Occupational Health
Summary
The history of occupational health is inseparable from the history of social power. As Alan Dembe and others have emphasized, occupational health issues are among the most obviously “social” in medicine as a whole, riven by biases of economic interest and by imbalances of power and resources that favor managers and their corporate employers over workers (Jackson (ed.), 2011). This structural observation organizes much of the field’s historiography: who gets to define a disease as occupational, which exposures attract sustained research attention, and whose testimony is credited in regulatory proceedings are all questions that turn on the distribution of economic and institutional authority. At the same time, the field has been transformed by two related intellectual developments: the “Hippocratic turn” in medical history, which has revived attention to airs, waters, and places as determinants of health (Jackson (ed.), 2011), and the rise of “risk factor” medicine, which eroded pre-established boundaries between clinical medicine and public health by directing physician attention toward exposures patients face beyond the clinic (Jackson (ed.), 2011).
Power, Interest, and the Politics of Disease Recognition
The most contested terrain in occupational health history is that of disease recognition itself: the process by which a pattern of illness acquires a name, a mechanism, and a set of regulatory or legal consequences. The history of asbestos-related disease is now probably the most widely studied of historical industrial pathologies, with scholarly work sharply divided between those who emphasize the corporate suppression of evidence and those who have sought to complicate or defend the industry’s record (Jackson (ed.), 2011). The asbestos case illustrates a dynamic common across occupational health history: the same industrial processes that generated wealth for employers generated disease in workers, and the resources available to each party to contest the evidence were radically unequal.
Labour movements have emerged from this historiography as critical actors in disease recognition and occupational health reform. From the work of David Rosner and Gerald Markowitz on American industrial disease to that of Ronald Johnston and Arthur McIvor in the United Kingdom, scholars have demonstrated time after time that workers and their organizations, rather than physicians or regulatory agencies, were frequently the primary force driving disease recognition and legislative change (Jackson (ed.), 2011). The labour movement’s role as a diagnostic and political agent, pressing for the acknowledgment of conditions that industry denied and medicine often overlooked, is one of the field’s most consistent findings across national and chronological contexts.
Spatial Environments and the Architecture of Harm
A significant intellectual reorientation in occupational and environmental health history has come from the spatial turn: the growing attention to how built environments, architecture, and physical space constitute conditions of health and illness. Foucault’s influential work on how architecture can mold discursive and intellectual shifts encouraged historians of science and medicine to attend more carefully to the role of buildings and space in structuring medical knowledge and practice (Jackson (ed.), 2011). This theoretical impetus opened analytical space for histories of specific built environments as sites of health risk, from the factory floor to the office building.
Among the phenomena that have attracted attention along this axis is “sick building syndrome,” explored by Michelle Murphy and others alongside the longer legacy of industrial fatigue research. These phenomena straddle the boundary between physiological and psychological hazards in the workplace, pointing to continuities between the famous Hawthorne experiments of the 1920s, which revealed the complexity of worker responses to environmental conditions, and more recently recognized forms of workplace-induced illness (Jackson (ed.), 2011). The difficulty of establishing clear causal mechanisms for such conditions, and the readiness of employers to invoke psychosomatic explanations rather than acknowledge material hazards, reflects the same dynamics of power and economic interest that characterize the broader field of occupational health history.