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Occupational and Environmental 1994;51:577-578 577

Occupational and Occup Environ Med: first published as 10.1136/oem.51.9.577 on 1 September 1994. Downloaded from Editorial Occupational and environmental medicine: what is it?

Environmental medicine has become a controversial the of genotoxic carcinogens such as benzene.6 issue amongst occupational , and the Faculty Remarkably little research effort has been expended on of Occupational Medicine of the Royal College of the health effects of outdoor air in the United Physicians has issued a report in the wake of the Kingdom over the last 20 years. American and Australian Colleges adopting Environmental risk assessments in organisations are Occupational and Environmental Medicine in their undertaken by multidisciplinary teams, and to interact titles.' with their non-medical colleagues occupational physi- But what debate, if any, is needed when most industry cians need to have a working knowledge of a wide range now puts health, safety, and environment under the same of subjects including atmospheric chemistry, toxic emis- management structure and academic units also covet sions and wastes, eco-toxicology and how to do life cycle environment in their titles? Unfortunately, the term envi- product analyses. In the prevention of chemical or other ronmental medicine lends itself to various interpreta- technological accidents the role of human factors remains tions. Business may see environmental concerns as the poorly understood. Disaster planning to comply with the potentially deleterious health, social, and ecological Control of Major Industrial Accident Hazards impacts of industrial activity, and occupational physi- Regulations 1984 (CIMAH)7 has in the past left physi- cians as responsible for advising on the aspects relating to cians of most chemical companies on the sidelines when human health. Company policy issues may also arise they should be an integral part of the planning and man- from the global impacts of technological change on agement process and key communicators on risk to the energy or climate, for example. But environmental medi- local community. The role of the sector in cine is also about the application of medical sciences for such planning has only been belatedly recognised by the study, interpretation, and provision of medical advice international bodies,8 showing that the neglect of this role on the interaction between external physical, chemical, is an international and not only a United Kingdom con- and biological factors and human health.' The health cern. risks under this definition, such as those arising from is an essential tool in environmental smoking, diet, and other lifestyle factors, or indirect links medicine for chronic and the investi- between poverty and health, embrace a wider range of gation of environmental factors in disease causation. One http://oem.bmj.com/ medical and non-medical specialties than occupational of the chief attractions of occupational medicine is the medicine alone. What needs to be resolved is how the scope for combining epidemiological and clinical skills. widening role of occupational medicine can be developed The important clinical role of occupational physicians,9 and at the same time integrated into the environmental which some have wished to minimise in the past, needs activities of health workers such as epidemiologists, pub- to be expanded to deal adequately with diseases known lic health physicians, family practitioners, and or suspected of having environmental causes such as clinicians. , electromagnetic fields, toxic waste, on September 27, 2021 by guest. Protected copyright. A new initiative in environmental medicine is overdue heavy metal pollution and pesticides,10'1 and to assist in with the changes in world technologies over the last two the management of patients by identifying and evaluating decades. In the United Kingdom, the influence of the exposure to specific causal agents. This essential role still medical profession on environmental issues has been waits to be filled in the NHS. The emergence in the weak, although the British Medical Association has 1980s of the NHS occupational health services as entered the fray with reports on pesticides,2 hazardous providers to other industries should broaden the range of waste, and the environmental and occupational risks of clinical referrals, but this role needs to be extended to health care.4 Compared with other major employers, include for the diagnosis and management of however, the NHS has failed to lead in the environmental patients with environmental as well as occupational con- auditing of its activities, with health care workers so far ditions.12 Clinical training for this task would need to be showing little interest in the environmental impacts of to a more advanced level than that required for speciali- their industry. Assessing the risks of expo- sation at present. sure to low levels of pollutants is not a requirement of the The impacts of workplace activi- curriculum in the training of public health or occupa- ties have been recognised since before the Industrial tional physicians, and the vast majority would be ill Revolution, yet it is only latterly that health has begun to equipped to comment on growing public and media con- be integrated into sustainable development,"3 or that the cerns on environmental topics such as from economic benefit of preventive medicine is being consid- traffic fumes and the implications of the health hazards ered in global investment strategies.'4 One of the key out- for a national policy on sustainable transport. The moves puts of the United Nations Conference on Environment to set air quality standards for the United Kingdom high- and Development in Rio de Janeiro in 1992 was agenda light the deficiencies in knowledge that exist on the envi- 21, a programme of action to move towards sustainable ronmental causes for the rising incidence of asthma5 and development. In response, the United Kingdom govern- 578 Editorial

tions do business and in the way they are structured, ment strategy on sustainable development makes only Occup Environ Med: first published as 10.1136/oem.51.9.577 on 1 September 1994. Downloaded from limited mention of health as a concern at all.'5 Even in whereas at the same time the importance of environmen- traditionally non-polluting industries, such as agriculture, tal health issues to industry has grown rapidly. For occu- environmental health impacts, with their associated costs, pational medicine to redefine its role outside the can be readily discerned and yet may still be ignored by workplace, however, it will need to widen its influence policy makers.'6 In the past economists and environmen- and find a broader vision than the one that has domi- talists viewed morbidity and mortality as too difficult or nated and constrained the thinking of government, too inconvenient to value but health should be an explicit industry, and the medical profession up to the present part of environmental and social impact assessments. time. is one which is PETER J BAXTER Occupational health the Department of Community Medicine, knowledgeable on , and health and safety University ofCambridge Clinical School, management, and whose expertise is readily transferable Addenbrooke's Hospital, to environmental hazards. Hills Road, Evidence for the continuing separation of occupational Cambridge CB2 2QQ and environmental medicine in the United Kingdom is seen in the division of responsibilities for these areas 1 Faculty of Occupational Medicine. Report on the Faculty of Occupational Medicine's Working Party on Environmental Medicine. London: Royal under three main government bodies-the Health and College of Physicians, 1993. Safety Executive, the Department of Health, and the 2 British Medical Association. Pesticides, chemicals, and health. London: Edward Arnold, 1990. Department of the Environment. Even when the Health 3 British Medical Association. Hazardous waste and human health. Oxford: and Safety Executive was established in the early 1970s Oxford University Press, 1991. 4 British Medical Association. Environmental and occupational risks of health the environmental health implications of radiation, care. London: BMA, 1994. , and vinyl chloride, as well as numerous other 5 Seaton A, Godden DJ, Brown K. Increase in asthma: a more toxic envi- ronment or a more susceptible population? Thorax 1994;49: 171-4. hazardous agents in the workplace, were obvious, but the 6 Department of the Environment, Expert Panel on Air Quality Standards. responsibility for the health of the community remained Benzene. London: HMSO, 1994. 7 Health and Safety Executive. The control of major industrial accident with other bodies. A clear focus for environmental medi- regulations 1984 (CIMAH): further guidance on emergency plans. London: cine has not developed in government or in universities HMSO, 1986. 8 Organisation for Economic Cooperation and Development. OECD envi- and their medical schools, nor indeed in the Royal ronment monograph No 81 on health aspects of chemical accidents. Paris: College of Physicians, where the public health physicians OECD, 1994. 9 Seaton A. Occupational medicine-let's keep our white coats and stetho- and the occupational physicians went separate ways to set scopes. Occup Med 1993;43:63-4. up their own Faculties in the 1970s. 10 Ducatman AM, Chase KH, Farid I, et al. What is environmental medi- cine?J Occup Med 1990;32:1130-1. With this background and with the need to make radi- 11 Rosenstock L, Rest KM, Benson JA, et al. Occupational and environmen- cal changes in practice and training, it may seem unduly tal medicine: meeting the growing need for clinical services. N Engl J Med 1991;325:924-7. optimistic or even rash to suppose that a realignment of 12 Raffle PAB, Adams PH, Baxter PJ, Lee WR, eds. Hunter's diseases ofoccu- environmental medicine is in the offing. Yet few would pations, 8th ed. London: Edward Arnold, 1994. 13 World Health Organization. Ourplanet, our health. Geneva: WHO, 1992. wish to dissuade the Faculty of Occupational Medicine 14 World development report 1993. Investing in health. Washington, DC: from urgently pursuing an initiative both inside and out- World Bank, 1993. 15 Department of Environment. Sustainable development: the UK strategy. side the Royal College of Physicians. Over the last decade HMSO: London, 1994. a revolution has been taking place in the way organisa- 16 Baxter PJ. Health and safety on the farm. BMY 1992;305:6-7. http://oem.bmj.com/ on September 27, 2021 by guest. Protected copyright.