Over the last six or seven weeks I have been involved in research reviews and had time to reflect on them while on several long plane rides. Here are some thoughts.
Too often it is assumed that the big questions in occupational health are solved, or at least mitigated to the point where they are minor concerns. Not true!
Old hazards are still around with plenty of unresolved issues of practical importance. For example, right now we are undergoing a re-evaluation of the health risk of benzene exposure, finding risks at levels much below what was usually studied in the past. It was only in the last decade that the evidence became conclusive for carcinogenicity of diesel exhaust particulates and welding fumes. Had we declared these issues settled, we would have missed important health effects.
New hazards are being invented constantly. Nanomaterials alone have opened a huge new area of concern. Consider that nano is not just a class of chemicals. Nano is more like a different state of matter in which solid-state chemicals (and some adsorbed liquids and gases and liquid aerosols) take on new and sometimes unpredictable properties with health implications.
We have also spent much time in recent years looking for biomarkers of vulnerability and mechanisms of susceptibility, particularly through genomics. That is fine, particularly as a theoretical framework. But we need to give most of our attention to exposure assessment, because without the exposure even the most susceptible workers would not be affected and in any population of workers it is exposure that drives the health outcome, not the prevalence of susceptibility states. We miss that important point when we talk about biomarkers and gene-toxicant interactions.
We have passed through phases in occupational health research, from first viewing the workplace as a hazardous, even hostile environment requiring a public health approach, to a social construct requiring a social construct. Psychosocial hazards that have captured or attention are not necessarily being studied the optimal way. The next turn of the wheel seems to be an approach that views work as an integral part of economic and environmental sustainability and treats issues of work capacity (including productivity, the aging workforce, and the burden of disability) as macro- level socioeconomic problems. These population-level issues are assuredly important, even critical, but we should not lose sight of the importance of occupational health issues on the ground or shop floor while we consider them and I think we may be doing exactly that.
What makes the workplace unique, and occupational health research challenging, is that the workplace is a combination of physical structure, work processes, work organization, an organizational culture, workers with their own health issues and profile, and an employment relationship that puts workers, management, and contractors into a mutually dependent framework. There are lots of variables and that makes our work all the more challenging. Most challenging of all is that no occupational health problem can be solved without attention to both its technical or mechanistic aspects and its social context, including motivating change in a complicated social environment. In other words, health and safety in the workplace is a sociotechnical problem and neither social nor technical approaches alone will solve its problems.
For example, studies stress in the workplace have been dominated by the familiar “demand-control” model to the exclusion of other ways of looking at the problem. The “organizational justice” model (applied to the workplace) actually adds useful predictive and explanatory power in the residuals and is directly relevant to work organization and labor-management relations, but it is uncommonly used.
Increasingly, clients of research (the end users in industry and management, the funding agencies, and regulatory agencies) want and expect “off-the-shelf” packaged solutions to problems, directly relevant to their circumstances. However, enterprises are mostly unwilling to enter into the long-term relationships with investigators that involve unrestricted access, frequent visits to (rapidly changing) workplaces, and candid input from workers. Without knowing what is going in the workplace, it is very difficult to study the problem and come up with specific targeted solutions.
I would like to see a robust, diverse occupational health research enterprise that does not marginalize individual risk for population-level outcomes, that balances priorities and is a little less prone to run away with the latest trend or timely concern, and that treats exposure as the key variable, not worker characteristics. I would like to see occupational health research applied with a focus on justice and equity for past exposures, prevention in the present, and proactive anticipation and sustainability for the future.
When I see this, I will know that occupational health research has come of age as a mature science.
(c) 2017, Tee L. Guidotti. Opinions expressed are my own.