A consensus exists in the history of South African occupational health that tracks back from
McCulloch to the very earliest writings on the gold mines. There is a general scholarly agreement
that the mines have acted as engines of disease in the subcontinent, and that the medical
interventions and forms of compensation offered by the institutions of industrial medicine
amounted to - at best - weak and ineffective remedies or - at worst - masks of ongoing
contamination. In this talk I offer a critique of this consensus, asking - in light of the rapid decline
in industrial employment and the widespread collapse of associated state institutions - what was
internationally interesting and significant about the century of South African industrial medicine,
and what it means for public health that the field no longer exists.ee
During the Belgian colonial rule of the Congo (1908-1960), the private company Union Miniere du Haut-Katanga (UMHK) had a monopoly on the extraction and processing of minerals in southern Katanga, the northern part of the African Copperbelt. Thousands of workers were employed in underground and open-cast mines, and in metallurgical plants producing copper, cobalt, uranium, and many other metals. The economic and social history of mining in Katanga has been addressed in many scholarly publications. In the first decades, the problem of worker shortage represented a major difficulty for the industry. Initially, men were forcefully recruited from surrounding or even faraway regions to work for three to six months; poor working and living conditions led to high mortality from dysentery and pneumonia. Later, efforts were made to improve hygiene in worker camps, which were initially built following the South African Orenstein model of dormitories. However, largely at the initiative of medical doctors, the UMHK took measures aimed at 'stabilising' the workforce. These measures consisted in building worker camps ('cites') with family housing, improving food rations, providing medical care, and educating children. This 'totalitarian' policy was conducted without worker participation; unions were forbidden. Nevertheless, organised forms of resistance did occur, including a violently repressed strike in December 1941. Although occupational accidents and work-related diseases are mentioned in passing, conspicuously little has been published about specific occupational safety and health issues at the UMHK. An interesting experiment consisting of aerosolising salt solutions to increase particle size in order to prevent silicosis was conducted in an underground mine, but the outcome of that study is unknown.
The first milestone in the history of agricultural worker health and safety was the work of the Swedish archbishop, Olaus Magnus. He recognised in his Historia de Gentibus Septentrionalibus (1555) that grain threshers damaged their lungs by exposure to grain dust. The father of occupational medicine, Bernadino Ramazzini, generalised this observation in his seminal work, De Morbis Artificum Diatriba (1700) to recognising that particles in a variety of occupations were dangerous to breath. These could be dusts from animal, vegetable, or mineral. He particularly recognized the respiratory hazards to millers, grain sifters, horseback riders, and tobacco workers. Ramazzini noted that farmers were at high risk of pleurisy, pneumonia, and asthma, mainly due to exposure to "the inclemency of the weather". In England, the Threshing Machines Act of 1878 focused on the mechanical hazards of agriculture, but the hazards of agricultural work were largely ignored as the industrial revolution focused on the dangers of mining and manufacturing. In 1939, John Powers wrote that "During the past quarter century the hazards of industry, transportation, mining and construction have been recognized. For agriculture...there has been no such recognition, and farming, thought the oldest occupation in the world, remains the most hazardous". That focus changed in the 1950s with the creation of the National Institute for Farm Safety in the US, and in the UK the Agriculture (Poisonous Substances) Act (1952), and the Agriculture Safety, Health and Welfare Act (1956). The Occupational Safety and Health Administration (OSHA) Act in the US (1970) largely ignored the agricultural workplace until 1991, when NIOSH was funded to create a farm health and safety programme. The recent years have recognised the reality that agricultural work is now largely and increasingly done by immigrant workers, and efforts by government, academia and non-governmental organisations have focused on this vulnerable population.
Margate, a picturesque town in Kent, England would be the ominous setting of a terrifying legacy to unfold thousands of miles away in South Africa. Margate was home to Thor Chemicals, the manufacturer of mercury-based products. In the late 1970s concerns were raised by the Health and Safety Executive (HSE UK) about the excessively elevated airborne levels of mercury and high levels of mercury in the workers' urine. In 1987, the HSE delivered an ultimatum to Thor Chemicals - to shut down processes or face prosecution. Thor chose to relocate to the remote, semi-rural Cato Ridge, in KwaZulu-Natal, South Africa in 1988. In South Africa, Thor transformed its English mercury production process into a mercury reclamation and recycling process. Escaping international and national scrutiny, Thor became the global leader in mercury waste recycling. In 1989, toxic mercury deposits were discovered in the nearby river. Workers began exhibiting symptoms of mercury poisoning. Urine levels of workers were found to be at least 12 times higher than the World Health Organization (WHO) limit, with workers complaining of "going mad". Protests in 1990 by non-governmental organisations and the Chemical Workers' Industrial Union (CWIU) and investigations by Dr. Mark Colvin, exposed the extent of mercury toxicity among the workers. By 1994, three workers had died from mercury poisoning and 32 workers had urine mercury levels of > 200 mg/l. The Government's Department of Labour fined Thor R13 000! In 1994, a civil claim of culpable homicide was filed against Thor Chemicals in the court of London. In 1997 and 1998, Thor settled, paying R17 million to affected workers. Despite its 1998 announcement of the closure of its plant, more than 10 000 drums of mercury waste remained improperly stored, stockpiled with evidence of seepage into the surrounding environment as recently as 2019. In August 2019, a fire destroyed at least 30% of the mercury waste and released toxic waste. In October 2019, after pressure from South African Government, a Thor Chemicals subsidiary agreed to pay R300 million to clean up the mercury waste and transport it to a Switzerland company. While the cycle of exportation of hazards from Europe and back is complete, some thirty years later, in its wake the destruction of the lives of workers, their families, their communities, and the farming environment remains the legacy.
Occupational health has evolved into a fundamentally technical and applied field dedicated to identifying and eliminating hazards found at the workplace. While this approach has led to significant reductions in occupational injury and illness, it has limited its ability to account for the social structures that circumscribe occupational health outcomes, particularly for socially marginalized populations such as immigrant workers. It has also led to the artificial, yet fundamental, distinction between work-related and nonwork-related exposures, injuries, and illnesses, which has evolved into a line of demarcation between occupational safety and health and other disciplines within public health such as migrant health. This presentation discusses key concepts that have been central to the development of occupational health over time. Specifically, it explores occupational health's historical roots in social medicine and how historical advances, such as the establishment of a regulatory infrastructure, may have inadvertently contributed to its increased reliance on reductionist views of cause and effect that are prevalent today. It discusses the predominance of the biomedical paradigm in occupational health and how this has limited the field's ability to address occupational health inequities for socially marginalized groups such as immigrants. Finally, it discusses the advantages of moving towards a biosocial approach to health and how this could lead to a more comprehensive understanding of the relationship between work and health. This understanding could also allow the field to better address the changing nature of work arrangements and the inequitable distribution of occupational health outcomes across the social axis.
'Guardians of Workers Bodies?' contributes to an ongoing conversation on the role trade unions have
played in occupational health and safety. The activities of unions are examined through the lens of
experience in Britain focusing on three themes: firstly, the idea within some of the literature that
historically unions neglected workers health, especially chronic ill-health and industrial disease;
secondly, the challenges to this negati
eve portrayal that supports a rehabilitation of the historic role of
unions; and, finally, the recent experience (since c1980) of unions in decline (and under attack) and the
impact of this on occupational health and safety standards. It is argued that the role of trade unions
needs to be contextualised and that tensions existed within some unions over jobs, wages, and
health. Also that we need to know more about working class environmentalism. Nevertheless, there is
robust and compelling evidence to support the argument that unions were, and continue to be, a
powerful countervailing force operating as the key sentinels protecting workers' bodies in production.
And this has been a significant buffer in hard times.
That said, it is also undeniable that capacity to resist and to mediate these wider degenerative forces
has been critically neutered now that less than a quarter of the UK workforce are union members and
collective bargaining has dissipated. Occupational health standards have worsened in the process,
though this manifests itself now (at least in developed economies like the UK) less in physical injury
and disability (though these legacies are still visible and continue to blight traditional working class
communities), and more in deteriorating psycho-social health with the stress epidemic in the modern
workplace. Workers' bodies and minds are again bearing the brunt of a profound economic
Background: What we today distinguish as silicosis and pulmonary tuberculosis have a long but
contested history of biological, epidemiological and nosological association.
Methods: To try to illuminate this history, the South African published literature on gold miners
over the past 100 years was examined to describe how co-occurrence and separation have been
Results: Between the turn of the 20th century and the 1930 Johannesburg Silicosis Conference,
there was continuing debate about whether the 'infective component' of 'miners' phthisis' was
always present in disabling silicosis. The conference established that the diseases, irrespective of
severity, were distinct. The phenomenon of subradiological silicosis was ignored in the new
definitions. Mid-century papers attempted to distinguish, inter alia, between 'silicotuberculosis'
and 'tuberculo-silicosis' on grounds of chronology of dust and mycobacterial exposure and
pathogenesis. By contrast, medical commentators in the mining industry challenged the
aetiological linkage of the two diseases into the 1980s. Even where it was accepted, it was argued
that silica in the absence of silicosis was not a causal factor, ignoring biological evidence to the
contrary. While clinicians continued to emphasise the co-occurrence and diagnostic complexity of
combined disease, epidemiological and laboratory studies on co-occurrence remain scarce, both
in South Africa and globally.
Conclusions: Despite a century of intimate (and tragic) association of silica and Mycobacterium
tuberculosis in the South African gold mining industry, the varying, multiple, and ultimately
unstable understanding of what is today called silicotuberculosis, along with historical resistance
within the South African mining industry, have hindered scientific inquiry.
The first description of an association between rheumatoid arthritis (RA) and pneumoconiosis is
generally attributed to Anthony Caplan, who reported in 1953 on a 'peculiar' pattern on chest Xrays of south Wales coal miners with concomitant RA and pneumoconiosis. As early as 1950,
however, Emile Colinet, a Belgian rheumatologist at the Saint-Pierre Hospital in Brussels, had
described a 30-year-old woman with a ten-year history of diffuse rheumatic arthritis that had
started two years after beginning work "in a factory where large quantities of silica flour were
handled". Her chest X-ray - which Colinet did not provide - was described as 'silico-tuberculosis'. In
March 1953, he reported a 34-year-old woman with clinical manifestations of both RA and
scleroderma, who at age 15 had begun work in the same factory - without specifying what this
The picture became clearer in December 1953 when Clerens, a colleague of Colinet, recapitulated
the two case histories of what he called, by then, 'Colinet-Caplan syndrome'. Clerens showed the
chest X-ray of the first patient with a typical 'Caplan' pattern. Also, he provided more information
on the patients' jobs: they were packaging scouring powder. It is likely that they worked in the Vim
scouring powder factory near the Saint-Pierre Hospital. This seems to be confirmed by a report
from the internal medicine department of the same hospital, from January 1953, of a 41-year-old
woman - a Vim scouring powder worker - with fatal 'acute' silicosis. Colinet had already noted that
several of the (female) coworkers of his first case had died from 'silico-tuberculosis'.
Although Colinet's name was soon dropped from the syndrome's eponym, his early reports
highlight the extent to which women in this industry were struck by occupational diseases and
underscore that the RA association is not limited to coal worker's pneumoconiosis, the general
understanding of Caplan's syndrome. Regrettably, more reports on autoimmune disorders in
scouring powder workers would follow.
A mine's history of injuries and fatalities was addressed with occupational health and safety (OHS)
programmes developed, from1923, by its medical director, Paul Richards, MD (born 25 November
1892). These efforts subsequently fostered academic programme development.
Background: Great human migrations are invariably motivated by economics. Mining is the
penultimate example of massive 'rushes', although more have migrated for agricultural and
manufacturing opportunities. Irrespective of economic driver(s) in the rushes to riches,
occupational health is often an after-thought.
Mine history: Bingham Copper Mine in Utah is the world's all-time greatest copper mine. Mining
began in 1863, and production is now 19M/17.2M short/metric tons (~$416B in inflation-adjusted
total value). After arriving at Bingham, Utah on 7 October 1922, Dr. Richards took over the town's
hospital, his employer, and began accident investigations, injury prevention programmes, and
respiratory protection. Mining deaths were eventually all but eliminated. Dr. Richards also helped
write Utah's Occupational Disease Act (1941). However, most OHS activity was relatively dormant
after his death on 20 November 1958.
Hopeful future: An OHS rebirth with business-labour partnerships, built on Dr. Richards' legacy in
the mining industry, is now accelerating. Efforts are spearheaded by a coalition of partners of the
University of Utah/Weber State University Rocky Mountain Center for Occupational and
Environmental Health (est. 1977). A series of state laws have been enacted including: (1) funding
support through tax credit mechanisms (SB159, 2005 General Session (GS)); (2) incorporation of
the Center into state law (1SSB234, 2007 GS); (3) statutory Center enlargement to involve a second
university (2SSB172 2021GS); and (4) new, ongoing state appropriations (2022 and 2023).
Conclusion: This example shows that with industry-labour historical partnerships and
government support, broad advances in OHS programmes with disease and injury reductions are
Hardly anything is known about the health impact of the use of asbestos in sub-Saharan Africa. We
attempted to retrace the history of the manufacture and use of asbestos-cement materials in the
(former) province of Katanga in the Democratic Republic of Congo (DRC).
During the colonial period, asbestos-cement roofing sheets (generally called 'Eternit') were
promoted for building houses, especially in mining estates. A total of 19 851 tons of
unmanufactured asbestos were imported by the Belgian Congo from 1950 to 1959, presumably for
supplying two factories producing asbestos-cement materials: Eternit du Congo (ETERCO) in
Leopoldville (now Kinshasa), and TRABEKA in Lubudi, Katanga (now in the Lualaba province). The
latter plant produced more than 30 million tons of various asbestos-cement products from 1929 to
1977. In addition, 55 719 tons of asbestos-cement products were imported into Congo from 1953
to 1959. No data are available for the period after independence (1960), except for the period
1975-1986 when 6 167 tons of unmanufactured asbestos were imported. Asbestos was never
mined in Congo and there is no evidence for environmental contamination by naturally occurring
In a recent case report, we attributed the occurrence, in a young man, of a malignant peritoneal
mesothelioma to his exposure to asbestos-cement materials in the house where he grew up, in a
mining housing estate in the (former) Katanga.
To this day, roofs of corrugated asbestos-cement sheets are widespread, and often in tatty
condition, in urban areas and mining compounds throughout southern Katanga. More cases of
mesothelioma are to be expected in the future.
Numerous unsuccessful silicosis medicinal treatments and preventatives have been used,
worldwide, over many decades. Among the most well-known is the Canadian McIntyre Research
Foundation's patented aluminium powder, which was used to "reduce the solubility of silicious
material", based on animal studies. The compound is approximately 15% aluminium metal and
85% aluminium oxide. It was administered to silica-exposed miners in countries such as Australia,
Canada, Chile, and Mexico, and factory workers in the USA and England, and possibly elsewhere, as
a prophylaxis against silicosis. The powder was dispersed into specific areas in the workplace, such
as change rooms, or inhaled directly by workers from the 1940s into the late 1970s. Mostly without
their formal consent, and sometimes as a condition of employment, tens of thousands of workers
were exposed to the powder: 27 000 in Ontario, Canada, alone.
Despite its widespread use globally, and the high rates of silicosis among South Africa's hundreds
of thousands of gold miners, aluminium powder was not introduced into the country. We examine
the reasons for the lack of enthusiasm for the 'treatment' in South Africa, notwithstanding its
potential commercial advantages, being cheaper than dust control. The presentation relies, in part,
on an influential 1963 report of an investigation by Prof. Ian Webster from the Pneumoconiosis
Research Institute in South Africa. Webster concluded that "There is no proof that aluminium powder
has prevented the development of silicosis" and that "Aluminium prophylaxis does not stop the
progression of silicotic fibrosis" but, somewhat surprisingly, recommended that "Should the State or
an industry wish to use aluminium prophylaxis, the Pneumoconiosis Research Unit should assist them".
Over the past fifteen years, Spain and Israel have each become 'Ground Zero' for an unexpected outbreak of silicosis among workers involved in cutting, bevelling, and polishing high-silica content material often called 'artificial stone'. These two countries house the main producers of this material worldwide. Medical reports have described accelerated forms of silicosis in young healthy workers exposed and (more rarely) have paid attention to immune-mediated diseases associated with crystalline silica. Several health agencies have recommended lower occupational exposure limits (OELs). However, exposure is still active in Spain, Israel, and worldwide. Andalusia, the most populous Spanish autonomous community, has been especially affected by this outbreak. Demand for artificial stone was fuelled by the housing boom during the first decade of the century, giving rise to intensive occupational exposure in small workshops. From 2007 to 2019, 3 320 cases of occupational diseases, due to exposure to crystalline silica recognised in Spain, can be identified with a specific industry code. Of these cases, 1 856 (55.9%) were attributable to the production and manufacture of artificial stone, of which 266 were reported in Andalusia. In 2017, an Integrated Silicosis Programme for managing quartz agglomerates was implemented by the Andalusian Regional Government. This paper explores the ways in which different stakeholders have coped with the silicosis outbreak in Andalusia and how this epidemic has challenged the traditional understanding of silica hazards. The aim is to illustrate how artificial stone has become what is defined by the social sciences as a 'public issue'. This research is drawn from a variety of sources, including interviews with local agents, medical and public health experts, and administrative and epidemiological data.
Metal working fluid (cutting fluid) has historically been used during the 20th century in industry for
processes such as grinding, turning, drilling, and milling. Since the 1970s, various types of nonmineral oil-based metal working fluids, including synthetic fluids, have been used in Sweden.
The mean exposure to cutting fluids in the form of either oil mist or aerosols has decreased over
time in many countries, using personal monitors, as: 1.23 mg/m3 during the 1970s; 0.57 mg/m3
during the 1980s, and 1.0 mg/m3 during the 1990s. In Sweden, we can see the same trend; in the
1970s 5 mg/m3 oil mist, during the 1980s around 3mg/m3 oil mist, and in the 2010s 0.2 mg/m3
Today, the average machining speed of the new machines is two times higher than for machines
30 years ago, and we know that aerosol generation increases with increasing machine rotating
speed. From Swedish studies, we can show that using compressed air over many years, working
with half-open machines, and grinding are important factors in exposure to inhalable aerosols and
in governing exposure levels.
In the 1990s, the workers were exposed to oil mist/aerosols of metalworking fluid containing P.
pseudoalcaligenes. Twenty years later, we can see the same bacteria genera grow and many other
Gram-negative bacteria such as Escherichia coli and Legionella ssp. Today, we can find
Mycobacterium immunogenum in MWF containing mineral oils. Bacterial content of the cutting
fluid varies depending on the cutting fluid type and biocidal additives, and can vary between the
tank and in the machine.
In the aftermath of the 9/11 attacks resulting in the collapse of the World Trade Center, responders
and workers in the impacted area developed a myriad of diseases, including cancer. Treatment is
now covered by government-funded programmes, but these treatment programmes started only
after extensive lobbying by sick workers and healthcare advocates. This calls into question
government's handling of worker protection and communication of air quality results following
the disaster. This presentation will look at several environmental disasters in the history of the
United States, and compare the governmental response to protect workers at these disasters. We
will review the response to radiation exposure at the Nevada Test Site, Asbestos exposure in Libby,
Montana, and Silica exposure in Hawks Nest Tunnel, West Virginia. History has shown that the time
it takes to institute coverage following evidence of exposure-related illnesses is prolonged, often
resulting in needless morbidity and mortality. Study of the history of response to environmental
disasters can improve the protection and health of workers involved in future events.
Occupational health in the non-mining sector became an entity recognised by the South African
Government in 1976. The Erasmus Commission of Enquiry (1976) into occupational health,
followed by the 1979 Wiehahn Commission Report on the Industrial Relations System in South
Africa, identified specific legal challenges to be addressed. After nearly 20 years, the Occupational
Health and Safety Act (Act No. 85 of 1993) defined in legal terms the occupational health services
that would be required. However, much earlier than 1985, non-governmental organisations
became pioneers in occupational health.
The South African Society of Industrial Health, constituted in 1948, underwent various changes
and was renamed the South African Society of Occupational Medicine (SASOM) in 1985. SASOM,
an affiliate member of the International Commission on Occupational Health (ICOH), is tasked with
promoting, protecting, and enhancing the quality of life and wellbeing of the working population
of South Africa. Its members are medical practitioners registered with the Health Professions
Council of South Africa (HPCSA).
In 1966, the Industrial Nurses of the Southern Transvaal met for the first time; during 1976 they
changed their name to 'occupational health nurses' to be in line with international standards at
that time. Since 1980, the organisation has been known as the South African Society of
Occupational Health Nursing Practitioners (SASOHN); its main mandates are promoting
occupational health nursing through accredited standards of practice, education, and training, and
co-operation with national and international organisations.
Occupational hygiene as a recognised discipline came into existence in 1992, at a meeting of the
transitional committee of the then Institute of Occupational Hygienists of Southern Africa (IOHSA).
At a strategic meeting in 2000, the Southern African Institute for Occupational Hygiene (SAIOH)
was launched; it is the officially recognised and accredited professional organisation responsible
for the certification and registration of occupational hygiene professionals in Southern Africa.
A synopsis of the Chemical Industry up to 1972 will be given, the reasons for the establishment of
MEDICHEM as to serve occupational health (OH) in the chemical industry, affiliation with ICOH, and
the Board of MEDICHEM approved as the ICOH Scientific Committee (SC) for the Chemical Industry.
We explore the archives of MEDICHEM and the SC, and now close to fifty years later we document
the successes, failures, needs for change, the future, and how this will affect OH in the chemical
The last fifty years, as for the beginnings of chemistry, has brought much to be debated. The
context of sustainable development (responsible care, corporate citizenship, green chemistry),
new, emerging and old technology, and the impact on and by OH professionals, ethics, and the
future of the relationship of OH professionals within the chemical industry, is further explored as a
finding during the search and archiving of the history of MEDICHEM and the SC.
In addition, the format of publication of such archiving and documentation will be discussed with
the ICOH repository as backdrop.
A few decades into the great Gold Rush of 1886, mine medical officers found themselves at the
crossroads of migrations, empires, and social movement, and diseases. There was a gradual
unanticipated, but disturbingly extensive, burden of ill health among manual labourers from
indigenous Black African populations, who were recruited locally and from neighbouring
Following a meeting in March 1921 held under the aegis of the Chamber of Mines, the Mine
Medical Officers Association (MMOA) was established. The first constitution set out two principal
objects, viz. to discuss problems of special interest relating to the work of mine medical officers,
and to foster friendly intercourse and exchange of views among the Association's members and
other organisations connected with the mining industry.
The history of the Association is replete with scientific papers written by its members, from as early
as 1924, on scurvy, meningitis, injuries, and sepsis, and, in later years, silicosis, tuberculosis, HIV,
and hearing loss - proof that the Association had not only achieved its mission but had become a
leader in the management of occupational diseases. Evolving from an era steeped in safety
culture, the Association steered its members towards ensuring the prioritisation of health, along
In its first 50 years, the name of the Association changed to the Transvaal Mine Medical Officers'
Association, and then back to the MMOA to accommodate members from the Free State mines. In
2009, to incorporate other medical professionals and sustain its membership, it was renamed the
Mine Medical Professionals Association (MMPA).
The MMPA has enjoyed a meritorious journey, fostering preventive healthcare and promoting
occupational health as enablers for safety in mines. As an Association, the MMPA has achieved its
vision of "raising the profile of medicine in mining" in the last 100 years. It celebrated its centenary in
The mining sector is a major driver of economic growth in South Africa, contributing some eight percent to the country's gross domestic product in 2022 and significantly to its foreign exchange earnings. However, despite the central role of mining in South Africa's economy for over 150 years, the associated health impacts have had a negative effect on mining communities, with mine workers in the southern Africa region historically registering the highest incidence rates of tuberculosis (TB) of any working population in the world. Before the 19th century, South Africa had a pastoral and subsistence economy, with Cape Town being a way station for passing ships on their way to and from the East for the colonial powers and 'explorers'. The discovery of diamonds in 1867 and gold in 1884 led South Africa on an economic trajectory that surpassed many countries. The mining economy sucked in migrant workers from many countries, especially those in southern Africa. As part of the political economy of mining, various legal instruments assisted in dispossession of Africans of their land and imposition of various taxes moved many into a cash economy based on migrant labour. The Anglo-Boer war dispossessed the Afrikaans- speaking population, and the scorched earth policy of the British ensured that farmland was destroyed, also leading to Afrikaner men seeking employment on the mines. The medical assessments of white workers for their employment on the mines were undertaken by state-employed doctors, given the distrust of white workers of the doctors employed by the mining companies. Black African workers were assessed by medical orderlies based at The Employment Bureau of Africa (TEBA) facilities in labour-sending areas/countries or in Johannesburg. The compensation systems for occupational injuries and occupational lung diseases in mine workers were initiated in 1894 and 1912 respectively. The occupational lung diseases compensation system covered white workers until 1973. Research was conducted by the South African Institute for Medical Research (SAIMR) into vaccines and treatment interventions for various communicable diseases in mine workers and two major international conferences covering silicosis/pneumoconiosis were convened in South Africa as early as 1930 and 1959. The lack of preventive interventions resulted in the major class action settlements from 2002 onwards in the asbestos and gold mining sectors. Social protection rights for Black African workers were only realised in the 1970s after the historic Durban strikes for collective bargaining and trade union rights. The mining sector, through the Minerals Council South Africa, has a legacy programme in partnership with the Department of Health that recognises the injustices of the past, and has taken corrective steps to restore the dignity of current and ex-mine workers and peri-mining communities that will ensure the sustainability of the sector.
In 1878, the Bessemer process for steel production was modified by adding lime stone to the
process in order to remove phosphorous. A by-product of alkaline slag, 'Thomas slag', was
generated, which could be used as a fertiliser. In Germany, it was noticed already in 1887 that
workers processing the Thomas slag had a high prevalence of infectious pneumonia. In 1888, a
drastic increase of deaths from lobar pneumonia, which mainly affected men in working age, was
noted in an English county. The workmen themselves attributed it to inhalation of dust from a
newly opened industry that was grinding and sifting alkaline slag from the Thomas process. A
report from the Local County Council concluded that exposure to 'slag dust' was not the primary
cause, but could be a contributing cause. In 1889, a German report concluded that workers
processing Thomas slag fell ill with severe croupous pneumonia that was probably caused by
pneumococci in combination with inhalation of the dust from the Thomas slag.
A German doctoral dissertation from 1890 described an epidemic of pneumonia among workers in
Thomas slag mills, with high mortality in this new fertiliser-production industry. The mills were so
dusty that workers two meters apart could not see each other. The content of the slag was
phosphate, lime, silica, iron oxides, and manganese compounds. The thesis also presented a
pathologic section from a deceased worker, noting copious slag particles in the lung. It was
explicitly stated that there were no pneumocooci in the lungs. The thesis concluded that this was a
pneumonia caused by inhalation of the Thomas slag that, due to its etching properties, injured the
lungs. In 1909 the German Government issued rules for the workplace conditions in Thomas slag
mills, but occurrence of severe, often fatal, illness remained high. From 1929, pneumonia among
workers processing Thomas slag was listed in Germany as an occupational disease.
The early investigators attributed the increased susceptibility to pneumococcal infections to the
irritating properties of the alkaline lime; manganese was not mentioned as a possible etiologic
factor. German researchers continued to describe case series of severe pneumonia among workers
processing Thomas slag. Despite this rich early history continuing well into the 20th century, over
the last 50 years the condition has been largely forgotten. Modern investigational techniques been
not been applied to understand more fully the mechanisms underlying Thomas slag pneumonia.
Wood pulp production in an industrial scale started at the end of 19th century and became an
important industrial product in Sweden. At around 1920, Sweden became the largest exporter
worldwide of pulp. In the early 1940s, the production of crepe paper and soft tissue paper started,
mainly for the production of toilet paper, a product increasing used. Currently, the demand for soft
tissue paper still is growing, especially in Asia, and production is increasing. One method to assess
exposure in retrospective, historical cohort studies is to apply job exposure matrices (JEMs). This
methodology started in the early 1980s and has been used both for general populations and
industry-specific exposure assessment.
We have collected data from the very early soft tissue papermills in Sweden, comprising a cohort
of 8 624 workers who started to work in the mills from the late 1940s. We performed exposure
assessments with regard to paper dust and noise, based on dust measurements starting from the
1970s from the mills. A total of 1 578 dust samples and 1 157 noise measurements were assessed.
The exposure for the 1940s-1980 period was based on reviews of historical trade association
books that described changes in equipment, processes, management, and economics over the
history of every paper mill in Sweden. In-depth interviews were conducted with previous and
current personnel - including operators, supervisors, and upper management - at each mill to
understand how working conditions in all sections of each mill had varied over the years.
From all our information we developed two mill-specific semi-quantitative JEMs; a dust-JEM with
seven levels from 0.01 to >10 mg/m3
, and a noise-JEM with seven levels from < 75 to > 100 dB(A).
For every year, department and job title categories were data populated and assigned exposure
levels that were used for analyses of different health outcomes. Dust exposures are considerably
reduced but noise exposures are still high.
Chalk dust exposure is the inhalation of dust particles that are generated when using chalk for
writing or wiping on a chalkboard. Chalk dust exposure can have negative effects on human
health, especially for teachers and students who use chalk frequently in classrooms. Chalkboards
were first used in the 19th century in Europe and in the United States of America, and became
popular because they were cheap, reusable, and easy to erase. However, they also produced a lot
of dust when writing or wiping with chalk. It is known that chalk dust exposure can cause health
problems, such as eye irritation, skin irritation, respiratory tract irritation, and mucous membrane
irritation. However, the history of chalk dust exposure and related diseases is not well
documented. Therefore, this review aimed to assess the history of chalk dust exposure and
disease. Some studies have suggested that chalk dust exposure may be associated with an
increased risk of asthma, allergies, chronic bronchitis, and lung cancer. In recent years, some
alternatives to chalkboards have been developed and adopted in schools, such as whiteboards,
smartboards, projectors, and tablets. These alternatives can reduce or eliminate the generation of
chalk dust and improve indoor air quality in classrooms. However, these technological tools are
not optimally used in countries like South Africa, due to power outages, software failure,
malfunction, and theft
The aims of this work are to analyse the process of creating agendas, subjects, and policies
concerning the production of asbestos in Brazil. It also identifies and studies the Brazilian
legislation on the use of asbestos, focusing on the actions of the various actors involved, and
describes scientific debate on the issue. Exploratory research of a qualitative nature was carried
out, using documentary research, from 1970 to 2019, and drawing on theoretical contributions
from the fields of sociology and history, with special attention focused on Kingdon's work. The
complexity of the interrelations between actors and the State in the formulation and
implementation of public policies is demonstrated. Asbestos has been on the decision-making
agenda several times, but the creation of a national public policy has occurred on only a few
occasions. The use of asbestos was banned by the Federal Supreme Court, but the actors involved
in the matter continue to duel.
"Things aren't always what they seem." The author, after producing a Silicosis Prevention Information Resource, including an Historical CD containing copies of the bulk of the known publications on dust prevention for the South African gold mining industry, became involved as a consultant to legal teams in the silicosis litigation class actions for and against the South African (SA) gold mining companies. Historical work conducted for this litigation influenced the author to research how African slavery was able to influence the poor working conditions in the SA gold mines. This work then influenced the author to conduct further extensive research for a possible book, viz. The European Greed for Gold and Silver, Slavery, and the Development of Occupational Health. For the purpose of this Keynote the author will present brief information from three of the thirty proposed book chapters: Hispaniola, New Spain (Mexico), and the last chapter on the Welsh Slate Industry. This will cover how the first Spanish missionaries were sent to the Indies (the Americas), and their efforts to try to improve working conditions for Indians forced to work by the Spanish colonists at the gold and silver mines. Some of the early Spanish Crown letters and instructions sent to protect African slaves and Indians in the Indies will also be discussed. The talk will end with brief information on the Welsh slate industry, which was originally funded from African slavery, and on the very distinguished nineteenth-century geologist and mining engineer, Sir Clement Le Neve Foster. He served as one of the first Inspectors of Metalliferous Mines in the United Kingdom from 1872, and from 1880 until his retirement in 1901 was the Metalliferous Mines Inspector for the North Wales District where he also had responsibility for the underground slate mines. Some examples will be given of his conspicuous service to protect the health of metalliferous and slate miners in the nineteenth century.
Jean Rodier (3 April 1920-9 June 2003) arrived in Morocco by accident in September 1945. He
became attached to the country and decided to return the year after he received his doctorate in
pharmacy, to work at the Institute of Hygiene of Morocco in Rabat.
In 1946, he was appointed Head of the laboratories of toxicology and chemistry-physics at the
Institute of Hygiene of Morocco. He carried out considerable work in the field of individual
toxicology and was designated in this capacity as an expert at the Moroccan courts, including the
Court of Appeal.
In Morocco, he was particularly interested in the mining toxicology of lead, cobalt, antimony,
phosphates, and - especially - manganese poisoning.
Jean Rodier worked in the field of manganese and the disease that it is related to, manganism. This
exceptional work spanned nearly twelve years, combining field research, biological essays, dust
analysis, and animal testing at the Institute of Hygiene. The outcome of this research was a twenty minute medical short film on manganism, which was awarded at the 20th Congress of
Occupational Medicine in Helsinki in July 1957.
He also authored a significant number of works in the field of water. These were grouped into a
125-page introductory book first published in Rabat in 1951. In 1956, he published a second book,
the Manual of Biochemistry Practice, which gathered the teaching courses he gave while he was a
professor at the School of Laboratory Technicians of Morocco (1948-1958).
He was appointed Head of the Industrial Hygiene Laboratory in Morocco from 1955 until his
departure in 1958, and organised the Centre for studies and research on occupational hygiene in
Morocco in 1956, at the dawn of independence.
During his twelve-year stay in Morocco, Jean Rodier wrote 70 articles, almost all in French,
favouring national journals including Bulletin de l'Institut d'hygiene du Maroc and Maroc medical. He
also occasionally published in Les Archives des maladies professionnelles and a review in La Revue
neurologique in 1954.
He won the medical prize of Morocco in 1949 for his work on manganism, and the scientific prize
of Morocco in 1957. He was decorated Knight in the Order of Academic Palms on 3 January 1961,
for all the work he achieved when he lived in Morocco.
Background: Occupational health and safety services are crucial for sustainable development,
reducing accidents and diseases. Improved worker health and safety boosts productivity, job
creation, and industrial harmony. Since Tanzania's independence in 1961, occupational health and
safety standards have been governed by the Factories Ordinance CAP. 288 of 1950. The
nationalisation policy of 1967 led to ineffective enforcement of occupational health and safety
standards, due to the Government's role as employer, enforcer, and regulator. In the 1990s,
factories were privatised, causing management to prioritise production over occupational health
and safety. Therefore, the Government established the Occupational Safety and Health Authority
(OSHA) in 2001 to improve workplace health and safety, reduce accidents and diseases, and
achieve better productivity through enforcement and promotion of occupational health and
Methods: This was a review of the published documents related to occupational health in
Tanzania. The following published documents were used in the review: Factories Ordinance CAP.
297, promulgated in 1950, Occupational Health and Safety (OHS) Act 2003, National Occupational
Health and Safety Policy 2009, A Performance Audit Report on the Management of Occupational
Health and Safety in Tanzania of 2013, Occupational Safety and Health Authority (OSHA) Strategic
Plan 2021-2026, Occupational Safety and Health - Country profile Tanzania 2014, and Status of
Occupational Health and Safety and Related Challenges in Expanding Economy of Tanzania of
Results: Occupational health services are accessed by less than 5% of the working population in
Tanzania. Only 24% of targeted formal workplaces were registered. OSHA has only 45% of the staff
needed for them to perform their duties efficiently. Few doctors are qualified as occupational
medicine practitioners (< 10 in the country). Over 80% of Tanzanians lack OSH law coverage and
occupational health services.
Conclusion: Tanzania needs to develop an effective institutional framework to enhance OHS in
the formal and informal sectors. Also, it is vital to develop a solid and effective research capacity in
Notwithstanding the deep history of the South African-born Chinese community, discourses of
'othering' and 'exclusion' continue to be developed around them. The unremembering of Chinese
indentureship to the South African Chamber of Mines in the early 20th century, in the so-called
'Chinese Experiment', is a case in point. Over 64 000 Chinese workers were subjected to extreme
forms of exploitation, which included exposure to known deadly working conditions, police
violence, and the legalised access to narcotics. While international historiography of Chinese
indentureship as a system of exploitation is extensive, the post-indentureship fates of Chinese
labourers is largely unknown and uncertain. For those indentured in South Africa, even less is
known since all were repatriated, excepting a small number of escapees, at the end of the scheme
in 1910. The only South African indentured-Chinese labourers for whom we have certain
knowledge are the group skeletons held by the Raymond A. Dart Collection of Human Skeletons at
the University of the Witwatersrand. By reflecting on the continued possession and use of those
skeletons for scientific research, this paper will pose broader questions regarding our professional
practice. Are we unremembering the migrant workers of the 2022 Qatar Football World Cup? Do
mandatory medical measures involve a degree of unremembering? Do our national healthcare
systems unremember workers? It will be suggested that only a change of paradigm to a workercentric, serviced-based model of occupational health and safety, where worker agency is
enhanced, will ensure that we, the professionals, listen and remember.
Against the background of informal work, and the intersection of the location of formal occupational health and safety (OHS) with formal work and workplaces, on the one hand, and global changes in the world of work on the other, the global research and advocacy organisation WIEGO (Women in the Informal Economy: Globalising and Organising) undertook research which aimed to explore and assess potential points of entry for the extension of OHS to the majority of workers in the global south, who are informal workers often working in informal workplaces. Starting in 2010, WIEGO worked through and with affiliated informal worker organisations in Brazil, Peru, Ghana, Tanzania, and India. Those involved were poorer workers in cities, with a focus on poorer women. The occupational sectors were industrial outwork (piece rate work in private homes), street and market vendors, waste pickers and domestic workers. Key aims of the study were to understand the risks faced by workers in their workplaces; identify how to modify legal and institutional barriers to including informal workers and workplaces in OHS; understand the allocation and control of primarily municipal resources to informal workers; support organisations to make focused demands for OHS interventions; and to help build in-country research and organising capacity in OHS for informal workers. Based on this empirical work, the paper will present lessons learned for policy development at local, national and international levels, and for practical implementation at municipal level. While the challenges in moving towards a more inclusive occupational health and safety practice are enormous, representing a significant break with the past, the comparative country research initiative points to avenues that can be pursued towards a post-colonial vision of OHS. This will require, however, a serious and sustained commitment from intellectual and professional leaders in the occupational health discipline.
In response to labour shortages during World War II, the Bracero programme enabled 4.6
million Mexican migrant men to work temporarily in the United States(US). The programme
began in 1942 but continued until 1965, well after the War. Workers(braceros) primarily
served Californian agriculture. This presentation describes the history of the largest guest
worker programme inUS history, focusing on occupational health and social issues. Sources
include: published articles, unpublished reports and public access documents, and historical
archives. While the programme helped provide cheap labour, braceros suffered from poor
working conditions and mistreatment by US employers. The US and Mexican Government backed programme promised a minimum wage, sanitation, housing, food, and protection
from racial discrimination. It attracted many impoverished rural Mexicans desperate for
work. In reality, however, the selection process for braceros was lengthy, humiliating, and
tainted by corruption. Agricultural employers frequently ignored governmental guarantees,
resulting in unpaid wages and substandard food and housing. The work was demanding and
hazardous. While injury data specific to braceros were not collected, in 1957 there were 50
disabling injuries/1000 workers in agriculture versus 32.4 disabling injuries/1000 workers in
all industries. Piece-rate compensation, the need for rapid work, and improper tools likely
contributed to high rates of injuries. Ignored safety regulations and transportation accidents
resulted in numerous fatalities. Braceros were unable to improve their working conditions, as
they were denied the right to representation and collective bargaining; those who filed
complaints and insurance claims faced retribution and deportation. The programme ended
due to increasing recognition of the hazards faced by workers, expansion of mechanisation,
and a successful labour movement leading to the formation of the United Farm Workers. The
Bracero programme allowed the US agricultural industry to grow, while severely exploiting
individual Mexican workers and influencing trade agreements to this day.
"How can we know what happened in the past? We cannot travel back in time, ask the people who were
alive long ago. Historians use evidence that survives from the past. Like detectives, they search for clues.
They piece together what they think the past was like." (How do we know? Kimberley, Mc Gregor
Searching for evidence on women in male-dominated work is hard to find, yet the hidden path of
women and girls forced into mine labour in Italy, from the beginning of the nineteenth century, will
be discussed in this paper.
In Italy, women were forced into carrying the ore out of slate quarries (slate contained 25% of silica)
(Meeting of Italian Scientists in Genoa, 1846); selecting lead and zinc minerals in Montevecchio
mines (Sardinia), where in 1871 eight girls (10-15 years old) and three women died due to the fall of
a wall (Peis Concas I, 2010); and going down sulphur mines for twelve and fourteen hours sometimes
during the night (Jessie White Mario, 1894). At that time, Sicily was a British trading colony (Kutney,
2007) and the 'track system' was imported, although it had been forbidden in England since 1834.
"Sulphur mine industry occupies many thousands of workers of every sex and age...hundreds and
hundreds of boys and girls go down on steep ladders along paths carved in wet ground at risk of
landslide" (Villari P., Letters from the South, 1875).
Montessori, one of the first Italian women medical doctors, attended the London International
Council of Women in 1899 to ask for the prohibition of women and children under the age of 14
years from working in sulphur and other mines (ICW Proceedings, London 1899), inspired by the
Factory Acts. In 1902, Italy finally had its first law on limiting women and child labour. Women in
South African copper mines and the data on silicosis among women concludes the paper's path
This paper addresses the understudied subject of women in the history of occupational and
environmental health and safety (OEHS) during the last 60 years in Africa. It is a period of critical
importance for the economic development of Africa. The past 60 years has seen many countries in
Africa gain their independence, increase their economic growth across both industrial and
agricultural sectors, and the emergence of trade unions as well as improved OEHS legislation.
However, the role of women in the history of OEHS in Africa is understated.
What is the historic role of women in these developments? Scattered sources of information,
including 'grey literature', suggest women have, over the decades, played an important role in
OEHS legislation and policy development, in teaching and training, in advocacy for improved
conditions of work, for child care and maternity and paternity leave, and for OEHS medical services
as well as freedom from violence. To explore this history and start a more informed discourse that
encourages research in this area, we are obtaining perspectives from different OEHS stakeholders
and some key informants in several countries in Africa.
The review of records will be triangulated with the results of a survey and interviews with OEHS
stakeholders and key informants in several countries in Africa, using a qualitative interview guide
informed by a structured literature review. The paper will elaborate on how women played an
important role in the history of OEHS during this significant economic period of Africa's
development. Women asserted their role and contributed to shaping, improving, and remaking
subsistence as well as public and private workspaces during this period.
For over a century, African minerals have played a particularly important role in fueling industrialised life across the globe. Today, the toxic residues of mineral extraction and use continue to plague communities throughout the continent - along, of course, with more recent forms of industrialised contamination. As the planet's environmental crisis continues to worsen, I argue that - contrary to stereotypes of Africa as marginal and "lagging" behind other continents - we must look to African experiences to understand the present and future of working and breathing on our planet. I explore this theme through two examples: large-scale gold and uranium mining in South Africa's Gauteng province, and air pollution in west African cities.
Poster Presentations and Discussion for Day 2 (17 November 2023)
Zambia's economy has largely been mining dependent, with the copper industry dominating for
more than eight decades. Increasing global demand for copper, combined with the liberalised
local economic policies pursued since the early 1990s, has seen the industry grow as old mines
were revived and new ones opened. Despite the greater economic opportunities the industry
offers the country, mining has attendant risks such environmental and health risks. We examined
the air pollution and respiratory health risks related to mining activities in the main mining area of
Zambia, the Copperbelt, from 2000 to 2018.
Sulphur Dioxide (SO2) and particulate matter of aero-dynamic size PM10, and PM2.5 were
predominant ambient pollutants from the mining operations over the years. Main sources of
pollutants were flue gases from smelter operations, and dusts from within the mines and blown
from abandoned waste rock. Emissions of PM10 amounted to 406.8 kilotonnes/year (kt/yr) and this
accounted for 35% of the total emissions. Similarly, SO2 emission of 346.7 kt/yr were reported. The
mines' operations contribute over 98% of the country's SO2 emissions. Recent investments in
mining activities are expected to yield even increased SO2 emissions because of several new
copper smelters. SO2 and PM emissions for most of the five large-scale mines, with smelters and
other licensed dischargers, were above national set limits by between 111-155% (the Zambia
Environmental Management Agency standards). Most residential areas in mining towns lie directly
within the affected vicinity of the smelters. Generally, studies reported that for an increase of 10
, the daily number of admissions of asthma in children increased by 1.3% (95% Cl 0.4 to
2.2%), while an increase in PM10 level by 10 ?g/m3 was associated with 1.27%, 1.45%, and 2.00%
increase in hospital admissions for heart disease, chronic obstructive pulmonary disease, and
Artisanal mining is one of the main sources of income in Rubaya, DR Congo. In the squares of open
land amidst the verdant vegetation of the territory of Masisi, in North Kivu, we do not see powerful
excavators, but simply shovels, pickaxes, and muscular arms to handle them. Carriers, more or less
solidly built, replace the trucks. They evacuate the ore via the small paths gullied by the torrential
downpours that fall on the region during the rainy season. In Rubaya, 45 km from Goma, a dozen
open-pit mining squares exploit niobium, cassiterite and coltan (colombo-tantalite). Around the
gutted earth, transformed into a mud pit at the slightest rain, young people of school age work:
digging, washing minerals, sorting, transport, etc. Judging by the grimacing faces of the young
people who work tirelessly, all the tasks seem exhausting. These ores will be used in particular for
the manufacture of capacitors, present in all electronic products. Demand does not seem about to
decrease, as the new digital economy is greedy for it. In 2011, the Congolese Government
submitted a national action plan to the International Labour Organization (ILO) to end their work
in the mines. In particular, it planned to "make known and apply the legislation relating to child
labour", "make technical and professional training accessible", and "give access to an education
programme for children removed from work". It also commited "to improve the living conditions of
vulnerable households", so that socioeconomic vulnerability does not push families to make their
children work. The programme was ambitious, but it never passed the milestone of official
adoption. The children working are exposed to neglected tropical diseases, tuberculosis,
respiratory tract infections, HIV/AIDS, and viral hepatitis B. There is also a major risk of the diseases
being spread in communities and increases in mortality rates of school-age children.
Agbogbloshie e-waste site has existed for nearly 27 years, with a current workforce of ~4 500-6
000 workers, often untrained individuals who learn the trade on the job. This site started as a scrap
market where various services such as vehicle repair, spare parts trading, welding, auto mechanics,
and tyre servicing were rendered to support operations of trucks supplying foodstuffs to the yam
market on the edge of the Korle Lagoon. This scrap market expanded and transitioned into an
informal e-waste recycling hub, as many young males from the northern sector of Ghana, escaping
the intertribal conflicts and unfavourable agricultural conditions, as well as seeking better
livelihoods in Accra, enrolled for this job.
Rapid growth in informal electronic waste recycling activities (delivery and receipt, sorting, manual
dismantling, and open burning) at Agbogbloshie, Ghana, has been propelled by a lack of stringent
enforcement policies and cost-effective technologies to properly manage e-waste
recovery/recycling. Usage of rudimentary techniques in recovering valuable materials and
associated pollutant emissions have not changed much, even after the passage of the Hazardous
and Electronic Waste Control and Management Bill in 2016. Pollutants emitted, especially from the
black plumes observed from the open e-waste burning, are destructive to the environment and
resources. Worker exposures to these hazardous working conditions, and pollutants in various
environmental media at the site, predispose them to several health effects. Exposures among ewaste workers over the years have been assessed mainly through cross-sectional studies. These
have estimated trace metals and organic pollutant concentrations in environmental (soil, air, fish,
sediment, water) and biological (blood, serum, urine, hair) samples. Worker health studies have
reported increased risk of respiratory symptoms and lung function decline among workers.
Findings from these studies have been useful in implementing health promotion campaigns and
have also encouraged stakeholders to build a wire-stripping workshop, a clinic post, and a
technical training support centre for the e-waste workers.
Poster Presentations and Discussion for Day 2 (17 November 2023)
Bernardino Ramazzini lived and worked in Modena and Padua, Italy, around the turn of the 16th
century. He published a collection of his orations and notes in 1710, called The Health of Princes.
The book deals with public health in respect of the lifestyle, environment, and medical treatment
of both simple country folk and nobility.
The presentation will analyse Ramazzini's writings and observations about fevers, health in
general, and lifestyle in Italy 300 years ago, with a discussion of the medical treatments provided.
Ramazzini was fond of relating medical anecdotes and theories. He published extensively, so much
so that his publisher grew weary of his prescientific writing, saying the doctors wanted to read
about clinical guidance rather than 'theories'. As a result, Ramazzini had to pay for the publication
of the last chapter of The Health of Princes himself.
Ramazzini had strong opinions on the common blood-letting practice of the time; unlike many of
his colleagues, he was not in favour of this as a panacea. He relates his treatment success in the
section Epidemic Constitutions of Modena over a five-year period (1690), where the patient - a poor
farmer - was suffering from a 'double tertian fever' with parotitis, and how "without taking any
other kind of remedy, his good health was restored by drinking abundant wine".
The possible medical background and mechanism of the treatment used in this case, among
others, is discussed.
The presentation will compare the medical thought and practice in Ramazzini's day with today,
and distil from the book some guiding principles still relevant for current public health.
Findings from these studies have been useful in implementing health promotion campaigns and
have also encouraged stakeholders to build a wire-stripping workshop, a clinic post, and a
technical training support centre for the e-waste workers.
Background: Paints are chemical products, which consist of resins, additives, solvents, and
pigments. Exposure to paints can cause occupational contact dermatitis (OCD), which affects
workers' productivity and working performance.
Objective: To describe the history of paints and OCD among paint workers.
Methodology: A retrospective cohort study was conducted; data were obtained from a literature
review based on occupational history of paint and OCD among paint workers, from ancient times
Results: During the 1700s, paint production began in Europe and the United States. Further
production demands arose after Second World War. Paint composition has changed over time;
currently, solvent-based paints have been replaced with water-based paints, which require more
preservative than the predecessors and, thus, increase risk of OCD in paint workers. In the 1960s,
benzisothiazolinone (BIT) was introduced in the paint industry as a preservative, which resulted in
an OCD case of two paint workers. A report was published in 1976, and BIT was identified by
Danish as an important allergen to painters. In the 1980s, Isothiazolinone preservative and its
derivates (methylchloroisothiazolinone (MCI), methylisothiazolinone (MI), BIT, and
octylisothiazolinone (OIT)) were highly used and OCD cases increased. Also in 1982, the first two
cases due to OIT usage among workers were published. In the early 2000s, MI was introduced as a
preservative in industrial products, where the first cases of OCD due to exposure were reported by
Isaksson. In 2013 MI was named as 'Contact Allergen of the Year' by the American Contact
Dermatitis Society. Exposure to MCI/MI had increased, by more than six times, the OCD cases
among workers from 2008 to 2015.
Due to contact with different allergen and irritants, paint workers were at risk. In the United States,
an estimated 13 million workers are exposed to chemicals each year and are at risk of developing
Conclusion: Excessive usage of chemicals in the paint industry has increased OCD cases among
paint workers through history.
Introduction: Workers represent half the world's population and are the major contributors to
economic and social development. However, millions of men and women have paid work that is
performed under poor and hazardous conditions. Lack of adequate workforces to curb the
situation faces developing countries. The project aims to build capacity for the universities in
Tanzania and Ethiopia in collaboration with University of Bergen, so as to produce a faculty and
workforce for quality research and training in occupational health. The effort started during the
Fogarty International project for southern Africa and was followed by the Norwegian Agency for
Development Cooperation (NORAD) project.
Methods: The universities in Tanzania (Muhimbili University of Health and Allied Sciences
(MUHAS)), Ethiopia (Addis Ababa University (AAU)), and Norway (University of Bergen (UiB)) are
working together to build the capacities of their institutions, in terms of improving teaching
quality and increasing the number of teaching staff, improving laboratories, and enhancing
libraries and online training. The project started in 2014 and will end in 2019. The development of
an online course on occupational health, Skype, and biannual meetings in Tanzania with partners
are used for regular communication among participants
Results: A total of thirty-five Master's students graduated in Occupational Health and Safety. Three
PhD and four postdoctoral candidates have done research in occupational epidemiology,
combined with exposure studies. Two laboratories have been strengthened by procurement of
equipment. One online course has been developed and a book produced. Thirty-four original
manuscripts have been published in peer-review journals, and thirty-one abstracts have been
presented at conferences. A gender sensitisation workshops has been held at MUHAS and AAU.
The knowledge sharing between AAU, MUHAS and UiB helped the project team. In 2006, the
Tanzanian Department of Environmental and Occupational Health had three faculties, the
Occupational Safety and Health Agency (OSHA) had two, the Occupational Health Services had
two, and the Workers' Compensation Fund did not exist. The various collaborations, starting with
Fogarty/NIH, Work and Health Southern Africa (WAHSA), NUFU, and NORAD, created a substantial
number of competent occupational specialist and laboratory facilities for sampling of occupational
exposures and analysis.
Conclusion: The number of occupational health practitioners in Tanzania has increased due to the
efforts of several players in the region (South Africa) and elsewhere. Different projects at different
times, such as WAHSA, NORAD, Netherlands Education Support Office (Nuffic), and Fogarty
International/NIH have been critical to capacity building.
On 8 October 1947, the first South African Society of Industrial Health was established. The
Constitution has been in existence since July 1948 as a group within the Medical Association of
South Africa (MASA), presently known as the South African Medical Association (SAMA).
Since then (and still applicable today), the standards of moral or ethical decision making are:
The workman must retain the right to choose his own doctor and that it would be
incumbent on the factory medical officer to retain any fees so earned by him, and
The Society will not at any time enter into discussion or negotiations with any other
individuals or organisations regarding remuneration for services rendered by its members.
At the annual general meeting (AGM) in 1951, the 'Rules in the case of part-time and full-time
medical appointmentsto factories and similar industrial organisations' were formulated. At the
1958 AGM, it was agreed to open membership to all members of the Medical Association of South
Africa who have occupational health interests.
The name changed in September 1957 to the South African Society of Occupational Health. The
Society was renamed again, in August 1985, to the South African Society of Occupational Medicine
(SASOM) - as it is known today.
SASOM successfully initiated the Occupational Health Southern Africa Journal (OSHA Journal) in
1995, achieved recognition of occupational medicine as a separate medical specialty in 2005, and
hosted the International Commission on Occupational Health (ICOH) 29th Triennial International
Congress on Occupational Health in Cape Town in March 2009.
Current interfaces in South Africa are with NIOH, SASOHN, SAIOH, MMPA, SASTM, OTOH,
Universities, FCPHMOccMed(SA), HPCSA, COHSASA, Department of Employment and Labour
(DoELForum), and Occupational Health Southern Africa Journal (OHSA Journal). International liaison
and collaboration include the ICOH, Occupational Health in the Chemical Industry (MEDICHEM),
and the International Occupational Medicine Society Collaborative (IOMSC).
The development of occupational health and safety (OHS) laws in Ghana has been driven mainly
by developmental and historical antecedents in the mining industry. Health and safety concerns
first gained prominence following agitations among the indigenous labourers from the northern
territory in the (then) Gold Coast. The labourers complained of high rates of morbidities and
mortalities from tuberculosis and injuries as a result of poor sanitation, housing, and workplace air
quality in the mines. The series of protests and worker agitations led to the first occupational
mortality audit in the mines and the subsequent passage of several mining health legislations,
including the Mining Health Ordinance to address mining area sanitation, housing, and worker
health issues. Since 1925, when the first mining health ordinance was passed, several other laws
have been promulgated. In fact, health and safety is a right guaranteed to all according to the
1992 Constitution of Ghana.
The three main statutes that have informed implementation of OHS in Ghana post-independence
are the Labour Act 651 (2003), the Factories, Offices and Shops Act 328 (1970), and the Workman's
Compensation Law PNDC Law 187 (1987). Others include: International Labour Organization (ILO)
Radiation Protection, 1960 (No.115), ratified in 1961, Mining Regulations LI 665 (1970), EPA Act 490
(1994), Ghana Health Service and Teaching Hospital Act 525 (1996), Atomic Energy Commission
Act 588 (2000), Public Health Act 851 (2012), and the Petroleum Commission Oil and Gas OHS
policy: LI 2258 (2015).
Although, there are legal instruments regulating most of the workplaces, these laws are
fragmented. Moreover, the absence of a national policy on OHS in Ghana prevents the proper
regulation of the occupational health space in Ghana. A draft bill of the OHS national policy is yet
to be enacted into law.
In the Philippines, efforts to promote occupational safety and health were already evident during
the American Period in the Philippines, with the institution of the Employer's Liability Act No. 1874.
The Act directed employers to compensate the family of a deceased worker whose death was
caused by workplace conditions, or by the neglect of employers in the execution of their duty to
protect the safety and health of their employees. There are other subsequent legislations aimed at
providing occupational health and safety. The Workmen's Compensation Act, through Act No. 3428
of 10 December 1927, required compensation not only for death but also for illnesses and injuries
caused by workplace exposures. Commonwealth Act No. 104 (29 October 1936), called the Industrial
Safety Law, enforced certain rules and standards for the mining industry. Republic Act No. 1054, or
the Free Emergency Medical and Dental Treatment Act (12 June 1954), stipulated the need for
emergency dental services to employees. In 1903, physicians began to be employed in industries to
provide medical treatment for sick and injured workers. During 1923-1932, the Section of Industrial
Hygiene was established under the then Bureau of Health. This was followed by the implementation
of the Workers' Compensation Act No. 3428 and the Emergency Dental and Medical Service Act No.
1054. After World War II, the Philippine Association of Occupational Medicine (now PCOM) was
formed (www.doh.gov.ph). In 1950, the Joint International Labour Organization-World Health
Organization (ILO-WHO) Committee on Industrial Hygiene issued its first international definition of
occupational health. Finally, the history of occupational health and safety started with the functions
and structure of the Department of Health. By virtue of E.O. 119, the DOH Office of Public Health
Service was created, which had the Non-Communicable Disease Control Service tasked with the
responsibility of formulating policies, programmes, and standards primarily for the prevention and
control of occupational health, cardiovascular diseases and cancer.
The title of occupational hygienist first came into use in Norway in the 1970s, starting with the
Norwegian Labour Inspectorate employing academics with a chemical or physical background,
and training them in the field of occupational hygiene. Part of the training was conducted in
Sweden. Before, the term 'occupational hygiene' mainly was used in Norway to describe the field
of preventive occupational medicine.
The first occupational hygienist in Norway recognised by the Norwegian Occupational Hygiene
Association was Karl Wulfert. He came to Norway in 1928, after he had finished his PhD at the
University of Munich (Germany) and had worked for a year in Sweden with the later Nobel Prize
Winner in Chemistry, Prof. von Euler. From 1931, he was involved in building up the new fish
canning laboratory in Stavanger. In 1947, he became chief chemist at the new Laboratory for
Chemical Analysis and Assessment of Exposure in Norwegian Working Life in Oslo. This laboratory
was the precursor of what later become our National Institute of Occupational Health. In 1977, we
got the modern Worker Protection Law, the same year the first academic position in occupational
hygiene was established at the Norwegian Technical University (NTH) in Trondheim. Our first
professor was Egil M. Ophus. The year after, we got our first occupational exposure limit (OEL)V list.
The Norwegian Occupational Hygiene Association was established in 1985. By 2022, the
Association had grown to approximately 380 members. The number has been stable over the last
10-15 years. The density of occupational hygienists in Norway, based on the number of members
of the association, is approximately 8 500 workers per occupational hygienist. This places Norway
among the top countries in the world; however, the numbers are still considered to be too low to
ensure sufficient protection of the workers.
A trade union is a workers' organisation that advocates for, and protects, the interests of its
members on matters such as working conditions. The three main categories in the definition of
environmental health (physical, biological, and chemical) establish working conditions in the
workplace that have a direct impact on human health. Understanding the concepts of
occupational hygiene (recognition, identification, evaluation, and control) enables agenda
formulation and trade union involvement in maintaining the sustainability of environmental and
occupational health in respective workplaces. In the context of Marxist economic analysis, a
capitalist society was divided into two classes: the bourgeoisie (business owners), who owned and
controlled the means of production, and the proletariat (workers), whose labor converted raw
commodities into marketable goods. The proletariat does not own the means of production and
has little power in the capitalist economic system, despite being paid the lowest possible wages
and being easily replaceable in times of high devaluing perceived worth, due to health effects and
ill health. Business owners had to get the most possible work out of their laborers in order to
maximise profits. Workers' health and safety were not prioritised in this system. Marx, on the other
hand, predicted that employees would become dissatisfied with their jobs and resentful of
company owners. The revolution would be headed by enlightened leaders known as 'the
vanguard of the proletariat', who understood the class struggle and would unite the working class
via increased awareness and class consciousness. According to the Labour Relations Act of 1995,
these leaders are referred to as trade unions. This paper discusses trade unions' involvement and
contribution to the sustainability of environmental and occupational health at workplaces,
through agenda setting of influence or determination of a programme of action through
negotiations, participation, and engagements with employers, employees, and stakeholders such
as labour inspectors.
Occupational Health Southern Africa is the only accredited occupational health journal in the
region. It was founded in 1995 by the South African Society for Occupational Medicine (SASOM)
and the South African Society for Occupational Health Nursing Practitioners (SASOHN), and was
later joined by the Southern African Institute for Occupational Hygiene (SAIOH) and the Mine
Medical Professionals Association (MMPA). The journal provides a platform for scholarly
engagement through the publication of peer-reviewed research articles, opinions, reports, news,
and related matters.
In 2004, the journal was accredited by the South African Department of Higher Education and
Training and, in 2011, it was added to the SABINET African Journals online platform to enhance its
accessibility and visibility. It is also listed on African Index Medicus. In 2017, the manuscript
submission and review processes moved to an online platform. The COVID-19 pandemic
necessitated a switch from print to digital publishing in 2019, which also prompted the overhaul of
the website to make it more appealing, and comparable to top international scientific journal
websites. That same year, an Editorial Advisory Panel, which includes international occupational
health experts, was constituted to augment the expertise of the Editorial Board, which is
constitutionally comprised of representatives of the stakeholder occupational health societies.
Over the years, the Editorial Board, Advisory Panel, and publisher have worked to transform the
original magazine-type publication into a respected scientific journal. The journal conforms to the
policies, procedures, and guidelines of the Committee on Publication Ethics (COPE) and the
International Committee of Medical Journal Editors (ICMJE) to promote best practices in
publishing. Despite the small team, 169 issues have been published to date, all of which are on the
website www.occhealth.co.za. Efforts are underway to apply for international accreditation and to
increase Occupational Health Southern Africa's footprint on the African continent.