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Education and Research in Occupational Health

by Luc Desnoyers & Donna Mergler

‘Science for the People’ Vol. 14, No. 1, January-February 1982, p. 18 — 23

Luc Desnoyers and Donna Mergler are both psychologists who teach at the Université du Québec à Montréal and work with trade unions on occupational health and safety.   

Within the last decade, in many countries, progressive scientists have begun working in occupational health and safety. Although the context and the conditions within which these activities developed differed from one place to another, they generally arrived at a similar analysis of their role as scientists in this field. The main features underlying this analysis are outlined in the following points. 

The first is that the health status of workers is directly related to the overall environmental and organizational conditions of the workplace. Industrial ailments are diseases of the working class. Exposure to asbestos fibers in the asbestos mines and mills is responsible for lung cancer, asbestosis, and mesothelioma, a rare cancer; repeated exposure to silica dust causes silicosis; exposure to vinyl chloride fumes in the plastics industry can result in angiosarcoma, a liver cancer. 

The second aspect of this analysis follows logically. The improvement of workers’ health will be obtained through an improvement of working conditions. Silicosis will be eliminated by reducing the exposure to silica dust, and not by the development of a new medical therapy. 

Thirdly, as several authors have shown^1,2,3,4 better working conditions are generally the result of struggles waged by workers and their trade union organizations. These battles have been fought not only against employers, for whom increased production is more important than workers’ health, but also against governments who resist changing inadequate exposure level limits and who are too often guilty of criminal negligence in not enforcing even the existing limits. Struggles have also been directed against the medical and scientific establishments, whose expertise have primarily served corporate interests. 

Role of Progressive Scientists 

Faced with this situation, progressive scientists working in occupational safety and health envisage their role first and foremost as providing technical and scientific support to workers’ struggles for better working conditions. Priority in teaching and research is given to the needs of the workplace, as expressed by the workers in their demands. 

This is what occurred in Italy where scientist were involved at the Montedison plant in Castellanza.^5,6 In France, a group of ergonomists (those who study the performance and efficiency of the work process) from the Conservatorié national des arts et métiers (National Conservatory of Arts) in Paris⁷, as well as interdisciplinary groups in Grenoble and Toulouse, work along similar lines. In England, this type of work is carried on by members of the British Society for Social Responsibility in Science (BSSRS). In the United States, committees on occupational safety and health (COSH-groups) were set up in many regions in the wake of the work of such pioneers as Jeanne Stellman who began her career with the Oil, Chemical, and Atomic Workers (OCAW).⁸ In Quebec, a group of university professors is working with two major trade union groups. 

Such involvement has necessarily led to new forms of scientific practice. Giving priority to workers’ needs has brought about changes in the teaching habits as well as the research practices of the concerned scientists. We would like to describe here some of the features of these practices as ilustrated in our activities. We work within the framework of an agreement signed in 1976 by the two major Quebec trade union groups, the Confederation des Syndicats Nationaux (National Confederation of Unions, CSN) and the Fédération des Travailleurs du Québec (Quebec Workers’ Federation, FTQ) and the Université du Québec à Montréal (University of Quebec at Montreal, UQAM). 

Under the terms of this agreement, the unions have access to the university resources, to its academic and non-academic personnel, technical services and facilities. Through this a number of professors and students have participated in union-organized teaching sessions as well as research projects involving union participation, particularly in the area of occupational safety and health.^9,10 

1. Teaching 

For several years now the CSN and the FTQ have organized workshops on occupational safety and health. These sessions are aimed at informing and promoting awareness among workers, as well as mobilizing and organizing around issues and actions leading to the improvement of working conditions. The sessions are built around three main themes: identification of the hazards of the workplace, the effects of these hazards on health, and possible union action to bring about changes in the workplace. A session usually starts with a round-table discussion where the participants describe their work process, the tools they use, the hazards involved, and the accidents and health problems that they have suffered. Our role is to show the links between the hazards mentioned and their health status. 

This means that the basis of our intervention is the workers’ empirical knowledge. First, we need knowledge concerning their working milieu. An Italian study¹¹ reports how this practical knowledge could be used to reconstitute the entire work process with much greater precision than the models put forward by management. From this detailed description of the workplace many health hazards that might have passed unnoticed can be identified. 

Second, workers’ knowledge concerning their own health is important. For example, we have heard workers who have been exposed to toxic metals describe in detail the symptoms of their intoxication. They could describe pre-clinical conditions which are not recorded in the medical literature, as well as classical symptoms. Their own experience has led them to ask precise questions on topics such as accelerated progression of symptoms in re-intoxication. 

Workers’ technical knowledge as well as their perception of body function at work is likewise referred to. Plumbers and maintenance workers know a lot about hydrodynamics. Cardiovascular reactions to heat stress are not much of a problem for them. They understand that the dilation of blood vessels will bring about a drop in blood pressure and that increased heart activity is required to restore the pressure. Another example is workers who use protective respiratory masks and have frequently experienced the stress that these cause to their heart. Wearing these while doing intense physical work may trigger a large increase in heart rate. The relationship between cardiovascular and respiratory systems is not difficult for them to grasp. 

These are only examples. They serve to illustrate that in these sessions knowledge does not only come from the scientist or the expert. Of course, the scientists bring their own academic background and training to the sessions. However, for it to be effective, this academic knowledge has to undergo reconditioning. It has to be free of jargon, whose purpose is more to disguise than to transmit knowledge. The scientist has to come in touch with the realities of the workplace. The workers are important ingredients in this training. This contact leads the scientists to expand their knowledge of scientific, technical, and health problems raised by workers. Textbooks on work physiology, ergonomics, industrial toxicology, etc. do not give all the answers. 

There are many aspects of the scientist’s role in these sessions. The first is to help workers express what they know about their working conditions and their health. This knowledge, essential for a global understanding of the situation, is underrated in our society. Indeed, the ruling classes have inculcated in us a contempt for popular wisdom; it is used as a justification to establish their power, based on their own form of knowledge, which they describe as scientific. We believe that progressive scientists have an important part to play in validating popular knowledge. 

Scientists can also help organize and structure empirical knowledge and complement it with scientific data. During these workshops, the scientist describes how physiological systems are affected by poor working conditions: how dust affects the respiratory and eventually the cardiovascular systems, how noise acts on hearing and creates a stress on the entire organism, etc. The objective here is not to paint a complete picture of clinical symptoms and pathologies, but rather to provide an explanatory framework which the participants can later use to analyze the effects of working conditions on their health. 

Another important task is to demolish the myth that it is technologically impossible to improve working conditions. Workers are imbued with a fatalistic notion about job hazards: jobs are inherently dangerous and nothing can be done about it. Building sites are “inevitably” dangerous, asbestos extraction “necessarily” engenders large clouds of dust, and backaches are “normal” in the textile industry, for example. The entire system of employer propaganda intentionally and repeatedly reinforces these notions. Our job is to demonstrate that it is technologically feasible to eradicate a large portion of the hazards. This is not such a difficult job in a society that is so proud of its technological achievements. When scientific know-how can send a person to the moon, and back to a precise location, it should be simple to reduce the noise level on a machine. 

In the workshops, we attempt to stress the gains brought about by union struggle. We mention, for example, the considerable reduction in asbestos fiber level in the Québec asbestos mines following the seven month long strike in 1975. The participants likewise put forward their own experience of improvement in working conditions, tools and machinery. 

The teaching methods used in these sessions are strikingly different from those currently used in the university. The relationship between scientist and workers differs significantly from a simple teacher-student relationship; the workers know more about the work environment than the teachers. Their concrete empirical experience constitutes an important resource. Questioning, listening, and interacting become the adequate substitute for lecturing, and the “teacher” is constantly brought down to the realities of every day working situations. 

2. Research 

As a rule, one can say that relatively little information is readily available in occupational health and safety. Progressive scientists who become involved in this field must therefore concentrate their research on the production of such knowledge. We can distinguish two types of research: synthesis research, which aims at establishing a critical synthesis of existing data related to a given occupational problem, and action-research, which is experimental in nature and seeks to analyze working conditions and health hazards in a given workplace or in a specific group of workers.

A. Synthesis research

This is necessary to produce useful documents and educational materials for workers and their union representatives. In other words, it aims at making the most recent scientific data available to workers.

The work done in this field by Jeanne Stellman is a good example of this type of research. Her books^12,13 serve as references for everyone working in industrial health. Other scientists have used similar methods to produce more specialized monographs. In England members of the BSSRS have published a series of pamphlets on various health problems.¹⁴ We have carried out similar research in collaboration with the Institute de Recherche Appliquée sur le Travail (Institute of Applied Research) in Montréal. A brochure on noise in the work environment has been published, and others are being prepared on the subject of visual problems in the workplace. Finally, a research project which will produce five thematic brochures is currently being carried out under the auspices of the UQAM-CSN-FTQ agreement. 

These research activities have been initiated to answer needs expressed by workers. If we want the answers to be adequate, a certain number of interactions between scientists and workers are necessary at all stages of the research. This interaction has to develop in the very early stages of the research while defining the research problems itself. Some of the research projects were undertaken after a given problem was raised consistently in educational sessions. Such is the case for a research synthesis on work in a hot environment. The workers and their representatives knew where and how frequently the problem occurred; they could point out some of the discomfort and illnesses, and knew of the inadequate solutions proposed in certain workplaces. On the other hand, the scientist could offer a general framework for analysis and had access to existing scientific data.¹⁵ 

The interaction between these two expertises permits those involved to pinpoint the problem and better define the objectives. This has important effects on the methods used in the research which also have to be based on continual interaction. These are two sources of data and both must be exploited. One can get relevant data from workers exposed to the problem. These are completed by visits to the workplace and case studies done on the site. The other source is scientific literature. Analytical and critical work is needed as there are numerous problems. 

A major consideration is the lack of available data. Often very little original work has been published on a given problem or the main data was produced in the thirties or fifties. Many very interesting projects have been carried out in socialist countries, but the language barrier is a lengthy and costly one to cross. 

Relevance constitutes another problem. In the western world much research has been done on the effects of noise on guinea pigs–much less on the effects of noise on workers. Though much of this data is transposable, analogies between people and guinea pigs have certain limits. 

There is finally the problem of the validity of the published data. We have come across fascinating examples of gross errors and outright dishonest manipulation of data, which coincidentally, tended to demonstrate the harmless nature of the working conditions under study. There are cases of control groups selected on faulty criteria, of conclusions based on non-significant differences, and even improper pooling of the data, which unduly favor the author’s thesis. The study of such reports involves a great deal of analysis and verification. 

The synthesis research we are involved in is closely followed by union representatives. In this way the research activity is carried out with constant reference to workers’ needs. This is even more true when writing up the results. The pamphlet or book must answer the questions asked by workers; the language used must in no way be a barrier. Experience has taught us that this can readily be achieved when workers and scientists work together at all stages of the project. 

B. Action research 

We are often at a loss when faced with workers’ health problems because there is little relevant information about the relationship between their health problems and their working conditions. For quite a few years abattoir (slaughterhouse) workers noticed that many of them were afflicted with warts, suffered pain in their hands and legs, suffered from cold, and many women were subject to severe menstrual cramps. They suspected their job conditions played a part in these problems. 

A survey of available literature quickly revealed a lack of relevant scientific data. A fresh approach was needed. That is why the Service de genie industriel and the Fédération du Commerce (Industrial Civil Service and the Federation of Commerce) of the CSN asked the joint committee UQAM-CSN-FTQ to initiate a study of the health problems and working conditions in the abattoirs. At the university, a staff member and two graduate students became involved in the project. A fulltime union worker became the fourth member of the team.¹⁶

Worker Participation 

The first step was to set up a series of meetings with the workers of the abattoirs. This provided us with an idea of how widespread the problem was and permitted us to discuss with the workers what kind of study was best suited to their situation and needs. It was clear that the health problems mentioned were not those usually referred to as “industrial disease,” and that an extensive list of symptoms was needed. It was also necessary to calculate the occurence of these problems as a basis of comparison with control groups. 

In the same way, the relationship between the health problems being discussed and the actual working conditions was not readily obvious. It was necessary to have a complete description of the working conditions, and to identify the organizational factors (pace, posture, etc.) and the environmental factors (noise, temperature, humidity, etc.) that characterized the work station. Once properly correlated, these two sets of facts revealed the relationship between health problems and working conditions. The researchers and participating workers concluded that a successful descriptive study could be carried out by means of a questionnaire. 

The questionnaire was developed and refined with the help of small groups of workers and delegates from each of the nine abattoirs involved. Thus the questions would be properly understood by all participants, and everyone would be able to describe fully his or her work area and state of health. The questionnaire was revised several times. The final version comprised 216 questions contained in seven sections: 

1. occupational history (age, sex, former jobs, etc.) 
2. job description (adapted to each abattoir so that every respondent’s job was mentioned) 
3. conditions of use of protective devices (steelmesh gloves, rubber gloves etc.) 
4. working conditions (organization, environment) 
5. health problems particular to women (menstrual and pregnancy problems) 
6. use of medication, tobacco, alcohol 
7. health problems 

Members of the research team distributed copies of the final questionnaire to workers at general assemblies of union delegate meetings. Its use was explained and it was then completed by the respondents. This approach made participation easy for elderly workers or those who read with difficulty. Then the delegates took charge of distributing copies to the other members, insisting on the greatest participation possible. The delegates were also responsible for picking up the completed questionnaires and sending them back to the researchers. 

During this time the researchers took measurements of certain working conditions. Wet-bulb and dry-bulb temperature readings were taken (for humidity), as well as noise levels in the workplace and, in certain cases, readings of carbon monoxide and ammonia vapor concentrations. The researchers thus became familiar with the workplaces, work processes and the work environment. 

The workers completed their questionnaires with great care; 54% of the workers participated. The sample was validated according to age, seniority and sex. The answers were then coded and transcribed for computer analysis. The first analytical operations simply involved calculating the frequencies of the various health problems and exposure to various working conditions. The data was then communicated to the various unions so as to keep the workers informed of the progress while the researchers were involved in lengthy analysis. 

The group produced a fairly sizeable report: a 115 page text outlining the methodology employed in the study, the processing of data, and the results. But clearly, the simple publication of a voluminous report ran the risk of being ineffectual, taking into account the limited level of schooling of a large section of the workers, and the lack of developed reading habits. The group therefore agreed to hold a special study section jointly with the Federation of Commerce. Rather than sending out the report, it was presented to some sixty representatives of workers from the nine abattoirs. 

Results 

The study session began with a planning session to present the background history and methodology of the research. The workers were then divided into groups who participated alternately in five workshops to study the results. Each of these workshops bore a specific theme: problems relating to muscles and joints, dermatology, problems specific to women, etc. In each workshop the pertinent section of the report was outlined with a discussion of the frequency of various ailments and their statistical relationship to factors of work organization or environment. 

All the workers assembled thus had the opportunity of gradually assimilating the assembled data and discussing their meaning and implications. Workshop moderators were able to discuss a specific section of the report with all the participants. A final planning session discussed various approaches to solutions of the problems. It was agreed to produce a short succinct version of the report for widespread distribution, including all significant correlations between the 39 working conditions and the 62 major health problems associated with them. 

Back at their workplace, through helping spread the research among their fellow workers, the participants are now in a position to play a key role in deciding and setting into motion the necessary means to achieve better working conditions. 

This study of the situation in slaughterhouses provides an example of scientific research focused on action. The aims pursued determine choices in methodology as well as the means of presentation and distribution of the results. 

Commentary 

We should stress that from the outset the research team was concerned that the workers themselves should be involved as participants in the work. In circumstances such as these it frequently happens that researchers consider the workers simply as objects of research. For one thing, they would cut themselves off from the most precious source of information on the work environment and occupational health, thereby limiting the scope and value of their research. At the same time, however, they would help to consolidate the ruling class ideology concerning knowledge, which is that science is a matter for specialists only and that popular wisdom is valueless.

 Use of a questionnaire is one means of involving workers in research.¹⁷ It draws upon their knowledge and their evaluation of their working conditions and state of health. While ordinary common sense should tell us that any worker can testify to the conditions of his or her workplace, or count the number of warts on his or her hand, there are many scientists who refuse to bother with anything but the instrument measurements they themselves have conducted, or the wart-count conducted by a dermatologist. Groups in Italy, however, have demonstrated the validity of workers’ judgements on the environment and health conditions.¹⁸

In such cases, it is the primary responsibility of the practitioner to inform those concerned; yet numerous physicians, particularly those employed by corporations, have in such cases either camouflaged the data or discreetly informed the employers alone.^19,20,21,22 

For many years, scientific information relating to occupational safety and health remained the private preserve of health professionals and employers. It may be recalled that in Québec from 1918 on, insurance companies stopped selling life insurance policies to asbestos miners: the actuaries had observed the very limited life expectancy of these workers. It took decades of struggle before the asbestos miners obtained access to the medical and scientific data concerning them.^23,24,25 If such practices are more difficult to indulge in these days, it should not be thought that they have disappeared. The contrary was demonstrated in the 1970s in the case of vinyl chloride.²⁶ 

Access to knowledge in the field of health and occupational safety will not be obtained spontaneously by the workers. There is need for the active intervention of progressive scientists. No doubt they alone will not change science; but they have special access to knowledge that the ruling classes have interred in university libraries and research centers, and they can at least open the door.

>> Back to Vol. 14, No. 1 <<

 

REFERENCES

1. P. Brodeur, Expendable Americans, Viking Press, New York, 1974.
2. L. Tataryn, Dying for a Living: The Politics of Industrial Death, Deneau and Greenberg, 1979.
3. D. Berman, Death on the Job, Monthly Review Press, New York, 1979.
4. D. Mergler, et L. Desnoyers, A Recherche Scientifique et Ia Lutte pour Ia Santé au Travail, Cahiers du Socialisme, 3: 40-71, 1979.
5. A. Cambrosio, De Ia Lutte Contre les Nuisances de L’usine à Ia Réappropration du Savior: Quelques Expériences Italiennes Récentes, Cahiers du Socialisme, 5: 28-50, 1980.
6. G. Assenato, and V. Navarro, Worker’s Participation and Control in Italy: The Case of Occupational Medicine, International Journal of Health Services, 10 (2): 217-232, 1980.
7. Union départementale CFDT Paris, “Bureaux modernes, paradis factices. Enquête sur des tours au-dessus de lat santé des travailleurs.” Edition Montholon Services, Paris, 1979.
8. D. Berman, Organizing for Job Safety: The Success of COSH Organizing Around the US, Science for the People, 12, (4): 11-16, 1980.
9. Entente UQAM-CSN-FTQ sur Ia formation syndicale. Service de l’éducation permanente, Université du Québec à Montréal, Texte polycopie, 1979.
10. M. Lizee, Resources Universitaires et Travailleurs Syndiqués: L’expérience D’un Programme Conjoint Université-Syndicat, Revue Internationale D’action Communautaire, 3143: 63-73, 1980.
11. Groupe de Prévention et d’Hygiéne du Milieu du Conseil de fabrique de Montedison de Castellanza et de Azimonti de Olgiate, La Soggettivita Insegna: Due Esperienze Operaie, Sapere, 799: 36-50, Avril, 1970.
12. J. Stellman, and S. Daum Work is Dangerous to Your Health, Vintage Books, New York, 1973.
13. J. Stellman, Women’s Work, Women’s Health: Myths and Realities, Pantheon Books, New York, 1977.
14. The British Society for Social Responsibility in Science, 9 Poland St., London, England. Relevant pamphlets are as follows: Oil: A Worker’s Guide to the Health Hazards and How to Fight Them, 1975, Vibrations 1978, Asbestos, 1980.
15. D. Mergler, F. Oullet, D. LeBorgne, et S. Simoneau, Le Bruit en Milieu de Travail, Institut de Recherche Appliquée sur le Travail, brochure #14, 1979.
16. D. Mergler, N. Vezina et A. Beauvais, “Etude des Effets des Conditions de Travail dans les Abattoirs sur Ia Sante de Travailleurs et Travailleurses.” Rapport soumis a Ia Federation du Commerce, Confederation des Syndicats Nationaux, Montreal, 1980.
17. Union départmentale CFDT Paris, Ibid.
18. Groupe de Prévention et d’Hygiéne du Milieu du Conseil de Fabrique de Montedison de Castellanza et de Azimonti de Olgiate, La Soggettivita Isegna: Due Esperienze Operaie, Ibid.
19. P. Brodeur, Ibid.
20. L. Tataryn, Ibid.
21. D. Berman, Ibid.
22. D. Mergler, et L. Desnoyers, Ibid.
23.  P. Brodeur, Ibid.
24. D. Mergler, et L. Desnoyers, Ibid.
25. D. Kotelchuck, Asbestos Research, Health Policy Advisory Center Bulletin, #61, Nov/Dec, 1974.
26. D. Mergler, et L. Desnoyers, Ibid.