Evolution of Modern Health

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Evolution of Modern Health Safety Concepts

• Tracing the historical development of heath
  safety concerns and programs

Robert Emery, DrPH, CHP, CIH, CSP, RBP, CHMM,
CPP, ARM Vice President for Safety, Health,
Environment Risk Management The University of
Texas Health Science Center at Houston Associate
Professor of Occupational Health The University
of Texas School of Public Health
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Earliest Civilization

• Family groups expanded to tribes
• Represented common interests, kinship
• A practical principle developed
• the greatest ultimate good for the greatest
  number
• thus, a person was not as important as the tribe,
  unless of course, it was the chief

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As Tribes Evolved

• Successes of one tribe meant the downfall of
  another
• Safety concerns centered around the tribe, and
  for select individuals
• Only when a proliferation of injuries or
  illnesses afflicted large or noticeable numbers
  of individuals did the tribe act

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As Tribes Evolved

• The first actions were probably against disease
  (great plagues)
• Accidents were, for the most part, considered
  personal matters

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First Control of Accidents

• Punishing countermeasures, not direct prevention
• Hammurabi (2100 BC) ordered a compilation of a
  body of laws for Babylon
• Known as the Code of Hammurabi, the rules were
  carved in cuneiform, now located in Paris

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Code of Hammurabi Examples

• If shipping by sea and freight lost, must
  reimburse owner
• If ship sank but was re-floated, half price
  reimbursement
• If caused by a collision, decision of blame was
  based on who was anchored first

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Code of Hammurabi Examples

• If a slave were injured (by other than the
  master) must pay master
• If an ox gores a man, the act is only compensible
  if the ox was known to be mean

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Primary Motivation of Babylonians

• Redress for damages
• If prevention was intended, it was only an
  outcome of the punishing indemnification schedules

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Focusing on Occupational Hazards

• In ancient times, most of the manual labor was
  performed by slaves
• Slaves were considered to be valuable capital
  assets
• Pliney the Elder (AD 23-79) wrote of the diseases
  of slaves

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Focusing on Occupational Hazards

• Bernardo Ramazzini (1600s) described diseases
  associated with various occupations
• English Labor Regulations
• excesses of apprentice system (children and
  subsequently women)
• limits for mining operations (no children, women)
• factory regulations for machine guarding

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Interesting Question

• Why didnt employers take control of situation to
  avoid the imposition of regulations?

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Follow-up Question

• How many successful prosecutions do you think
  occurred?

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The Indemnification/Enforcement Approach

• Advent of Workers Compensation
• Master-servant relationship was historically
  close
• Master concept has since grown into, perhaps, a
  corporation
• Injured workes sought protection,
  indemnification, redress

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Workers Compensation

• Three ironclad defenses
• contributory negligence
• assumption of risk
• fellow servant rule
• Also, what employee would want to sue their
  employer? And what fellow employees might serve
  as witnesses?

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Workers Compensation

• No fault insurance system developed
• The only proof needed was that the injury
  occurred on the job
• In general, medical bills covered, and a portion
  of salary provided
• Events categorized as temporary or permanent,
  partial or total.

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Workers Compensation

• Casualty insurance carriers motivated to keep
  accidents to a minimum
• Insurance companies initated safety inspection
  services
• what about this shift of attention and perhaps
  liability) from employer to insurance company?

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Experience Rating System

• Problem overcome by use of experience rating
  system, which affected rates
• (what about disincentive to report?)
• Need for uniformity in reporting arose
• In 1937, the ANSI Z16.1 method for compiling work
  injury data, was developed

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Other Notable Events

• Public safety concerns and product liability laws
• Advent of OSHA, 1970
• Environmental concerns
• Evolution of specialties industrial hygiene,
  health physics, biosafety
• Other regulations, guidelines, standards of care

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Age of Selected Safety-Related Organizations(and
parallel certifications)
(CBSP)
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Review

• The concept of safety evolved from a
  population-based, or tribal, approach
• The first safety controls were punishing
  countermeasures
• Indemnification approach evolved into workers
  compensation system
• The master-servant relationship has changed
  dramatically

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Reference

• Grimaldi, JV Simonds, RH Safety Management,
  Fifth Edition. American Society of Safety
  Enigneers, 1993.

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In Class Exercise

• What does the health and safety function within
  an organization do today?
• What is its mission?
• Who are the stakeholders?
• What are the hazards/risks?
• How are they controlled or managed?
• How are they evaluated, and by whom?