Change in the world of occupational health: silica control, then and now

To control silicosis, we need to understand how change happens in occupational health. Science alone does not drive policy, because we have known the causes of silicosis, and how to prevent it for decades, yet the disease persists. To control occupational disease, we need to enter the social realm of work. To investigate the determinants of a successful silicosis control program, we wrote a social history of the Vermont Granite Industry from 1938 to 1960, examining union journals, newspapers, industry journals, scientific literature and government documents, and interviewing key informants. The crucial factor of the successful program was a strong public health movement to control tuberculosis, rather than pressure to control the occupational disease. Using this lesson, to protect workers from silica exposure now, we chose to regulate silica under an environmental law, the Massachusetts Toxics Use Reduction Act. Science is but one small factor, necessary but insufficient, in policy change. We in occupational health need to hitch onto a stronger movement, currently the environmental movement. Where unions are too weak to demand safe technologies, we need to learn to speak the language of employers, because they may have little idea of the costs of interventions. We need to gather more economic information about the costs of interventions.