What historically has constituted occupational safety and health? From as early as the nineteenth century, from the very origins of the American industrial revolution this question was as much a political and social issue as it was a medical one. Were they only problems of accidents or acute poisonings caused by exposures to lead, arsenic, mercury and other heavy metals or did they include chronic diseases such as silicosis and asbestosis, harbinger of the problems we now confront in the wake of the new industrial world that emerged in the middle of the twentieth century?

To doctors and public health practitioners throughout the past two centuries, occupational safety and health has changed as the new industrial age has exposed millions of people to dusts and chemicals that have become the basis of much of modern society. Today, as we have become dependent on coal, petrochemicals and new sources of energy, the presence of dust and various toxins in the working and living environments is no longer exceptional. It is not only doctors and public health officials who have been engaged with these issues, but industry and labor have helped to define the boundaries between normal and abnormal, healthy and diseased. Industry often argued that workers and their families had to accommodate to the new industrial realities. To inhale dust was a normal everyday occurrence for people living in industrial communities and cities. Under these modern conditions, health and disease were part of one continuum, not two dichotomous categories. The presence of dust in workers’ lungs was not pathological; only ‘excessive’ amounts that limited their activity could be considered pathological. However, as we trace in this chapter through to the contemporary period, for workers and their families the normalizing of insults to their bodies had personal meaning that was part of a larger struggle over who would control their bodies and their lives.

In recent years, occupational diseases have become an area of intense interest to medicine, public health, industry, and labor. Whole new areas of medical and public health specialization have developed since the end of World War II, partly in response to the detection of carcinogens in the workplace, dust in the air that workers breathe, and human-made chemicals that workers touch, taste, or inhale. Black lung (coal workers’ pneumoconiosis), brown lung (byssinosis), and white lung (asbestosis) are three industry-specific diseases that have gained international attention and highlighted the role of occupation in the creation of illness. Laborers as well as physicians have become acutely aware of the dangers posed by substances and materials at work in a host of industries from steel to petrochemicals.

The growing attention to the hazards of the industrial workplace has alerted workers even in “clean” worksites to occupational disease. Physical dangers are posed to office workers by video display terminals, poorly designed furniture, noise, and vibrations. Stress at the workplace is now seen as important in the creation of the modern epidemics of high blood pressure, heart disease, and stroke. The very definition of disease has been altered by a rising popular and professional consciousness of the importance of occupation as a source of illness.