Pub. Date:
Yale University Press
Occupation and Disease: How Social Factors Affect the Conception of Work-Related Disorders

Occupation and Disease: How Social Factors Affect the Conception of Work-Related Disorders

by Allard E DembeAllard E Dembe


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How and why do physicians come to regard certain medical disorders as work-related? Is this process merely a matter of gathering and interpreting empirical evidence or is it a complex social phenomenon? In this fascinating book, Allard Dembe studies the histories of three ailments now commonly considered to be work-related—cumulative trauma disorders (especially carpal tunnel syndrome), occupational back pain, and noise-induced hearing loss—and demonstrates that numerous social factors affect whether the medical community recognizes an illness as job-related.

According to Dembe, physicians may be influenced by such social factors as: the advent of new technologies (computers replacing typewriters, for example); passage of laws establishing workers' compensation; union campaigns and labor activism; public outcry against environmental hazards; cultural stereotyping (some complaints of hearing loss, for example, have been linked to "nervous tendencies" of women); medical specialization and competition (diagnosis of back pain as a traumatic injury corresponded with the growth of orthopedics after World War I); and media attention. Dembe contends that physicians have been forced to act as society's "gatekeepers"—referees in controversies having significant implications for labor relations and the industrial economy. He maintains that physicians should instead be free to concentrate on the health of patients and suggests alternative methods for conferring appropriate medical benefits and ensuring protection against occupational hazards.

Product Details

ISBN-13: 9780300064360
Publisher: Yale University Press
Publication date: 06/26/1996
Pages: 358
Product dimensions: 6.12(w) x 9.25(h) x (d)

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This book examines the process by which certain medical disorders come to be regarded by physicians as work-related. My thesis is that this is not merely a matter of gathering and interpreting empirical evidence but rather a complex social phenomenon. The determination that a disorder is caused by a patient's job occurs in a rich social context colored by the unequal power relationship that generally prevail between employees and management in the work environment and between patients and physicians in the health care setting. The intense social dynamics that permeate these two context help determine whether a particular disorder eventually becomes known as an occupational disease.

My interest in this question initially grew out of my professional experience as a health and safety specialist in the workers' compensation insurance industry - an industry predicated on the assumption that medical experts can draw a clear distinction between disorders induced by employment and those that are not. Over the past two decades, a great deal of concern has been expressed about the seemingly ever-increasing assortment of maladies that are considered to be work-related. Many authorities have claimed that the expansion in the definition of what constitutes an occupational disorder has been a major factor contributing to the sharp escalation of workers' compensation costs that has occurred during those years.

Concern over the broadened scope of work-related injuries and illnesses intensified during the late 1980s and early 1990s as an influx of new claims were submitted by workers suffering from a host of unfamiliar disorders such ascarpal tunnel syndrome and other so-called cumulative trauma disorders. The reasons underlying the proliferation of these apparently "new" occupational diseases were perceived as mysterious and frustrating by many employers, insurers, and workers' compensation officials. Various explanations were suggested for the sudden appearance of these ailments, including the introduction of new chemicals and technologies into the workplace, the increasing pace of production activities, and better medical knowledge about the relationship between disease and occupational exposure. As a representative of America's largest workers' compensation insurance carrier, I was frequently in the center of these controversies, and had the opportunity to serve on a number of industry and government panels that examined the issue.

At about the same time, I was completing my doctoral studies in work environment policy at the University of Massachusetts, Lowell. Stimulated by these studies, I came to investigate this question from a perspective that places emphasis on understanding the broader social and historical context in which judgments about occupational etiology are made. These investigations revealed to me that medical determinations about work-relatedness are often shaped by deep-seated social, political, economic, and cultural forces. This book represents my attempt to describe those forces and to illustrate through historical examples the variety of ways that social factors can influence the medical recognition and conception of occupational disease.

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