Occupational health: the intersection between clinical medicine and public health

Our plain-English summary of Occupational health: the intersection between clinical medicine and public health, by L. Rosenstock, P.J. Landrigan (Annual Review of Public Health, 1986).

The study

• Authors: L. Rosenstock, P.J. Landrigan
• Journal: Annual Review of Public Health
• Published: 1986;7:337-56
• Type of article: Historical article, Review
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002570).

Summary of the article

This review examined the historical isolation of occupational health in the United States from clinical medicine and public health and proposed strategies to integrate it with both. The authors traced the field's history, linking its isolation to workers' compensation programs and to post-World War II health insurance that almost always excluded work-related conditions. They reported that most (70%) of about 100 million US workers worked in plants without medical care services, that fewer than 15% worked in plants with physician services, and that only about 1000 physicians had become board-certified in occupational medicine since 1955. They outlined features of occupational disease relevant to prevention, including latency, exposure dose and multifactorial causation, illustrated by the combined effect of smoking and asbestos exposure on lung cancer. They described the clinician's tools, criteria for causality in occupational epidemiology, and the Sentinel Health Event (Occupational) list of 50 work-related diseases. A case study of benzene and leukemia summarized a NIOSH cohort study of about 1000 Ohio rubber workers (7 leukemia deaths observed vs 1.25 expected) and the 1980 Supreme Court decision that vacated a 1 ppm benzene standard. The authors noted that the standard remained at 10 ppm despite later dose-response data. They recommended clinician education, integration of occupational health into traditional medical services, development of biologic markers, and occupational disease reporting systems, including record linkage.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a review and commentary, not an original study. The authors traced how occupational health in the United States developed apart from mainstream clinical medicine and public health, and proposed ways to bring it back into both. They discussed how doctors can recognize work-related disease through occupational histories and laboratory tests, the role of epidemiology, and a list of 50 'Sentinel Health Events (Occupational).' Asbestos appeared as an example taken from earlier research. Citing other studies, the authors wrote that asbestos exposure multiplies lung cancer risk by about 2- to 5-fold in both smokers and nonsmokers. They described a cited calculation assuming relative risks of 10 for smoking, 5 for asbestos and 50 for both. Under those assumptions, among asbestos workers who smoke, 92% of their lung cancers would have been avoided had none been smokers, and 82% had none been exposed to asbestos. They also noted that basilar rales are neither sensitive nor specific to asbestosis. A case study reviewed NIOSH research on benzene and leukemia. The authors concluded that clinician education, occupational health in ordinary medical care, better biologic markers and national reporting systems were needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review and commentary (not an original study)
• Who was studied: No study population of its own; the review concerns occupational health and its services in the United States
• Exposure: Occupational exposures in general. Asbestos is discussed as an example of interaction with cigarette smoking in lung cancer, and benzene is discussed in a case study on leukemia. No asbestos fiber types are specified.
• Main results:
  • Citing earlier studies, the authors stated that asbestos exposure multiplies lung cancer risk by about 2- to 5-fold for both smokers and nonsmokers. In their example, if a smoker's relative risk is 10, smoking combined with asbestos exposure may raise it to 20- to 50-fold, while an asbestos-exposed nonsmoker has an overall relative risk of 2-5.
  • Citing a calculation from another author that assumed relative risks of 10 for smoking, 5 for asbestos and 50 for both, the authors wrote that among asbestos workers who smoke, 92% of their lung cancers would have been avoided had none been smokers. They added that 82% would have been avoided if none had been exposed to asbestos. These are illustrative estimates that depend on the assumed relative risks.
  • The authors stated that basilar inspiratory rales are neither sensitive nor specific to asbestosis.
  • Reviewing a NIOSH cohort study of about 1000 benzene-exposed workers at two Ohio rubber plants, the authors reported 7 leukemia deaths observed versus 1.25 expected (SMR 560). In unpublished updated data, the leukemia SMR was 328 (9 observed vs 2.7 expected).
• The authors' conclusion: The authors concluded that the scientific basis for preventing occupational disease can be strengthened by expanding occupational health activity in both clinical medicine and public health. They recommended educating clinicians, integrating occupational health into traditional medical services, developing biologic markers of exposure and effects, and building reporting systems for occupational diseases, with the Sentinel Health Events (Occupational) list as a possible framework.
• Limitations the authors state:
  • The authors stated that a comprehensive review of laboratory testing was beyond the scope of the article.
  • The authors stated that problems with workers' compensation, such as undercompensation of chronic occupational diseases, were beyond the scope of the discussion.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Disease, Latency, Causation, Asbestos Exposure, Lung Cancer, Epidemiology, NIOSH, Cohort Study.

Related studies

• Not just a research method: If used with caution, can job-exposure matrices be a useful tool in the practice of occupational medicine and public health? — M. Fadel, B.A. Evanoff, et al. (2020)
• Public health significance of smoking-asbestos interactions — A.L. Frank (1979)
• Exposure science will not increase protection of workers from asbestos-caused diseases: NIOSH fails to provide needed public health action and leadership — R.A. Lemen, H. Anderson, et al. (2011)
• Comments on the Health Effects Institute-Asbestos Research (HEI-AR) report: "Asbestos in public and commercial buildings," with emphasis on risk assessment methods used — T.D. Sterling, C.W. Collett, et al. (1993)
• Public health control of environmental asbestos disease: consumer products — B.H. Franklin (1979)
• The Public Health Value of Opioid Litigation — R.L. Haffajee (2020)

Browse more research in Annual Review of Public Health, or return to medical research.