Environmental and occupational medicine. Rom WN, Renzetti AD Jr., Lee JS, Archer VE, eds. Boston, MA: Little, Brown and Company, 1983 Jan; :7-19
The prevention of occupational disease by routine methods of monitoring and surveillance is reviewed. The evaluation of acute and chronic health hazards is also discussed. Four categories of occupational disease are proposed: diseases that are only occupational in origin, those in which occupation is a causative factor or in which it is a contributory factor, and those in which occupation may aggravate a preexisting disease. Risk assessment factors that relate airborne exposures in occupational and community settings to the effective inhaled dose are listed. The need for routine surveillance of occupational diseases is seen as self evident; however, it is noted that routine reporting of occupational diseases has been complicated by economic, political, scientific, and legal factors. Methods of health hazard evaluation are described including toxicological tests in-vivo and in-vitro, industrial hygiene and routine environmental monitoring, industrial medical programs and occupational disease surveillance, worker education, and health promotion. A logical team oriented framework for the conduct of a health hazard evaluation is proposed. Suggestions are made for information gathering, critical review of the literature, formulation of tentative hypotheses, conduct of a site visit or walk through, and planning a comprehensive epidemiological survey. Evaluation of health hazard recommendations is discussed. The application of clinical decision analysis in public health planning requires acquisition of more data on the relative values (ethical, economic, and social) as well as the probable health outcomes of different occupational and environmental health services. The authors conclude that the benefits of implementation of recommendations resulting from the health hazard evaluation should be based on consideration of effects on production, health, and safety in relation to the cost of occupational health risks from hazardous workplace exposures.