Occupational health is global, too

Anyone reading this journal or following the world literature knows perfectly well that environmental health is a global concern, because pollution and ecosystem change know no boundaries. However, occupational health seems much more particularistic, local, and tied to specific industries, occupations, and processes, not so much to communities. Yet, this perception may reflect a failure to conceptualize the true scope of occupational health rather than actual limitations on the field. Occupational health is global, too.¹

First, what is meant by “global”? Some years ago, many academic departments of international health began calling themselves departments of “global health”. They did this for a number of reasons: to emphasize that there are common principles and conditions for the development of health care and public health services in most countries, to move away from single or multiple bilateral relationships (“inter”, between + “national”, implying specific countries) and toward broad programs that address the needs of regions or any country with which they choose to have a working relationship, to conform to the preference of government agency or non-governmental organizations partners for broad programing, and to look sexy for funding agencies.

However, there were also sound theoretical and academic reasons for changing the emphasis from country-to-country relationships to a comprehensive perspective. The big one was the emergence of a greater appreciation by the World Bank and in the literature of economic development for the role of health as both a desired outcome (of course) and an important input to economic growth. Sick people do not produce goods and services, spend more money on their health if they have it, and struggle to stay out of poverty. Somehow this big picture eluded development economists for a long time and eludes them still on occupational health. This was one among many factors that limited the vision of the old “international health”, which tend to restrict itself to healthcare and health services and the most obvious public health problems, mostly on a community level (dominated by the need for clean water). Reframing the field as “global health” allowed all this to be rethought, much as health promotion forced a rethinking of preventive medicine and community public health.

Obviously, there are elements of occupational health that are “international” in the old sense, such as travel medicine, management of occupational health services in-country by global companies, and the heroic uphill battle being fought by the World Health Organization to create “Basic Occupational Health for All” based on the primary care system in developing countries. On a macroeconomic level, occupational health is thought of, when it is thought of at all, most often in terms of sacrifice, related to globalized trade and the pressures this puts on production and workers who pay in this generation for the opportunities it provides for economic growth benefiting the next.

But occupational health is also “global” in the new sense. In an era of globalized trade and supply chains, workers in different countries and regions, industry sectors, and occupations are affected at the same time although often in different ways by the same underlying drivers of economic growth (or decline), changing demand, and new technology. Cell phones (more often called mobile phones outside the United States!) and fiber optics bring enormous economic advantages, such that sub-Saharan African continent was largely able to skip copper-wire communications technology altogether, and after first crashing the copper industry has revived the economies of some of these same countries, like Zambia through Chinese investment, but at the same time resulted in dangerous, unregulated informal work in small, unsafe mines and scavenging operations in Congo, Zambia, and elsewhere. The health and safety of miners and informal workers in these places are determined by global factors over which they have no control and do not have the resources to mitigate.

Occupational health is also global in the sense of reallocating risk at the workforce level. A strategy in many developing countries, pioneered by China, has been to provide social security coverage and protections first to workers employed in the formal economy, especially state- or foreign-owned owned enterprises. From there, coverage is expanded and extended to other sectors as the economy develops and more wealth is generated. This strategy is apparent in South Africa today: citizens who have a job are covered by an essentially modern social security network; those who are not are outside the shield of protection. In the United States, the strategy works similarly for health insurance, because it is tied to employment for those of working age. But it cannot and should not work for occupational health protection because when employers cut corners or workers do not follow best practices, the entire culture of safety frays around the edges and disintegrates and entry of new, younger, and frankly less expensive workers undermines compliance and protection for all. That is one reason why there needs to be a national and comprehensive framework for occupational health protection down to small and medium-scale enterprises from the beginning and reaching out into the informal sector. Occupational health is truly global, in the sense of requiring to be complete in its coverage.

Occupational health is global no less than environmental health but the parts of it that cross boundaries are people and technology and product. Its structure and local application should not obscure the reality that protecting the health of workers is no less a global enterprise than protecting the environment and the health of communities.¹

Tee L. Guidotti
Editor Emeritus
Archives of Environmental and Occupational Health
[email protected]