Towards a Biosocial Approach to Occupational Safety and Health

The integration of the social determinants of health paradigm by occupational and public health researchers and institutions is leading to a recognition of the need for a more holistic and nuanced perspective on work and its impact on population health (Ahonen et al 2018; Schulte and Vainio, 2010; WHO 2008). Fundamental to this transformation is the need to complement traditional approaches to occupational health with new conceptual and methodological perspectives that can better account for the social aspects of health and well-being.

Occupational health evolved into a fundamentally technical and applied field dedicated to identifying and eliminating the physical, chemical, and biologic hazards found at the workplace (Peckham et al, 2017). This has resulted in a view of cause and effect rooted in the biomedical model of health (Farmer et al, 2006). As a result, the injury experience is removed from its geographical, historical, and social context. While this approach has led to significant reductions in occupational injury and illness, it has separated occupational health from its historical roots in social medicine and limited its ability to account for the social structures that circumscribe health outcomes (Flynn, 2018).   It has also led to the distinction between work-related and non-work-related exposures, injuries, and illnesses which has evolved into a line of demarcation between occupational safety and health and other disciplines within public health (Peckham et al, 2017; Flynn and Wickramage 2017). This division has limited the ability of occupational and public health institutions to address the significant influence that work has over aspects of life that contribute or detract from workers’ health and that of their families.

My recent commentary in a special issue of the Anthropology of Work Review dedicated to the occupational health of immigrants highlights the limitations of current approaches to occupational safety and health and argues for the need to move toward a biosocial approach (Farmer 2006) to worker health and well-being (Flynn, 2018). Greater inclusion of the social sciences in occupational health is essential in addressing the challenges that shifting social trends such as the increasing reliance on new employment arrangements and the growing demographic diversity in the workforce. Anthropological theory, methods, and approaches are particularly important to advancing our understanding of the social aspects of workplace safety and addressing calls in the literature for a more holistic, public health-oriented approach to worker health.

The ethnographic approach, central to anthropology, can help researchers develop an understanding of society in general, and specific aspects in particular, from the point of view of the subject of the study. This approach can be used to reinsert occupational injuries or illnesses into their social context and the lived experiences of workers, their families, and their communities (Leong et al 2014; Saxton & Stuesse, 2018; Stuesse, 2018; Unterberger, 2018). It not only provides a better understanding for how social vulnerability materializes in the lives of workers, but also helps bridge the divide between occupational health and other public health disciplines. Anthropology also provides theoretical perspectives and methodological approaches to identify how exclusionary social structures are codified in occupational safety and health organizations and internalized by the professionals who staff them (NIOSH 2018; Castillo 2018).

The relationship between migration, work, and health is a rich but underexplored area in social science research. Because the search for employment is a central motivation to migrate, work represents an ideal location to study the convergence of the forces of global macro-economic structure and policy with the pursuit of survival and well-being for labor migrants, their families and their communities (Flynn, 2010). Indeed, the experiences of immigrant workers figured prominently in the early development of occupational health as a field (Abrams, 2001). However, anthropological research with migrants rarely explicitly addresses occupational health.

Limited interaction between occupational health and social sciences such as anthropology is truly a missed opportunity. Cross-fertilization between these disciplines would not only help develop our understanding of the social aspect of safety, but could help bridge the gap between occupational and community health and further our understanding of how structural vulnerabilities materialize in workers’ lives.

If you have used social sciences, specifically anthropology, in your occupational safety and health research please share your experiences or examples in the comment section below.

Michael Flynn, MA, is a Social Scientist in the NIOSH Education and Information Division and Coordinates the Occupational Health Equity Program.

References

Abrams, Herbert K. 2001 “A Short History of Occupational Health.” Journal of Public Health Policy, 22:34-80.

Ahonen EQ, Fujishiro K, Cunningham TR, Flynn MA. (2018). Work as an Inclusive Part of Population Health Inequities Research and Prevention. American Journal of Public Health 108(3): 306-311. doi:10.2105/AJPH.2017.304214

Castillo, C. G. (2018). What the Doctors Don’t See: Physicians as Gatekeepers, Injured Latino Immigrants, and Workers’ Compensation System. Anthropology of Work Review, 39(2), 94-104.

Farmer, Paul, Bruce Nizeye, Sara Stulac, Salmaan Keshavjee 2006. “Sturcutral Violence and Clinical Medicine.” PLoS Medicine 3:1686-91.

Flynn, M. A. (2018). Im/migration, Work, and Health: Anthropology and the Occupational Health of Labor Im/migrants. Anthropology of Work Review, 39(2), 116-123. doi: 10.1111/awr.12151

Flynn, Michael A. 2010.  Undocumented Status and the Occupational Lifeworlds of Latino Immigrants in a Time of Political Backlash: The Workers’ Perspective. Masters Thesis, Department of Anthropology, University of Cincinnati.

Flynn MA, Wickramage K. (2017). Leveraging the Domain of Work to Improve Migrant Health. Int. J. Environ. Res. Public Health 14(10): 1248, doi: 10.3390/ijerph14101248.

Leong, F.T.L., Eggerth, D.E., & Flynn, M.A. (2014). A Life Course Perspective on Immigrant Occupational Health and Well-Being. In Eds. Robert Sinclair and Stavroula Leka,   Contemporary Occupational Health Psychology: Global Perspectives on Research and Practice. Volume 3. Wiley-Blackwell: New York. doi:10.1002/9781118713860.ch7

National Institute for Occupational Safety and Health. 2018. Occupational Health Equity: Program Description. Accessed from https://www.cdc.gov/niosh/programs/ohe/description.html

Peckham, Trevor K, Marissa G Baker, Janice E Camp, Joel D Kaufman, Noah S Seixas 2017. “Creating a Future for Occupational Health.” Ann Work Expo Health 61:3–15.

Saxton, D. I., & Stuesse, A. (2018). Workers’ Decompensation: Engaged Research with Injured Im/migrant Workers. Anthropology of Work Review, 39(2), 65-78.

Schulte Paul, Harri Vainio. 2010  “Well-being at Work – Overview and Perspective.” Scandinavian Journal of Work, Environment & Health 36:422-29.

Stuesse, A. (2018). When They’re Done with You: Legal Violence and Structural Vulnerability among Injured Immigrant Poultry Workers. Anthropology of Work Review, 39(2), 79-93.

Unterberger, A. (2018). “No One Cares if You Can’t Work”: Injured and Disabled Mexican‐Origin Workers in Transnational Life Course Perspective. Anthropology of Work Review, 39(2), 105-115.

World Health Organization. 2008. Final Report of the Commission on Social Determinants of Health; World Health Organization: Geneva, Switzerland.