Tuber&
and Lung Disease (1992) 73.45
Editorial
Occupational lung disease: a worldwide problem in a changing world
In the 20th century, remarkable growth and change in industial production methods and in worldwide patterns of production has occurred, and during the latter half of this century our knowledge of the occupational lung diseases that result from industrial exposures has increased dramatically. Unfortunately, just as industrial development has not spread uniformly across the globe, our knowledge and control of occupational lung diseases has been focused on the industrialized countries, to the exclusion of the developing countries. In May 1990, the American Thoracic Society, American Lung Association and International Union Against Tuberculosis and Lung Disease jointly sponsored a symposium entitled ‘Occupational Lung Disease in the Industrialized and Industrializing Countries: Commonalities and Contrasts’ at the World Congress on Lung Disease in Boston, Massachusetts. That session, summarized in this first issue of the new journal addressed many of the important and difficult issues the pulmonary confronting and public health communities on this topic. During the first half of the 20th century, the industrialized countries underwent rapid development of industrial production. Agricultural, mineral and smallcommodity production decreased in importance in the industrialized countries, but became the major industrial focus of developing countries. In the second half of this century a new pattern of industrial globalization has occurred, with the migration of industrial production to developing countries, often creating industrial enclaves or ‘world-market factories’. Changes in worldwide production patterns can be seen in the more traditional industries to modem high technology processes such as semiconductor manufacturing.’ This shift was usually created by multinational or transnational corporations and driven by the availability of lower-cost, unorganized labor, and possibly by more lax environmental regulations in developing countries.’ The result has been enormous changes in the social and economic structures of the developing countries, and public health concerns about occupational health in these locations.3X 4 Unfortunately, too little attention has been paid to occupational lung diseases in the industrializing countries. When lung disease specialists considered this topic, they tended to focus on a disease-specific
approach without consideration of the unique social and political issues confronting different industrializing countries. Conversely, social scientists frequently focused on the exploitative/political issues or the economic realities without an understanding of the occupational health issues underlying recognition and prevention of specific lung diseases. Clearly, strategies to control occupational lung disease in the developing and developed countries must integrate the medical and social aspects of this problem. Furthermore, it must be an approach that is sensitive to unique local and national cultures and governmental structures.4” These are certainly very different for places such as Asia, Latin America and Africa. The mineral dust diseases (pneumoconioses) exemplify many of the commonalities and contrasts between the industrialized and industrializing countries. New cases of silicosis and asbestosis, which were rampant in the developed countries during the first half of this century, are now distinctly uncommon there. This has occurred because of greater attention to all components of occupational health and an attempt to eliminate these preventable disorders. It has also occurred because mining, mineral extraction and many other dusty industries have moved largely to the industrializing countries, where the industries may even be increasing and placing large numbers of new workers at risk.6 Even though the biology of these disorders is fundamentally the same around the world, the effects of malnutrition and other chronic diseases, more common in developing countries, may alter the manifestations and severity of these disorders. A similar pattern may be seen with byssinosis, with a reduction of exposures and disease in the industrializing world, and the health problems and exposures seen there earlier in this century now transposed to the industrializing countries. Occupational health professionals have given much less attention worldwide to dusts and other respiratory toxin exposures in agriculture than to industrial cotton dust exposures. This relative neglect recently shows signs of being corrected.‘** This is particularly important in many developing countries where 50-90% of the economically active population may be involved in agriculture, in contrast to less than 10% being involved in the industrialized countries. 4
More research is necessary to understand the causes of and means of reducing agricultural lung diseases around the world. Finally, modem industries present yet another pattern of commonalities and contrasts between the developed and developing nations. Recent years have witnessed the globalization of high technology production, often with the more labor-intensive processes being moved to industrializing countries. While some of the ‘older’ modem industries such as chemical production may show the same pattern as the mineral and mining industries, with higher workplace exposures in the developing countries, little is known about the conditions in electronics or semiconductor manufacturing plants in the industrializing countries. The fire and explosion hazards, and acute lethality, of many of the agents used in semiconductor manufacturing dictate that careful attention must be paid to safe handling of these materials. A difference between these high technology industries and the more traditional industries is that the respiratory effects of working in these newer industries are largely unknown. Despite the highly toxic nature of materials handled in semiconductor production, there has been very little research on acute or chronic respiratory effects. Furthermore, these are rapidly changing industries with new materials frequently being introduced, often with no biologic data on their potential health effects. More research is necessary on the occupational health consequences of working in these new industries, and the lessons learned must be applied to facilities around the globe. How can the knowledge of occupational lung disease in industrialized countries be successfully applied to the developing nations? The first step must certainly be a commitment at all levels to reduce these preventable diseases. Industry, health care delivery and government agencies must be aware of the problem and commit resources to its reduction. Attention to occupational health must be an integral part of establishing new industrial plants in developing countries, and the commitment must extend to adequate training of workers and health and safety professionals. Lessons learned in the industrialized countries must be communicated to public health personnel, and those lessons must in turn be translated into methods appropriate for the country. This recognition of occupational lung diseases in industrializing countries need
not require high technology equipment. Standardized respiratory questionnaires and spirometry are powerful tools for the surveillance of most occupational lung diseases. Successful models for such implementation in industrializing countries exist, as evidenced by the dramatic reductions in disease that have occurred in China’, lo The obstacles to reducing occupational lung diseases in industrializing countries are great, particularly when there are the more basic public health problems of inadequate nutrition and infectious diseases confronting many of these nations.“’ I2 The fact that new industry often improves the general level of health should not negate the need to simultaneously pay attention to diseases caused by new industry. It is not an either/or proposition, but rather a question of how to industrialize and reduce or prevent occupational diseases that may result from that industrialization. Marc Schenker MD Division of Occupational
and Environmental
Medicine
University of California at Davis Davis, California USA
References 1. Henderson J. The globalisation of high technology production. Society, space, and semiconductors in the restructuring of the modem world. New York: Routledge, 1989. 2. Castleman B I. The export of hazardous factories to developing nations. Int J Health Serv 1979; 9: 569406. 3. El-Batawi M A. The third Theodore F. Hatch symposium lecture. Ami Am Conf Gov Ind Hyg 1986; 14: 3-15. 4. Mendes R. The scope of occupational health in developing countries. Am J Public Health 1985; 75: 467-168. 5. Jeyaratnam J. 1984 and occupational health in developing countries. Stand J Work Environ Health 1985; 1 I : 229-234. 6. Van Sprundel M P M. Pneumoconioses: the situation in developing countries. Exp Lung Res 1990; 16: 5-13. 1. Dosman J A, Cockcroft D W. Principles of health and safety in agriculture. Boca Raton: CRC Press, 1989. 8. Terho E 0, Husman K, Kauppinen T, eds. Proceedings of the international symposium on work-related respiratory disorders among farmers. Eur J Respir Dis 1987; (suppl) 154: 7 1. 9. Christiani D C. Occupational health in developing countries: a review of research needs. Am J Ind Med 1990; 17: 393-401. 10. Stem E C, Schenker M B. Occupational health in developing nations: the case of China. Prev Med 1989; 18: 532-540. 11. Walsh J A, Warren K S. Selective primary health care, an interim strategy for disease control in developing countries. New Engl J Med 1979; 301: 967-974. 12. Evans J R, Hall K L, Warford J. Shattuck lecture-health care in the developing world: problems of scarcity and choice. New Engl J Med 1981; 305: 1117-1127.
and Lung Disease (1992) 73.45
Editorial
Occupational lung disease: a worldwide problem in a changing world
In the 20th century, remarkable growth and change in industial production methods and in worldwide patterns of production has occurred, and during the latter half of this century our knowledge of the occupational lung diseases that result from industrial exposures has increased dramatically. Unfortunately, just as industrial development has not spread uniformly across the globe, our knowledge and control of occupational lung diseases has been focused on the industrialized countries, to the exclusion of the developing countries. In May 1990, the American Thoracic Society, American Lung Association and International Union Against Tuberculosis and Lung Disease jointly sponsored a symposium entitled ‘Occupational Lung Disease in the Industrialized and Industrializing Countries: Commonalities and Contrasts’ at the World Congress on Lung Disease in Boston, Massachusetts. That session, summarized in this first issue of the new journal addressed many of the important and difficult issues the pulmonary confronting and public health communities on this topic. During the first half of the 20th century, the industrialized countries underwent rapid development of industrial production. Agricultural, mineral and smallcommodity production decreased in importance in the industrialized countries, but became the major industrial focus of developing countries. In the second half of this century a new pattern of industrial globalization has occurred, with the migration of industrial production to developing countries, often creating industrial enclaves or ‘world-market factories’. Changes in worldwide production patterns can be seen in the more traditional industries to modem high technology processes such as semiconductor manufacturing.’ This shift was usually created by multinational or transnational corporations and driven by the availability of lower-cost, unorganized labor, and possibly by more lax environmental regulations in developing countries.’ The result has been enormous changes in the social and economic structures of the developing countries, and public health concerns about occupational health in these locations.3X 4 Unfortunately, too little attention has been paid to occupational lung diseases in the industrializing countries. When lung disease specialists considered this topic, they tended to focus on a disease-specific
approach without consideration of the unique social and political issues confronting different industrializing countries. Conversely, social scientists frequently focused on the exploitative/political issues or the economic realities without an understanding of the occupational health issues underlying recognition and prevention of specific lung diseases. Clearly, strategies to control occupational lung disease in the developing and developed countries must integrate the medical and social aspects of this problem. Furthermore, it must be an approach that is sensitive to unique local and national cultures and governmental structures.4” These are certainly very different for places such as Asia, Latin America and Africa. The mineral dust diseases (pneumoconioses) exemplify many of the commonalities and contrasts between the industrialized and industrializing countries. New cases of silicosis and asbestosis, which were rampant in the developed countries during the first half of this century, are now distinctly uncommon there. This has occurred because of greater attention to all components of occupational health and an attempt to eliminate these preventable disorders. It has also occurred because mining, mineral extraction and many other dusty industries have moved largely to the industrializing countries, where the industries may even be increasing and placing large numbers of new workers at risk.6 Even though the biology of these disorders is fundamentally the same around the world, the effects of malnutrition and other chronic diseases, more common in developing countries, may alter the manifestations and severity of these disorders. A similar pattern may be seen with byssinosis, with a reduction of exposures and disease in the industrializing world, and the health problems and exposures seen there earlier in this century now transposed to the industrializing countries. Occupational health professionals have given much less attention worldwide to dusts and other respiratory toxin exposures in agriculture than to industrial cotton dust exposures. This relative neglect recently shows signs of being corrected.‘** This is particularly important in many developing countries where 50-90% of the economically active population may be involved in agriculture, in contrast to less than 10% being involved in the industrialized countries. 4
More research is necessary to understand the causes of and means of reducing agricultural lung diseases around the world. Finally, modem industries present yet another pattern of commonalities and contrasts between the developed and developing nations. Recent years have witnessed the globalization of high technology production, often with the more labor-intensive processes being moved to industrializing countries. While some of the ‘older’ modem industries such as chemical production may show the same pattern as the mineral and mining industries, with higher workplace exposures in the developing countries, little is known about the conditions in electronics or semiconductor manufacturing plants in the industrializing countries. The fire and explosion hazards, and acute lethality, of many of the agents used in semiconductor manufacturing dictate that careful attention must be paid to safe handling of these materials. A difference between these high technology industries and the more traditional industries is that the respiratory effects of working in these newer industries are largely unknown. Despite the highly toxic nature of materials handled in semiconductor production, there has been very little research on acute or chronic respiratory effects. Furthermore, these are rapidly changing industries with new materials frequently being introduced, often with no biologic data on their potential health effects. More research is necessary on the occupational health consequences of working in these new industries, and the lessons learned must be applied to facilities around the globe. How can the knowledge of occupational lung disease in industrialized countries be successfully applied to the developing nations? The first step must certainly be a commitment at all levels to reduce these preventable diseases. Industry, health care delivery and government agencies must be aware of the problem and commit resources to its reduction. Attention to occupational health must be an integral part of establishing new industrial plants in developing countries, and the commitment must extend to adequate training of workers and health and safety professionals. Lessons learned in the industrialized countries must be communicated to public health personnel, and those lessons must in turn be translated into methods appropriate for the country. This recognition of occupational lung diseases in industrializing countries need
not require high technology equipment. Standardized respiratory questionnaires and spirometry are powerful tools for the surveillance of most occupational lung diseases. Successful models for such implementation in industrializing countries exist, as evidenced by the dramatic reductions in disease that have occurred in China’, lo The obstacles to reducing occupational lung diseases in industrializing countries are great, particularly when there are the more basic public health problems of inadequate nutrition and infectious diseases confronting many of these nations.“’ I2 The fact that new industry often improves the general level of health should not negate the need to simultaneously pay attention to diseases caused by new industry. It is not an either/or proposition, but rather a question of how to industrialize and reduce or prevent occupational diseases that may result from that industrialization. Marc Schenker MD Division of Occupational
and Environmental
Medicine
University of California at Davis Davis, California USA
References 1. Henderson J. The globalisation of high technology production. Society, space, and semiconductors in the restructuring of the modem world. New York: Routledge, 1989. 2. Castleman B I. The export of hazardous factories to developing nations. Int J Health Serv 1979; 9: 569406. 3. El-Batawi M A. The third Theodore F. Hatch symposium lecture. Ami Am Conf Gov Ind Hyg 1986; 14: 3-15. 4. Mendes R. The scope of occupational health in developing countries. Am J Public Health 1985; 75: 467-168. 5. Jeyaratnam J. 1984 and occupational health in developing countries. Stand J Work Environ Health 1985; 1 I : 229-234. 6. Van Sprundel M P M. Pneumoconioses: the situation in developing countries. Exp Lung Res 1990; 16: 5-13. 1. Dosman J A, Cockcroft D W. Principles of health and safety in agriculture. Boca Raton: CRC Press, 1989. 8. Terho E 0, Husman K, Kauppinen T, eds. Proceedings of the international symposium on work-related respiratory disorders among farmers. Eur J Respir Dis 1987; (suppl) 154: 7 1. 9. Christiani D C. Occupational health in developing countries: a review of research needs. Am J Ind Med 1990; 17: 393-401. 10. Stem E C, Schenker M B. Occupational health in developing nations: the case of China. Prev Med 1989; 18: 532-540. 11. Walsh J A, Warren K S. Selective primary health care, an interim strategy for disease control in developing countries. New Engl J Med 1979; 301: 967-974. 12. Evans J R, Hall K L, Warford J. Shattuck lecture-health care in the developing world: problems of scarcity and choice. New Engl J Med 1981; 305: 1117-1127.
