By Anthony Robbins

It has been many years, 26 in fact, since I left NIOSH, victim of the Reagan landslide of 1980.  It is fair to say that I have spent little time engaged in worker health issues since then. Yet Michael Silverstein’s future oriented document offered surprisingly few new or unexpected insights as it forcefully argued for a better and more effective OSHA. His passion is admirable.

Perhaps I should not have been surprised to read about old hazards, old strategies, and old indictments of those in power. It has always been thus.  For a view of worker health and environmental health issues that puts today’s challenges in historical perspective, I strongly urge readers to take up Paul Blanc’s new book, How Everyday Products Make People Sick: Toxins at Home and in the Workplace.  It reminds us that most of the problems we see in workplaces and the environment in the 21st century have their roots hundreds or even thousands of years back. 

Silverstein’s arguments reminded me that we, those who work to protect workers, are always playing catch-up and perhaps even more pointedly, that when we appear to be succeeding, that the real causes of improvement are likely to be changes in the economy–new products and processes leading to changes in exposures–not triumphs of workers or their advocates.  When Phil Landrigan and I contributed a chapter on workplace injuries to a CDC volume called Silent Victories : The History and Practice of Public Health in Twentieth-Century America, we probably disappointed the folk at CDC. OSHA and NIOSH had pointed proudly to a century of reductions in workplace injuries, but a closer look suggested to us that the bulk of the change could be explained by shifts in the US economy and employment away from agriculture, extraction, and manufacturing to the safer service sector.  Motor vehicle injuries are the workplace events that have grown most rapidly. As much as we would like it to be otherwise, greater safety was only in small part due to the tireless efforts of reformers to protect workers. 

Silverstein’s report reminded me of an old idea of mine, one that might help the world use scientific advances and improved knowledge of hazardous exposures and how they damage human health to get ahead of the curve in the battle to protect workers and citizens in general.  And worker health may be in the vanguard, because that is where we learn soonest about dangerous exposures. 

Can we create a global picture to show how exposures to toxics and other hazards appear and disappear, one that would permit us to foresee risks to workers and the general public? Every workplace exposure is caused by the growth or decline of the economy–in manufacturing, service, and natural resources sectors–new products, processes, inputs, etc.  Driven by commerce (and occasionally by public investment, as is the case for nuclear weapons), new and hazardous exposures appear, old ones disappear.  Most often, reduced exposures or less hazardous one result from change driven by the economy, not deliberate decisions by employers to protect workers or the environment; or to respond to more effective regulatory and enforcement regimes.  (At the margin, these interventions certainly play a role, but in a global economy where industry can usually find a less regulated environment, government regulation has become even less consequential.)

If it is the economy, [stupid!], then perhaps we can harness economists’ methods to look at trends in exposure.  Leontief’s input-output models were originally built using monetary units to describe economies–national, regional, or sectoral.  But why not account for hazards similarly?  Tally employment by the jobs in which people work, to know how many workers are potentially exposed; account for material inputs and intermediate products by industry, by workplace, or even by job to learn to what workers are exposed; quantify wastes discharged to environment, note the geographic location of these economic activities, including transport; and then record the final products that enter into other processes in the economy or into the consumer sector. 

I am not technically qualified to build an input-output model of exposures, but if we are to protect workers and the general public from toxics in workplace and general environments, surely it will take more than catch-up.  The only way that the global public will reject future dangers is if they can be foreseen; and all the misery they will cause.  Perhaps industries, too, can be deterred from decisions that will kill people because everyone will share the same predictions of harm.

Anthony Robbins, MD, MPA, is Professor, Tufts University School of Medicine and Co-editor, Journal of Public Health Policy. Dr. Robbins served as Chair of the Department of Family Medicine and Community Health of Tufts University School of Medicine from 1999-2002. He has directed the Vermont Department of Health, the Colorado Department of Health, the US National Institute for Occupational Safety and Health, and the US National Vaccine Program. He was President of the American Public Health Association, and for five years he edited Public Health Reports, the scientific journal of the US Public Health Service. He is a member of the planning committee of the Project on Scientific Knowledge and Public Policy (SKAPP).