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Disease Forecasting

Labor Pains by Mike Field, Illustration

As American labor transitions from the assembly line to the office cubicle, fewer workers risk death in explosions or industrial accidents. But serious health risks still lurk in the swiftly changing 21st-century workplace.

A long line of grim-faced men in work boots clutching lunch pails passes through a narrow gate in a chain-link fence. A whistle screams. Up ahead, the roar and clang of production pounds through the factory's streaked windows and dirty brick walls. Acrid smoke laces the air.

During much of the 20th century, this was just everyday work—hard, hot, noisy, utterly glamourless, sometimes dangerous and occasionally lethal. In earlier decades especially, fires, explosions and industrial accidents both large and small regularly injured and killed thousands of workers each year.

Today in America, jobs have migrated from the factory floor to the office cubicle, the fast-food restaurant and the family business. The hours are long, the pace is frantic, and the windows are hermetically sealed. While hardly rife with the lethal threats so common in past decades, the 21st-century American working environment is relentlessly stressful. And no one knows for sure exactly what health consequences arise from this new kind of workplace.

Nor is it easy to tell. Workers today change jobs frequently. Many find jobs with small businesses, privately held companies too tiny and with too few resources to rigorously observe worker health and safety practices. In this environment, work's effects on health are unlikely ever to come to light. Another complicating factor is that Americans are staying on the job longer—some well into their 70s—and living for decades beyond retirement.

"If you look for one big trend in occupational health, it is this transition from studying the effects of high-level toxin exposures to beginning to think about workplaces without traditional hazards," says Brian Schwartz, Environmental Health Sciences (EHS) professor and director of the Division of Occupational and Environmental Health. "The new concerns are mental health, stress, indoor air quality and other less overt dangers."

Schwartz is one of many Bloomberg School faculty researching ways to keep contemporary workers safe and healthy—in environments ranging from office buildings to chicken farms.

American Work Shifts

Half a century ago, the School's Anna Baetjer conducted groundbreaking research that linked workplace chromium exposure to lung cancer. Her work paved the way for a new era in occupational health and industrial hygiene at a time when most workers stayed at a job for many years—and not uncommonly, for all their lives. The work of Baetjer and her colleagues focused on keeping workers safe on the factory (or mill or processing) floor. A fairly constant workforce in stable industries made it relatively easy to associate certain workplace exposures—such as chromium dust—with subsequent health outcomes like cancer.

But that world changed. "We are no longer a manufacturing economy," notes Schwartz, MD, MS. "Only a small percentage of American workers are engaged in manufacturing, and the number continues to fall." Today, manufacturing jobs account for less than 15 percent of U.S. employment.

"Most workers today are in the service sector. There has been a dramatic decline of unions and organized workers, especially in the manufacturing sector, and a global trend to the free movement of capital, goods, information and services—but not people," says Schwartz. "In manufacturing there has been a rush to the bottom, looking for lower labor costs and less strict occupational and environmental laws in other countries."

In the United States, recent immigrants tend to stay "beneath the radar" of many occupational health protections because they often work in small or family-owned businesses. Jacqueline Agnew, EHS professor and director of the School's Education and Research Center in Occupational Health and Safety, cites one example: Vietnamese nail salon workers. "These are workers who typically spend 60-plus hours a week on the job," she says, "where they receive high exposures to methyl methacrylate used to create artificial nails. It has been linked to neurological symptoms, but we currently have no way of knowing how it may affect these workers." Recently, the National Alliance of Vietnamese Service Agencies teamed with Bloomberg School researchers to begin investigating how to design voluntary interventions that could help reduce chemical exposure levels and other work hazards among salon workers.

Agnew, PhD '85, MPH '78, and her team begin by asking both workers and owners (who often work side by side) to identify any health-related issues they are experiencing. In addition to chemical exposures, health concerns include musculoskeletal risks presented by the work's ergonomic demands. Agnew hopes the research, which is continuing, will lead to a healthier work environment.

One curious irony of the new economy is that even as traditional industries have decamped to foreign shores, other occupations previously performed by individual owner/operators are becoming increasingly industrialized. Take, for instance, raising food animals.

"People don't understand what has happened to animal farming in this country; it has really become an industrial process," says Ellen Silbergeld, EHS professor. "The farmers are now contractors to the corporations, and their job is to provide animals to the processing plants seven days a week, 24 hours a day. The farmers who actually raise the animals have very little control."

A prime example: Poultry farmers on the Chesapeake Bay's Eastern Shore. They operate on a contractual basis with the big poultry producers, agreeing to raise a certain number of chickens at a specified price within a set time. In these arrangements—which Silbergeld, PhD '72, describes as "basically a modern form of share-cropping"—the chicken producers provide the feed (which often includes antibiotics to speed growth). But the health consequences of this practice—both to consumers and to the farmers and workers who handle the antibiotic-impregnated feed and wastes from their animals—are largely unknown.

Among the potential health risks posed to poultry farmers and workers are drug-resistant infections bred through the indiscriminate use of antibiotics. Silbergeld's team is studying antiobiotic-resistant bacteria in farmers, farm workers and residents on the Eastern Shore to see if their levels are higher than in the general population. Silbergeld says the practice also accounts for high levels of antibiotic-resistant bacteria found on some consumer meat products. Earlier this year, Lance B. Price, MS, a doctoral student working with Silbergeld, compared store-bought chicken samples from large producers with samples from nonantibiotic using producers, and found significantly higher levels of drug-resistant bacteria on the products of big-name brands. The results were published this spring in Environmental Health Perspectives. "This is a double risk, first to the farmers and workers who handle the chickens, and then ultimately to all of us who eat them," says Silbergeld. "There are a lot of potential victims in this story."

Though their work is vastly different, the chicken farmers and Vietnamese nail salon workers do have one thing in common: They work for businesses whose small size and disparate locations make monitoring and surveillance especially difficult. The Occupational Safety and Health Administration was created with large pools of centrally located, long-term workers in mind.

"We have not, as a society, done well in figuring out how to monitor and ensure worker health and safety in small companies," says Clifford Mitchell, EHS associate professor and director of the School's Occupational Medicine Residency Program. "Occupational health resources tend to be concentrated in large companies, but increasingly you have all sorts of mom-and-pop operations working with all kinds of exotic materials." He worries that safety precautions against even known hazards can be easily ignored, either willfully to save money or out of simple ignorance. "There are a whole host of companies that we just don't know about—who they are, where they are, how bad things are. For all intents and purposes, they're invisible," says Mitchell, MD, MPH '91.

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