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An assessment of occupational disease in New York State was undertaken that partially replicated and expanded earlier work from 1987. Utilizing an expanded conception of occupational disease, the assessment used a variety of data sources and methods to provide estimates of mortality and morbidity of occupational disease; workers exposed to specific workplace hazards; disparities in occupational disease among racial/ethnic groups and gender; costs and distribution of costs of occupational disease; and accessible occupational medical resources. Examples of the pathways work may impact health in some of the major health issues of current import including stress-related health conditions; substance use; and overweight/obesity were included. The report contains recommendations for addressing the problem of occupational disease in New York State and advocates for the convening of a statewide group to develop an occupational disease prevention agenda.

The state plays a major role in occupational safety and health in the United States, impacting all aspects including resources, training, research, standard setting, and enforcement. Howard Waitzkin has challenged public health activists to rethink their understanding of the State and to replace the dominant pluralist view with a conception that serves as the theory for more effective public health action to improve the health of working people. This paper is a response to Waitzkin’s challenge utilizing a framework that views the State as a reflection of the relationship and power dynamics between capital and labor, within the confines of institutions, policies, and laws organized to protect and maintain the capitalist system. A historical review of safety and health since the Occupational Safety and Health Act of 1970 in the context of the capitalist state serves as the basis for suggestions as to how this might shape safety and health advocates’ strategy.

Unions, health and safety activists, and professionals came together to create Coalitions for Occupational Safety and Health (COSH groups) in a number of cities across the United States beginning in the 1970s. The COSHes have played an important and unique role in advocating worker health and safety since that time, through activities including technical assistance, training and education, and campaigns on workplace and public policies. In New York State, activist coalitions created eight COSH groups distributed around the state. This paper presents a history of New York’s COSHes based on interviews with key participants. The interviews shed light on the origins of the COSH movement in New York, the development and activities of the COSHes, and the organizational trajectory of individual New York COSHes in response to both extra and intraorganizational challenges. Participants’ accounts of these issues may be useful for those seeking to sustain the COSH movement.

Background Few occupational researchers have examined “return to work” among patients with work-related respiratory diseases. In addition, prior studies have emphasized individual patient characteristics rather than a more multi-dimensional approach that includes both clinical and structural factors. Methods A retrospective chart review identified patients with occupational respiratory diseases in the Occupational Health Clinical Center, Syracuse, NY between 1991 and 2009. We assessed predictors of work status using an exploratory, sequential mixed methods research design, multinomial (n = 188) and Cox regressions (n = 130). Results The findings suggest that patients with an increased number of diagnoses, non-union members, and those who took more than a year before clinical presentation had significantly poorer work status outcomes, after adjusting for age, education level, and relevant diagnoses. Conclusions Efforts to prevent slow return to work after developing occupational respiratory disease should recognize the importance of timely access to occupational health services, disease severity, union membership, and smoking status. Am. J. Ind. Med. 56:1371–1382, 2013. © 2013 Wiley Periodicals, Inc.

Para tratar o problema do sub-reconhecimento de agravos relacionados ao trabalho, em 1987, o estado de Nova York utilizou financiamentos públicos para criar uma rede de ambulatórios de saúde ocupacional, que continua sendo o único projeto de seu tipo nos Estados Unidos. Sua missão é o diagnóstico, o tratamento e a prevenção de doenças ocupacionais. O financiamento público foi necessário para sustentá-la e permitir que funcionasse de forma independente e universalmente acessível. Este artigo relata as experiências dos Ambulatórios de Saúde Ocupacional (Occupational Health Clinical Centers - OHCC) ao longo dos últimos 25 anos. Cada serviço é parte da rede e atende grande parte da região central do estado de Nova York. Durante este período, os ambulatórios construíram uma experiente equipe multidisciplinar e um programa multifacetado, que inclui atividades clínicas, ações de capacitação e educação, assessoria técnica e pesquisa. Alcançaram considerável sucesso em estabelecer-se como um recurso para os trabalhadores acidentados na região e como defensores, do ponto de vista clínico, de trabalhadores acidentados nos seus locais de trabalho e junto ao sistema de compensação. Como os OHCCs se movem em direção à nova fase, desafios consideráveis permanecem, especialmente na identificação e no acesso de trabalhadores submetidos a situações de alto risco com pouco alcance aos serviços de saúde.

In a response to Joseph LaDou's article in this issue, Michael Lax focuses on the broader issues. If we are agreed that we need significant change in Workers' Compensation, what should the nature of those changes be? Of equal importance to knowing what we want is the development of a strategy for how to get there. Without an effective strategy, we will be consigned to discussing the issues again and again, developing attractive alternatives that live only on paper or at conferences.

The impact of an occupational illness or injury on an injured worker can be severe. This study assessed several dimensions of the impact on a group of 50 injured workers, all patients at an Occupational Health Center. The dimensions assessed included aspects of access to health care, support from treating physicians in obtaining Workers' Compensation benefits, financial impacts, the role of attorneys and “Independent Medical Examiners,” and the impact on mental health. The results showed almost two-thirds of respondents lost their health insurance after diagnosis with a work-related illness or injury, most for more than a year. Many reported that their treating physician did not want to become involved in Workers' Compensation, despite indicating a belief that the health condition was work-related. The financial impacts of a work-related diagnosis were particularly striking, with respondents reporting that they were burdened with both costs directly related to the medical care of their condition, and with coping with ongoing general expenses on a reduced income. Many respondents reported depleting savings, borrowing money, taking out retirement funds, and declaring bankruptcy in efforts to cope. Emotionally, respondents almost universally reported their diagnosis and related issues were associated with depression, anxiety, and loss of identity and self-worth. This study demonstrates how a work-related injury or illness can extend far beyond the physical impact for injured workers. Existing systems fail to adequately compensate or rehabilitate injured workers, leaving them to their own devices to deal with their losses, medical or otherwise.

The idea that efforts are necessary to transform the dominant framework of workplace safety and health in the United States, from one of compensation and disability to one of stay at work/return to work (SAW/RTW) for workers injured or made ill on the job, has become increasingly widespread. SAW/RTW advocates argue that everyone “wins” when unnecessary disability is reduced. Toward this end, advocates have put forward a program and implemented a strategy with strong proponents among a coalition of corporate-connected professionals. The seemingly obvious conclusions of their arguments bear closer critical scrutiny, however. Addressing key questions—why injured workers do not SAW/RTW, who the coalition of SAW/RTW proponents includes, and what the coalition proposes—reveals that the SAW/RTW approach mainly benefits employers and the corporate-connected advocates. These assertions are detailed, and principles of an alternative approach that will serve the needs of injured workers are outlined.

The U.S. Bureau of Labor Statistics and workers' compensation insurers reported dramatic drops in rates of occupational injuries and illnesses during the 1990s. The authors argue that far-reaching changes in the 1980s and 1990s, including the rise of precarious employment, falling wages and opportunities, and the creation of a super-vulnerable population of immigrant workers, probably helped create this apparent trend by preventing employees from reporting some injuries and illnesses. Changes in the health care system, including loss of access to health care for growing numbers of workers and increased obstacles to the use of workers' compensation, compounded these effects by preventing the diagnosis and documentation of some occupational injuries and illnesses. Researchers should examine these forces more closely to better understand trends in occupational health.

Clinicians practicing occupational medicine are increasingly confronted with patients who have complex illnesses with chronic nonspecific symptoms. Most clinicians use the traditional tools of biomedicine to diagnose and treat the illness, determine etiology, and assess disability. This article argues that the biomedical approach is inadequate to effectively evaluate and treat occupational illness. After reviewing several critiques of biomedicine, including biopsychosocial, feminist, class, and critical theory/postmodern perspectives, the author offers an alternative approach that builds on aspects of these perspectives as well as the “popular education” work of Paulo Freire. Constraints on, and possibilities for, the development of an alternative approach that attempts to build patients' capacities for transformative action are explored.

Experience at a publically funded occupational health clinical center in New York State suggests that patients with work-related illnesses often have great difficulty accessing diagnostic and treatment services. A study was designed to more quantitatively investigate the extent and nature of barriers to medical services for patients with Workers' Compensation claims. Medical practices from 13 selected medical specialties were identified from telephone directories. The directories covered six areas encompassing almost all of a 15-county region. All practices from each selected specialty were contacted by phone and asked a set of standardized questions regarding patient acceptance policies. A number of barriers were identified by the survey including practices closed to new patients and practices closed specifically to patients with Workers' Compensation claims. Barriers also were found to be widespread among practices that did accept Workers' Compensation claims, primarily related to requiring a guarantee of payment prior to seeing the patient. The results were compared by medical specialty and geographic area. While the study showed some of the difficulties patients with occupational illnesses face attempting to access medical services, it most likely underestimated the extent of the problem. Attitudes and practices that impede access, but were not measurable, create additional barriers. Our study strongly suggests that policies that improve access to medical care for individuals with Workers' Compensation claims are necessary to better serve the needs of workers with occupational illnesses.

Multiple chemical sensitivities (MCS) has emerged as an important and highly controversial issue in occupational health. Debate centers on whether the illness is “physical” or “psychological.” A strong corporate-backed campaign has framed the debate and has pushed MCS advocates into a strategy of “proving the physical” nature of MCS. Proponents of both positions, however, share key assumptions that impede long-term efforts to benefit MCS sufferers, including acceptance of the physical/psychological dichotomy as a paradigm for the illness, a desire to rid the debate of “politics” to allow “objective scientific” data to be amassed, and a view of MCS as unique without links to other occupational illnesses. While a grassroots movement has benefited MCS sufferers in a number of important ways, the shared assumptions have impeded development of a more complex model for the illness that is reflective of a complex reality, reproduced mainstream expert/non-expert relationships, and failed to connect with the broader occupational health and safety movement. The author outlines an alternative theory and practice to begin addressing these issues, beginning with a recognition of MCS as a problem of developing knowledge within a context of class power.

Over-exposure to lead was identified among developmentally disabled workers engaged in furniture refinishing at two separate sites. The index case was identified at the first site by a public health nurse assigned to provide care to some of the workers. Referral to a regional occupational health clinic initiated an exposure assessment and medical consultation at both work sites. Blood lead levels (BLLs) among sanders and helpers at site A averaged 60 micrograms per deciliter of blood (mcg/dl). At site B, BLLs were lower, but 6 individuals had BLLs greater than 25 mcg/dl. Hand sanding of chemically stripped wood previously coated with lead-based paint was determined to be the exposure source. These incidents document potential lead overexposure in an underecognized setting. They also emphasize the importance of incorporating a workplace health risk assessment in the process of placing and protecting the developmentally disabled on the job. Am. J. Ind. Med. 34:191–196, 1998. © 1998 Wiley-Liss, Inc.

The occurrence of deaths due to lung cancer was studied among 883 white male workers from a pulp and paper company in northern New Hampshire. All subjects had participated in a longitudinal study of respiratory morbidity, and data from interviews were used to construct lifetime cigarette smoking and occupational histories. Most of the subjects had entered follow-up in the 1960s and, at that time, their mean age was 51 years and they had worked for the pulp and paper company a mean of 25 years. By the end of follow-up in 1992, the 512 deceased subjects included 35 whose underlying cause of death had been lung cancer. With an internal comparison using the Cox proportional-hazards model, the hazard ratio for sulfite pulp mill work was 2.5 (95% CI 1.3-4.9), while controlling for the effects of age, cigarette smoking, and work in other parts of the pulping operation. In addition, the hazard ratio for the combination of35 pack-years of smoking and10 years sulfite mill work was greater than the product of the hazard ratios for each factor alone. While these findings are consistent with past asbestos exposure in the sulfite pulp mill environment, the absence of mesothelioma cases is inconsistent with this type of exposure.

The occupational safety and health movement has been transformed from a struggle emphasizing workplace democracy to a de-politicized technical debate. Professionals involved in occupational safety and health (OSH) are continuously urged to keep “politics” out of their work. However, “politics,” defined as the participation in knowledge production and decision-making that profoundly affects working life, is inherent to the work of OSH professionals. These professionals function within specified roles largely created and shaped to meet the needs of the corporate class. In this context, there is a need for professionals who are explicitly allied to workers struggling for health and safety. However, there are powerful constraints to the development of this alliance, including professionals’ need for jobs, job security, and credibility. Additionally, many professionals seeking an alliance with workers remain under the sway of hegemonic myths that limit their ability to function as worker allies. These myths include non-recognition of class power and its effects on workplace health, a view of OSH as purely a technical issue, and a failure to recognize how OSH knowledge is shaped by its political/economic context. Ideas for developing an alternative praxis are offered.

Few occupational researchers have examined "return to work" among patients with work-related respiratory diseases. In addition, prior studies have emphasized individual patient characteristics rather than a more multi-dimensional approach that includes both clinical and structural factors.A retrospective chart review identified patients with occupational respiratory diseases in the Occupational Health Clinical Center, Syracuse, NY between 1991 and 2009. We assessed predictors of work status using an exploratory, sequential mixed methods research design, multinomial (n = 188) and Cox regressions (n = 130).The findings suggest that patients with an increased number of diagnoses, non-union members, and those who took more than a year before clinical presentation had significantly poorer work status outcomes, after adjusting for age, education level, and relevant diagnoses.Efforts to prevent slow return to work after developing occupational respiratory disease should recognize the importance of timely access to occupational health services, disease severity, union membership, and smoking status.

Lead poisoning among workers processing lead sheathed telephone cable was identified at five worksites. High blood lead levels (BLLs) were identified during the medical evaluation of symptomatic workers following employer mandated air monitoring and through employer mandated blood lead levels. Once high BLLs were identified, governmental agencies became involved at every site, either as a result of worker complaints to OSHA or as a registry reporting mechanism. Workplace evaluation revealed significant overexposure to lead, particularly among workers mechanically stripping the lead sheaths. After intervention by a government agency, four of the workplaces chose to stop lead cable processing. Because the ongoing replacement of lead sheathed telephone cable with fiber optics may be continuing in many areas of the country, there is concern that the clusters we have identified represents a widespread and little recognized setting for lead overexposure. Recommendations for preventing overexposure to lead in this setting are given.

Workers suffering from a work-related health condition frequently are required to undergo examination by a physician chosen by the employer or a Workers' Compensation Insurance Carrier. While the opinions of physicians performing these “Independent Medical Examinations” (IMEs) have been criticized as biased by a conflict of interest, IME advocates assert that the methods used by the IME result in an objective and superior opinion. This article explores this claim to objectivity and superiority. It argues that proemployer/carrier bias is embedded in the methodology IMEs advocate, and that the practical impact of the IME approach is to reduce the recognition of occupationally related health conditions and to minimize the disability associated with such conditions. The IME approach is more accurately characterized as a tool to standardize a product that can be marketed to corporate clients, rather than a way to precisely assess work-related health conditions.

Pressure is mounting for clinicians to rely solely on “objective” measures when evaluating workers with possible work-related disease. These measures are intended to largely supplant the worker's history as sources of information regarding diagnosis, work relatedness, and extent of disability. While seeming to promote more accurate and neutral evaluation methods, the underlying agenda is to reduce business costs by denying work-related illness and disability. Promoting the view of occupational health as the province of technical experts, the campaign for the “objective” finding silences workers as unqualified to comment. The methods proposed to enhance objectivity also suffer from significant specific shortcomings. To resist efforts to fetishize the objective finding, clinicians need to recognize the subjective elements of objective methods as well as the objective value of subjective data. This requires recognition of the central role of workers and histories in the clinical evaluation process.

Treating physicians' and independent medical examiners' (IMEs') opinions were compared to identify differences of opinion and to develop a basis for understanding the differences. Twenty-three patients of an occupational health center (OHC) who had been examined by an IME were studied. OHC and IME opinions regarding diagnosis, work-relatedness, treatment recommendations, and disability assessment were categorized by degree of agreement. There was agreement on all four issues for only one patient. Opinions were most divergent with regard to disability assessment and least divergent with regard to diagnosis. Disagreement was unidirectional: the IMEs made fewer diagnoses, deemed fewer illnesses work-related, made fewer treatment recommendations, and assessed lower levels of disability than the OHC examiners. The results suggest that differences in opinion between the OHC and IMEs are due to differences in perspective, rather than skill or training.

Thirty-five people with work-related Multiple Chemical Sensitivities were studied to learn about the onset and progression of illness. The subjects were selected from patients at an occupational health clinic. Individuals were identified as subjects if they fulfilled a seven-point case definition for Multiple Chemical Sensitivities and if onset of symptoms was related to workplace exposures. Three occupational exposures to solvents, poor indoor-air quality, and remodeling were associated with onset of Multiple Chemical Sensitivities in 63% of the subjects. Symptoms indicative of a nervous-system disorder topped the list of the most frequently reported symptoms. Commonalities in exposures and symptoms suggest that Multiple Chemical Sensitivities represents a distinct diagnostic category. Even with an incomplete understanding of etiology, it may be possible to limit the onset of work-related Multiple Chemical Sensitivities.