Health Promotion in the Workplace CHARLES LEVENSTEIN Chair, Council on OccupationalHealth, National Associationfor Public Health Policy

and MARTA MORET Chair, WorksiteHealth Promotion Committee, Council on OccupationalHealth, National Associationfor Public Health Policy

GUEST EDITORIAL

field.Signifj CCUPATIONAL healthisa contentious icanteconomicandpoliticalinterestsareat stake.No O^ withit thevolatilehistory ? {other publichealthissuecarries thatworkplacehealthandsafetydo,bothatthenegotiating tableand on the Senateand House floors.Unlike otherformsof publichealth,occupational healthis in a of the NationalInstitutefor Occupacategoryof its own. PhilLandrigan "SalmotionalSafetyandHealth(NIOSH) wryly definesthe differences. nella,"he says,"haveno lobby." for creatingwarringcampsis workplace Currently,anissueresponsible healthpromotion.Sincethe early70s, occupationalhealthactivistsand havestruggledto impressuponpolicymakers,company workeradvocates andscientists theneedto reducetoxicexposures andotherworkmanagers, on theindustrial placehazards.Theseeffortshavebeenpredicated hygiene environmentis superiorto reliance principlethatchangingthe hazardous on theotherhand, on changingindividualworkerbehavior.Management, controlsaretoo expensive,andthat hasfrequentlyinsistedthatengineering couldbe basedon personalprotectivedevices. adequatesafetystandards Thepremisefor thisapproachis thatmostaccidentsarecausedby careless workersand that occupationaldiseasefrequentlyis not occupationalin etiology,but is causedby cigarettesmoking,alcoholconsumptionand behaviors. otherpersonal"risk-taking" thenthattherecentinterestin workplacehealthproIt is not surprising r k

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1985

Corpohealthveterans. by occupational motionis greetedwithskepticism exposures occupational indealingwithhazardous spottyrecords rationswith urgingtheiremployeesto giveupsmokseemto be receptiveto programs maysupportemployeecounstrategists ing.Healthcarecost-containment to copewith stress, for employees teaching selingprogramsandservices issuesrelatedto stress.Computorganizational yetignorethefundamental are achievingwide currencyin industry erizedHealthRiskAppraisals validityandefficacyhavenotbeendemonstrated althoughtheirreliability, of proofrequiredof studiesof occupaWhilethe standard scientifically. arenotputto tionaldiseaseis quiterigorous,healthpromotionprograms the sametest. Thisis not to say thatthereis no corporateoppositionto workplace healthpromotionactivities.The tobaccoindustryand liquormanufacturershavereasonto be unhappywith publichealthprogramsaimedat healthprofessionals theircustomers.Nor do occupational discouraging andalcohol. of healthriskfactorssuchas cigarettes denythe imnportance and, reportsminimizingthehealtheffectsof toxicexposures Nevertheless, seriousconcernamong ondiet,havearoused forinstance, focusingattention healthscientists.Comingduringa time of administrative occupational workerhealthadvocatesare deeplyconcernedthatDoll, deregulation, hazards Petoandothersprovidetherationalefor neglectof occupational by industryandgovernment. Thereis a legitimateconcernaboutresourceallocation.At a timewhen SafetyandHealth,for fundsto the NationalInstitutefor Occupational havebeendiverted cutback,someresources havebeendrastically instance, withhealthrisk health including experimentation promotion, to worksite of enviBut evenmoreimportantis the symbolicdenigration appraisal. ronmentalcontrolandthe riseof a rhetoricof voluntarycomplianceby Manyworkersno longerbotherto callOSHA industryandderegulation. fitnessprograms, In thiscontext,suspicionof corporate with complaints. drives,andthelikeis high.Andit is intothisworkplacethat anti-smoking advocatesof healthpromotionarewalking. healthprofessionals and The needfor a dialoguebetweenoccupational There is no question is urgent. healthpromotionpractitioners progressive betweenunhealthy personalbehaviorandtoxicexpothattheinteraction suresin theworkplaceandcommunityis worthexamining.Thereis also to workerhealthisneeded.Occuapproach no questionthatanintegrated to pationalhealthactivistsmaybe ableto helpdevelopa socialapproach riskfactorsthatappearto be individualin nature.Dialogueis essentialif

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only to defusemistrustandantagonismamongpublichealthproponents similarproblemsfromdifferentangles,butwith thehealthof approaching workingpeopleas a unifyingconcern.The bottomline for occupational thattheethics in sucha discussion will be theassurance healthprofessionals of healthpromotionin theworkplacerequirehealthpromotersto be alert andthattheyinformemployers andworkprocesses exposures to hazardous andworkersaboutsuchhazards.