Towards a new millennium

摘要

The turn of a millennium is a solemn event - after all, it happens only once in a thousand years. Yet, nothing in our surroundings is supposed to change with a jerk, perhaps apart from our computers if they encounter some Y2K problems. The objective changes in our environment are gradual, like all day-to-day events. The first year of the new millennium will probably not differ dramatically from the last year of the previous one. The millennium shift nevertheless gives us an excuse to stop and look both backwards and forwards. If we focus on the realm of occupational health, it is very obvious that work itself and work conditions have changed rapidly and fundamentally during the latter half of the 20th century. Many traditional forms of production, work procedures, and tasks have vanished, while many new ones have been introduced and developed further. Consider, for example, lumbering. Horses and handsaws were common in the 1950s; now giant, complex harvesters are substituting even the chain saw. Agriculture has undergone equally fundamental changes. To mention a few more examples, a foundry or a metal engineering shop is no longer what it was 30 years ago. Paper machines are bigger, faster, computerized, and more complex than before. Oil is being drilled offshore. Traffic and transport have increased tremendously. We have nuclear power plants - clean energy but a potential risk of major accident. Automation and robots are commonplace in the manufacturing industry, and computerization has been integrated into almost every type of work. Information technology has created an enormous number of jobs of a completely new character. Biotechnology is having its breakthrough. Entire branches of industry have disappeared from many industrialized countries, only to reappear in less developed ones. The list could go on almost indefinitely. Such profound changes have had a deep impact on occupational health, both for the better and for the worse. Improved technology, even in conventional plants, and the birth of entirely new work environments and work processes, together with advances in occupational health research, occupational hygiene, and improvements in the quality of occupational health services, have changed the spectrum of work-related morbidity drastically, mostly but not always for the better. In the developed world, many chemical and physical occupational hazards have been controlled, with the result that many classical occupational diseases have almost disappeared or at least become milder. On the other hand, new diseases have entered the picture, for example, allergies and mesotheliomas. Long-term nonspecific effects, such as cancer and adverse pregnancy outcome, have certainly existed for a long time, but modern epidemiologic research has been able to link some of them to the work environment, the first requirement for successful prevention. General morbidity, such as cardiovascular diseases, allergies, musculoskeletal disorders, as well as mental ill health, has also been shown to be work-related in many instances. These categories of morbidity have substituted clinical occupational diseases as the number one problem in occupational health. Especially psychosocial problems and their health effects have received much attention lately. This is not to say that more traditional problems have ceased to exist. Most countries have not yet reached such a level of sophistication. Newly industrialized and underdeveloped countries are repeating the mistakes of the Western world during its industrialization. Work conditions are often appalling, and occupational health expertise is lacking. In such countries all the old occupational diseases abound. But side by side with primitive workplaces, there can exist high-tech industries, perhaps belonging to multinational companies, whose employees face exactly the same psychosocial problems as those characterizing the developed world. And even in highly developed countries there are dark spots.