U
A
HEALTH AND WORK Howard Rusk has said that there are three minimal essentials for the rehabilitation of handicapped people-a home to live in, someone who loves them, and a useful job to do. At the recent Aninual 'Meeting of the American Public Health Association in New Orleans, the Governing Council voted to suggest as the theme for the 1975 meeting the third of these essentials. Subsequently, APHA's Executive Board approved the theme, 'Health and Work." In the largest sense of the word, work is the keynote, not only of restoration of health after injury but also of health maintenance throughout life in our work-ethic society. The bread winner has self-respect and community acceptance because he or she has a job to do. Employment enables one to cope with almost any stress and, indeed, to react positively to most illness. Poverty with a steady job may be consistent with excellent health; but poverty accompanied by the hopelessness of unemployment opens the door to many illnesses. Joblessness is itself a major health hanidicap. It can destroy Rusk's first two essentialsthe home and the respect of loved ones. Recent emphasis among national issues has been focused on job hazards in the work place. This occupational health and safety crusade, although important. is only one of the reciprocal relationships between work and health. This issue of the Journal offers several articles devoted to this crusading undertaking. But the APHA Section on Occupational Health and Safety hopes that its sponsorship of these papers will not seem to restrict the 1975 theme to this limited aspect of health and work. Medical surveillance of the health of working people, even under NIOSH and OSHA regulations, will increasingly involve the whole medical care delivery system, including the services of laboratorv personnel, public health nurses, radiologists, epidemiologists, mental health professionals, dentists. community health planners, environmentalists, health educators, veterinarians, social workers, and new professionals, to name just a few. The concerned interest of labor unions, employers, and government officials in both public health and labor departments should also contribute to our 1975 discu ssioIs. In addition to the OSHA and NIOSH portion of the theme, this subject obviously includes such specific health-related issues as unemployment and disability insurance, workmen's compensation and rehabilitation, the disability aspects of social security, retirement and pension plans, and the criteria for employment developed by various voluntary health agencies. But, the theme is open-ended and should include a broad spectrum of other health-related topics. Women as workers, nutritional needs of workers, effects of working mothers on children, mental health and job satisfaction-all are potential areas for attention. The full utilization of APHA's many resources for 82
A I'" JANUARY, 1975, Vol. 65, No. 1
studies of all aspects of "health and work" should make 1975 a fascinating year. Everybody come aboard! Henry F. Howe, MD
UPSIDE-DOWN THE ORGANIZATION Public health is in danger of being obfuscated by cliches and driven to catatonia by conferences on roles. To the extent that it exists at all within the federal government, national public health leadership has little understanding of the skills and functions of local public health workers. Instead of trying to free the effectiveness of local workers from anachronistic and myopic restraints, our nominal leaders have become followers of clich6s: "Accessible, acceptable, and accountable" "Reallocation of existing resources" "Health care is a right" "Program planning, budgeting systems" "Physical, mental, social, and 'of course' environmental health" "Cost-benefit analysis" "The health care crisis"
And, since it is difficult to negotiate land use planning or treat mental retardation with a clich6, we get conferences on our roles so we can all chant in unison the litany
of little minds. It seems that we are upside down. Public health work is done in cities, blocks, homes, clinics, and council chambers. And the workers generally know what's wrong. What they need is thoughtful and bold leadership-not cliches. It is sad to see so many people running around rediscovering what our sanitarians have always known about our environment. But the sanitarians have been restrained for years by timid politics which reflected an uncaring public voice. Now that the public voice has been aroused, and let's hope it stays awake, it seems blind to the skill and experience of the sanitarian and wants some new creature to clean the place up. It is frustrating to listen to our national planners talk about a "health care system" which any good public health nurse could have put together yesterday if given the opportunity and support. The objectives, the instinicts, the skills, and the interests of local public health workers are completely in tune with what this country wants and needs, and, given thoughtful leadership, they will get it for us. What is holding us back? WVell, for one thing, we probably are upside down. If you assume that public health services have to be provided, for the most part, at the local level, then our local structure should be designed for that purpose so local citizens can reach out and contact something identifiable by them. Form should follow function, and function, for the most part, involves a front-line worker doing something recognizable and sensible
A
HEALTH AND WORK Howard Rusk has said that there are three minimal essentials for the rehabilitation of handicapped people-a home to live in, someone who loves them, and a useful job to do. At the recent Aninual 'Meeting of the American Public Health Association in New Orleans, the Governing Council voted to suggest as the theme for the 1975 meeting the third of these essentials. Subsequently, APHA's Executive Board approved the theme, 'Health and Work." In the largest sense of the word, work is the keynote, not only of restoration of health after injury but also of health maintenance throughout life in our work-ethic society. The bread winner has self-respect and community acceptance because he or she has a job to do. Employment enables one to cope with almost any stress and, indeed, to react positively to most illness. Poverty with a steady job may be consistent with excellent health; but poverty accompanied by the hopelessness of unemployment opens the door to many illnesses. Joblessness is itself a major health hanidicap. It can destroy Rusk's first two essentialsthe home and the respect of loved ones. Recent emphasis among national issues has been focused on job hazards in the work place. This occupational health and safety crusade, although important. is only one of the reciprocal relationships between work and health. This issue of the Journal offers several articles devoted to this crusading undertaking. But the APHA Section on Occupational Health and Safety hopes that its sponsorship of these papers will not seem to restrict the 1975 theme to this limited aspect of health and work. Medical surveillance of the health of working people, even under NIOSH and OSHA regulations, will increasingly involve the whole medical care delivery system, including the services of laboratorv personnel, public health nurses, radiologists, epidemiologists, mental health professionals, dentists. community health planners, environmentalists, health educators, veterinarians, social workers, and new professionals, to name just a few. The concerned interest of labor unions, employers, and government officials in both public health and labor departments should also contribute to our 1975 discu ssioIs. In addition to the OSHA and NIOSH portion of the theme, this subject obviously includes such specific health-related issues as unemployment and disability insurance, workmen's compensation and rehabilitation, the disability aspects of social security, retirement and pension plans, and the criteria for employment developed by various voluntary health agencies. But, the theme is open-ended and should include a broad spectrum of other health-related topics. Women as workers, nutritional needs of workers, effects of working mothers on children, mental health and job satisfaction-all are potential areas for attention. The full utilization of APHA's many resources for 82
A I'" JANUARY, 1975, Vol. 65, No. 1
studies of all aspects of "health and work" should make 1975 a fascinating year. Everybody come aboard! Henry F. Howe, MD
UPSIDE-DOWN THE ORGANIZATION Public health is in danger of being obfuscated by cliches and driven to catatonia by conferences on roles. To the extent that it exists at all within the federal government, national public health leadership has little understanding of the skills and functions of local public health workers. Instead of trying to free the effectiveness of local workers from anachronistic and myopic restraints, our nominal leaders have become followers of clich6s: "Accessible, acceptable, and accountable" "Reallocation of existing resources" "Health care is a right" "Program planning, budgeting systems" "Physical, mental, social, and 'of course' environmental health" "Cost-benefit analysis" "The health care crisis"
And, since it is difficult to negotiate land use planning or treat mental retardation with a clich6, we get conferences on our roles so we can all chant in unison the litany
of little minds. It seems that we are upside down. Public health work is done in cities, blocks, homes, clinics, and council chambers. And the workers generally know what's wrong. What they need is thoughtful and bold leadership-not cliches. It is sad to see so many people running around rediscovering what our sanitarians have always known about our environment. But the sanitarians have been restrained for years by timid politics which reflected an uncaring public voice. Now that the public voice has been aroused, and let's hope it stays awake, it seems blind to the skill and experience of the sanitarian and wants some new creature to clean the place up. It is frustrating to listen to our national planners talk about a "health care system" which any good public health nurse could have put together yesterday if given the opportunity and support. The objectives, the instinicts, the skills, and the interests of local public health workers are completely in tune with what this country wants and needs, and, given thoughtful leadership, they will get it for us. What is holding us back? WVell, for one thing, we probably are upside down. If you assume that public health services have to be provided, for the most part, at the local level, then our local structure should be designed for that purpose so local citizens can reach out and contact something identifiable by them. Form should follow function, and function, for the most part, involves a front-line worker doing something recognizable and sensible
