I must question some of Bashyr's historical information. Public Health is
NOT new to the UK. Our Victorian Fore-fathers (and Fore-mothers)
established the foundations not only for modern public health but also a
public occupational health. Think of the 1833 Factories Act which grew out
of the iniquities suffered by workers. Think of scrotal cancer among the
chimney sweeps, and remember 'phossy jaw' among match workers, etc.. These
were documented and led to structural changes.
The links between public and occupational health were more clearly noticed
up to the mid 1970's when a new philosophy seemed to sweep the nation which
rang with words like 'management' and 'efficiency'. Up to 1974, local
authorities contained a clinical medical wing headed by a Medical Officer of
Health. They were responsible for enforcement (via their Public Health
Inspectors) of occupational safety legislation. On the other hand, EMAS
(already in existence) was reconstituted at this time by the Health and
Safety at Work etc. Act 1974.
What I believe is fairer to say is that there has been a renaissance in
public and occupational health which I trace to about 1990 when the evidence
could no longer be suppressed regarding issues such as poverty and health.
As an aside, it is interesting that about this time saw the Acheson report
on Public Health which partly was a response to horrors such as Stanley Royd
(apologies if is be a mis-spelling).
Suspicions abound. I agree. The expression 'occupational health' itself is
plastic enough to allow all sorts of inclusions and distortions. It is what
the anthropologist Mary Douglas called a Mother Concept: rather like
apple-pie, motherhood, and democracy we are all for it. We can, however,
stretch it to include and attempt to legitimise our actions through it. For
example in the late 1970's many managers authorised expenditure arguing that
the project was important "for health and safety purposes".
This is also a problem with 'professions' who have a discipline (and may be
bound by codes from their professional body to defend and enhance their
profession in a form of imperialism) when they come together in a
multidisciplinary area such as occupational health. Each has a clear idea
of the solution and the problem (usually in that order).
There is also a new wave of problems with the concept of auditing. We even
had a prime minister in the UK who was an accountant It seems so
reasonable to begin with: why should we not have value for money; why should
we not make explicit what we are trying to achieve and then be tested on how
well we achieve those goals; etc, etc.?
As to the future, well we can hope.
There was a time in the 1950s, 1960s and maybe the 1970s that the workplace
was an excellent locus of health activity. Now with unemployment and
underemployment, people may be exposed to work activity hazards without
being at work. In this sense we are back to the Victorian age with, for
example, increased home-based working, often badly paid. If this is the
case then 'occupational health' becomes less legitimate as a concept and
occupational health workers should be subsumed in a greater group of public
health workers - again local government in the UK continues to enforce
Health and Safety legislation in relation to outworkers.
I hope that we can have a period of stability in which the excesses of
rampant market philosophies are driven out ( I dream that we can tell
accountants what we want and tell them to find the resources for it). I
also hope that occupational health is funded more centrally in order to
cross this increasingly artificial 'divide' between organised employment
and 'non-organised' subsistence.
Good luck to you all for 2000.
Kevin MAGUIRE
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