A short history of occupational health.
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Biomedical subjects
Publications and source records attributed to H K Abrams.
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In the early years following the Chinese revolution in 1949, the Chinese mounted mass campaigns against the preventable communicable diseases including the venereal diseases. These were characterized by mass education, a national health insurance system, training and dispersion of the "barefoot doctors," elimination of prostitution, emancipation of women, and full employment. By 1996, the Chinese claimed that they had virtually eliminated venereal diseases. This was confirmed by western visitors in the 1970s. However, following the economic reforms which began in the 1980s, sexually transmitted diseases reappeared. Later, HIV infection appeared, and STDs today constitute a major public health problem in China. This resurgence parallels the privatization of the economy, the breakdown of the national health insurance system, the return of prostitution, and other factors.
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The chronic respiratory diseases are a pervasive cause of morbidity and mortality. In the developed countries the chronic nonspecific respiratory diseases (CNRD), eg, chronic bronchitis, emphysema, bronchial asthma, are a major cause of morbidity and mortality. They have been increasing during a period when, in many countries, there has been a decline in total mortality rates and in certain major chronic illnesses such as coronary heart disease. In many developing countries, acute and chronic respiratory diseases are leading causes of death with chronic bronchitis as a major cause of disability. The boundary between occupationally caused and "work-related" chronic lung diseases is indistinct, reflecting the multifactorial nature of the diseases. This report focuses primarily on the CNRD, and the work-related risk factors which play a role in their etiology and/or aggravation. These factors include specific work exposures such as inhaled noxious materials and other work conditions, immunologic considerations, combined exposures in the work and community environment, societal trends such as industrialization and urbanization, behavioral patterns, stress, social support, and other socioeconomic elements. The available evidence is examined, and directions are indicated for further research for the identification of those factors in the environment which initiate, potentiate, or aggravate CNRD and for the development of measures for the prevention of disability and premature death.
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The worker is the major source of information about job hazards. Frequently, workers themselves discover new occupational diseases. Physicians need to regard the worker as a member of the occupational health team.
Making work safe and satisfying continues to be an uphill struggle. The passage of the Occupational Safety and Health Administration (OSHA) in 1970 came after a long fight. The forces that opposed it now try to emasculate it. Workers, scientists and emancipated employers need to find ways to reduce the hostility in our adversarial system, to persuade employers that, in the long run, their best interests are served by making work safe. Several instances of labor influence at corporate levels are mentioned. Eternal vigilance with be needed in the 1980s to protect OSHA and other hard-won environmental legislation.
The Chinese are engaged in an intensive campaign to modernize the nation by the year 2000, and occupational medical problems are proliferating. The Chinese are meeting these problems by establishing occupational disease hospitals and research institutes and by working through public health agencies for prevention and correction. The report, based on a visit in October 1979, describes in detail some of these efforts and calls attention to the opportunity for a U.S.-Chinese exchange program.
Japan emerged from feudalism a century ago. Farmers comprise 20 percent of the population of 110 million. The agricultural cooperative movement sponsors 118 hospitals in rural areas. Of these, the Saku Central Hospital is the largest, and provides leadership to a vigorous rural health movement. Its unique outreach program and its contributions to rural health are described, together with remarks about Japan's health situation generally. There may be lessons here for America.
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This article is an exploration of the way in which social developments in countries may have international impact, with specific reference to the implications of health care developments in the People's Republic of China. Even though the social systems of countries may be totally different, developments of value do get through the national boundaries, or are achieved independently as responses to similar problems.
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