Michael Morgan, ScD, Professor, Industrial Hygiene and Safety Program

Our professional societies have spent several years of hand wringing over what to call ourselves, yet the historical name may be the best fit. “Hygiene” refers to actions taken to achieve and preserve human health. These actions are taken by individuals on their own behalf, by employers and employees for the benefit of groups, and by society and government for us all.

Despite its misunderstanding by the public, the word “hygiene” is clearly the best single term to describe our activity. We should get over this anxiety about the title of occupational or environmental hygienist, and move on. There is much work still to be done.

THE PAST

The field began with the work of Alice Hamilton, a young energetic physician who was appointed by the governor of Illinois in 1911 as the state’s first industrial health inspector. Before then, Illinois and nearly all other states had focused on industrial accidents, neglecting workplace exposures to agents causing illness. Hamilton pioneered the familiar approach we take today in practicing occupational and environmental hygiene—recognition, evaluation, and control of exposures to chemical, physical, and biological agents of disease.

Once she completed an inspection, Hamilton would spend many hours with the plant owner reviewing her findings and explaining the connection between exposure and disease. She preferred a gentle means of persuasion to threats of regulation. Personal communication of the facts and a series of carefully considered recommendations were Hamilton’s primary tools. While she focused on exposures to lead and silica, Hamilton’s contributions to our general approach today have justified her informal title as the founder of Occupational Hygiene, at least in North America.

Here are other highlights in the century-long history of the field:

• the reduction of lead in the environment
• the reduction of silica-related lung disease in workers
• the recognition and control of several cancer-causing agents in the workplace such as vinyl chloride monomer
• the steady reduction in water-borne infections and food-borne illnesses in the general public

THE PRESENT

Before we pat ourselves on the back for jobs well done, we should take a closer look at how we pursue our familiar mantra of “recognition, evaluation, and control.” Think of this as a tug-of-war between employees on one end of the rope, and the employer on the other. The hygienist’s job is to assure that neither side draws the other into the abyss.

The occupational or environmental hygienist works at the center of contention between two imperatives: the need to protect the public from harmful agents, and the need to maintain industrial productivity and sustain a standard of living. In our part of the world the contending forces remain nearly in balance, but in the developing nations they may be grossly out of balance. Hygienists have a crucial role to play in fostering this balance. Here are three keys to success.

Education, or a firm grounding in the underlying natural sciences and mathematics. This foundation allows us to impart knowledge to our successors.

Commitment, or the Three P’s: perseverance, patience, and passion. Hamilton was among the first to demonstrate the traits that underlie professional commitment. As educators, our task is to recognize commitment in our students, and to encourage and nurture it. Students in occupational or environmental hygiene should understand that more is being asked of them than mere mastery of scientific principles.

Public trust. I see this as the greatest challenge to the survival and growth of hygiene as a respected profession. I offer some suggestions on how to gain and keep the public trust:

• Use scientific data wisely: in dealing with a contentious situation, we should make certain we have all of the data available, that the data were obtained according to recognized scientific methods (and subject to peer review), and that we are aware of any shortcomings in the data.
• Be objective: we should strive to present an unbiased, neutral evaluation of the situation, again based upon the available scientific infor-mation. “Black-and-white” issues where one contender is clearly in the wrong and the other in the right are rare.
• Be accessible: our job is to manage the contention between groups, and to do so requires us to communicate with all sides on a schedule that will often seem unreasonable. However, developing an effective rapport with our audiences can pay very big dividends, and we always get to rest later.

We need to consider our audience carefully when we speak. It is especially important that we not assume that the audience cannot understand the technical aspects of the problem. I must admit to making this mistake myself more than once, and always to my regret. The general lesson I have learned is that we regularly underestimate the ability of the public to understand health-related issues. There is clearly room for improvement in our communication skills.

THE FUTURE

Three areas hold promise for the future of occupational hygiene:

Biomarkers and Biological Monitoring
What are the pharmacokinetic (relating to the disposition of drugs in the body: their absorption, distribution, metabolism, and elimination) and pharmaco-dynamic (relating to drug action) relationships among biological markers, exposures, and health over time? Can biomarkers of susceptibility and early biological effects be used to control occupational illness? How can we account for nonoccupational exposures? This work is erasing the boundary between occupational and environmental exposure.

We are developing molecular marker techniques to predict individual susceptibility, which raises ethical issues. Could these predictions be used to discriminate against susceptible individuals?

How can we make these technologies more acceptable to employees and employers? We have less invasive ways of sampling biomarkers, such as exhaled breath, which is a convenient way of extracting a representation of the components of arterial blood.

Nanoscience and Nanotechnology
How can we exploit the rapid miniaturization of chemical monitoring instruments to characterize chemical exposure and risk, and benefit employees and employers? We now have gas chromatographs that fit in the pocket, and sensors that can be placed on or under the skin to measure blood chemistry.

Public Health Genetics
What role do genetic polymorphisms play in associations with work exposures? How can we communicate this information? How can we use it? Universities in the United States have generally determined that it is premature to institute programs for genetic counseling of workers, yet that day is coming. Again, how do we safeguard people’s rights?

As I noted in my opening, there is much work still to be done. A combination of old-fashioned skills and new tools will carry us far.

—This is excerpted from Morgan’s keynote address and panel presentation at the 10th anniversary celebration of the School of Occupational and Environmental Hygiene at the University of British Columbia in April 2003

FOR FURTHER READING

Hamilton A. Exploring the Dangerous Trades: The Auto-biography of Alice Hamilton. 1943. (Reprinted, Boston: Northeastern University Press, 1953, AIHA Press, 1995).

Sicherman B. Alice Hamilton: A Life in Letters. Cambridge, MA: Harvard University Press, 1984.

We are in the midst of a technological revolution that will dramatically change the field that our graduates enter. We have asked two of our senior faculty to reflect on the past and the future of occupational and environmental hygiene.

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