Industry, environment, and the politics of medical

interventions

Lecture 13

HI31L

Occupational and industrial diseases not uniquely 20th c. phenomenon

Large scale state/governmental responses are!

• 1893 Federal law requiring safety equipment on railroad engines.• 1902 100,000 coal miners go on strike; federal govt takes action

leading to a wage increase, shorter work week.• 1906 Upton Sinclair's "The Jungle" (meat packing industry expose)• 1907 Bureau of Labor estimates 15-17,500 of 26 million male

workers are killed that year.26 states pass legislation making it easier for workers to sue employers if injured or killed on the job.

• 1910-20 Workers Compensation Acts passed in many states • 1913 Federal Employee Compensation Act passes, est. Office of

Workers Compensation• 1920 All but eight states have workman comp. laws, (but these

prevented workers from suing their employers. Supported by U. S. Steel and the National Association of Manufacturers).

• 1935 Social Security Act (Old age, unemployment, mother and child benefits, some public health)

• 1936 Walsh-Healy Act is passed: establishes first national standards for workplace safety (only for corporations getting federal contracts). Violators could be "blacklisted" from federal contracts for 3 years.

The war in the workplace

“It has become as perilous to live in the United States as to participate in actual warfare…”

The Outlook, 1904

‘Statistics are good stuff to start a revolution with’

Crystal Eastman, 1911

The coalition for change

• Muckracking journalism• Industrial employers• Labour movement• Social activists

• BUT: not necessarily the Public Health Service or medical professionals, groups which tended to be more sympathetic to business, and to urge ‘low-key’ and cooperative approaches

Industrial diseases: new challenges

• Not ‘germ-theory’ contagious diseases;

• Often difficult to diagnose early on and in milder cases;

• Delayed onset; tolerance for pathogens highly idiosyncratic

• Causality hard to determine, easy to contest;

• Chronicity!

Silicosis

Silicosiswith TB

Miner presenting with silicosis followed by tuberculosis. WHO (at NLM)

Modelling ‘industrial diseases’

Ill-health caused directly by the workplace

• Silicosis• Asbestosis• Pneumonoconiosis• ‘Fossy jaw’• Aplastic anaemia

Ill-health caused by poor working conditions and poor pay (poverty)

• Tuberculosis• Premature

debility/death• Workplace accidents

Rationales for Workplace Safety

• Economic: worker as resource

• Social/Moral: worker as citizen/victim

Strategies for Change

Legislation Persuasion Organization

Note role of medical claims about women’s bodies in justifying and informing legislative efforts, workplace reform, and efforts to remove women from workplace

(re)Modelling ‘industrial health’

Focus on ‘safety’ • Adopted by industry

(e.g. National Safety Council) to limit impact of reform movements

• Technocratic• Tendency to put

responsibility on workers

Focus on ‘health’• Maintained by labor

movement, social workers, some consumer groups

• Much broader: calls for reform of pay structures, hours of work, workplace hygiene and regulation

Safety: Whose job is it?

Rosner & Markowitz’s 4 themes

• Ideological strands of the coalition• Different notions of occupational safety and

health that unified the movement (role of home AND workplace)

• Different actors--> different interpretations of workers’ sufferings

• Need for at least minimal protection for workers (--> need for state intervention)

‘Street of Walking Death’

Key Points• Alliance between labor movement and New Deal

government’s Department of Labour• Alliances between industry and Public Health

Service• (Industry’s) Efforts to redefine ‘diseased’ and

‘healthy: not to be considered as a dichotomy but as a continuum! (p.541-2)

• WHAT CAN WE LEARN FROM THE TRI-STATE?

Still at war?• ‘Blue-collar’ workplace

environments in decline, while % of working families below the poverty line increases;

• Still a tie between poor workplace, high rates of community poverty, environmental degradation, poor heath

• ‘bio-trash’ and other wastes

Questions for seminar

• What relationships developed between medicine and industry in the 20th century?

• Were they collaborative or adversarial, and why?

• What role did the growing environmental movement play?