Background The failure to recognize occupational health as an economic phenomenon limits the effectiveness of interventions ostensibly designed to prevent disease and injury. Hence, consideration of economic efficiency is essential in the evaluations of interventions to reduce hazardous working conditions. In this paper, we present an analysis of the cost effectiveness of alternative means of preventing silicosis. Methods To evaluate the cost effectiveness of specific interventions for the prevention of occupationally induced silicosis, we have used the simulation models based on the generalized cost‐effectiveness analysis (GCEA) developed by the WHO‐CHOICE initiative for two representative subregions namely AMROA (Canada, United States of America), and WPROB1 (China, Korea, Mongolia). Results In both of the two subregions, engineering controls are the most cost effective with ratios varying from $105.89 per healthy year or disability adjusted life year saved in AMROA to approximately $109 in WPROB1. In the two subregions, the incremental cost‐effectiveness ratio of engineering controls (EC) looks most attractive. Although dust masks (DM) look attractive in terms of cost, the total efficacy is extremely limited. Conclusions To the extent that this analysis can be generalized across other subregions, it suggests that engineering control programs would be cost effective in both developed and developing countries for reducing silica exposure to save lives. Note that this analysis understates health benefits since only silicosis and not all silica‐related diseases are considered. Am. J. Ind. Med. 48:503–514, 2005. © 2005 Wiley‐Liss, Inc.
Background A new conceptual framework is needed to evaluate health‐based interventions based on the premise that like the environment, workplaces are complex ecologies. The proposed Work Environment Impact Assessment (WEIA) is analogous to Environmental Impact Assessment (EIA), a concept and method developed 30 years ago in the environmental policy arena to evaluate potential consequences of human activity for the natural environment. WEIA entails identifying and evaluating both intended and unintended consequences, or outcomes, associated with a particular intervention. Because the workplace is a complex ecology, changes in one aspect may lead to changes in other aspects. WEIA calls for a systematic and comprehensive approach to the total work environment. Methods To illustrate the utility of WEIA we use this approach to evaluate an intervention to reduce the public's exposure to the pesticide Alar®, which had been used on apples until it was withdrawn from the market in 1989. Results While this intervention did indeed reduce the public's exposure to Alar, it also led to other unintended consequences, namely new ergonomic hazards for apple pickers, increased stress levels in the orchards for both pickers and growers, as well as new worker, and perhaps public, exposure to potent neurotoxins. Conclusions The goal of using WEIA is not to engage in a risk–risk debate that stalls worthwhile interventions. Rather, we propose that by conducting a Work Environment Impact Assessment, all possible positive and negative “ripple” effects stemming from an intervention can be considered, so that the intervention can be designed to achieve maximum benefit. Am. J. Ind. Med. 39:218–226, 2001. © 2001 Wiley‐Liss, Inc.
Emotional labor is a subtle but serious occupational hazard that is likely to spread rapidly as the global service economy continues to grow. Emotional labor requires more than just acting friendly and being helpful to customers; the worker must manage his or her emotions to create a company-dictated experience for customers. The practice of emotional labor in an unsupportive work environment produces work-related stress, which has a wide range of potentially serious health effects. Though many employers do not acknowledge the existence of emotional labor, it is a real occupational hazard that may generate life-altering effects on physical and emotional health. While no official regulations or identification standards specify emotional labor as an occupational hazard, some guidelines exist regarding its outcome: occupational stress. Emotional labor should be recognized as an occupational hazard by the Occupational Safety and Health Administration (OSHA), but this hazard does not lend itself to regulation through standards. The business culture that demands its performance is questioned.
Hypersensitivity pneumonitis (HP) is a complex syndrome of varying intensity and clinical presentation, and has been described in association with numerous exposures. Early diagnosis is essential to limit irreversible lung damage. We describe a case of HP in a 42-year-old dry cleaner following occupational exposure to tetrachloroethylene (TCE). The diagnosis was suspected based on clinical presentation and radiographic studies, and confirmed by lung biopsy. A review of the literature reveals that HP has not been reported previously as an occupational lung disease in dry cleaners. We conclude that HP should be suspected in dry cleaners presenting with pulmonary complaints, and TCE should be considered as a potential trigger of disease. The spectrum of TCE-related occupational diseases and the diagnosis of HP are reviewed.
In a period of declining union membership and severe economic and environmental crisis it is important that labor unions rethink their traditional roles and organizational goals. Responding to some of these problems and reflecting a history of innovative and progressive unionism, the Oil, Chemical and Atomic Workers Union (OCAW) has sought to address occupational and environmental health problems within the context of a political struggle. This study suggests that by joining with the environmental movement and community activists, by pursuing a strategy of coalition building, and by developing an initiative to build and advocate for a new political party, OCAW provides a model for reinvigorating trade unionism in the United States.
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