POSITIVE HEALTH ACCOUNTING: OCCUPATIONAL HEALTH AT THE ECONOMIC CROSSROADS Charles Levinson International Federation of Chemical, Energy and General Workers’ Unions (ICEF) I21 I Geneva 19. Switzerland
Occupational health and safety has been the Cinderella of industrial relations for decades, but its current eminence on center stage as a, top-priority ICEF program reflects a profound shift in social and political attitudes related to the processes of production. The objectives of ICEF policies, which seek constantly to upgrade levels of health protection for workers, are to redefine the “problem” of occupational health as a central and positive aim of industrialized society. Workers’ rights to proper protection at the workplace have been the major casualty of the philosophy of “scientific management,” which set the pattern for industrial organization around the turn of the century and which has been progressively modified but never displaced by even the more recent attempts at “humanization.” The central quest of industrialized and industrializing economies is for everincreasing productivity, accumulating cash flow or surplus to fuel the next step forward. All levels and types of management charged with the practical realization of these goals, understandably, are compelled to regard any factors that seemingly add to costs without increasing short-term results and efficiency as deviant items to be eliminated or minimized. From this perspective, most health safeguards in the workplace have been viewed universally as such a cost liability. The cost-conscious manager, held to account for the short-term profitability of the enterprise, would willingly alleviate only those health hazards that impede the efficient operation of workers in direct relation to their allotted tasks. If manual efficiency is being reduced by the effects of heat or fumes, for example, or if high levels of absenteeism are resulting from physical debilitation or work accidents, action to remove the immediate causes of these problems could be expected to show positive improvements in manpower productivity. A basic “subsistence level” for safe working conditions could therefore be expected to receive encouragement from management up to the point where expenditure on new safeguards looked likely to exceed the increase in profits stemming directly from increased worker efficiency. Beyond that point, the individual manager is in tension between his contractual commitment to performance and his conscience. Forced to achieve greater corporate efficiencies for his own success, the top corporate decisionmaker must choose the hierarchy’s goals. The increased investment needed to defend the worker from long-term hazards is of major proportions, involving, for example, new equipment, reengineering of processes, slowing down the pace of work, which may well jeopardize the targeted goals and therefore the “achievements” of the firm. Risks above this productivity line are held to be “acceptable,” a concept that is entirely economic in definition within this context and that involves no wider “acceptance” than that of the management team responsible for the data analysis. Trade union demands for improved health and safety are not freed from this dilemma within the traditional constraints of industrial relations. Increased realization of the longer-term risks inherent in the nature and organization of many jobs has
507 0077-8923/79/03304507 $01.75/00 1979. NYAS
508
Annals New York Academy of Sciences
led to better organized pressure on management to raise the threshold of “acceptability.” But even these attempts have been restricted within a bargaining framework in which workers and their representatives have been expected to “trade off’ more obvious economic benefits, such as salary increases, against these improvements in working conditions, so that the uneasy equilibrium between profitability and occupational safety is maintained. By the same criteria, many of the demands by ICEF affiliates for drastic reductions in exposure to workplace hazards have been met by the threat of job loss through plant closure and of the wholesale transfer of production to another location with a more amenable or underorganized workforce. These threats were loudly heard during the campaign to prevent exposure to carcinogenic vinyl chloride monomer, while the transfer of “dirty” asbestos production from North America and Western Europe to Latin America and Eastern Europe is a looming problem. Once again, the criterion of “acceptability” is likely to be modified even by workers themselves when the immediate alternative of unemployment is set against a long-term probability of disablement. Economic inevitability is accepted as hard fact; occupational health as an expensive “extra.” Under these circumstances, it is inevitable that both management and workers have frequently preferred to leave the final decision on health and safety reforms to government. Certainly, the involvement of governmental agencies in occupational health issues has grown rapidly over recent years under pressure from concerned trade unionists. Where governments have been more responsive to the trade union viewpoint, information and legislation have brought real and potential improvements in the plant. But the fundamental contradiction inherent in the economic evaluation of health protection is not removed by passing responsibility on to government. In many ways, the situation is exacerbated. While the taking of the decision is yet further distanced from the realities of the workplace and from the possibility of intervention by the workers who are directly affected, the economic cost pressures on government are multiplied. A country that introduces rigorous legislation and effective enforcement is likely to face the threat of mass capital export as manufacturers shift their production to new locations overseas rather than invest heavily in bringing older plants up to the new standards. This “hazard export’’ is frequently encouraged by recipient countries desperate for jobs and development capital whatever the long-term health effects on their citizens. These pressures lead them to offer investment grants and tax incentives to further facilitate the economic decision to transfer production, thus providing a tax haven where workers’ illnesses may flourish alongside company profits. For the government whose humanitarian health policies are likely to result in such a flight of hazardous industries, however, the prospect is reduced national productivity and a higher unemployment level, problems that few governments would willingly invite. The effects of the economic counterweight to necessary occupational health controls have been very keenly experienced in response to trade union pressure on government allied with the ICEF Occupational Health Program. In some cases, this has been overt, as in the introduction of “economic impact” reports as an official restraining procedure on government decision-making; in others, governmental agencies confronting this dilemma have merely adopted an ultra-cautious approach, resulting in footdragging of the slowest kind. There are about three million known chemicals, but because commercial insistence on the use of code names has never been effectively opposed by legislation, nobody has any real idea just how many of these substances are in current industrial use or precisely how many of them may be hazardous (even carcinogenic) to workers and to other users. Meanwhile, new compounds are being introduced at the rate of about 3000 every year. Yet, the
Levinson: Occupational Health Accounting
509
protection achieved in the workplace by health and regulatory agencies to date has been no more than thinly cosmetic. From an original list of nearly 1500 chemicals suspected of causing cancer, for example, the Occupational Safety and Health Administration (surely the largest funded and most publicized government health agency in the world) has still set only 16 “health standards” for carcinogens. This trade-off between health and productivity or profit, with the emphasis very firmly in favor of the latter, has been enshrined as a principle within the mechanisms of control themselves. The ICEF International Conference on Occupational Health recognized clearly that there could be no “safe” limit declared for exposure to carcinogenic substances encountered in the workplace. Threshold limit values (TLVs) set for these and for other hazards are at best a compromise, negotiated within the tripartite industrial relations framework (employer, trade unions, government) as a more or less “acceptable” solution to the contradictory requirements of worker protection, company profitability, and the national economy. Out of a conservatively estimated 10,000 toxic chemicals in regular industrial use, TLVs have been set in some countries and are properly enforced in even fewer for less than 600 of them. Even so, there is constant evidence that many of the TLVs that are set are quite inadequate to eradicate harmful effects on workers, especially in the long term, while little or no account is taken of the likely consequences of combined exposure to several harmful substances at once, the normal industrial situation. The continued use of untested, even suspect, substances in the workplace underlines the accepted priorities of production in which chemicals, declared valuable to new processes, are assumed to be safe unless workers die in sufficient numbers over time to outweigh their economic utility. The idea that people should be used as guinea pigs for scientific experimentation is held to be abhorrent. Yet, this is the precise result of exposing workers without their knowledge or consent to the unknown effects of process chemicals. Legal defenses of workers’ rights in occupational health matters also exhibit the preponderance of economic considerations in the application of justice to this sector of social affairs. In a remarkable reversal of their traditional role in a democracy of defending individual rights, courts dealing with such cases concentrate on the defense of corporate rights in the face of prosecution by the individual employee. It is up to the individual sufferer from mesothelioma or angiosarcoma, for example, to prove “beyond reasonable doubt” that his fatal disease was caused by long-term exposure to asbestos or vinyl chloride. Even then, the employee may not win a case in which a company can claim in the absence of evidence to the contrary that it was applying the appropriate exposure standards at the appropriate times, however inadequate these standards may prove to be. The principles employed in heavy sentencing in cases of intentional criminal injury or homicide include priorities to deter other would-be law-breakers to protect society from further harm, and to reform the offender. These principles are uniquely absent from most laws related to occupational injury, where the economic nature of society’s concern is displayed by a focus on matters of compensation rather than prevention or deterrence. Most fines levied on culprit companies are derisory in the light of assets and profitability, and out of court settlements for injury and pollution are universally encouraged. It is much cheaper for companies to pay out the occasional fine than to invest in proper preventive engineering. In one recent case, illustrative of the law’s reversal in such matters, National Lead Industries was able to negotiate through the United States courts a fixed fine of SlOOO per day as a rental to continue its admitted pollution of the Mississippi River. The final abandonment of all protective regulation at the workplace has even been suggested in a recent report to the United States Labor Department, in favor of a system of “economic incentives” in the form of “increased worker compensation and penalties tied to the injury rate.”
5 10
Annals N e w York Academy of Sciences
The process of obfuscation and delay in achieving adequate protection against unseen but deadly hazards is facilitated by the long “latency period” of most industrial diseases, especially cancers, that separates exposure from eventual detection. The problems of proving an immediate and direct causal relationship between the hazardous substance and the resultant illness are of a quite distinct character from those that involve risks that are immediate, dramatic, and visible in their injurious effects, such as explosions, machine accidents, major escapes of noxious substances, polluting smoke emissions, falls and broken bones. In the case of many substances whose fumes and fibers pervade the work environment, a 15- or even a 30-year gap may intervene between initial exposure and final detection of disease. In some cases, such as mesothelioma resulting from an invasive asbestos fiber, a single exposure may be sufficient to begin the deadly sequence. This period of indeterminacy, coupled with the difficulty of accumulating proof in advance over such a time scale, has permitted economic interests to be pursued to the detriment of workers’ rights to health. By insisting that only epidemiologic data, in other words a body count, could be taken as sufficient evidence to introduce exposure restrictions (and even then by long-drawnout questioning of the validity or applicability of these harsh proofs), the process of creating profitability from death has been sheltered from rapid and effective scrutiny. Furthermore, those who have sought to press for earlier controls, often on the basis of work experience and even with the support of data from animal tests, have been labeled as irresponsible alarmists by management apologists in a neat confusion of normal reason. Among the most vigorous proponents of the existing schizophrenic system of setting workers’ health in the balance against economic factors are many of the established “experts” of industrial medicine and hygiene. This sector of health care has been consistently underdeveloped, with the consequence that most practitioners are ordinary doctors who practice medicine on a company budget, in a company clinic. Trained as physicians, they are frequently unfamiliar with the industrial realities of the shopfloor, and segregated from the engineering function, they confine their attention to results rather than prevention. The natural caution of the specialist in the face of complex data is magnified when the declaration of a cause and effect relationship between a particular substance and a common illness would have costly consequences for the firm that pays his salary. The role of the industrial hygienist once more encapsulates the dilemma of the cost evaluation of occupational health. Employed by the company or government agency as a buffer between medicine and industrial engineering, his prime responsibility is to minimize the cost of meeting existing regulations and TLVs and to monitor their observance. As a trouble-shooter for occupational health “problems,” he is part of the modern management team and is oriented to show ways of meeting the (usually inadequate) regulations while contributing to improved productivity. It would be out of character and subjectively unwise for him to embrace as his aim the prevention of an occupational hazard in its broader aspect. This orientation has produced the delinquencies of the medicoeconomic research method, which pursue solutions by modifying the victim rather than the process. Although attempts to prove “accident proneness” by identifying character types in workers have notoriously failed over the years, more recent efforts have sought to provide other grounds for discrimination, alleging a similar propensity to contract illness from particular hazards among different categories of workers. Thus, it is recommended that women be excluded from exposure situations likely to induce fetal damage or that only older workers be employed in jobs that involve exposure to long-term carcinogens (on the grounds that most of them will die from natural causes before cancer symptoms become apparent). This approach has already led to calls for
Levinson: Occupational Health Accounting
51 I
preemployment genetic screening to indicate applicants deemed “unsuitable” because of their metabolic makeup for exposure to filthy plant conditions. The experts who promote such “solutions” to obtaining safety on the cheap are plainly subject to what may kindly be described as a mixture of motivations. This built-in contradiction between health and profitability a t every level of the existing occupational health structure explains the extreme difficulties encountered by trade unions in their fight to remove the obvious hazards of the workplace. The notion that each day’s work should begin with a public human sacrifice to the company shareholders and the national economy might seem horrific to civilized society. Yet, it is now evident that workers’ health and lives are being placed in jeopardy in the name of productivity and profit, with the willing connivance of those who claim to give protection. The reason why this institutionalization of hazards to health can continue without wholesale rejection is that workers are slotted into organograms as economic factors of production. It may be a human being who contracts cancer, but it is “labor costs” that are the concern of the managerial economist. Attempts have been made by so-called welfare economists and social accountants to soften the edges of this fundamental opposition between high economic performance and what is best for the continued health of the individual worker. Social accounting methods seek to show a cost relationship between the overall social budget and hidden “expenditures” in loss of income, welfare subsidies, and disablement benefits, for example, that result from occupational illness. But this is simply a search for another basis for the “acceptability” of risks and merely deepens the dilemma; it does not solve it. While social accountants may feel able to play the “saint” by allocating cost values to disease, disability, and distress, these values are unlikely to be accepted by the workers involved for whom these values must be literally infinite. Yet, this institutionalized ethical blindness on the part of management and society is not even a logical one. The only justification offered for the concentration on productivity as the key to social progress by the keenest of its advocates, from the freest of free market capitalists to the most Stakhanovite of authoritarian Stalinists, is that the ever-increasing output of goods and services will ensure a better life for all. If the very process of production is allowed to confound that guiding principle, however, by actually endangering the well being of the bulk of society’s members engaged in production, this justification collapses entirely. The separation of individual human welfare from the nature of daily work is a logical inconsistency and a fundamental flaw of industrial society, which is utterly rejected by our insistence on the fullest protection for workers as a right. The false dislocation of these twin elements of social concern by subordinating life to productivity is the result of a parallel dislocation of decision-making from the workplace, where these factors are in constant evidence, to the unpolluted atmosphere of the boardroom, where a single set of economic interests is alone allowed consideration. The fundamental aim of the ICEF Occupational Health Program is therefore to reconstruct decision-making in industry to reflect the raised status of occupational welfare considerations as the primary datum that gives validity to the drive for increased output. Unless this value is taken as the starting point for management economics, the rest of the exercise becomes irrational and unnatural. Workplace protection by engineering for safety first will put people values back into economic decisions. The only assurance that the positive supremacy of these values will not be submerged in the parallel (and not naturally contradictory) interests of cost value economics is the direct and permanent involvement of workers in the decisions that shape the future direction of industry and the conditions that prevail within it. Past tendencies to deal with issues of occupational health at a generalized, national level will need to be reversed to establish the fundamental right to health as a priority
512
Annals New York Academy of Sciences
objective of direct collective bargaining. The separation of workplace protection and regulation from trade union activity at the factory floor, where the realities of risk are encountered, has only strengthened the supremacy of managerial economic considerations. Calls for yet further research and investigation into health matters are spurious without a firm foundation within the work environment through collective bargaining. Lack of knowledge concerning the ravages wrought by exposure to industrial carcinogens has never been a problem. The cases against exposure to asbestos, arsenic, benzene, lead, mercury, nickel, chromium, bis-chloromethyl ether, coal tar, and the aromatic amines (to mention only 10 examples from among tens of thousands) have been established over many decades of death and disablement, yet the fatalities continue to provide company-funded “experts” with statistics on which to further their reputations while the substances remain open to widespread abuse in a host of industrial applications. While the discoveries of truly objective scientists will always be needed to inform the constant improvement of workers’ protection, not even such uncompromised research can of itself provide the cure for recalcitrance. Monitoring and preventive and regulatory systems must be directly and positively work-related to ensure that health is given its natural human priority. A joint union-management framework needs urgent implementation at every level of collective bargaining. Parity representation in such a system throughout company operations is a necessity and cannot be compromised by the inclusion of third-party or consultant determination. While doctors, lawyers, or politicians may provide useful data inputs to inform or interpret data or to formulate and enforce supportive legislation, they can never again be allowed to exceed their specialist roles and to encroach on the workers’ right to decide on their own safety needs. Union health specialists should be given equal and unrestricted access to all aspects of plant operations as decided by those who carry out the work with whom the settlement of such priorities must rest. These rights cannot be simply proclaimed, however, and then left to wilt unheeded without steps being taken to ensure their effective and continuous promotion within the industrial function. This necessary orientation toward positive health improvement as the right of the worker and the duty of the enterprise must be firmly established at the heart of future collective agreements. The extent of present hazard to workers’ health is so great that this issue demands attention more urgently than most of the traditional aspects of industrial relations to become a top priority of the trade union function and responsibility. For ICEF, it is the crux of our program. A united campaign by ICEF affiliates to promote occupational health as a positive and essential element in the validation of industrial objectives will invest our efforts with a new dynamic at every level of collective bargaining. Consolidation of achievements through the extension of democratic principles into the workplace will provide continuing support for this campaign, which is essential.
Occupational health and safety has been the Cinderella of industrial relations for decades, but its current eminence on center stage as a, top-priority ICEF program reflects a profound shift in social and political attitudes related to the processes of production. The objectives of ICEF policies, which seek constantly to upgrade levels of health protection for workers, are to redefine the “problem” of occupational health as a central and positive aim of industrialized society. Workers’ rights to proper protection at the workplace have been the major casualty of the philosophy of “scientific management,” which set the pattern for industrial organization around the turn of the century and which has been progressively modified but never displaced by even the more recent attempts at “humanization.” The central quest of industrialized and industrializing economies is for everincreasing productivity, accumulating cash flow or surplus to fuel the next step forward. All levels and types of management charged with the practical realization of these goals, understandably, are compelled to regard any factors that seemingly add to costs without increasing short-term results and efficiency as deviant items to be eliminated or minimized. From this perspective, most health safeguards in the workplace have been viewed universally as such a cost liability. The cost-conscious manager, held to account for the short-term profitability of the enterprise, would willingly alleviate only those health hazards that impede the efficient operation of workers in direct relation to their allotted tasks. If manual efficiency is being reduced by the effects of heat or fumes, for example, or if high levels of absenteeism are resulting from physical debilitation or work accidents, action to remove the immediate causes of these problems could be expected to show positive improvements in manpower productivity. A basic “subsistence level” for safe working conditions could therefore be expected to receive encouragement from management up to the point where expenditure on new safeguards looked likely to exceed the increase in profits stemming directly from increased worker efficiency. Beyond that point, the individual manager is in tension between his contractual commitment to performance and his conscience. Forced to achieve greater corporate efficiencies for his own success, the top corporate decisionmaker must choose the hierarchy’s goals. The increased investment needed to defend the worker from long-term hazards is of major proportions, involving, for example, new equipment, reengineering of processes, slowing down the pace of work, which may well jeopardize the targeted goals and therefore the “achievements” of the firm. Risks above this productivity line are held to be “acceptable,” a concept that is entirely economic in definition within this context and that involves no wider “acceptance” than that of the management team responsible for the data analysis. Trade union demands for improved health and safety are not freed from this dilemma within the traditional constraints of industrial relations. Increased realization of the longer-term risks inherent in the nature and organization of many jobs has
507 0077-8923/79/03304507 $01.75/00 1979. NYAS
508
Annals New York Academy of Sciences
led to better organized pressure on management to raise the threshold of “acceptability.” But even these attempts have been restricted within a bargaining framework in which workers and their representatives have been expected to “trade off’ more obvious economic benefits, such as salary increases, against these improvements in working conditions, so that the uneasy equilibrium between profitability and occupational safety is maintained. By the same criteria, many of the demands by ICEF affiliates for drastic reductions in exposure to workplace hazards have been met by the threat of job loss through plant closure and of the wholesale transfer of production to another location with a more amenable or underorganized workforce. These threats were loudly heard during the campaign to prevent exposure to carcinogenic vinyl chloride monomer, while the transfer of “dirty” asbestos production from North America and Western Europe to Latin America and Eastern Europe is a looming problem. Once again, the criterion of “acceptability” is likely to be modified even by workers themselves when the immediate alternative of unemployment is set against a long-term probability of disablement. Economic inevitability is accepted as hard fact; occupational health as an expensive “extra.” Under these circumstances, it is inevitable that both management and workers have frequently preferred to leave the final decision on health and safety reforms to government. Certainly, the involvement of governmental agencies in occupational health issues has grown rapidly over recent years under pressure from concerned trade unionists. Where governments have been more responsive to the trade union viewpoint, information and legislation have brought real and potential improvements in the plant. But the fundamental contradiction inherent in the economic evaluation of health protection is not removed by passing responsibility on to government. In many ways, the situation is exacerbated. While the taking of the decision is yet further distanced from the realities of the workplace and from the possibility of intervention by the workers who are directly affected, the economic cost pressures on government are multiplied. A country that introduces rigorous legislation and effective enforcement is likely to face the threat of mass capital export as manufacturers shift their production to new locations overseas rather than invest heavily in bringing older plants up to the new standards. This “hazard export’’ is frequently encouraged by recipient countries desperate for jobs and development capital whatever the long-term health effects on their citizens. These pressures lead them to offer investment grants and tax incentives to further facilitate the economic decision to transfer production, thus providing a tax haven where workers’ illnesses may flourish alongside company profits. For the government whose humanitarian health policies are likely to result in such a flight of hazardous industries, however, the prospect is reduced national productivity and a higher unemployment level, problems that few governments would willingly invite. The effects of the economic counterweight to necessary occupational health controls have been very keenly experienced in response to trade union pressure on government allied with the ICEF Occupational Health Program. In some cases, this has been overt, as in the introduction of “economic impact” reports as an official restraining procedure on government decision-making; in others, governmental agencies confronting this dilemma have merely adopted an ultra-cautious approach, resulting in footdragging of the slowest kind. There are about three million known chemicals, but because commercial insistence on the use of code names has never been effectively opposed by legislation, nobody has any real idea just how many of these substances are in current industrial use or precisely how many of them may be hazardous (even carcinogenic) to workers and to other users. Meanwhile, new compounds are being introduced at the rate of about 3000 every year. Yet, the
Levinson: Occupational Health Accounting
509
protection achieved in the workplace by health and regulatory agencies to date has been no more than thinly cosmetic. From an original list of nearly 1500 chemicals suspected of causing cancer, for example, the Occupational Safety and Health Administration (surely the largest funded and most publicized government health agency in the world) has still set only 16 “health standards” for carcinogens. This trade-off between health and productivity or profit, with the emphasis very firmly in favor of the latter, has been enshrined as a principle within the mechanisms of control themselves. The ICEF International Conference on Occupational Health recognized clearly that there could be no “safe” limit declared for exposure to carcinogenic substances encountered in the workplace. Threshold limit values (TLVs) set for these and for other hazards are at best a compromise, negotiated within the tripartite industrial relations framework (employer, trade unions, government) as a more or less “acceptable” solution to the contradictory requirements of worker protection, company profitability, and the national economy. Out of a conservatively estimated 10,000 toxic chemicals in regular industrial use, TLVs have been set in some countries and are properly enforced in even fewer for less than 600 of them. Even so, there is constant evidence that many of the TLVs that are set are quite inadequate to eradicate harmful effects on workers, especially in the long term, while little or no account is taken of the likely consequences of combined exposure to several harmful substances at once, the normal industrial situation. The continued use of untested, even suspect, substances in the workplace underlines the accepted priorities of production in which chemicals, declared valuable to new processes, are assumed to be safe unless workers die in sufficient numbers over time to outweigh their economic utility. The idea that people should be used as guinea pigs for scientific experimentation is held to be abhorrent. Yet, this is the precise result of exposing workers without their knowledge or consent to the unknown effects of process chemicals. Legal defenses of workers’ rights in occupational health matters also exhibit the preponderance of economic considerations in the application of justice to this sector of social affairs. In a remarkable reversal of their traditional role in a democracy of defending individual rights, courts dealing with such cases concentrate on the defense of corporate rights in the face of prosecution by the individual employee. It is up to the individual sufferer from mesothelioma or angiosarcoma, for example, to prove “beyond reasonable doubt” that his fatal disease was caused by long-term exposure to asbestos or vinyl chloride. Even then, the employee may not win a case in which a company can claim in the absence of evidence to the contrary that it was applying the appropriate exposure standards at the appropriate times, however inadequate these standards may prove to be. The principles employed in heavy sentencing in cases of intentional criminal injury or homicide include priorities to deter other would-be law-breakers to protect society from further harm, and to reform the offender. These principles are uniquely absent from most laws related to occupational injury, where the economic nature of society’s concern is displayed by a focus on matters of compensation rather than prevention or deterrence. Most fines levied on culprit companies are derisory in the light of assets and profitability, and out of court settlements for injury and pollution are universally encouraged. It is much cheaper for companies to pay out the occasional fine than to invest in proper preventive engineering. In one recent case, illustrative of the law’s reversal in such matters, National Lead Industries was able to negotiate through the United States courts a fixed fine of SlOOO per day as a rental to continue its admitted pollution of the Mississippi River. The final abandonment of all protective regulation at the workplace has even been suggested in a recent report to the United States Labor Department, in favor of a system of “economic incentives” in the form of “increased worker compensation and penalties tied to the injury rate.”
5 10
Annals N e w York Academy of Sciences
The process of obfuscation and delay in achieving adequate protection against unseen but deadly hazards is facilitated by the long “latency period” of most industrial diseases, especially cancers, that separates exposure from eventual detection. The problems of proving an immediate and direct causal relationship between the hazardous substance and the resultant illness are of a quite distinct character from those that involve risks that are immediate, dramatic, and visible in their injurious effects, such as explosions, machine accidents, major escapes of noxious substances, polluting smoke emissions, falls and broken bones. In the case of many substances whose fumes and fibers pervade the work environment, a 15- or even a 30-year gap may intervene between initial exposure and final detection of disease. In some cases, such as mesothelioma resulting from an invasive asbestos fiber, a single exposure may be sufficient to begin the deadly sequence. This period of indeterminacy, coupled with the difficulty of accumulating proof in advance over such a time scale, has permitted economic interests to be pursued to the detriment of workers’ rights to health. By insisting that only epidemiologic data, in other words a body count, could be taken as sufficient evidence to introduce exposure restrictions (and even then by long-drawnout questioning of the validity or applicability of these harsh proofs), the process of creating profitability from death has been sheltered from rapid and effective scrutiny. Furthermore, those who have sought to press for earlier controls, often on the basis of work experience and even with the support of data from animal tests, have been labeled as irresponsible alarmists by management apologists in a neat confusion of normal reason. Among the most vigorous proponents of the existing schizophrenic system of setting workers’ health in the balance against economic factors are many of the established “experts” of industrial medicine and hygiene. This sector of health care has been consistently underdeveloped, with the consequence that most practitioners are ordinary doctors who practice medicine on a company budget, in a company clinic. Trained as physicians, they are frequently unfamiliar with the industrial realities of the shopfloor, and segregated from the engineering function, they confine their attention to results rather than prevention. The natural caution of the specialist in the face of complex data is magnified when the declaration of a cause and effect relationship between a particular substance and a common illness would have costly consequences for the firm that pays his salary. The role of the industrial hygienist once more encapsulates the dilemma of the cost evaluation of occupational health. Employed by the company or government agency as a buffer between medicine and industrial engineering, his prime responsibility is to minimize the cost of meeting existing regulations and TLVs and to monitor their observance. As a trouble-shooter for occupational health “problems,” he is part of the modern management team and is oriented to show ways of meeting the (usually inadequate) regulations while contributing to improved productivity. It would be out of character and subjectively unwise for him to embrace as his aim the prevention of an occupational hazard in its broader aspect. This orientation has produced the delinquencies of the medicoeconomic research method, which pursue solutions by modifying the victim rather than the process. Although attempts to prove “accident proneness” by identifying character types in workers have notoriously failed over the years, more recent efforts have sought to provide other grounds for discrimination, alleging a similar propensity to contract illness from particular hazards among different categories of workers. Thus, it is recommended that women be excluded from exposure situations likely to induce fetal damage or that only older workers be employed in jobs that involve exposure to long-term carcinogens (on the grounds that most of them will die from natural causes before cancer symptoms become apparent). This approach has already led to calls for
Levinson: Occupational Health Accounting
51 I
preemployment genetic screening to indicate applicants deemed “unsuitable” because of their metabolic makeup for exposure to filthy plant conditions. The experts who promote such “solutions” to obtaining safety on the cheap are plainly subject to what may kindly be described as a mixture of motivations. This built-in contradiction between health and profitability a t every level of the existing occupational health structure explains the extreme difficulties encountered by trade unions in their fight to remove the obvious hazards of the workplace. The notion that each day’s work should begin with a public human sacrifice to the company shareholders and the national economy might seem horrific to civilized society. Yet, it is now evident that workers’ health and lives are being placed in jeopardy in the name of productivity and profit, with the willing connivance of those who claim to give protection. The reason why this institutionalization of hazards to health can continue without wholesale rejection is that workers are slotted into organograms as economic factors of production. It may be a human being who contracts cancer, but it is “labor costs” that are the concern of the managerial economist. Attempts have been made by so-called welfare economists and social accountants to soften the edges of this fundamental opposition between high economic performance and what is best for the continued health of the individual worker. Social accounting methods seek to show a cost relationship between the overall social budget and hidden “expenditures” in loss of income, welfare subsidies, and disablement benefits, for example, that result from occupational illness. But this is simply a search for another basis for the “acceptability” of risks and merely deepens the dilemma; it does not solve it. While social accountants may feel able to play the “saint” by allocating cost values to disease, disability, and distress, these values are unlikely to be accepted by the workers involved for whom these values must be literally infinite. Yet, this institutionalized ethical blindness on the part of management and society is not even a logical one. The only justification offered for the concentration on productivity as the key to social progress by the keenest of its advocates, from the freest of free market capitalists to the most Stakhanovite of authoritarian Stalinists, is that the ever-increasing output of goods and services will ensure a better life for all. If the very process of production is allowed to confound that guiding principle, however, by actually endangering the well being of the bulk of society’s members engaged in production, this justification collapses entirely. The separation of individual human welfare from the nature of daily work is a logical inconsistency and a fundamental flaw of industrial society, which is utterly rejected by our insistence on the fullest protection for workers as a right. The false dislocation of these twin elements of social concern by subordinating life to productivity is the result of a parallel dislocation of decision-making from the workplace, where these factors are in constant evidence, to the unpolluted atmosphere of the boardroom, where a single set of economic interests is alone allowed consideration. The fundamental aim of the ICEF Occupational Health Program is therefore to reconstruct decision-making in industry to reflect the raised status of occupational welfare considerations as the primary datum that gives validity to the drive for increased output. Unless this value is taken as the starting point for management economics, the rest of the exercise becomes irrational and unnatural. Workplace protection by engineering for safety first will put people values back into economic decisions. The only assurance that the positive supremacy of these values will not be submerged in the parallel (and not naturally contradictory) interests of cost value economics is the direct and permanent involvement of workers in the decisions that shape the future direction of industry and the conditions that prevail within it. Past tendencies to deal with issues of occupational health at a generalized, national level will need to be reversed to establish the fundamental right to health as a priority
512
Annals New York Academy of Sciences
objective of direct collective bargaining. The separation of workplace protection and regulation from trade union activity at the factory floor, where the realities of risk are encountered, has only strengthened the supremacy of managerial economic considerations. Calls for yet further research and investigation into health matters are spurious without a firm foundation within the work environment through collective bargaining. Lack of knowledge concerning the ravages wrought by exposure to industrial carcinogens has never been a problem. The cases against exposure to asbestos, arsenic, benzene, lead, mercury, nickel, chromium, bis-chloromethyl ether, coal tar, and the aromatic amines (to mention only 10 examples from among tens of thousands) have been established over many decades of death and disablement, yet the fatalities continue to provide company-funded “experts” with statistics on which to further their reputations while the substances remain open to widespread abuse in a host of industrial applications. While the discoveries of truly objective scientists will always be needed to inform the constant improvement of workers’ protection, not even such uncompromised research can of itself provide the cure for recalcitrance. Monitoring and preventive and regulatory systems must be directly and positively work-related to ensure that health is given its natural human priority. A joint union-management framework needs urgent implementation at every level of collective bargaining. Parity representation in such a system throughout company operations is a necessity and cannot be compromised by the inclusion of third-party or consultant determination. While doctors, lawyers, or politicians may provide useful data inputs to inform or interpret data or to formulate and enforce supportive legislation, they can never again be allowed to exceed their specialist roles and to encroach on the workers’ right to decide on their own safety needs. Union health specialists should be given equal and unrestricted access to all aspects of plant operations as decided by those who carry out the work with whom the settlement of such priorities must rest. These rights cannot be simply proclaimed, however, and then left to wilt unheeded without steps being taken to ensure their effective and continuous promotion within the industrial function. This necessary orientation toward positive health improvement as the right of the worker and the duty of the enterprise must be firmly established at the heart of future collective agreements. The extent of present hazard to workers’ health is so great that this issue demands attention more urgently than most of the traditional aspects of industrial relations to become a top priority of the trade union function and responsibility. For ICEF, it is the crux of our program. A united campaign by ICEF affiliates to promote occupational health as a positive and essential element in the validation of industrial objectives will invest our efforts with a new dynamic at every level of collective bargaining. Consolidation of achievements through the extension of democratic principles into the workplace will provide continuing support for this campaign, which is essential.
