The Making of the Occupational Hygienist


(Presented at the opening of the 5th IOHA Scientific Conference,

10 June 2002, Bergen, Norway, upon receiving the “IOHA Life-Achievement Award”)


Berenice I. F. Goelzer, CIH

Occupational Hygienist

E-mail: berenice@goelzer.net


(I had chosen to speak about “the training” of the occupational hygienist, because this is a fundamental issue. However, I opted for “the making” instead, because training is only part of it).


The “making” of the occupational hygienist requires knowledge, experience and a code of ethics, as well as great commitment and perseverance. Only a strong commitment to protect workers’ health and the environment, as well as the belief in the indispensable role of our profession, may give us the perseverance to fight for it.


Adequate training is the basis


Through training and experience, occupational hygienists should be able to perform many tasks, mainly:


  • To foresee and prevent occupational and environmental health hazards through, for example, adequate planning, selection of cleaner technologies, guidelines for the safe operation and maintenance of work processes


  • To recognize hazardous agents and factors (chemicals and dusts, physical agents, biological hazards, ergonomic and psychosocial factors), which may be associated with different work processes, and understand their effects on the health and well-being of workers


  • To assess – qualitatively and quantitatively - workers’ exposure to hazardous agents, and to evaluate the results, with a view to eliminating exposure, or reducing it to acceptable levels


  • To design and/or recommend, effective/economical prevention and control measures, within the framework of well-managed and sustainable programmes


  • To recognize agents that may have environmental impact, and contribute to environmental protection.


Moreover, occupational hygienists should be able to work well integrated in multidisciplinary occupational health teams.


Occupational hygiene training should be thorough. To start with, it requires a solid knowledge base, drawn from many sciences and professions, including: Chemistry, Physics, Toxicology, Physiology, Statistics, Epidemiology, Ergonomics, Psychology, Engineering (Technological Processes), Safety, Medicine (Work-related Health Effects), Public Health, Environmental Sciences, Communication, Management.


Specific topics should cover from the historical evolution and legal aspects of occupational hygiene to strategies, methodologies and techniques for the:


  • anticipated preventive actions

  • recognition of all types of hazards

  • exposure assessment and interpretation of results

  • hazard prevention and control (including programmes and management systems)


Needless to say that practical experience is also a must.


My vision of a “comprehensive practice” occupational hygienist is like a GP physician of the workplace, able to perceive it as a whole (comprised by work processes and workers, as well as the facility itself and its surroundings), to identify if and what is wrong, and to which extent and, then, recommend what should be done to “treat and cure it”, calling on other specialists, as needed.


There are also those professionals who prefer to focus on one or more very specific aspects and who should then work with colleagues having complementary skills.


Quality is a critical issue


Competence must be attained, verified and maintained. Therefore, accreditation of courses and certification of professionals are definitely essential.


Courses must meet defined requirements for curriculum, faculty, facilities and infrastructure (including information systems). Professionals must prove continued competence. Through the dedicated work of its Certification Committee, IOHA has contributed to this important issue, by developing a Model Certification Programme and by promoting efforts to harmonize certification procedures in different countries.


A space for occupational hygienists


The making of occupational hygienists is not enough. In many places, there is still a need to create conditions for their existence and acceptance, side by side with all the other recognized occupational health professionals.


The positive impact that occupational hygiene may have, not only on workers’ health, but also on environmental protection, sustainable development and decent globalization, has not yet been fully perceived by all involved with these issues.


One hears many simplistic approaches, such as “technology is responsible for the destruction of the planet”, or, “ban toxic chemicals and workers will be protected”.

Nevertheless, everybody continues to eat, and to wear clothes and shoes, and to live under shelter, and to ride cars, buses and planes, and to read and watch TV, and therefore somehow requiring the use all kinds of chemicals, plastics, cement, glass, wood, and so on. Why not face the reality of our daily needs (including for leisure) and find a formula to fulfil them without adversely affecting workers’ health and the environment ? An essential ingredient for this formula is the prevention and control of hazards associated with work processes.


Even so, there are many initiatives and projects, which aim at goals requiring the contribution of occupational hygiene, and yet fail to include the availability of occupational hygienists in their agenda.


Some Specific Examples


Workers’ Health: For example, there are many idealistic people who fight for workers’ health, but do not consider all that it takes to actually ensure it, and (amazingly to me) do not seem concerned by a shortage, or even a lack, of adequately trained occupational hygienists in their countries.


Even workers’ organizations seldom include the development of our profession among their priorities. A recent public statement by a leader in the fight for workers’ health was very upsetting to me, and that was: “it is obvious that occupational hygiene has failed in protecting workers’ health”; this is not true, (in this case) legislators and other occupational health professionals have failed in understanding the importance of occupational hygiene and what it takes to practice it.


We still see paradoxes, such as what is happening now in a certain country, where a national standard requires that workplaces have programmes for the “anticipation, evaluation and control of occupational hazards”, while occupational hygiene is far from being officially recognized as a profession, and is, in fact, often ignored and even blocked. There is a legal requirement, but no provisions to ensure the availability of competent professionals to implement it.


In this particular country (as in many others around the world), the result has been that the protection of workers’ health, well-being and even life, is often left in the hands of persons who do not have the required training and skills.


Why does this happen ? Don’t people wish to have specialized professionals to treat them when they are sick ? or to defend them in court ? or to build their houses ? why not, to protect their health at work ?


Environmental Protection

As to the general environment, occupational hygiene, if well practiced, may greatly contribute to its protection.

If a harmful chemical is eliminated from a work process, or is used under strict control, it will neither affect the workers, nor go beyond and pollute the environment.

Effective risk management in the workplace, including adequate waste disposal, can appreciably limit the negative impact of industrialization on the environment.


Nevertheless, it is not uncommon to see conferences, or publications on environmental protection, and even on cleaner production, with no mention of the important link with occupational hygiene, or, environmentalists ignoring the need for occupational hygienists in their programmes.


Sustainable Development

“It is possible to have development that meets the needs of the present world population for food, water, energy and shelter without causing adverse effects on health and on the environment, and, without depleting or damaging the global resource base, hence without compromising the ability of future generations to meet their own needs.” This is the paradigm of sustainable development and, here again, occupational hygiene has a role to play.


Occupational hygienists should include, in their practice, concerns for sustainable development, and should also be involved in many of the related issues (the latter is not easy to achieve!). There is much need for better intersectoral understanding and collaboration.


Globalization


Globalization may contribute to better living standards across the world, provided that trade policies duly account for social issues such as human rights, workers’ health, environmental protection and sustainable development. Certain technological advances, which have enabled the globalization of the economy, can also be used for the improvement of working conditions and environmental protection, worldwide. Safer and cleaner technologies can and should be increasingly developed and used everywhere. Information technology has greatly contributed to the sharing of knowledge and experience, including on the occurrence of hazards, their prevention and control.


Unfortunately financial markets often rule and economic gain often prevails over concerns for the social dimensions of globalization. For example, it happens that, as standards become more stringent and compliance more costly in certain countries, hazardous and polluting work processes are transferred elsewhere (mostly from developed to developing nations) thus creating unethical globalization.


Proposals to solve or attenuate the associated problems should include the protection of workers’ health, as this is a key social issue. If, for example, occupational hygiene practice is considered as an indispensable “companion” to any work process, wherever it goes, part of the negative aspects of globalization, for developing countries, can be eliminated. In fact, this could even serve as a bridge for transferring preventive technologies.

I would like to say, though, that it is not only a matter of taking occupational hygiene along with companies that cross borders, but of promoting it locally, everywhere, as we cannot overlook the fact that about the worst working conditions are usually found in small enterprises and the informal sector. These often flourish around larger companies (both multinational and national). Some companies outsource certain hazardous tasks to small and even home industries, in order to have cheaper production, as well as evade legal requirements for the protection of workers’ health and of the environment (less controls on wages and hazards, much lower costs).


Some difficulties and proposed actions


We have to face the fact that something is wrong, somewhere, with the protection of workers’ health. Although there is nowadays enough science and technology to prevent most occupational hazards, workers still get sick, disabled and die at work, everyday, everywhere. Even occupational diseases known for centuries still haunt and kill workers today.


A recent ILO report stated, “about 270 million workers are involved in occupational accidents annually, while another 160 million workers incur occupational diseases (and remember, these are extremely under-diagnosed). Worse still, 12,000 children die each year working in hazardous conditions.”


In my opinion, one of the drawbacks (which are many) is the fact that more often than not the multidisciplinary approach, which is indispensable for the successful practice of occupational health, has not been adequately followed. This multidisciplinary work must include occupational hygiene, thus giving due importance to primary prevention (which is the only way to stop occupational diseases).


On our side, and with a view to contributing to the improvement of this unsatisfactory situation, it is important to think about what is wrong with the development of our profession and with the approaches that have been followed to establish it worldwide.


In my experience, difficulties hindering the progress of occupational hygiene stem from a number of factors, which I would divide into internal and external to the profession, and which include the following:


As external factors:


  • occupational diseases are very much under-diagnosed and under-reported, and this does not help to trigger political will to effectively avoid their causes


  • occupational hygiene and its possibilities are not well known everywhere, and misconceptions abound, thus making its recognition, as an indispensable occupational health profession, rather difficult


I have heard statements such as, “an occupational hygienist is someone who measures” (and this was not a bad one because measuring is one of the occupational hygiene tasks, although it is only a component of its practice).


I have seen workers mistrusting us because they believe that we are “on the employers side”, and employers waiving our advice because we fight for workers’ health, emphasizing primary prevention and source control, not always as easy as giving a mask.


Some of the internal factors are:


  • lack of internationally harmonized and accepted minimum criteria for the development and practice of the profession


  • still, too much emphasis on quantitative evaluations (sometimes leading to unrealistic sampling requirements and delays in preventive interventions)


  • inadequate preventive approaches, such as too many “end of pipe” control measures, and insufficient workers’ participation


In theory, and in our minds, occupational hygiene is a profession – but is it really so? In many countries it is not; it is not recognised, hence not properly developed. The resulting scenario (in these cases) usually is: “inadequately trained persons practicing it – unsatisfactory solutions - people not trusting the profession – blockages to its recognition”.

What can we do about it? I do not have all the answers and can only present some suggestions for overcoming the problems just mentioned. I must say that much is already being done; however, I believe that certain key aspects still need to be further elaborated and more widely promoted.


As to the “making” of the occupational hygienists, more efforts should be put towards having:


  • a clear and universal definition of the role of occupational hygienists and their scope of action

  • stricter and universally harmonized minimum requirements for occupational hygiene training

  • wider implementation of certification schemes, at the country level


As to occupational hygiene practice, more emphasis should be placed on:


  • pro-active prevention (before harmful consequences occur) particularly hazard anticipation and source control (through, for example, substitution and work practices)


  • workers’ participation


  • pragmatic control solutions applicable in small enterprises (in this respect, we should be proud that IOHA has a leading role in the ILO Toolkit project, to be tested shortly in a number of developing countries, in collaboration with the ILO and WHO)


  • more cost-benefit studies on preventive interventions.


There is no doubt that a strong scientific and technical basis is needed for the practice of occupational hygiene. However, let’s not dwell so much on issues such as, if an OEL should be 0.20 or 0.25 mg/m3 (which most analytical procedures being used cannot distinguish anyway) – or, if a sophisticated direct-reading instrument will measure a concentration (which is constantly fluctuating anyway) with 3 or 4 decimal places. Let’s worry, even more, about if and how effectively, these guidelines and findings are being translated into actual preventive interventions at the workplace level.


(Here I would like to make a comment) The fact that there is much need for simple solutions, does not mean that we can afford less training for occupational hygienists - much to the contrary, we need even better training. Sound knowledge and experience are required to solve problems in new and unique situations; it is more difficult to design simple, efficient, cost-effective and innovative control solutions than to measure, compare results with a list, and recommend some ready-made solution from a ventilation book.


As to raising awareness and promoting political will to support the establishment of occupational hygiene worldwide, there should be increased efforts concerning:


  • multidisciplinary studies aimed at better estimating the magnitude of adverse effects associated with occupational exposure (in fact, collaboration with other occupational health professions, such as occupational medicine and epidemiology, needs to be strengthened)


  • more assertive action and innovative ways to spread our message, beyond our peers, in order to effectively reach governments, relevant institutions and organizations, employers and workers.


In this context, let’s not overlook donor and funding agencies, that very often grant funds more easily to programmes aiming at treatment, rehabilitation and “counting bodies” than to those aiming at preventing disease, disability and deaths.


We should speak to the general public, to young people in schools, to the media, to other professionals - such as engineers, physicians, economists, lawyers, administrators, in fact, to anyone who, at a time or another, will act as a decision maker.


There must be considerable mentality changes, in many places, if occupational hygiene is to be recognized as a profession, across the world.


The importance of international collaboration, between relevant organizations and associations, countries and individuals, cannot be overemphasized. In fact, this is what IOHA is about.


Conclusion


(To conclude I would like to say that) Industrialization and economic development, which may bring numerous benefits, including to health and quality of life, do not necessarily need to be linked with adverse effects on health and on the environment. Such deplorable consequences can and should be avoided, and occupational hygiene can make a significant contribution in this respect.


The theme of this Conference (our first in the new millennium) - “A New Era of Occupational Hygiene” - was very well chosen. We must definitely enter a new era; there must be some changes in our focus.


Ample knowledge on hazard identification, prevention and control has been accumulated so far. The outstanding challenge now is to create conditions to apply it, timely, efficiently and universally.


So, along with the quest for a continuously improved development of our profession (which is indispensable for such a dynamic field), let’s strive for more visibility and wider understanding of the contribution it can bring to the achievement of healthy and sustainable development for all nations.

The struggle to develop and establish a new profession is not an easy one. However, even when successes are slow and sparse, we must not give up. Remember that victory is not only measured in terms of achievements. I recently ran across a definition for victory (which I liked very much): “victory is the art of persevering when others decide to stop trying”. And that is what I ask from you - colleagues from all over the world: no matter how difficult the challenge, let’s keep trying and, if only for this, victory will certainly be ours.


Thank you.