Introduction to Occupational Health in Public Health Practice

Bernard J. Healey, Kenneth T. Walker

• Publisher: Jossey-Bass
• Year: 2009
• ISBN:
  9780470504055
• Edition: 1
• Topic: Medicina
• Subtopic: Medicina ocupacional e industrial

Introduction to Occupational Health in Public Health Practice

Bernard J. Healey and Kenneth T. Walker

Introduction to Occupational Health in Public Health Practice

Introduction to Occupational Health in Public Health Practice uses concepts of prevention, epidemiology, toxicology, disparities, preparedness, disease management, and health promotion to explain the underlying causes of occupational illness and injury and to provide a methodology to develop cost-effective programs that prevent injury and keep workers safe. Students, health educators, employers, and other health care professionals will find that this essential resource provides them with the necessary skills to develop, implement, and evaluate occupational health programs and forge important links between public health and worker safety.

Praise for Introduction to Occupational Health in Public Health Practice

"Successful evidence-based health promotion and disease prevention efforts recognize that health choices and outcomes of individuals and communities are profoundly affected by their respective social and physical environments. This book is a great tool to identify opportunities and strategies to integrate and leverage efforts for the individual, family, workplace, and broader community."
—Robert S. Zimmerman, MPH, president of Public Health Matters LLC, former Secretary of Health, Pennsylvania

"A timely and crucial book for all health care professionals."
—Mahmoud H. Fahmy, PhD, Professor of Education, Emeritus, Wilkes University

PART 1

PUBLIC HEALTH PREVENTION FOCUS

CHAPTER 1

HISTORY AND IMPORTANCE OF PUBLIC HEALTH

After reading this chapter, you should be able to

• Understand the use of the skills of public health in the prevention of workplace illness and injuries.

• Understand what public health departments do and how they accomplish their goals.

• Discuss the advantages of partnerships between workplaces and public health departments.

• Explain the evolution of public health responsibilities in the United States.

It is difficult for most people to understand what public health does because they very rarely if ever have to deal with a public health department. Public health agencies become visible only when a health problem receives extensive media coverage. Yet the work that has been completed by public health over the last century is one of the main reasons for the long life expectancy of most Americans.

One way to understand public health is to compare a physician and a public health professional. The physician is most concerned with the health of his or her individual patient whereas the public health professional is concerned with the health of the community. More broadly, the medical care system in our country focuses attention and resources on the individual and the cure of disease whereas the public health system is concerned with the population and the prevention of disease.

Shi and Singh (2008) point out that many people believe that public health is nothing more than a massive welfare system. The agency responsible for the good health of Americans is not a welfare program but a separate agency of government that is supplemented by many nonprofit public health agencies. Every organization should have an interest in the important programs that protect and promote the health of all citizens. It is unfortunate that most people do not come to really understand public health until there is an emergency and that they forget about public health after the emergency ends.

Schneider (2006) believes that public health is concerned with the prevention of disease and the promotion of health. This definition places public health in the area of primary care. McKenzie, Pinger, and Kotecki (2005) argue that public health involves governmental actions to promote, protect, and preserve the health of a population. However, public health activities are also performed by nongovernmental agencies. The perception of public health agencies as responders to health emergencies prevents even health policy experts from understanding the contribution that could be made by public health departments in solving the current health care problems in this country. These departments do many things that prevent disease but that are never publicized and therefore are not known by the average person.

The public health system is always working at making good health available for all individuals. It is usually seen as a silent component of health services, one that demands few resources and still produces immense value for all of our citizens in terms of better health for all. This system employs some of the most dedicated health professionals to be found in any part of this country’s health care system. These individuals have special skills that could be extremely useful in helping employers keep their workforces healthy and free from disease and injury.

A BRIEF HISTORY OF U.S. PUBLIC HEALTH

As just described, the valuable contribution made by public health professionals year after year is largely taken for granted. People think of public health and public health departments only when an emergency threatens their health and they need guidance and answers from public health officials and the various governmental agencies that they represent. Problems like E. coli in our food supply, anthrax in the mail, contaminated water, or drug-resistant tuberculosis bring public health to the forefront until the crisis subsides, and then public health departments seem to disappear until we need their help again.

Many definitions of public health point to a science dedicated to the improvement of the health of everyone. In 1926, Winston defined public health as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.” McKenzie et al. (2005) define public health as the health status of the population, including governmental action to promote, protect, and preserve people’s health. Novick, Morrow, and Mays (2008) define public health as “organized efforts to improve the health of communities.” Vetter and Matthews (1999) argue that public health is “the process of promoting health, preventing disease, prolonging life and improving the quality of life through the organized efforts of society.” And Turnock (2009) points out that public health represents a collective effort to deal with unacceptable realities that usually result in poor life outcomes that could have been prevented.

These various definitions of public health also offer a vision of population-based medicine rather than medical care centered around a specific individual. They emphasize prevention of health problems rather than a cure for health problems. If fully employed, the principles of public health could provide an answer to many of the problems that plague our current medical care delivery system. There also seems to be a major role for public health involvement in workplace health and safety issues.

Awofeso (2004) identifies six major approaches to public health that have been taken over the centuries:

• Public health as health protection (antiquity to 1830s)

• Public health as sanitary movement (miasma control) (1840s to 1870s)

• Public health as contagion control (1880s to 1930s)

• Public health as preventive medicine (1940s to 1960s)

• Public health as primary health care (1970s to 1980s)

• The “new public health”—health promotion (1990s to present)

These approaches offer a number of insights into the history of public health in the United States. There has been an emphasis on control of disease, regulation of some parts of the health care system, and more recently a stronger role in the development and implementation of prevention programs. The word control is frequently heard when describing the historical development of public health: control of disease, control of the free movement of people (quarantine), and control of certain high-risk behaviors.

Public health departments in the late 1800s and early 1900s became very successful at controlling the spread of diseases but were not so good at preventing these diseases from occurring in the first place. This changed with the development of vaccines that virtually eliminated childhood illnesses. In addition, the discovery of penicillin allowed public health departments to cure many sexually transmitted diseases in special clinics that concentrated on the control of venereal diseases. Public health professionals were trained to interview those infected with venereal diseases, find their sexual contacts, and bring them to treatment. This strategy resulted in a reduction in these diseases until public health resources were reduced through budget cuts.

It has taken a long time for the emphasis to begin to shift from the word control to a new word, prevention. Public health departments are now assuming greater roles in prevention that entail keeping people healthy and free from disease. Unfortunately, up to this time, limited budgets never allowed these departments to truly prevent anything except through the use of vaccines.

Nevertheless, from these earlier approaches came a number of very effective public health programs that saved lives, reduced morbidity, and added several years to the average life span of most Americans. In antiquity, in the very early years of the development of public health, people believed that disease was somehow caused by supernatural forces and therefore that epidemics were a punishment by god or other spiritual forces. When epidemics of plague, leprosy, cholera, and the like occurred, it was thought very little could be done about these outbreaks, some of which had mortality rates greater than 30 percent of the population.

Miasma control, an approach beginning in the 1830s, was usually the result of industrialism and urbanization that allowed public health conditions to worsen. The United States and other countries moved from farming to manufacturing, and people moved from farms to cities. People working and living closer together provided an environment for disease to develop and spread rapidly from person to person. According to McKenzie et al. (2005), the major theory of disease at this time was that vapors or miasmas were the cause of many diseases and that these diseases, resulting from a filthy environment, could be eliminated only by cleaning and other environmental precautions. A famous report by Edwin Chadwick, titled Report on an Inquiry into the Sanitary Condition of the Labouring Population of Great Britain, documented the influence of filthy conditions on the occurrence of disease.

Lemuel Shattuck’s 1850 Report of the Sanitary Commission of Massachusetts was one starting point for the development of public health in the United States. This report called for the development of public health departments that would have the responsibility for handling the public health concerns of the population of a locality or state. This report was a response to the need to have the authority to deal with infectious diseases and environmental problems, and it focused on state and local responsibility to deal with these issues.

The next era of public health involved the germ theory of disease, first proposed by Louis Pasteur in 1862. Discoveries in this era revealed the identity of such bacterial diseases as typhoid fever, leprosy, tuberculosis, cholera, diphtheria, and tetanus. This era also saw the founding of the American Public Health Association, the start of local public health departments, and the pasteurization of milk. It was now known that many diseases were caused by microbes and that the spread of disease could be controlled through public health activities. As the public health departments were established, they were given the goal of protecting the health of the community. In order to accomplish this goal these departments were granted powers to enforce public health laws and regulations. These powers included quarantine, isolation, immunization, and investigative powers.

Public health was now ready to move to the next stage of development, which involved the effort to prevent communicable diseases and to focus that prevention on high-risk groups. The discovery of penicillin gave physicians a weapon that could be used to cure many communicable diseases. The development of vaccines allowed the virtual elimination of many childhood diseases. Public health departments became very good at organizing and implementing mass immunization campaigns, which were credited with preventing enormous morbidity and mortality from communicable diseases.

The science of epidemiology was also developing. In 1849, John Snow, a London physician, had used epidemiological techniques to discover the cause of the spread of cholera in a particular city district. Having previously studied the transmission of cholera through contaminated water, Snow surveyed households of cholera victims and traced their water supply to the Broad Street well, one of three wells being used in that area. Once the suspect well was closed at his urging, the outbreak ended.

A study conducted by Doll and Hill in the 1950s implicated the use of tobacco in causing a form of cancer rarer at that time than now, lung cancer. This study paved the way for additional chronic disease studies that linked secondhand smoke to the same deadly form of cancer. Tobacco became identified as the leading cause of death for 430,000 Americans every year. Secondhand smoke was identified as a cause of over 80,000 additional deaths from lung cancer. After Doll and Hill’s study, it seemed a natural follow-up to start using epidemiology to evaluate high-risk health behaviors as a potential cause of other chronic diseases. Epidemiology was now ready to deal with diseases involving very long incubation periods that had no visible starting point.

Epidemiology has been called the basic science of public health by...