AOMA). 1986. Drug screening in the workplace: Ethical guidelines. J Occup Med 28(12):1240-1241.

Andersen, D, L Attrup, N Axelsen, and P Riis. 1992. Scientific dishonesty and good scientific practice. Danish Med Res Counc :126.

Ashford, NA. 1986. Medical screening in the workplace: Legal and ethical considerations. Sem Occup Med 1:67-79.

Beauchamp, TL, RR Cook, WE Fayerweather, GK Raabe, WE Thar, SR Cowles, and GH Spivey. 1991. Ethical guidelines for epidemiologists. J Clin Epidemiol 44 Suppl. 1:151S-169S.

Brieger, GH, AM Capron, C Fried, and MS Frankel. 1978. Human experimentation. In Encyclopedia of Bioethics, edited by WT Reich. New York: Free Press.

Broad, W and N Wade. 1982. Betrayers of the Truth: Fraud and Deceit in the Halls of Science. New York: Simon & Schuster.

Chalk, R, MS Frankel, and SB Chafer. 1980. AAAS Professional Ethics Project: Professional Ethics Activities in the Scientific and Engineering Societies. AAAS Publication 80-R-4. Washington, DC: American Association for the Advancement of Science, Committee on Scientific Freedom and Responsibility.

Chemical Manufacturers Association’s Epidemiology Task Group. 1991. Guidelines for good epidemiology practices for occupational and environmental epidemiologic research. J Occup Med 33(12):1221-1229.

Cohen, KS. 1982. Professional liability in occupational health: Criminal and civil. In Legal and Ethical Dilemmas in Occupational Health, edited by JS Lee and WN Rom. Ann Arbor, Mich.: Ann Arbor Science Publishers.

Conrad, P. 1987. Wellness in the work place: Potentials and pitfalls of work-site health promotion. Milbank Q 65(2):255-275.

Coriel, P, JS Levin, and EG Jaco. 1986. Lifestyle: An emergent concept in the social sciences. Cult Med Psychiatry 9:423-437.

Council for International Organizations of Medical Sciences (CIOMS). 1991. International Guidelines for Ethical Review of Epidemiological Studies. Geneva: CIOMS.

—. 1993. International Ethical Guidelines for Biomedical Research Involving Human Subjects. Geneva: CIOMS.

Coye, MJ. 1982. Ethical issues of occupational medicine research. In Legal and Ethical Dilemmas in Occupational Health, edited by JS Lee and WN Rom. Ann Arbor, Mich.: Ann Arbor Science Publishers.

Dale, ML. 1993. Integrity in science: Misconduct investigations in a US University. J Expos Anal Environ Epidemiol 3 Suppl. 1:283-295.

Declaration of Helsinki: Recommendations guiding medical doctors in biomedical research involving human subjects. 1975. Adopted by the Eighteenth World Medical Assembly, Finland, 1964 and revised by the Twenty-ninth World Medical Assembly, Tokyo, Japan, 1975.

Einstein, A. 1949. Reply to criticisms. In Albert Einstein: Philosopher-Scientist, edited by Schlipp. La Salle: Open Court.

Fawcett, E. 1993. Working group on ethical considerations in science and scholarship. Account Res 3:69-72.

Fayerweather, WE, J Higginson, and TC Beauchamp. 1991. Industrial epidemiology forum’s conference on ethics in epidemiology. J Clin Epidemiol 44 Suppl. 1:1-169.

Frankel, MS. 1992. In the societies. Professional ethics report. Newslett Am Assoc Adv Sci 1:2-3.

Ganster, D, B Mayes, W Sime, and G Tharp. 1982. Managing organizational stress: A field experiment. J Appl Psychol 67:533-542.

Gellermann, W, MS Frankel, and RF Ladenson. 1990. Values and Ethics in Organization and Human Systems Development: Responding to Dilemmas in Professional Life. San Fransisco: Josey-Bass.

Gert, B. 1993. Defending irrationality and lists. Ethics 103(2):329-336.

Gewirth, A. 1986. Human rights and the workplace. In The Environment of the Workplace and Human Values, edited by SW Samuels. New York: Liss.

Glick, JL and AE Shamood. 1993. A call for the development of “Good Research Practices” (GRP) guidelines. Account Res 2(3):231-235.

Goldberg, LA and MR Greenberg. 1993. Ethical issues for industrial hygienists: Survey results and suggestions. Am Ind Hyg Assoc J 54(3):127-134.

Goodman, KW. 1994a. Case Presentation on Ethical Topics in Epidemiology. American College of Epidemiology (March.)

—. 1994b. Review and Analysis of Key Documents on Ethics and Epidemiology. American College of Epidemiology (March.)

Graebner, W. 1984. Doing the world’s unhealthy work: The fiction of free choice. Hastings Center Rep 14:28-37.

Grandjean, P. 1991. Ethical aspects of genetic predisposition to disease. Chap. 16 in Ecogenetics: Genetic Predisposition to Toxic Effects of Chemicals, edited by P Grandjean. London: Shapman & Hall.

Grandjean, P and D Andersen. 1993. Scientific dishonesty: A Danish proposal for evaluation and prevention. J Expos Anal Environ Epidemiol 3 Suppl. 1:265-270.

Greenberg, MR and J Martell. 1992. Ethical dilemmas and solutions for risk assessment scientists. J Expos Anal Environ Epidemiol 2(4):381-389.

Guidotti, TL, JWF Cowell, GG Jamieson, and AL Engelberg. 1989. Ethics in occupational medicine. Chap. 4 in Occupational Health Services. A Practical Approach. Chicago: American Medical Association.

Hall, WD. 1993. Making the Right Decision: Ethics for Managers. Toronto: John Wiley & Sons.

IEA Workshop on Ethics, Health Policy and Epidemiology. 1990. Proposed ethics guidelines for epidemiologists (Revised). Am Publ Health Assoc Newslett (Epidemiol Sect) (Winter):4-6.

International Code of Medical Ethics. 1983. Adopted by the Third General Assembly of the World Medical Association, London, 1949, amended by the Twenty-second World Medical Assembly, Sydney, 1968 and the Thirty-fifth World Medical Assembly, Venice, 1983.

International Labour Organization (ILO). 1996. Management of Alcohol and Drug-related
Issues in the Workplace. Geneva: ILO.

International Statistical Institute. 1986. Declaration on professional ethics. Int Stat Rev 54:227-242.

Johnson, OA. 1965. Ethics: Selections from Classical and Contemporary Writers. New York: Holt, Rinehart & Winston.

Jowell, R. 1986. The codification of statistical ethics. J Official Stat 2(3):217-253.

LaDou, J. 1986. Introduction to Occupational Health and Safety. Chicago: National Safety Council.

Lemen, RA and E Bingham. 1994. A case study in avoiding a deadly legacy in developing countries. Toxicol Ind Health 10(1/2):59-87.

Levine, CA. 1984. A cotton dust study unmasked. Hastings Center Rep 14:17.

Maloney, DM. 1994. Human Research Report. Omaha, Nebraska: Deem Corp.

Melden, AI. 1955. Ethical Theories. New York: Prentice Hall.

Mothershead, JL Jr. 1955. Ethics, Modern Conceptions of the Principles of Right. New York: Holt.

Murray, TH and R Bayer. 1984. Ethical issues in occupational health. In Biomedical Ethics Reviews, edited by JM Humber and RF Almeder. Clifton, NJ: Humana Press.

Nathan, PE. 1985. Johnson and Johnson’s Live for Life: a comprehensive positive lifestyle change program. In Behavioral Health: A Handbook of Health Enhancement and Disease Prevention, edited by JD Matarazzo, NE Miller, JA Herd, and SM Weiss. New York: Wiley.

Needleman, HL, SK Geiger, and R Frank. 1985. Lead and IQ scores: A reanalysis. Science 227:701-704.

O’Brien, C. 1993. Under the Influence? Drugs and the American Work Force. Washington, DC: National Research Council.

Office of Technology Assessment. 1983. The Role of Genetic Testing in the Prevention of Occupational Disease. Washington, DC: US Government Printing Office.

Office of the Assistant Secretary for Health. 1992. Guidelines for the Conduct of Research within the Public Health Service. Washington, DC: Department of Health and Human Services, PHS.

Office of Research Integrity (ORI). 1993. Findings of scientific misconduct. Fed Reg 58:117:33831.

Parasuramen, S and MA Cleek. 1984. Coping behaviours and managers’ affective reactions to role stressors. J Vocat Behav 24:179-183.

Pearlin, LI and C Schooler. 1978. The structure of coping. J Health Soc Behav (19):2-21.

Pellegrino, ED, RM Veatch, and JP Langan. 1991. Ethics, Trust, and the Professions: Philosophical and Cultural Aspects. Washington, DC: Georgetown Univ. Press.

Planck, M. 1933. Where is science going? Woodbridge: Oxbow.

Price, AR. 1993. The United States Government scientific misconduct regulations and the handling of issues related to research integrity. J Expos Anal Environ Epidemiol 3 Suppl. 1:253-264.

Ramazzini, B. 1713. De Morbis Artificum (Diseases of Workers). New York: Hafner.

Reed, RR. 1989. Responsibilities of awardee and applicant institutions for dealing with and reporting misconduct in science. Fed Reg 54(151):32446-32451.

Rest, KM. 1995. Ethics in occupational and environmental health. Chap. 12 in Occupational Health - Recognizing and Preventing Work-Related Disease, edited by BS Levy and DH Wegman. Boston: Little Brown & Co.

Roman, P. 1981. Prevention and Health Promotion Programming in Work Organizations. DeKalb, Illinois: Northern Illinois Univ.

Roman, PM and TC Blum. 1987. Ethics in worksite health programming: Who is served? Health Educ Q 14(1):57-70.

Royal College of Physicians of London. 1993a. Guidance on Ethics for Occupational Physicians. London: Royal College of Physicians.

—. 1993b. Guidance on Ethics for Occupational Physicians. London: Royal College of Physicians.

Russel, E and C-G Westrin. 1992. Ethical issues in epidemiological research: Guidelines containing the minimum common standards of practice recommended for use by project leaders and participants in the operation of future concerted actions. In Commission of the European Communities. Medicine and Health: COMAC Epidemiology, edited by M Hallen and Vuylsteek. Luxembourg: COMAC.

Russell, B. 1903. The Principles of Mathematics. New York: Oxford University Press.

Russell, B. 1979. What I believe. Chap. 3 in Why I Am not a Christian - and other Essays on Religion and Related Subjects, edited by P Edwards. London: Unwin Paperbacks.

Samuels, SW. 1992. Principles for ethical practice of environmental and occupational medicine. Chap. 124 in Environmental and Occupational Medicine, edited by WN Rom. Boston: Little, Brown & Co.

Sharphorn, DH. 1993. Integrity in science: Administrative, civil and criminal law in the USA. J Expos Anal Environ Epidemiol 3 Suppl. 1:271-281.

Soskolne, CL. 1985. Epidemiological research, interest groups, and the review process. J Publ Health Policy 6(2):173-184.

—. 1989. Epidemiology: Questions of science, ethics, morality and law. Am J Epidemiol 129(1):1-18.

—. 1991. Ethical decision-making in epidemiology: The case-study approach. J Clin Epidemiol 44 Suppl. 1:125S-130S.

—. 1991/92. Rationalizing professional conduct: Ethics in disease control. Publ Health Rev 19:311-321.

—. 1993a. Introduction to misconduct in science and scientific duties. J Expos Anal Environ Epidemiol 3 Suppl. 1:245-251.

—. 1993b. Questions from the delegates and answers by the panelists concerning “Ethics and Law in Environmental Epidemiology”. J Expos Anal Environ Epidemiol 3 Suppl. 1:297-319.

Soskolne, CL and DK Macfarlane. 1995. Scientific misconduct in epidemiologic research. In Ethics and Epidemiology, edited by S Coughlin and T Beauchamp. New York: Oxford Univ. Press.

Standing Committee of Doctors of the EEC. 1980. Occupational Health Charter. Document Number CP80/182. Adopted at Brussels, 1969, revised at Copenhagen, 1979, and at Dublin, 1980.

Summers, C, CL Soskolne, C Gotlieb, E Fawcett, and P McClusky. 1995. Do scientific and scholarly codes of ethics take social issues into account? Account Res 4:1-12.

Susser, M. 1973. Causal Thinking in the Health Sciences: Concepts and Strategies of Epidemiology. New York: Oxford University Press.

Swazey, JP, MS Anderson, and LK Seashore. 1993. Encounters with ethical problems in graduate education: Highlights from national surveys of doctoral students and faculty. Publ Am Assoc Adv Sci Scientific Free Resp Law Prog VI(4 Fall):1,7.

Teich, AH and MS Frankel. 1992. Good Science and Responsible Scientists: Meeting the Challenge of Fraud and Misconduct in Science. Washington, DC. :American Association for the Advancement of Science.

Vineis, P and CL Soskolne. 1993. Cancer risk assessment and management: An ethical perspective. J Occup Med 35(9):902-908.

Woodger, JH. 1937. The Axiomatic Method in Biology. Cambridge: Cambridge University Press.

Yoder, JD. 1982. Ethical issues in industrial hygiene in the 1980s. In Legal and Ethical Dilemmas in Occupational Health, edited by JS Lee and WN Rom. Ann Arbor, Mich.: Ann Arbor Science Publishers.