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FILE NAME: Metropolitan Life (ML) DATE: 1952 DOC#: ML160 DOCUMENT DESCRIPTION: Journal Article by Dr. Abrams - Labor, Management, and the Official Agency - Relationships Illustrated by Plant Study Volume 42, 1952 IN D E X J anuan hbruarc March \pril VI a \ J unt' Pages VIM n s ~U2 233-352 353-498 499-648 649-778 July August September October November December Pages 779 904 905- 1040 1041 1227 1223 1366 1367' 1506 I 1507 164? *i ! ,ir Until, l l m ? Suppkimnt lo M.u Jouriu! A M E R I C A N f 'r m . K ' H E A L T H . ASSOCI,v u o x . I X C' 1790 Buo urn ay y' f v , V g k k 1 9 , X V 'V Oeoige Washington ' - ii'ierlical Lib!aiy ; ;35 H Stfsei, ri v> Mcir.ii'finii 'i ! 1 `X m m X M J tm -W t .y y - Labor, Management, and the Officiai Agency--Relationships Illustrated by a Plant Study* HERBERT K. ABRAMS, M.D., F.A.P.H.A. Chief, Bureau of Adult Health, Laltlarnta State Department of Public Health, Berkeley, Calif THE work of a governmental mdustnal hygiene agency involve;, activi ties which are more complex than the control of occupational diseases. In vestigation of occupational health haz ards, measures for (heir prevention, promotion of good health services in plants-- these are the cardinal elements of the program, But in the background of all of these and directlv bearing on the success or failure of the progTam are the more complex social and economic factors, for example: attitudes of labor and management to health measures, attitudes of labor and management to each other- and attitudes of these groups to the governmental agency, A governmental industrial hygiene agency must observe certain basic principles if its work is to be successful I It has primary responsibility to safeguard the health oi workers 2 Its technical work and its policies must be unbiased 1 It must be able to speak authoritatively refunding; health hazards and the adequacy ol measures for protecting the health of e m ployees t It mus t be able to interpret intelligently us pro gram to Labor and management and to the health provisions ' It should endeavor so to conduct studies that not only the plant's previous ' Presented beli-Vu the IndlzllrV-i Hy.pcnc Vceotl i.l the tenerum i Public H c 'ilh V'-'.cti'.uon u 'he s.-.-.G-, ntneh Annuii M tclln; in Asa tranci,en c -m Celebri SO, ISSI methods and proerams but also ils own are improved thereby. UNION REQUESTS STUDY Recently, the Bureau of Adult Health, California State Department of Public Health, had a particularly challenging opportunity to test these principles The union at a large lead smelter came to the bureau in search of medical advice on the lead problem The initial re quest was for advice concerning the adequacy of provisions in the collective bargaining contract on protection of employee health from lead They com plained that whereas formerly four blood smear tests per year on each man had been mandatory, the company had suddenly abrogated this policy and in stead was doing less frequent testing and then only on the urine Union repre sentatives also complained that the men were not being informed of the results of the tests taken. They suspected that (here was still a Ie3d haxerd in the work and they were concerned as to whether they were being adequately protected This approach was followed by a union request to the bureau that it in vestigate the entire plant tor evidence of lead hazards and make recommendations for control During the course oi and since the lundusion of. this project bureau per sonnel have been confronted with rnanv questions which arise in (he dailv bit Cot. of an official mi How do we hz Who gets The re written? How d pany ? How can at the same tim in a labor-rnana conclusion of tb gamed, or lost, agement, the t rally' Where industrial hygie should be the i essence, what i bility of a i hygiene agency these issues so report to the pc in stimulating tion of methods It was relatn the union men type of tests ch evidence of lean that the quant was superior t after conferrir medical staff, satisfaction tha conscientious l as many urine ! whose findings and less frequei for whom it v Bureau represen plain this pohc>' accepted Ihe to learn that it b to become an had failed to reasons for the agement appre cleared up During the the bureau . u held in the h tentative? of th including one ical repi event, met toe-, the, Voi. 42 O ccupational H ealth H azards 39 of an official industrial hygiene agency How do we handle a union request? Who gets the report? How 5 the report written? How do we work with the com pany? 1How can we do an honest job and at the same time not become embroiled in a labor-management dispute? At the conclusion of the project, what has been gained, or lost, by the workers, the man agement, the bureau, the people gen erally? Where private medical and industrial hygiene facilities exist, what should be the extent of our work? In essence, what is the role and responsi bility of a governmental industrial hygiene agency? This study pointed up these issues so strikingly that we felt a report to the profession would be helpful in stimulating discussion and clarifica tion of methods. It was relatively simple to explain to the union men the rationale behind the type of tests chosen by the company foi evidence of lead poisoning. We explained that the quantitative test on the urine was superior to the blood smear and after conferring with the company medical staff, we also learned to our satisfaction that they were following a conscientious checking program-- doing as many urine tests as necessary on men whose findings or exposures were high, and less frequent testing on those men for whom it was found unnecessary. Bureau represents lives were able to ex plain this policy to the union and it was accepted. The company was chagrined to learn that it had permitted this rnattei to become an issue simply because it had failed to inform the union of the reasons for the change in policy .Man agement appreciated haring this poim cleared up During the course of this episode, ai the bureau's initiation, conferences wine held in the bureau offices with repre sentatives of the union and the company includin', one conferrnce in '."Inch med leal repiossntetu'es oi the two groups mi i 10 .',,fitr h ,-p-, dunny his 0 -iiorl that the company agreed to cosponsor, with the union, an invitation to study the plant for lead health hazards. However, collective bargaming talks became deadlocked over economic issues and the projected study had to be post poned because of a 90 day strike. It was m this atmosphere that tbc bureau later commenced its study THE STUDY While the bureau realized a need to combine medical with engineering pro cedures, only an environmental study, including air sampling and chemical analysis for lead, was at first contem plated. Upon completion of the en vironmental phase of the study, it became apparent that a clinical study of the workers was essential to evaluate correctly the extent of the lead health hazard. Such a study was proposed to both the union and the company and both agreed. Both groups were informed that none of the findings would be re leased until after the medical study was completed The environmental phase of the project was conducted with as full par ticipation by the company and union as any agency could hope for. Each time an engineer of the bureau took air sam ples, he was accompanied by a repiesentative from the company and one from the union Parenthetically, it is of interest to note that the time of the union representative was paid for by the union When the union man felt that the particular process being sampled was not 111 tspica 1opeiation at the time, the bureau engineet would anange foi additional samples ;l( other nines .Ample opportunity was given to both sides to tec the method of sampling and to object 11 eithei thought anythin;-: was wrong, fn 01x10 cases, an industnal hygienist from the company took samples at the ame -ucs. ind th u . v rs oppoitumty l.u.i id tnmp;xe 1 .suits, although riw bu,':eu made : rle."i ii di, comperi; 40 A m erican J ournal of P ublic H ealth Jan.,iysz Vol. 42 i that it would report only its own re dithizone and spectrographic methods. sults. irrespective oi company findings In addition, porphy rinurias were de Discussions with management and termined as an experimental project, with the union look place before the and with the aid of equipment and a engineering sampling Following these chemist furnished by the company to meetings were also held 'n learn the time the bureau. It was understood that the spent by employees in different ex porphyrin tests would not be considered posures on which to establish 8 hour in the results of the study but would ( 'weighted' ) exposure levels for jobs. serve as an incidental research project to 1 Before the medical study was planned, evaluate its usefulness and compare its and again before it was begun, the in efficiency with the other tests trade unions, and on its own imtia quested by manap findings and rec< livered only to m: lieved that a volun of a problem is itse m it and hence 1 whatever hazard n When emploveemake a request formation to be obtained and the extent Summaries of clinical findings on each of medical study were cleared with both individual were sent as he directed, identical reports of both to manageme IWaiTniito#^ management and union representatives either to the plant physician or to his to the former bee The fundamental right of each employee own physician. sponsibihty for 1 to decide to wbat medical personnel his In summary of the laboratory work, mendations will I findings should be made available was 157 air samples were analyzed: over sponsibihty. to tb established and safeguarded from ihe 1,000 biochemical analyses done and union is the employ outset. Criteria to be used in evaluating over 500 blood counts and smears ex Since the study medical data were presented to and dis amined been requested im cussed with physiciahs for both the identical reports > union and management. These discus FINDINGS OF STUDY tecommendations i sions led us to revise some of our state Results of the investigation m this union and compar ments so that we could all agree on the study may be summarized as follows the report was sent meaning of the language used. As a re copy to managemr sult, company and union representatives approved in advance the validity of our interpretations of the data, and com municated their technical approval to l Inadequatelv controlled, Urge-scale ma< lenals-handling and processing operations, together with seeon dan sources of settled dust, resulted in a RenerQl plant atmospheric c o n tamination near the maximum acceptable con was followed to ass they were recemnii was so understood their respective organizations Thus the data we submitted, in effect became not just our findings but also theirs It is difficult to overstress the force of this point With the aid of the bureau public health analyst, a JO per cent crosssection sample of employees working in all departments was selected taking into cognizance length of employment Forms were prepared, and a physician and nurse team did the medical studv which included history, general physical ex amination and laboratory tests The battery oi tests included complete centration ( M A O of 0 1S milligrams of lead per cubic meter of air, and m the weighted. employee exposures exceeding this figure at all operations studied Jn part, these exposures resulted irom inadequate maintenance oi existing control equipment There was evidence of clinical effects at iributable to lead exposure In the '0 per cent sample ol emplovees examined i 103 out of s4.M 8 ' per cent showed cither excessive lead excretion (over 0 15 mg per liter ol ,mne> <.r more positive findings These were of a relatively mild nature. v When emplovees were grouped according to levels ol weighted atmospheric lead ex posure there appeared to be a direct correla tion between increasing lead exposure levels and the trequenev of clinical findings a t r e po r t ANt The bureau request mem round table nn pose of presenttne recommendations, to week after the wrtitt received Such a m the plant The rnmpanv ' -everal top admuns' national industrial the national medic, tional industrial by the local plant phys The union wars r blood count blood smears for stippling tributed to lead officers and by the and basophilic aggregation sedimenta 'horn it had rmp tion rate quantitative '.".ul determina P O L IO IN REPORTING <uKise the union 0, tions m blood and urine, urine albumin, Thi` Bureau of Adult Health makes and to enable the tin and. for good measure, urine sugar. Lead inviMuzalions ol occupational disease man who inuui per levels were determined hv both the (HoVem'- on toques-; of management. oiwNiai on a i.'eha- ' ,, -w "A = J W 5w o g p r Voi 42 O ccupational H ealth H azards (rade unions and official agencies, and on us on initiation. In studies re quested b> management the report of findings and recommendations is de livered only to management It is be lieved that a voluntary request for study ol a problem is itself evidence of interest in it and hence promises lorrertion of whatever hazard may be lound to exist When employees. throuKh their union, make a request for a bureau study, identical reports of findings are delivered both to management and to the union; to the former because the primary re sponsibility for carrying out recom mendations will be management s re sponsibility; to the latter because the union is the employees' representative Since the study under discussion had been requested initially by the union, identical reports of our findings and recommendations were given to both union and company The original of the report was sent to the union, and a copy to management. This procedure was followed to assure both parties that they were receiving the same report and was so understood REPORT AMD FOLLOW-VP The bureau requested a labor-managenient round table meeting for the pur pose of presenting its findings and recommendations, to be held about one week after the vjritten report had been received Such a meeting was held at 'be plant The company waa represented by 'evnal top administrative personnel, its national industria,! hygiene consultant, ;he national medical director the natl()nal industrial hygiene engineer arid !be Iin al plant physician fhe union was represented bv thiee offirrrs and by the medicai consultant whom it had employed especiallv to `UKisc the union on medical questions aod to enable the union to Iw e a spokes `Ran who could pam cipatc in the dis ' cssions nn a medici'1 kvri fhe' fortunate tn obtamins a physician with wide industrial experience and high pro fessional integrity The bureau was represented by several staff members The county health officer and health educator, who had been consulted throughout the course of the study, were also present. The report was read word for word by the bureau chief H stated there was need to protect the health of employees further both bv engineering improve ments and by individual safety practices This was evident not onlv in the jobs of highest exposure but also m areas now receiving too little attention by man agement and ttxi little understanding care by employees Wage differentials, it was pointed out are not an acceptable substitute for health protection While other specific recommendations were made. I should like to a te the two major ones: 1 A continuously operating local engineer ing control program should be established The objective should be not only to improve but also to maintain control measures so that lead furo and dust arc controlled at the point of emission in the plant, to the degree that working conditions art equivalent to na tionally accepted standards for the lead in duct nos 1 Participation of employees in measures for their own health protection is essential to successiul protection against occupational illness This must he hased on the individual's understanding of neressarv precautions An emplo>ce-manascmcni health committee should be established Us personnel should include employee representatives from fhe most im* portant plant operations and ^eograpbicaJ arcaj, an official union representative, the local industrial hsgicnc engineer, the plant physician an d /o t pla nt nursx. and other ropiec.*nt?..tiv\ of plant m a n a ^ em .n t Tins corrumtUe would serve as a cltarinn hi-ust foi health in fo rm a tion and should lead to a bettor undcnt-inding and cooperation between management and employees a basic condition tor the success of any plant health protection program The committee should both icceiVw from and fin der to managemi.nl and thi union periodic reports on thw hi_;Ith status bv plaru operation:, m d arr-'.s It should also .ubrfl't r re pon of U_ m t i\itiu i to "n'.'.n \nd nv, n', '-emL.tu - t lerat 'cmi?amr ii 42 A merican J ournal of P ublic H ealth Jan., 1952 Following the reading of the report, EVALUATION OF RESULTS there was general discussion Various What has been gained to date by the questions were raised to clarify specific company, the union, and the official parts of the report. The findings were agency as a result of this study? accepted by both groups without chal The company has now employed an lenge of any basic point. Most of the industrial hygiene engineer for the plant, discussion revolved about the recom The union has placed the labor-manage mendations. The company in general ment health committee on the collective agreed with these principles. Company bargaining table as one of its demands representatives announced their inten It is especially significant to us that the tion of employing an industrial hygiene union has not made any other health engineer for the plant in accordance item a collective bargaining issue nor has with one of our recommendations. They it demanded extra pay for jobs found to described improvements they had made be especially hazardous. We believe this in the plant in the past several years is evidence of an honest desire to effect and declared their intention to continue real health protection for the workers. improvement. Apart from health, very real savings out j The company declined to set up the of proper maintenance of control equip employee-management health committee. ment should result. j The union spokesman emphasized that While the bureau has put in the hands j this was the most important measure to of the union facts which may be at the be taken to improve the situation from moment embarrassing to the company, j the viewpoint of the employees. Fie thereby perhaps causing increased ten- j stressed the need for a mechanism to sion and resentment, this very procedure \ afford to both a two way channel of in once and for all creates the possibility formation and a voice in health matters of ending a long period of mutual dis- i at the plant. trust and suspicion nourished by pre Subsequently, the union called a vious failure to give the facts. The air membership meeting and invited its own is cleared for both sides to see the health medical consultant and a bureau repre issues, and to work together on them sentative to speak on the study Here rather than against each other < the results and recommendations were The study stimulated the union local explained to the rank and file of the lor the first time in its existence to en union. At this meeting the bureau gage a medical consultant The union stimulated frank criticism of the report, informs us that the workers themselves ; Various methods of dealing with man are showing a keener interest in personal ; agement and labor toward achieving health practices. * health protection were explored, and the The study, demonstrating the scope of fallacies of paying wages for removable health protection, has greatly strength risks were also discussed. It was agreed ened in the minds of both management that differences of opinion regarding and labor the importance of health J correct safety measures could be re services in industry. It has enhanced J solved only by scientific fact and the status of the company s medical and I not by bargaining The discussion industrial hygiene units within the com- J seemed to result in understanding of the pany itself ) teal need for two wav communication The newly employed industrial hy 'j with access to the facts and for accept giene engineei and the employee-man- | ance both hv management and bv labor agement health committee, working to of the employee's shaie in responsibility gether. will generally effect smoothei for health more efficient health protection meaxitu. Vol. 42 .Among other quests lor m equipment tr, gaining table The bureau ways The te fessional persstudy of this t educational el also brought between the u industries in technical side about the lea tained data and on clinic, tionships whu reports Ud> so rare that other tlinicu findings Most irnpor this plant ha\ and better pre such prorectiu study was um We believe practice, a phi official health We would bki cardinal piemen 1 The otTinal %rmzi72s-i Vol. O ccupational H ealth H azard? 4 3 Among other things, it will prevent re quests tor inadequate or unnecessary equipment irom appearing at the bar gaining table. The bureau has also earned m many ways. The teamwork of the varied pro fessional personnel required to make a study of this type has been an important educational experience. The study has also brought about a closer relationship between the county health ofticer and the industries m his community On the technical side, we have learned much about the lead problem We have ob tained data on laboratory techniques and on clinical and environmental rela tionships which we believe merit future reports Classical lead poisoning is now so rare that we were compelled to use other clinical classifications for our findings. Most important of all, the workers at this plant have better health protection and bettei prospects for improvement of such protection than they had before the study was undertaken. CONCLUSIONS We believe we have exemplified, in practice a philosophy of the place of the official health agency in private industry We would like to summarize here the cardinal elements of this philosophy. 1 T V offic.nl mdiihin.nl health <>,gency b vs a pnfnar\ responsibility 1 safeguard the health ot worker* ' Us technical v.ork and in policies must be unbiased It must assume, as a working premise, th a t requesting groups have no other motivation but the desire tn protect health This is the common denominator lor recon ciling the tompliM m m i u i i n i b of all groups 1 U must substantiate with tacts its evalU' lions Ot health hazards and ot the adequacy oi protective measures t It must constantly stimulate the m u m nu n t of high standards oj q u a lm in tn dustru l health practice! 5 It must he able to interpret intelligently its program to labor and management and to the health professions Improvement ot tech niques and programs results from obtaining participation of all personnel involved in such changes, recognizing the existence of differing levels of technical understanding Critical dis cussion of techniques must be limited to per son.! qualified to understand and participate Resulting information must be clear! with all groups and agencies concerned ft As a corollary ot its first responsibility (o protect the health of workers, the official agenev has responsibility to evaluate the ade quacy of private facilities for employee health However, it avoids duplication of existing service* which can and should be pnvatelv maintained as a proper charge against the cost of production, I* It is a major objective so to conduct studies that not nnls the plant's previour. methods and programs, but also the agency's, tre improved thereby B The public health results of governmental industrial hygiene work arc bu-dt durm g t':e rtiMrjt* of Cl liwdv and are not a scl'ing job based on a studv report il f 5 , ! : i j f - . t H ia! 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