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17. Disability and Work
Chapter Editors: Willi Momm and Robert Ransom
Table of Contents
Disability: Concepts and Definitions
Willi Momm and Otto Geiecker
Case Study: Legal Classification of Disabled People in France
Marie-Louise Cros-Courtial and Marc Vericel
International Labour Standards and National Employment Legislation in Favour of Disabled Persons
Willi Momm and Masaaki Iuchi
Rehabilitation and Noise-induced Hearing Loss
Rights and Duties: An Employer’s Perspective
Rights and Duties: Workers’ Perspective
Angela Traiforos and Debra A. Perry
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18. Education and Training
Chapter Editor: Steven Hecker
Introduction and Overview
Principles of Training
Gordon Atherley and Dilys Robertson
Worker Education and Training
Robin Baker and Nina Wallerstein
Evaluating Health and Safety Training: A Case Study in Chemical Workers Hazardous Waste Worker Education
Thomas H. McQuiston, Paula Coleman, Nina Wallerstein, A.C. Marcus, J.S. Morawetz, David W. Ortlieb and Steven Hecker
Environmental Education and Training: The State of Hazardous Materials Worker Education in the United States
Glenn Paulson, Michelle Madelien, Susan Sink and Steven Hecker
Worker Education and Environmental Improvement
Safety and Health Training of Managers
Training of Health and Safety Professionals
A New Approach to Learning and Training:A Case Study by the ILO-FINNIDA African Safety and Health Project
Antero Vahapassi and Merri Weingerv
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19. Ethical Issues
Chapter Editor: Georges H. Coppée
Codes and Guidelines
Colin L. Soskolne
Responsible Science: Ethical Standards and Moral Behaviour in Occupational Health
Richard A. Lemen and Phillip W. Strine
Ethical Issues in Occupational Health and Safety Research
Paul W. Brandt-Rauf and Sherry I. Brandt-Rauf
Ethics in the Workplace: A Framework for Moral Judgement
Sheldon W. Samuels
Surveillance of the Working Environment
Lawrence D. Kornreich
Ethical Issues: Information and Confidentiality
Peter J. M. Westerholm
Ethics in Health Protection and Health Promotion
D. Wayne Corneil and Annalee Yassi
Case Study: Drugs and Alcohol in the Workplace - Ethical Considerations
Behrouz Shahandeh and Robert Husbands
International Code of Ethics for Occupational Health Professionals
International Commission on Occupational Health
20. Development, Technology and Trade
Chapter Editor: Jerry Jeyaratnam
Occupational Health Trends in Development
Industrialized Countries and Occupational Health and Safety
Case Studies in Technological Change
Michael J. Wright
Transfer of Technology and Technological Choice
Product Stewardship and the Migration of Industrial Hazards
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1. Small-scale enterprises
2. Information from foreign investors
3. Costs of work accidents & health (Britain)
4. Types of economic evaluation
5. Development of China’s township enterprises
6. Country HEPS & OHS coverages in China
7. Compliance rates of 6 hazards in worksites
8. Detectable rates of occupational diseases
9. Hazardous working & employers, China
10. OHS background in foreign-funded enterprises
11. Routine instruments for OHS, 1990, China
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21. Labour Relations and Human Resources Management
Chapter Editor: Anne Trebilcock
Labour Relations and Human Resources Management: An Overview
Rights of Association and Representation
Collective Bargaining and Safety and Health
Michael J. Wright
Forms of Workers’ Participation
Muneto Ozaki and Anne Trebilcock
Case Study: Denmark: Worker Participation in Health and Safety
Labour Relations Aspects of Training
Labour Relations Aspects of Labour Inspection
María Luz Vega Ruiz
Collective Disputes over Health and Safety Issues
Shauna L. Olney
Individual Disputes over Health and Safety Issues
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22. Resources: Information and OSH
Chapter Editor: Jukka Takala
Table of Contents
Information: A Precondition for Action
Finding and Using Information
P.K. Abeytunga, Emmert Clevenstine, Vivian Morgan and Sheila Pantry
Case study: Malaysian Information Service on Pesticide Toxicity
D.A. Razak, A.A. Latiff, M.I. A. Majid and R. Awang
Case Study: A Successful Information Experience in Thailand
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23. Resources, Institutional, Structural and Legal
Chapter Editors: Rachael F. Taylor and Simon Pickvance
Table of Contents
Institutional, Structural and Legal Resources: Introduction
Wolfgang von Richthofen
Civil and Criminal Liability in Relation to Occupational Safety and Health
Felice Morgenstern (adapted)
Occupational Health as a Human Right
Ilise Levy Feitshans
Right to Know: The Role of Community-Based Organizations
The COSH Movement and Right to Know
Occupational Health and Safety: The European Union
Frank B. Wright
Case Study: Exposure Standards in Russia
Nikolai F. Izmerov
Case Study: ILO Conventions--Enforcement Procedures
International Organization for Standardization (ISO)
Lawrence D. Eicher
International Social Security Association (ISSA)
Dick J. Meertens
International Commission on Occupational Health (ICOH)
International Association of Labour Inspection (IALI)
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24. Work and Workers
Chapter Editors: Jeanne Mager Stellman and Leon J. Warshaw
Table of Contents
Health, Safety and Equity in the Workplace
Precarious Employment and Child Labour
Leon J. Warshaw
Transformations in Markets and Labour
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25. Worker's Compensation Systems
Chapter Editor: Terence G. Ison
Table of Contents
Terence G. Ison
Organization, Administration and Adjudication
Eligibility for Benefits
Multiple Causes of Disability
Subsequent Consequential Disabilities
Objections to Claims
Rehabilitation and Care
Obligations to Continue the Employment
Health and Safety
Claims against Third Parties
Social Insurance and Social Security
26. Topics in Workers' Compensation Systems
Chapter Editors: Paule Rey and Michel Lesage
Table of Contents
Prevention, Rehabilitation and Compensation in the German Accident Insurance System
Dieter Greiner and Andreas Kranig
Workers’ Accident Compensation in Japan
Kazutaka Kogi and Haruko Suzuki
Country Case Study: Sweden
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Most people seem to know what a disabled person is and are certain that they would be able to identify an individual as disabled, either because the disability is visible or because they are aware of a specific medical condition that lends itself to be called disability. However, what precisely the term disability means is less easy to determine. A common view is that having a disability makes an individual less capable of performing a variety of activities. In fact, the term disability is as a rule used to indicate a reduction or deviation from the norm, a shortcoming of an individual that society has to reckon with. In most languages, terms equivalent to that of disability contain the notions of less value, less ability, a state of being restricted, deprived, deviant. It is in line with such concepts that disability is exclusively viewed as a problem of the affected individual and that the problems indicated by the presence of a disability are considered to be more or less common to all situations.
It is true that a disabling condition may affect to varying degrees the personal life of an individual and his or her relations with family and community. The individual who has a disability may, in fact, experience the disability as something that sets him or her apart from others and that has a negative impact on the way life is organized.
However, meaning and impact of disability change substantially depending on whether the environment and the attitudes of the public accommodate a disability or whether they do not. For example, in one context, the person who uses a wheelchair is in a state of complete dependency, in another he or she is as independent and working as any other person.
Consequently, the impact of an alleged dysfunction is relative to the environment, and disability is thus a social concept and not solely the attribute of an individual. It is also a highly heterogeneous concept, making the search for a homogeneous definition a virtually impossible task.
Despite many attempts to define disability in general terms, the problem remains concerning what renders an individual disabled and who should belong to this group. For example, if disability is defined as dysfunction of an individual, how to classify a person who despite a serious impairment is fully functional? Is the blind computer specialist who is gainfully employed and has managed to solve his or her transport problems, secure adequate housing and have a family still a disabled person? Is the baker who can no longer exercise his profession because of a flour allergy to be counted among disabled job-seekers? If so, what is the real meaning of disability?
To understand this term better, one has first to distinguish it from other related concepts that are often confused with disability. The most common misunderstanding is to equate disability with disease. Disabled people are often described as the opposite of healthy people and, consequently, as needing the help of the health profession. However, disabled people, as anyone else, need medical help only in situations of acute sickness or illness. Even in cases where the disability results from a protracted or chronic illness, such as diabetes or a cardiac disease, it is not the sickness as such, but its social consequences that are involved here.
The other most common confusion is to equate disability with the medical condition that is one of its causes. For example, lists have been drawn up that classify disabled people by types of “disability”, such as blindness, physical malformations, deafness, paraplegia. Such lists are important for determining who should be counted as a disabled person, except that the use of the term disability is inaccurate, because it is confounded with impairment.
More recently, efforts have been made to describe disability as difficulty in performing certain types of function. Accordingly, a disabled person would be someone whose ability to perform in one or several key areas—such as communication, mobility, dexterity and speed—is affected. Again, the problem is that a direct link is made between the impairment and the resulting loss of function without taking into account the environment, including the availability of technology that could compensate for the loss of function and thus render it insignificant. To look at disability as the functional impact of impairment without acknowledging the environmental dimension means to put the blame for the problem entirely on the disabled individual. This definition of disability still stays within the tradition of regarding disability as a deviation from the norm and ignores all other individual and societal factors that together constitute the phenomenon of disability.
Can disabled people be counted? This may be possible within a system that applies precise criteria as to who is sufficiently impaired to be counted as disabled. The difficulty is to make comparisons between systems or countries that apply different criteria. However, who will be counted? Strictly speaking, censuses and surveys that undertake to produce disability data can count only people who themselves indicate that they have an impairment or a functional restriction on account of an impairment, or who believe that they are in a situation of disadvantage because of an impairment. Unlike gender and age, disability is not a clearly definable statistical variable, but a contextual term that is open to interpretation. Therefore, disability data can offer only approximations and should be treated with utmost care.
For the reasons outlined above, this article does not constitute yet another attempt to present a universal definition of disability, or to treat disability as an attribute of an individual or a group. Its intention is to create an awareness about the relativity and heterogeneity of the term and an understanding about the historical and cultural forces that have shaped legislation as well as positive action in favour of people identified as disabled. Such an awareness is the prerequisite for the successful integration of disabled people in the workplace. It will permit a better understanding of the circumstances that need to be in place to make the disabled worker a valuable member of the workforce instead of being barred employment or pensioned off. Disability is presented here as being manageable. This requires that individual needs such as skill upgrading or the provision with technical aids, be addressed, and accommodated by adjusting the workplace.
There is currently a vivid international debate, spearheaded by disability organizations, regarding a non-discriminatory definition of disability. Here, the view is gaining ground that disability should be identified where a particular social or functional disadvantage occurs or is anticipated, linked to an impairment. The issue is how to prove that the disadvantage is not the natural, but rather the preventable result of the impairment, caused by a failure of society to make adequate provision for the removal of physical barriers. Leaving aside that this debate reflects primarily the view of disabled people with a mobility impairment, the possible unwelcome consequence of this position is that the state may shift expenditures, such as for disability benefits or special measures, based on disability, to those that improve the environment.
Nevertheless, this debate, which is continuing, has highlighted the need to find a definition of disability that reflects the social dimension without sacrificing the specificity of the disadvantage based on an impairment, and without losing its quality as an operational definition. The following definition tries to reflect this need. Accordingly, disability can be described as the environmentally determined effect of an impairment that, in interaction with other factors and within a specific social context, is likely to cause an individual to experience an undue disadvantage in his or her personal, social or professional life. Environmentally determined means that the impact of the impairment is influenced by a variety of factors, including preventive, corrective and compensatory measures as well as technological and accommodative solutions.
This definition recognizes that in a different environment that erects fewer barriers, the same impairment could be without any significant consequences, hence without leading to a disability. It stresses the corrective dimension over a concept that takes disability as an unavoidable fact and that simply seeks to ameliorate the living conditions of the afflicted persons. At the same time, it maintains the grounds for compensatory measures, such as cash benefits, because the disadvantage is, despite the recognition of other factors, still specifically linked to the impairment, irrespective of whether this is the result of a dysfunction of the individual or of negative attitudes of the community.
However, many disabled people would experience substantial limitations even in an ideal and understanding environment. In such cases the disability is primarily based in the impairment and not in the environment. Improvements in environmental conditions can substantially reduce dependency and restrictions, but they will not alter the fundamental truth that for many of these severely disabled people (which is different from severely impaired) participation in social and professional life will continue to be restricted. It is for these groups, in particular, that social protection and ameliorative provisions will continue to play a more significant role than the aim of full integration into the workplace which, if it takes place, is often done for social rather than for economic reasons.
But this is not to suggest that persons thus defined as severely disabled should live a life apart and that their limitations should be grounds for segregation and exclusion from the life of the community. One of the major reasons for exercising utmost caution as regards the use of disability definitions is the widespread practice of making a person thus identified and labelled the object of discriminatory administrative measures.
Nevertheless, this points to an ambiguity in the concept of disability that gives rise to so much confusion and that could be a main reason for the social exclusion of disabled people. For, on the one hand, many campaign with the slogan that disability does not mean inability; on the other, all existing protective systems are based on the grounds that disability means inability to make a living on one’s own. The reluctance of many employers to hire disabled people may be founded in this basic contradiction. The answer to this is a reminder that disabled people are not a homogeneous group, and that each case should be judged individually and without bias. But it is true that disability may mean both: an inability to perform according to the norm or an ability to perform as well as or even better than others, if given the opportunity and the right kind of support.
It is obvious that a concept of disability as outlined above calls for a new foundation for disability policies: sources of inspiration for how to modernize policies and programmes in favour of disabled persons can be found among others in the Vocational Rehabilitation and Employment (Disabled Persons) Convention, 1983 (No. 159) (ILO 1983) and the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities (United Nations 1993).
In the following paragraphs, the various dimensions of the disability concept as it affects present law and practice will be explored and described in an empirical manner. Evidence will be provided that various disability definitions are in use, mirroring the world’s different cultural and political legacies rather than giving cause for the hope that a single universal definition can be found which is understood by everyone in the same manner.
Disability and normality
As mentioned above, most past regulatory attempts at defining disability have fallen prey, in one form or another, to the temptation of describing disability as primarily negative or deviatory. The human being afflicted with disability is seen as a problem and becomes a “social case”. A disabled person is assumed to be unable to pursue normal activities. He or she is a person with whom all is not quite in order. There is an abundance of scientific literature that depicts disabled people as having a behavioural problem, and in many countries “defectology” was and still is a recognized science that sets out to measure the degree of deviation.
Individuals who have a disability generally defend themselves against such a characterization. Others resign themselves to the role of a disabled person. Classifying persons as disabled disregards the fact that what disabled individuals have in common with the non-disabled usually far outweighs that which makes them different. Further, the underlying concept that disability is a deviation from the norm is a questionable value statement. These considerations have incited many people to prefer the term persons with disabilities to that of disabled persons, as the latter term could be understood as making disability the primary characteristic of an individual.
It is thoroughly conceivable that human and social reality be defined in such a way that disability be regarded as consistent with normalcy and not as a deviation from it. In fact, the Declaration that was adopted in 1995 by the heads of state and government at the UN World Summit for Social Development in Copenhagen describes disability as a form of social diversity. This definition demands a conception of society which is a society “for all”. Thereby previous attempts at defining disability negatively, as deviation from the norm or as deficiency, are no longer valid. A society which adapts itself to disability in an inclusive manner could substantially overcome those effects of disability which were previously experienced as overly restrictive.
Disability as identity
Despite the danger that the label will invite segregation and discrimination, there are valid reasons to adhere to the usage of the term disability and to group individuals in this category. It cannot be denied, from an empirical standpoint, that many individuals with disability share similar, mostly negative, experiences of discrimination, exclusion and economic or social dependency. There exists a factual categorization of human beings as disabled, because specific negative or censorious social behaviour patterns appear to be based upon disability. Conversely, where there are efforts made to fight discrimination on the basis of disability, it also becomes necessary to stipulate who should have the right to enjoy protection under such measures.
It is in reaction to the way society treats people with disabilities that many individuals who have experienced discrimination in one form or another because of their disability join together in groups. They do so partly because they feel more at ease among individuals who share their experience, partly because they wish to advocate common interests. They accordingly accept the disabled role, if indeed for very different motives: some, because they want to induce society to view disability, not as an attribute of isolated individuals, but rather as the result of action and neglect on the part of the community which unduly curtails their rights and opportunities; the others, because they acknowledge their disability and demand their right to be accepted and respected in their difference, which includes their right to struggle for equality of treatment.
However, most individuals who, on account of an impairment, have a functional limitation of one form or another appear not to see themselves as disabled. This creates a problem not to be underestimated for those engaged with the politics of disability. For example, should those who do not self-identify as disabled be counted among the numbers of disabled persons, or only those who register as disabled?
Legal recognition as disabled
In many constituencies definitions of disability are identical with an administrative act of recognizing a disability. This recognition as disabled becomes a prerequisite for the claiming of support on the basis of a physical or mental limitation or for litigation under an anti-discrimination law. Such support can comprise provisions for rehabilitation, special education, retraining, privileges in the securing and preserving of a place of employment, guarantee of subsistence through income, compensation payments and assistance with mobility, etc.
In all cases in which legal regulations are in force in order to compensate for or to prevent disadvantages, there arises the need to clarify who has a claim on such legal provisions, be these benefits, services or protective measures. It follows thereupon, that the definition of disability is conditioned by the type of service or regulation which is offered. Virtually every existing definition of disability thus mirrors a legal system and draws its meaning from this system. Being recognized as disabled means to fulfil the conditions for benefiting from the possibilities presented by this system. These conditions, however, may vary among constituencies and programmes and, consequently, many different definitions may coexist side by side within a country.
Further evidence that the legal realities of the respective nations determine the definition of disability is offered by those countries, such as Germany and France, which have introduced a regulation including quotas or the levying of fines in order to assure disabled people access to employment opportunities. It can be demonstrated that with the introduction of such legislation, the number of “disabled” workers has risen drastically. This rise is to be explained only by the fact that employees—often on the recommendation of employers—who in the absence of such a law would never have designated themselves as disabled, register themselves as such. These same individuals were also never previously registered statistically as disabled.
Another legal difference among countries is the treatment of a disability as a temporary or permanent condition. In some countries, which offer disabled persons specific advantages or privileges, these privileges are limited to the duration of a recognized disadvantage. If this state of disadvantage is overcome through corrective actions, the disabled person loses his or her privileges—independently of whether medical facts (e.g., the loss of an eye or a limb) remain. For example, an individual who has successfully completed rehabilitation that has re-established lost functional abilities may lose entitlements to disability benefits or may not even enter a benefit scheme.
In other countries, lasting privileges are offered to offset real or hypothetical handicaps. This practice has resulted in the development of a legally recognized disability status bearing elements of “positive discrimination”. These privileges often apply even to those who are no longer actually in need of them because they are socially and economically well integrated.
The problem with statistical registration
A definition of disability that can be applied universally is impossible, since every country, and practically every administrative body, works with different concepts of disability. Every attempt to measure disability statistically must take into account the fact that disability is a system-dependent, and therefore a relative, concept.
Consequently, most regular statistics contain information only about the beneficiaries of specific state or public provisions who have accepted disability status in accordance with the operative definitions of the law. People who do not view themselves as disabled and manage alone with a disability usually do not come within the purview of official statistics. In fact, in many countries, such as the United Kingdom, many disabled people avoid statistical registration. The right not to be registered as disabled is in keeping with the principles of human dignity.
Therefore, occasionally, efforts are made to determine the total number of disabled persons through surveys and censuses. As already argued above, these come up against objective conceptual limits which render the comparability of such data between countries practically impossible. Above all, it is controversial what precisely such surveys are meant to prove, in particular as the notion of disability, as an objective set of findings that is equally applied and understood in all countries, cannot be sustained. Thus, a low number of statistically registered persons with disability in some countries does not necessarily reflect an objective reality, but most likely the fact that the countries in question offer fewer services and legal regulations in favour of disabled persons. Conversely, those countries which have an extensive social protection and rehabilitation system are likely to show a high percentage of disabled individuals.
Contradictions in the use of the concept of disabled persons
Objective results are, therefore, not to be expected on the level of quantitative comparison. But there is also no uniformity of interpretation from a qualitative point of view. Here again, the respective context and the intention of lawmakers determine the definition of disability. For example, the effort to guarantee disabled persons social protection requires disability to be defined as the inability to earn one’s own living. In contrast, a social policy whose goal is vocational integration endeavours to describe disability as a condition that, with the help of appropriate measures, need not have any detrimental effects on the level of performance.
International Definitions of Disability
The concept of disability in Convention No. 159 of the International Labour Organization
The above considerations also underlie the framework definition used in the Vocational Rehabilitation and Employment (Disabled Persons) Convention, 1983 (No. 159) (ILO 1983). Article 1.1 contains the following formulation: “For the purposes of this Convention, the term ‘disabled person’ means an individual whose prospects of securing, retaining and advancing in suitable employment are substantially reduced as a result of a duly recognized physical or mental impairment”.
This definition contains the following constituent elements: the reference to mental or physical impairment as the original cause of the disability; the necessity of a state recognition procedure that—in accordance with the respective national realities—determines who should be considered disabled; the determination that disability is not constituted by the impairment itself but by the possible and real social consequences of an impairment (in this case a more difficult situation on the labour market); and the established entitlement to measures which help to secure equality of treatment on the labour market (see Article 1.2). This definition consciously avoids an association with concepts such as inability and leaves room for an interpretation which holds that disability can also be conditioned by misconceived opinions held by an employer which may result in conscious or unconscious discrimination. On the other hand, this definition does not rule out the possibility that, in the case of a disability, objective limitations with respect to performance can occur, and leaves open whether or not the equal treatment principle of the Convention would apply in this case.
The definition in the ILO Convention does not make a claim to be a comprehensive, universally applicable definition of disability. Its sole intention is to provide for a clarification of what disability could mean in the context of employment and labour measures.
The concept of disability in light of the definition of the World Health Organization
The International Classification of Impairments, Disabilities and Handicaps (ICIDH) of the World Health Organization (WHO 1980) offers a definition of disability, in the area of health policy, which differentiates between impairment, disability and handicaps:
The new and distinctive aspects of this conceptual differentiation do not lie in its traditional epidemiological approach and its classificatory apparatus, but rather in its introduction of the concept of handicap, which calls on those concerned with public health policy to reflect on the social consequences of specific impairments on a person affected and to regard the treatment process as part of a holistic concept of life.
The WHO clarification was especially necessary because the words impairment and disability were previously often equated with concepts such as crippled, mentally retarded and the like, which convey an exclusively negative image of disability to the public. A categorization of this kind is, in fact, not suited to a precise definition of the concrete situation of a disabled individual within society. The WHO terminology has since become a reference for the discussion on the concept of disability at the national and international levels. It will, therefore, be necessary to dwell on these concepts a little more.
Impairment. With this concept, health professionals customarily designate an existing or developing injury to bodily functions or to vital life processes in a particular person that affects one or more parts of the organism or that indicates a defect in the psychic, mental or emotional functioning as the result of an illness, accident or congenital or hereditary condition. An impairment can be temporary or permanent. The influences of professional or social contexts or of the environment as a whole are not taken into consideration in this category. Here, the physician’s assessment of a person’s medical condition or an impairment is exclusively at issue, without consideration of the consequences that this impairment may have upon that person.
Disability. Such impairment or loss can result in substantial limitation to the active lives of persons afflicted. This consequence of impairment is termed disability. Functional disorders of the organism, such as, for example, psychic disorders and mental breakdowns, can lead to more or less severe disabilities and/or negative effects in the execution of specific activities and duties of daily living. These effects can be temporary or permanent, reversible or irreversible, constant, progressive or subject to successful treatment. The medical concept of disability designates, therefore, functional limitations which arise in the lives of specific individuals as the direct or indirect result of a physical, psychosocial or mental impairment. Above all, disability reflects the personal situation of the individual who has an impairment. However, as the personal consequences of a disability depend upon age, sex, social position and profession, and so on, the same or similar functional disorders can have thoroughly different personal consequences for different individuals.
Handicap. As soon as persons with physical or mental impairments enter their social, professional or private context, difficulties may arise which bring them into a situation of disadvantage, or handicap, in relation to others.
In the original version of the ICIDH, the definition of handicap signifies a disadvantage which emerges as the result of an impairment or a disability, and which limits an individual in the performance of what is regarded as a “normal” role. This definition of handicap, which bases the problem exclusively upon the personal situation of the person afflicted, has since come under criticism, for the reason that it does not sufficiently take into account the role of the environment and the attitude of society in bringing about the situation of disadvantage. A definition which takes these objections into account should reflect upon the relationship between the disabled individual and the manifold environmental, cultural, physical or social barriers that a society reflecting the attitudes of non-disabled members tends to erect. In light of this, every disadvantage in the life of a specific person that is not so much the result of an impairment or a disability, but of negative or unaccommodating attitudes in the largest sense, should be termed “handicap”. Further, any measures taken towards the improvement of the situation of disabled individuals, including those that help them to fully participate in life and in society, would contribute to preventing the “handicap”. A handicap thus is not the direct result of an existing impairment or disability, but the result of the interaction between an individual with a disability, the social context and the immediate surroundings.
It may not be assumed at the outset, therefore, that a person with an impairment or disability must automatically also have a handicap. Many disabled individuals succeed, despite the limitations caused by their disability, in the full pursuit of a profession. On the other hand, not every handicap can be attributed to a disability. It can also be caused by a lack of education that may or may not be linked with disability.
This hierarchical system of classification—impairment, disability, handicap—can be compared with the various phases of rehabilitation; for example, when the purely curative treatment is followed by rehabilitation of functional and psycho-social limitations and is completed with vocational rehabilitation or training for an independent pursuit of life.
The objective assessment of the degree of a disability in the sense of its social consequences (handicap) cannot, for this reason, rely solely upon medical criteria, but must take into account the vocational, social and personal contexts—especially the attitude of the non-disabled population. This state of affairs makes it quite difficult to measure and unequivocally establish a “state of disability”.
Definitions in Use in Various Countries
Disability as a legal category for the establishment of claims
Disability status is determined, as a rule, by a competent national authority on the basis of findings after an examination of individual cases. Therefore, the purpose for which disability status should be recognized plays an essential role—for example, where the determination of the presence of a disability serves the purpose of laying claim to specific personal rights and legal benefits. The primary interest in having a legally sound definition of disability is thus motivated not by medical, rehabilitative or statistical reasons, but rather by juridical reasons.
In many countries, persons whose disability is recognized can lay claim to the right to various services and regulatory measures in specific areas of health and social policies. As a rule, such regulations or benefits are designed to improve their personal situation and to support them in overcoming difficulties. The basis for the guarantee of such benefits thus is an act of official recognition of an individual’s disability on the strength of the respective statutory provisions.
Examples of definition from legislative practice
These definitions vary widely between different states. Only a few examples that are currently in use can be cited here. They serve to illustrate the variety as well as the questionable character of many definitions. As it cannot be the purpose here to discuss specific legal models, the sources of the quotations are not given, nor is an evaluation of which definitions appear more adequate than others. Examples of national definitions of disabled persons:
The multitude of legal definitions which partially supplement and partially exclude one another suggest that definitions serve, above all, bureaucratic and administrative goals. Among all the listed definitions not one can be considered satisfactory, and all raise more questions than they answer. Beyond a few exceptions, most definitions are oriented towards the representation of an individual deficiency and do not address the correlation between an individual and his or her environment. What in reality is the reflection of a complex relativity is reduced in an administrative context to an apparently clear-cut and stable quantity. Such oversimplified definitions then tend to take on a life of their own and frequently force individuals into accepting a status that is commensurate with the law, but not necessarily with their own potential and aspirations.
Disability as an issue for sociopolitical action
Individuals who are recognized as disabled are, as a rule, entitled to measures such as medical and/or vocational rehabilitation or to draw on specific financial benefits. In some countries, the range of sociopolitical measures also includes the granting of certain privileges and support as well as special protective measures. Examples include: a legally embodied principle of equality of opportunity in vocational and social integration; a legally established right to needed assistance in the realization of equal opportunity, a constitutional right to education and vocational integration; the furtherance of vocational training and placement in employment; and a constitutional assurance of increased support in case of need of special help from the state. Several states proceed from the absolute equality of all citizens in all areas of life and have set the realization of this equality as their goal, without seeing a reason for treating the special problems of disabled persons in laws enacted expressly for that purpose. These states usually refrain from defining disability altogether.
Disability in the context of vocational rehabilitation
In contrast to the establishment of pension claims or privileges, the definition of disability in the area of vocational integration emphasizes the avoidable and correctable effects of disability. It is the purpose of such definitions to eliminate, through rehabilitative provisions and active labour market policies, the vocational disadvantages connected with disability. The vocational integration of disabled persons is supported by the allocation of financial assistance, by accompanying provisions in the area of vocational training and by the accommodation of the workplace to the special needs of the disabled worker. Here again, the practices vary greatly between different countries. The range of benefits runs from relatively slight and short-term financial allocations to large-scale, longer-term vocational rehabilitation measures.
Most states set a relatively high value on the furtherance of vocational training for disabled individuals. This can be provided in ordinary or special centres run by public or private agencies, as well as in an ordinary enterprise. Preference given to each differs from country to country. Sometimes the vocational training is conducted in a sheltered workshop or provided as on-the-job training that is reserved for a disabled worker.
As the financial implications of these measures can be considerable for the taxpayer, the act of recognizing a disability is a far-reaching measure. Often, however, the registration is done by a different authority than that which administers the vocational rehabilitation programme and which meets its costs.
Disability as a permanent disadvantage
While the goal of vocational rehabilitation is to overcome the possible negative effects of disability, there exists wide agreement in disability legislation that further protective social measures are sometimes necessary to assure the vocational and social integration of rehabilitated individuals. It is also generally recognized that disability presents the continuing risk of social exclusion independent of the existence of an actual functional disorder. In recognition of this permanent threat, legislators provide a series of protective and supportive measures.
In many countries, for example, employers who are prepared to employ disabled persons in their companies can expect subsidies towards the wages and social security contributions of the disabled workers, the amount and duration of which will vary. Generally, an effort is made to assure that disabled employees receive the same income as non-disabled employees. This can result in situations wherein disabled individuals who receive a lower wage from their employers are refunded up to the full difference through arrangements made by the social protection system.
Even the establishment of small businesses by disabled individuals may be supported through various measures such as loans and loan guarantees, interest subsidies and rent allowances.
In many countries, the protection of disabled individuals from dismissal and the protection of their right to re-employment is handled in different ways. Many states have no special legal regulation for the dismissal of disabled persons; in some, a special commission or institution decides on the justification and legitimacy of a dismissal; in others, special regulations for victims of industrial accidents, for severely disabled workers and for workers on extended periods of sick-leave are still in effect. The legal situation with regard to the re-employment of disabled individuals is similar. Here too, there are countries which recognize a general obligation of the enterprise to keep a worker employed after injury or to re-employ him or her after completion of rehabilitation measures. In other countries, businesses are not under any obligation to re-employ disabled employees. Furthermore, there exist in some countries recommendations and conventions as to how to proceed in such cases, as well as countries in which the employee who has suffered a specific occupational disability is guaranteed either redeployment or return to the previous job after his or her medical recovery is complete.
Differences in treatment by cause of disability
The above overview helps to illustrate that laws provide different types of legal claim which bear clear consequences for the respective national concept of disability. Also the reverse is true: in those countries which provide no such legal entitlements, there exists no need to define disability in legally clear and binding terms. In such cases, the predominant inclination is to recognize as disabled only those who are visibly and markedly disabled in a medical sense—that is, persons with physical impairments, blindness, deafness or mental handicap.
In modern disability legislation—though less in the realm of social security provision—the principle of finality is becoming more grounded. This principle means that not the cause of a disability, but exclusively the needs associated with the disability and the final outcome of measures should be the concern of legislators. Nevertheless, the social status and the legal claims of disabled individuals are often dependent on the cause of their disability.
In consideration of the cause of disability, definitions differ not only in meaning but also in the implications they have in terms of potential benefits and assistance. The most important distinctions are made between disabilities that result from hereditary or birth-related physical, mental or psychological deficiencies or impairments; disabilities brought on by diseases; disabilities caused by home, work, sport or traffic accidents; disabilities brought on by occupational or environmental influences; and disabilities as a result of civil strife and armed conflict.
The relative preference shown to some disabled groups is often the consequence of their respectively better coverage under the social security system. Preference can also reflect the attitude of a community—for instance in the case of war veterans or accident victims—that feels a co-responsibility for the incident that led to the disability, while hereditary disability is often regarded as a problem of the family only. Such societal attitudes towards disability often have more significant consequences than official policy and can sometimes exert a decisive influence—negative or positive—on the process of social reintegration.
Summary and outlook
The diversity of historical, legal and cultural situations renders the discovery of a unitary concept of disability, equally applicable to all countries and situations, virtually impossible. For lack of a common and objective definition of disability, statistics are frequently provided by authorities as a means of keeping client records and interpreting the outcome of measures—a fact that makes an international comparison very difficult, as systems and conditions vary greatly among countries. Even where reliable statistics exist, the problem remains that individuals may be included in statistics who are no longer disabled or who, after successful rehabilitation, are no longer inclined to consider themselves disabled.
In most industrialized countries, the definition of disability is, above all, connected with legal entitlements to medical, social and vocational measures, to protection against discrimination or to cash benefits. As such, most definitions in use reflect legal practice and requirements that differ from country to country. In many cases, the definition is linked to an act of official recognition of disability status.
Owing to developments as different as the emergence of human rights legislation and technological advancements, traditional concepts of disability that led to situations of protected exclusion and segregation are losing ground. A modern concept of disability puts the issue at the intersection between social and employment policies. Disability is thus a term of social and vocational, rather than of medical, relevance. It demands corrective and positive measures to ensure equal access and participation, rather than passive measures of income support.
A certain paradox arises out of the understanding of disability as, on the one hand, something which can be overcome through positive measures, and, on the other, as something lasting which necessitates permanent protective or ameliorative measures. A similar frequently encountered contradiction is that between the idea of disability as fundamentally an issue of individual performance or function restriction, and the idea of disability as the unjustified cause for social exclusion and discrimination.
Opting for one all-encompassing definition can have grave social consequences for particular individuals. Were it declared that all disabled persons are able to work, many would be deprived of their pension claims and social protection. Were all disabled persons judged to show a reduced productivity/performance, hardly a disabled individual would obtain employment. This means that a pragmatic approach must be sought that accepts the heterogeneity of the reality that an ambiguous term such as disability tends to conceal. The new view of disability takes into account the specific situation and needs of disabled individuals as well as the economic and social feasibility of removing barriers to integration.
The goal of preventing undue disadvantage that may be linked with a disability will best be achieved where a flexible definition of disability is applied that takes into account the specific personal and social circumstances of an individual and that avoids stereotyped assumptions. This calls for a case-by-case approach to recognizing disability, which still is needed where different statutory rights and entitlements, notably those to achieve equal training and employment opportunities, are granted under various national laws and regulations.
Nonetheless, definitions of disability are still in use that evoke negative connotations and that contradict integrative concepts by overemphasizing the limiting effects of an impairment. A new view of the matter is called for. The focus should be on recognizing disabled individuals as citizens endowed with rights and abilities, and on empowering them to take charge of their destiny as adults who want to take part in the mainstream of social and economic life.
Likewise, efforts must continue to instill in the community a sense of solidarity that no longer uses a flawed concept of disability as grounds for the careless exclusion of fellow citizens. Between excessive care and neglect there should exist a sober conception of disability which neither mystifies nor underestimates its consequences. Disability can, but need not always, provide the grounds for specific measures. It should in no case provide a justification for discrimination and social exclusion.
Until very recently the effectiveness of training and education in controlling occupational health and safety hazards was largely a matter of faith rather than systematic evaluation (Vojtecky and Berkanovic 1984-85; Wallerstein and Weinger 1992). With the rapid expansion of intensive federally-funded training and education programmes in the past decade in the United States, this has begun to change. Educators and researchers are applying more rigorous approaches to evaluating the actual impact of worker training and education on outcome variables such as accident, illness and injury rates and on intermediate variables such as the ability of workers to identify, handle and resolve hazards in their workplaces. The programme that combines chemical emergency training as well as hazardous waste training of the International Chemical Workers Union Center for Worker Health and Safety Education provides a useful example of a well-designed programme which has incorporated effective evaluation into its mission.
The Center was established in Cincinnati, Ohio, in 1988 under a grant which the International Chemical Workers Union (ICWU) received from the National Institute for Environmental Health Sciences to provide training for hazardous waste and emergency response workers. The Center is a cooperative venture of six industrial unions, a local occupational health centre and a university environmental health department. It adopted an empowerment education approach to training and defines its mission broadly as:
… promoting worker abilities to solve problems and to develop union-based strategies for improving health and safety conditions at the worksite (McQuiston et al. 1994).
To evaluate the programme’s effectiveness in this mission the Center conducted long-term follow-up studies with the workers who went through the programme. This comprehensive evaluation went considerably beyond the typical assessment which is conducted immediately following training, and measures trainees’ short-term retention of information and satisfaction with (or reaction to) the education.
Programme and Audience
The course that was the subject of evaluation is a four or five-day chemical emergency/hazardous waste training programme. Those attending the courses are members of six industrial unions and a smaller number of management personnel from some of the plants represented by the unions. Workers who are exposed to substantial releases of hazardous substances or who work with hazardous waste less proximately are eligible to attend. Each class is limited to 24 students so as to promote discussion. The Center encourages local unions to send three or four workers from each site to the course, believing that a core group of workers is more likely than an individual to work effectively to reduce hazards when they return to the workplace.
The programme has established interrelated long-term and short-term goals:
Long-term goal: for workers to become and remain active participants in determining and improving the health and safety conditions under which they work.
Immediate educational goal: to provide students with relevant tools, problem-solving skills, and the confidence needed to use those tools (McQuiston et al. 1994).
In keeping with these goals, instead of focusing on information recall, the programme takes a “process oriented” training approach which seeks “to build self-reliance that stresses knowing when additional information is needed, where to find it, and how to interpret and use it.” (McQuiston et al. 1994.)
The curriculum includes both classroom and hands-on training. Instructional methods emphasize small group problem-solving activities with the active participation of the workers in the training. The development of the course also employed a participatory process involving rank-and-file safety and health leaders, programme staff and consultants. This group evaluated initial pilot courses and recommended revisions of the curriculum, materials and methods based on extensive discussions with trainees. This formative evaluation is an important step in the evaluation process that takes place during programme development, not at the end of the programme.
The course introduces the participants to a range of reference documents on hazardous materials. Students also develop a “risk chart” for their own facility during the course, which they use to evaluate their plant’s hazards and safety and health programmes. These charts form the basis for action plans which create a bridge between what the students learn at the course and what they decide needs to be implemented back in the workplace.
The Center conducts anonymous pre-training and post-training knowledge tests of participants to document increased levels of knowledge. However, to determine the long-term effectiveness of the programme the Center uses telephone follow-up interviews of students 12 months after training. One attendee from each local union is interviewed while every manager attendee is interviewed. The survey measures outcomes in five major areas:
The most recent published results of this evaluation are based on 481 union respondents, each representing a distinct worksite, and 50 management respondents. The response rates to the interviews were 91.9% for union respondents and 61.7% for management.
Results and Implications
Use of resource materials
Of the six major resource materials introduced in the course, all except the risk chart were used by at least 60% of the union and management trainees. The NIOSH Pocket Guide to Chemical Hazards and the Center’s training manual were the most widely used.
Training of co-workers
Almost 80% of the union trainees and 72% of management provided training to co-workers back at the worksite. The average number of co-workers taught (70) and the average length of training (9.7 hours) were substantial. Of special significance was that more than half of the union trainees taught managers at their worksites. Secondary training covered a wide range of topics, including chemical identification, selection and use of personal protective equipment, health effects, emergency response and use of reference materials.
Obtaining worksite improvements
The interviews asked a series of questions related to attempts to improve company programmes, practices and equipment in 11 different areas, including the following seven especially important ones:
The questions determined whether respondents felt changes were needed and, if so, whether improvements had been made.
In general, union respondents felt greater need for and attempted more improvements than management, although the degree of difference varied with specific areas. Still fairly high percentages of both unions and management reported attempted improvements in most areas. Success rates over the eleven areas ranged from 44 to 90% for unionists and from 76 to 100% for managers.
Questions concerning spills and releases were intended to ascertain whether attendance at the course had changed the way spills were handled. Workers and managers reported a total of 342 serious spills in the year following their training. Around 60% of those reporting spills indicated that the spills were handled differently because of the training. More detailed questions were subsequently added to the survey to collect additional qualitative and quantitative data. The evaluation study provides workers’ comments on specific spills and the role the training played in responding to them. Two examples are quoted below:
Following training the proper equipment was issued. Everything was done by the books. We have come a long way since we formed a team. The training was worthwhile. We don’t have to worry about the company, now we can judge for ourselves what we need.
The training helped by informing the safety committee about the chain of command. We are better prepared and coordination through all departments has improved.
The great majority of union and management respondents felt that they are “much better” or “somewhat better” prepared to handle hazardous chemicals and emergencies as a result of the training.
This case illustrates many of the fundamentals of training and education programme design and evaluation. The goals and objectives of the educational programme are explicitly stated. Social action objectives regarding workers’ ability to think and act for themselves and advocate for systemic changes are prominent along with the more immediate knowledge and behaviour objectives. The training methods are chosen with these objectives in mind. The evaluation methods measure the achievement of these objectives by discovering how the trainees applied the material from the course in their own work environments over the long term. They measure training impact on specific outcomes such as spill response and on intermediate variables such as the extent to which training is passed on to other workers and how course participants use resource materials.
The role of community groups and the voluntary sector in occupational health and safety has grown rapidly during the past twenty years. Hundreds of groups spread across at least 30 nations act as advocates for workers and sufferers from occupational diseases, concentrating on those whose needs are not met within workplace, trade union or state structures. Health and safety at work forms part of the brief of many more organizations which fight for workers’ rights, or on broader health or gender-based issues.
Sometimes the life-span of these organizations is short because, in part as a result of their work, the needs to which they respond become recognized by more formal organizations. However, many community and voluntary sector organizations have now been in existence for 10 or 20 years, altering their priorities and methods in response to changes in the world of work and the needs of their constituency.
Such organizations are not new. An early example was the Health Care Association of the Berlin Workers Union, an organization of doctors and workers which provided medical care for 10,000 Berlin workers in the mid-nineteenth century. Before the rise of industrial trade unions in the nineteenth century, many informal organizations fought for a shorter working week and the rights of young workers. The lack of compensation for certain occupational diseases formed the basis for organizations of workers and their relatives in the United States in the mid-1960s.
However, the recent growth of community and voluntary sector groups can be traced to the political changes of the late 1960s and 1970s. Increasing conflict between workers and employers focused on working conditions as well as pay.
New legislation on health and safety in the industrialized countries arose from an increased concern with health and safety at work amongst workers and trade unions, and these laws in turn led to further increases in public awareness. While the opportunities offered by this legislation have seen health and safety become an area for direct negotiation between employers, trade unions and government in most countries, workers and others suffering from occupational disease and injury have frequently chosen to exert pressure from outside these tripartite discussions, believing that there should be no negotiation over fundamental human rights to health and safety at work.
Many of the voluntary sector groups formed since that time have also taken advantage of cultural changes in the role of science in society: an increasing awareness amongst scientists of the need for science to meet the needs of workers and communities, and an increase in the scientific skills of workers. Several organizations recognize this alliance of interest in their title: the Academics and Workers Action (AAA) in Denmark, or the Society for Participatory Research in Asia, based in India.
Strengths and Weaknesses
The voluntary sector identifies as its strengths an immediacy of response to emerging problems in occupational health and safety, open organizational structures, the inclusion of marginalized workers and sufferers from occupational disease and injury, and a freedom from institutional constraints on action and utterance. The problems of the voluntary sector are uncertain income, difficulties in marrying the styles of voluntary and paid staff, and difficulties in coping with the overwhelming unmet needs of workers and sufferers from occupational ill-health.
The transient character of many of these organizations has already been mentioned. Of 16 such organizations known in the UK in 1985, only seven were still in existence in 1995. In the meantime, 25 more had come into existence. This is characteristic of voluntary organizations of all kinds. Internally they are frequently non-hierarchically organized, with delegates or affiliates from trade unions and other organizations as well as others suffering from work-related health problems. While links with trade unions, political parties and governmental bodies are essential to their effectiveness in improving conditions at work, most have chosen to keep such relationships indirect, and to be funded from several sources—typically, a mixture of statutory, labour movement, commercial or charitable sources. Many more organizations are entirely voluntary or produce a publication from subscriptions which cover printing and distribution costs only.
The activities of these voluntary sector bodies can be broadly categorized as based on single hazards (illnesses, multinational companies, employment sectors, ethnic groups or gender); advice centres; occupational health services; newsletter and magazine production; research and educational bodies; and supranational networks.
Some of the longest-established bodies fight for the interests of sufferers from occupational diseases, as shown in the following list, which summarizes the principal concerns of community groups around the world: multiple chemical sensitivity, white lung, black lung, brown lung, Karoshi (sudden death through overwork), repetitive strain injury, accident victims, electrical sensitivity, women’s occupational health, Black and ethnic minority occupational health, white lung (asbestos), pesticides, artificial mineral fibres, microwaves, visual display units, art hazards, construction work, Bayer, Union Carbide, Rio Tinto Zinc.
Concentration of efforts in this way can be particularly effective; the publications of the Center for Art Hazards in New York City were models of their kind, and projects drawing attention to the special needs of migrant minority ethnic workers have had successes in the United Kingdom, the United States, Japan and elsewhere.
A dozen organizations around the world fight for the particular health problems of ethnic minority workers: Latino workers in the United States; Pakistani, Bengali and Yemeni workers in England; Moroccan and Algerian workers in France; and South-East Asian workers in Japan among others. Because of the severity of the injuries and illnesses suffered by these workers, adequate compensation, which often means recognition of their legal status, is a first demand. But an end to the practice of double standards in which ethnic minority workers are employed in conditions which majority groups will not tolerate is the main issue. A great deal has been achieved by these groups, in part through securing better provision of information in minority languages on health and safety and employment rights.
The work of the Pesticides Action Network and its sister organizations, especially the campaign to get certain pesticides banned (the Dirty Dozen Campaign) has been notably successful. Each of these problems and the systematic abuse of the working and external environments by certain multinational companies are intractable problems, and the organizations dedicated to resolving them have in many cases won partial victories but have set themselves new goals.
The complexity of the world of work, the weakness of trade unions in some countries, and the inadequacy of statutory provision of health and safety advice at work, have resulted in the setting up of advice centres in many countries. The most highly developed networks in English-speaking countries deal with tens of thousands of enquiries each year. They are largely reactive, responding to needs as reflected by those who contact them. Recognized changes in the structure of advanced economies, towards a reduction in the size of workplaces, casualization, and an increase in informal and part-time work (each of which creates problems for the regulation of working conditions) have enabled advice centres to obtain funding from state or local government sources. The European Work Hazards Network, a network of workers and workers’ health and safety advisers, has recently received European Union funding. The South African advice centres network received EU development funding, and community-based COSH groups in the United States at one time received funds through the New Directions programme of the US Occupational Safety and Health Administration.
Occupational Health Services
Some of the clearest successes of the voluntary sector have been in improving the standard of occupational health service provision. Organizations of medically and technically trained staff and workers have demonstrated the need for such provision and pioneered novel methods of delivering occupational health care. The sectoral occupational health services which have been brought into existence progressively over the last 15 years in Denmark received powerful advocacy from the AAA particularly for the role of workers’ representatives in management of the services. The development of primary-care-based services in the UK and of specific services for sufferers from work-related upper limb disorders in response to the experience of workers’ health centres in Australia are further examples.
Changes within science during the 1960s and 1970s have lead to experimentation with new methods of investigation described as action research, participatory research or lay epidemiology. The definition of research needs by workers and their trade unions has created an opportunity for a number of centres specializing in carrying out research for them; the network of Science Shops in the Netherlands, DIESAT, the Brazilian trade union health and safety resource centre, SPRIA (the Society for Participatory Research in Asia) in India, and the network of centres in the Republic of South Africa are amongst the longest established. Research carried out by these bodies acts as a route by which workers’ perceptions of hazards and their health become recognized by mainstream occupational medicine.
Many voluntary sector groups produce periodicals, the largest of which sell thousands of copies, appear up to 20 times a year and are read widely within statutory, regulatory and trade union bodies as well as by their target audience amongst workers. These are effective networking tools within countries (Hazards bulletin in the United Kingdom; Arbeit und Ökologie (Work and the Environment) in Germany). The priorities for action promoted by these periodicals may initially reflect cultural differences from other organizations, but frequently become the priorities of trades unions and political parties; the advocacy of stiffer penalties for breaking health and safety law and for causing injury to, or the death of, workers are recurrent themes.
The rapid globalization of the economy has been reflected in trade unions through the increasing importance of the international trade secretariats, area-based trade union affiliations like the Organization of African Trade Union Unity (OATUU), and meetings of workers employed in particular sectors. These new bodies frequently take up health and safety concerns, the African Charter on Occupational Health and Safety produced by OATUU being a good example. In the voluntary sector international links have been formalized by groups which concentrate on the activities of particular multinational companies (contrasting the safety practices and health and safety record of constituent businesses in different parts of the world, or the health and safety record in particular industries, such as cocoa production or tyre manufacture), and by networks across the major free trade areas: NAFTA, EU, MERCOSUR and East Asia. All these international networks call for the harmonization of standards of worker protection, the recognition of, and compensation for, occupational disease and injury, and worker participation in health and safety structures at work. Upward harmonization, to the best extant standard, is a consistent demand.
Many of these international networks have grown up in a different political culture from the organizations of the 1970s, and see direct links between the working environment and the environment outside the workplace. They call for higher standards of environmental protection and make alliances between workers in companies and those who are affected by the companies’ activities; consumers, indigenous people in the vicinity of mining operations, and other residents. The international outcry following the Bhopal disaster has been channelled through the Permanent People’s Tribunal on Industrial Hazards and Human Rights, which has made a series of demands for the regulation of the activities of international business.
The effectiveness of voluntary sector organizations can be assessed in different ways: in terms of their services to individuals and groups of workers, or in terms of their effectiveness in bringing about changes in working practice and the law. Policy making is an inclusive process, and policy proposals rarely originate from one individual or organization. However, the voluntary sector has been able to reiterate demands which were at first unthinkable until they have become acceptable.
Some recurrent demands of voluntary and community groups include:
The voluntary sector in occupational health and safety exists because of the high cost of providing a healthy working environment and appropriate services and compensation for the victims of poor working conditions. Even the most extensive systems of provision, like those in Scandinavia, leave gaps which the voluntary sector attempts to fill. The increasing pressure for deregulation of health and safety in the long-industrialized countries in response to competitive pressures from transitional economies has created a new campaign theme: the maintenance of high standards and upward harmonization of standards in different nations’ legislation.
While they can be seen as performing an essential role in the process of initiating legislation and regulation, they are necessarily impatient about the speed with which their demands are accepted. They will continue to grow in importance wherever workers find that state provisions fall short of what is needed.
The Vocational Rehabilitation and Employment (Disabled Persons) Convention, 1983 (No. 159) and Vocational Rehabilitation and Employment (Disabled Persons) Recommendation, 1983 (No.168), which supplement and update the Vocational Rehabilitation (Disabled) Recommendation, 1955 (No. 99), are the principal reference documents for a social policy on the issue of disability. However, there are a number of other ILO instruments which explicitly or implicitly make reference to disability. There are notably the Discrimination (Employment and Occupation) Convention, 1958 (No. 111), the Discrimination (Employment and Occupation) Recommendation, 1958 (No. 111), the Human Resources Development Convention, 1975 (No. 142) and the Human Resources Development Recommendation, 1975 (No.150)
In addition, important references to disability issues are included in a number of other key ILO instruments, such as: Employment Service Convention, 1948 (No. 88); Social Security (Minimum Standards) Convention, 1952 (No. 102); Employment Injury Benefits Convention, 1964 (No. 121); Employment Promotion and Protection against Unemployment Convention, 1988 (No. 168); Employment Service Recommendation, 1948 (No. 83); Labour Administration Recommendation, 1978 (No. 158) and Employment Policy (Supplementary Provisions) Recommendation, 1984 (No. 169).
International labour standards treat disability basically under two different headings: as passive measures of income transfer and social protection, and as active measures of training and employment promotion.
One early objective of the ILO was to ensure that workers receive adequate financial compensation for disability, in particular if it was caused in relation to work or war activities. The underlying concern has been to ensure that a damage is adequately compensated, that the employer is liable for accidents and unsafe working conditions, and that in the interest of good labour relations, there should be fair treatment of workers. Adequate compensation is a fundamental element of social justice.
Quite distinct from the compensation objective is the social protection objective. ILO standards which deal with issues of social security look at disability largely as a “contingency” which needs to be covered under social security legislation, the idea being that disability can be a cause of loss of earning capacity and therefore be a legitimate reason to secure income through transfer payments. The principal objective is to provide insurance against loss of income and thus guarantee decent living conditions for people deprived of the means of gaining their own income due to impairment.
In a similar way, policies which pursue a social protection objective tend to provide public assistance to people with disabilities not covered by social insurance. Also in this case the tacit assumption is that disability means incapacity to find adequate income from work, and that a disabled person has therefore to be the responsibility of the public. As a result, disability policy is in many countries predominantly a concern of the social welfare authorities, and the primary policy is that of providing passive measures of financial assistance.
However, those ILO standards which deal explicitly with disabled persons (such as Conventions Nos. 142 and 159, and Recommendations Nos. 99, 150 and 168) treat them as workers and put disability—quite in contrast to the compensation and social protection concepts—in the context of labour market policies, which have as their objective to ensure equality of treatment and opportunity in training and employment, and which look at disabled people as being part of the economically active population. Disability is understood here basically as a condition of occupational disadvantage which can be and should be overcome through a variety of policy measures, regulations, programmes and services.
ILO Recommendation No. 99 (1955), which for the first time invited member States to shift their disability policies from a social welfare or social protection objective towards a labour integration objective, had a profound impact on law in the 1950s and 1960s. But the real breakthrough occurred in 1983 when the International Labour Conference adopted two new instruments, ILO Convention No. 159 and Recommendation No. 168. As of March 1996, 57 out of 169 member States had ratified this Convention.
Many others have readjusted their legislation so as to comply with this Convention even if they have not, or not yet, ratified this international treaty. What distinguishes these new instruments from the former ones is the recognition by the international community and by employers’ and workers’ organizations of the right of disabled persons to equal treatment and opportunity in training and employment.
These three instruments now form a unity. They aim to ensure active labour market participation of disabled people and thus to challenge the sole validity of passive measures or of policies which treat disability as a health problem.
The purposes of the international labour standards which have been adopted with this objective in mind can be described as follows: to remove the barriers which stand in the way of full social participation and integration of disabled people in the mainstream, and to provide the means to promote effectively their economic self-reliance and social independence. These standards oppose a practice that treats disabled people as being outside the norm and excludes them from the mainstream. They object to the tendency of taking disability as a justification for social marginalization and for denying people, on account of their disability, civil and workers’ rights which non-disabled people enjoy as a matter of course.
For the purpose of clarity we may group the provisions of international labour standards which promote the concept of the right of disabled people to active participation in training and employment into two groups: those which address the principle of equal opportunity and those which address the principal of equal treatment.
Equal opportunity: the policy goal which lies behind this formula is to ensure that a disadvantaged population group has access to the same employment and income-earning possibilities and opportunities as the mainstream population.
In order to achieve equal opportunity for disabled people, the pertinent international labour standards have established rules and recommended measures for three types of action:
Therefore, these standards, which have been developed to guarantee equality of opportunity, imply the promotion of special positive measures to help disabled people make the transition into active life or to prevent unnecessary, unwarranted transition into a life reliant upon passive income support. Policies geared to establish equality of opportunity are, therefore, usually concerned with the development of support systems and special measures to bring about effective equality of opportunities, which are justified by the need to compensate for the real or presumed disadvantages of disability. In ILO legal parlance: “Special positive measures aimed at effective equality of opportunity … between disabled workers and other workers shall not be regarded as discriminating against other workers” (Convention No. 159, Article 4).
Equal treatment: The precept of equal treatment has a related but distinct objective. Here the issue is that of human rights, and the regulations which ILO member States have agreed to observe have precise legal implications and are subject to monitoring and—in case of violation—to legal recourse and/or arbitration.
ILO Convention No. 159 established equal treatment as a guaranteed right. It furthermore specified that equality has to be “effective”. This means that conditions should be such as to ensure that the equality is not only formal but real and that the situation resulting from such treatment puts the disabled person into an “equitable” position, that is one which corresponds by its results and not by its measures to that of non-disabled persons. For example, to assign a disabled worker the same job as a non-disabled worker is not equitable treatment if the worksite is not fully accessible or if the job is not suited to the disability.
Present Legislation on Vocational Rehabilitation and Employment of Disabled Persons
Each country has a different history of vocational rehabilitation and employment of disabled persons. The legislation of member States varies due to their different stages of industrial development, social and economic situations, and so on. For example, some countries already had legislation on disabled persons before the Second World War, deriving from disability measures for disabled veterans or poor people at the beginning of this century. Other countries started to take concrete measures to support disabled persons after the Second World War, and established legislation in the field of vocational rehabilitation. This was often expanded following the adoption of the Vocational Rehabilitation of the Disabled Recommendation, 1955 (No. 99) (ILO 1955). Other countries only recently started taking measures for disabled persons due to the awareness created by the International Year of Disabled Persons in 1981, the adoption of ILO Convention No.159 and Recommendation No. 168 in 1983 and the United Nations Decade of Disabled Persons (1983–1992).
Figure 1. Four types of legislation on rights of persons with disabilities.
We must realize that there are no clear divisions between these four groups and that they may overlap. Legislation in a country may correspond not only to one type, but to several. For example, the legislation of many countries is a combination of two types or more. It seems that the legislation of Type A is formulated in the early stage of measures for disabled persons, whereas the legislation of Type B is from a later stage. The legislation of Type D, namely the prohibition of discrimination because of disabilities, has been growing in recent years, supplementing the prohibition of discrimination on the basis of race, sex, religion, political opinion and so on. The comprehensive nature of legislation of Types C and D may be used as models for those developing countries which have not yet formulated any concrete legislation on disability.
Sample Measures of each Type
In the following paragraphs, the structure of legislation and measures stipulated are outlined by some examples of each type. As measures for vocational rehabilitation and employment of disabled persons in each country are often more or less the same, regardless of the type of legislation in which they are provided for, some overlaps occur.
Type A: Measures for disabled persons on vocational rehabilitation and employment which are provided for in general labour legislation such as employment promotion acts or vocational training acts. Measures for disabled persons may also be included as part of comprehensive measures for workers in general.
The characteristic of this type of legislation is that measures for disabled people are provided for in the acts which apply to all workers, including disabled workers, and to all enterprises employing workers. As measures on employment promotion and employment security for disabled persons are basically incorporated as part of comprehensive measures for workers in general, the national policy gives priority to internal rehabilitation efforts of enterprises and to preventive activities and early intervention in working environments. To this end, working environment committees, which consist of employers, workers and safety and health personnel are often set up in enterprises. The details of the measures tend to be provided for in regulations or rules under the acts.
For example, the Working Environment Act of Norway applies to all workers employed by most enterprises in the country. Some special measures for handicapped persons are incorporated: (1) Passageways, sanitary facilities, technical installations and equipment shall be designed and arranged so that handicapped persons can work in the enterprise, as far as possible. (2) If a worker has become handicapped in the workplace as a result of accident or sickness the employer shall, as far as possible, take the necessary measures to enable the worker to obtain or retain suitable employment. The worker shall preferably be given an opportunity to continue his or her former work, possibly after special adaptation of the work activity, alteration of technical installations, rehabilitation or retraining and so on. The following are examples of action that must be taken by the employer:
In addition to these measures, there is a system which provides employers of handicapped persons with subsidies concerning the additional cost to adapt the workplace to the worker, or vice versa.
Type B: Measures for disabled persons which are provided for in special acts which deal exclusively with vocational rehabilitation and employment of disabled persons.
This type of legislation usually has specific provisions on vocational rehabilitation and employment dealing with various measures, while other measures for disabled people are stipulated in other acts.
For example, the Severely Disabled Persons Act of Germany provides for the following special assistance for disabled persons to improve their employment opportunities, as well as vocational guidance and placement services:
Type C: Measures for the vocational rehabilitation and employment of disabled persons which are provided for in comprehensive special acts for disabled persons linked together with measures for other services such as health, education, accessibility and transportation.
This type of legislation usually has general provisions concerning the purpose, declaration of policy, coverage, definition of terms in the first chapter, and after that several chapters which deal with services in the fields of employment or vocational rehabilitation as well as health, education, accessibility, transportation, telecommunications, auxiliary social services and so on.
For example, the Magna Carta for Disabled Persons of the Philippines provides for the principle of equal opportunity for employment. The following are several measures from chapter on employment:
Furthermore, this act has provisions concerning prohibition of discrimination against disabled persons in employment.
Type D: Measures for prohibition of discrimination in employment on the basis of disability which are provided for in a comprehensive special anti-discrimination act along with measures for prohibition of discrimination in areas such as public transportation, public accommodation and telecommunications.
The feature of this type of legislation is that there are provisions which deal with discrimination on the ground of disability in employment, public transportation, accommodation, telecommunications and so on. Measures for vocational rehabilitation services and the employment of disabled people are provided for in other acts or regulations.
For example, the Americans with Disabilities Act prohibits discrimination in such important areas as employment, access to public accommodations, telecommunications, transportation, voting, public services, education, housing and recreation. As for employment in particular, the Act prohibits employment discrimination against “qualified individuals with a disability” who, with or without “reasonable accommodation”, can perform the essential functions of the job, unless such accommodation would impose “undue hardship” on the operation of the business. The Act prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training and other terms, conditions and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits and all other employment-related activities.
In Australia, the purpose of the Disability Discrimination Act is to provide improved opportunities for people with a disability and to assist in breaking down barriers to their participation in the labour market and other areas of life. The Act bans discrimination against people on the grounds of disability in employment, accommodation, recreation and leisure activities. This complements existing anti-discrimination legislation that outlaws discrimination on the grounds of race or gender.
Quota/Levy Legislation or Anti-discrimination Legislation?
The structure of national legislation on vocational rehabilitation and employment of disabled persons varies somewhat from country to country, and it is therefore difficult to determine which type of legislation is best. However, two types of legislation, namely quota or levy legislation and anti-discrimination legislation, seem to emerge as the two main legislative modes.
Although some European countries, among others, have quota systems which are usually provided in the legislation of Type B, they are quite different in some points, such as the category of disabled persons to whom the system is applied, the category of employers on whom the employment obligation is imposed (for example, size of the enterprise or public sector only) and the employment rate (3%, 6%, etc.). In most countries the quota system is accompanied by a levy or grant system. Quota provisions are also included in the legislation of non-industrialized countries as varied as Angola, Mauritius, the Philippines, Tanzania and Poland. China is also examining the possibility of introducing a quota system.
There is no doubt that a quota system that is enforceable could contribute considerably to raising the employment levels of disabled persons in the open labour market. Also, the system of levies and grants helps to rectify the financial inequality between the employers who try to employ disabled workers and the ones who do not, while levies contribute to accumulating valuable resources that are needed to finance vocational rehabilitation and incentives for employers.
On the other hand, one of the problems of the system is the fact that it requires a clear definition of disability for recognizing qualification, and strict rules and procedures for registration, and therefore it may raise the problem of stigma. There may also be the potential discomfort of a disabled person being at a place of employment where he or she is not wanted by the employer but is merely tolerated to avoid legal sanctions. In addition, credible enforcement mechanisms and their effective application are required for quota legislation to achieve results.
Anti-discrimination legislation (Type D) seems to be more appropriate for the principle of normalization, ensuring disabled persons equal opportunities in society, because it promotes employers’ initiatives and social consciousness by means of environmental improvement, not employment obligation.
On the other hand, some countries have difficulties in enforcing anti-discrimination legislation. For example, remedial action usually requires a victim to play the role of complainant, and in some cases it is difficult to prove discrimination. Also the process of remedial action commonly takes a long time because a lot of complaints of discrimination on the basis of disability are sent to courts or equal rights commissions. It is generally admitted that anti-discrimination legislation has still to prove its effectiveness in placing and maintaining large numbers of disabled workers in employment.
Although it is difficult to forecast future trends in legislation, it appears that anti-discrimination acts (Type D) are one stream which both developed countries and developing countries will consider.
It seems that industrialized countries with a history of quota or quota/levy legislation will watch the experience of countries such as the United States and Australia before taking action to adjust their own legislative systems. In particular in Europe, with its concepts of redistributive justice, it is likely that the prevailing legislative systems will be maintained, while, however, introducing or strengthening anti-discrimination provisions as an additional legislative feature.
In a few countries like the United States, Australia and Canada, it could be politically difficult to legislate a quota system for disabled people without having quota provisions also in relation to other population groups that experience disadvantages in the labour market, such as women and ethnic and racial minority groups currently covered by human rights or employment equity legislation. Although a quota system would have some advantages for disabled people, the administrative apparatus required for such a multicategory quota system would be enormous.
It appears that developing countries which have no disability legislation may choose legislation of Type C, including a few provisions concerning prohibition of discrimination, because it is the more comprehensive approach. The risk of this approach, however, is that comprehensive legislation which cuts across the responsibility of many ministries becomes the affair of a single ministry, mostly that responsible for social welfare. This may be counterproductive, reinforce segregation and weaken the government’s ability to implement the law. Experience shows that comprehensive legislation looks good on paper, but is rarely applied.
The term environmental education covers a potentially wide range of issues and activities when applied to employees, managers and workplaces. These encompass:
This article focuses on the state of worker training and education in the United States in the growing environmental remediation field. It is not an exhaustive treatment of environmental education, but rather an illustration of the link between occupational safety and health and the environment and of the changing nature of work in which technical and scientific knowledge has become increasingly important in such traditional “manual” trades as construction. “Training” refers in this context to shorter-term programmes organized and taught by both academic and non-academic institutions. “Education” refers to programmes of formal study at accredited two-year and four-year institutions. Currently a clear career path does not exist for individuals with interest in this field. The development of more defined career paths is one goal of the National Environmental Education and Training Center, Inc. (NEETC) at Indiana University of Pennsylvania. Meanwhile, a wide range of education and training programmes exist at different levels, offered by a variety of academic and non-academic institutions. A survey of the institutions involved in this type of training and education formed the source material for the original report from which this article was adapted (Madelien and Paulson 1995).
A 1990 study conducted by Wayne State University (Powitz et al. 1990) identified 675 separate and distinct noncredit short courses for hazardous waste worker training at colleges and universities, offering over 2,000 courses nationwide each year. However, this study did not cover some of the primary providers of training, namely community college programmes, US Occupational Safety and Health Administration training programmes and independent firms or contractors. Thus, the Wayne State number could probably be doubled or tripled to estimate the number of noncredit, noncertification course offerings available in the United States today.
The major government-funded training programme in environmental remediation is that of the National Institute for Environmental Health Sciences (NIEHS). This program, established under the Superfund legislation in 1987, provides grants to non-profit organizations with access to appropriate worker populations. Recipients include labour unions; university programmes in labour education/labour studies and public health, health sciences and engineering; community colleges; and non-profit-making safety and health coalitions, known as COSH groups (Committees on Occupational Safety and Health). Many of these organizations operate in regional consortia. The target audiences include:
The NIEHS program has resulted in extensive curriculum and materials development and innovation, which has been characterized by considerable sharing and synergy among grantees. The programme funds a national clearinghouse which maintains a library and curriculum centre and publishes a monthly newsletter.
Other government funded programmes offer short courses targeting hazardous waste industry professionals as opposed to front-line remedial workers. Many of these programmes are housed in university Educational Resource Centers funded by the National Institute for Occupational Safety and Health (NIOSH).
The broadest change on the hazardous waste education and training landscape in the past few years is the dramatic development of community college programmes and consortia to improve vocational education at the associate’s degree level. Since the 1980s, community colleges have been doing the most organized and extensive curriculum development work in secondary education.
The Department of Energy (DOE) has funded programmes nationwide to provide for a trained workforce at sites where the need has changed from nuclear technicians to hazardous waste clean-up workers. This training is taking place most rigorously at community colleges, many of which have historically provided for personnel needs at specific DOE sites. DOE-funded programmes at community colleges have also given rise to major efforts in curriculum development and consortia for sharing information. Their goals are to establish more consistent and higher standards of training and to provide mobility for the workforce, enabling an individual trained to work at a site in one part of the country to move to another site with minimal retraining requirements.
Several consortia of community colleges are advancing curricula in this area. The Partnership for Environmental Technology Education (PETE) operates in six regions. PETE is working with the University of Northern Iowa to create a world-class network of community college environmental programmes, linked with high schools, that inform and prepare students for entry into these two-year degree programmes. The goals include the development of (1) nationally validated curriculum models, (2) comprehensive professional development programmes and (3) a national clearinghouse for environmental education.
The Hazardous Materials Training and Research Institute (HMTRI) serves the curriculum development, professional development, print and electronic communications needs of 350 colleges with two-year environmental technologies credit programmes. The Institute develops and distributes curricula and materials and implements educational programmes at its own Environmental Training Center at Kirkwood Community College in Iowa, which has extensive classroom, laboratory and simulated field site facilities.
The Center for Occupational Research and Development (CORD) provides national leadership in the US Department of Education’s Tech Prep/Associate Degree initiative. The Tech Prep program requires coordination between secondary and post-secondary institutions to give students a solid foundation for a career pathway and the world of work. This activity has led to the development of several contextual, experiential student texts in basic science and mathematics, which are designed for students to learn new concepts in relationship to existing knowledge and experience.
CORD has also played a significant role in the Clinton administration’s national educational initiative, “Goals 2000: Educate America”. In recognition of the need for qualified entry-level personnel, the initiative provides for the development of occupational skills standards. (“Skills standards” define the knowledge, skills, attitudes and level of ability necessary to successfully function in specific occupations.) Among the 22 skills standards development projects funded under the programme is one for hazardous materials management technology technicians.
Articulation between vocational and baccalaureate programmes
A continuing problem has been the poor linkage between two-year and four-year institutions, which hampers students who wish to enter engineering programmes after completing associate’s (two-year) degrees in hazardous/radioactive waste management. However, a number of community college consortia have begun to address this problem.
The Environmental Technology (ET) consortium is a California community college network that has completed articulation agreements with four four-year colleges. The establishment of a new job classification, “environmental technician”, by the California Environmental Protection Agency provides added incentive for graduates of the ET program to continue their education. An ET certificate represents the entry level requirement for the environmental technician position. Completion of an associate’s degree makes the employee eligible for promotion to the next job level. Further education and work experience allows the worker to progress up the career ladder.
The Waste-management Education and Research Consortium (WERC), a consortium of New Mexico schools, is perhaps the most advanced model which attempts to bridge gaps between vocational and traditional four-year education. Consortium members are the University of New Mexico, the New Mexico Institute of Mining and Technology, New Mexico State University, Navajo Community College, Sandia Laboratory and Los Alamos Laboratories. The approach to curriculum transfer has been an interactive television (ITV) program in distance learning, which takes advantage of the varied strengths of the institutions.
Students enrolled in the environmental programme are required to take 6 hours of courses from the other institutions through distance learning or an offsite semester of coursework. The programme is decidedly inter-disciplinary, combining a minor in hazardous materials/waste management with a major from another department (political science, economics, pre-law, engineering or any of the sciences). The programme is “both broad and narrow” in focus, in that it recognizes a need to develop students with both a broad knowledge base in their field and some specific training in hazardous materials and hazardous waste management. This unique programme couples student participation in realistic applied research and industry-led curriculum development. The courses for the minor are very specific and take advantage of the particularized specialties at each school, but each program, including the associate degree, has a large core requirement in humanities and social sciences.
Another unique feature is the fact that the four-year schools offer two-year associate’s degrees in radioactive and hazardous materials technology. The two-year associate’s degree in environmental science offered at the Navajo Community College includes courses in Navajo history and substantial courses in communications and business, as well as technical courses. A hands-on laboratory has also been developed on the Navajo Community College campus, an unusual feature for a community college and part of the consortium’s commitment to hands-on laboratory learning and technology development/applied research. The WERC member institutions also offer a “non-degree” certificate programme in waste management studies, which seems to be above and beyond the 24-hour and 40-hour courses offered at other colleges. It is for individuals who already have a bachelor’s or graduate degree and who further wish to take advantage of seminars and specialty courses at the universities.
Several significant changes have taken place in the focus of education and training related to the hazardous waste industry in the past few years, in addition to the proliferation of short-course training programmes and traditional engineering programmes. Overall, the Department of Energy seems to have focused education at the community college level on workforce retraining, primarily through the Partnership for Environmental Technology Education (PETE), the Waste-management Education and Research Consortium (WERC) and other consortia like them.
There is a major gap between vocational training and traditional education in the environmental field. Because of this gap, there is not a clear, routine career path for hazardous waste workers, and it is difficult for these workers to advance in industry or government without classic technical degrees. Although inter-departmental options for education at a management level are being established within economics, law and medicine departments which recognize the breadth of the environmental industry, these are still academic-based professional degrees which miss a large part of the available and experienced workforce.
As the environmental clean-up industry matures, the long-term needs of the workforce for more balanced training and education and a well-developed career path become more clear. The large numbers of displaced workers from closed military sites means more people are entering the environmental workforce from other fields, making the demand on union training and placement of displaced workers (both discharged military personnel and displaced civilian personnel) even greater than before. Educational programmes are needed which meet both the needs of personnel entering the industry and of industry itself for a more balanced and better-educated workforce.
Since labour union members are one of the main groups poised to enter the hazardous waste clean-up and environmental remediation field, it would seem that labour studies and industrial relations departments might be logical entities to develop degree programmes that incorporate a hazardous waste/environmental curriculum with development of labour/management skills.
In the context of occupational health and safety, “right to know” refers generally to laws, rules and regulations requiring that workers be informed about health hazards related to their employment. Under right-to-know mandates, workers who handle a potentially harmful chemical substance in the course of their job duties cannot be left unaware of the risk. Their employer is legally obligated to tell them exactly what the substance is chemically, and what kind of health damage it can cause. In some cases, the warning must also include advice on how to avoid exposure and must state the recommended treatment in case exposure does occur. This policy contrasts sharply with the situation it was meant to replace, unfortunately still prevailing in many workplaces, in which workers knew the chemicals they used only by trade names or generic names such as “Cleaner Number Nine” and had no way to judge whether their health was being endangered.
Under right-to-know mandates, hazard information is usually conveyed through warning labels on workplace containers and equipment, supplemented by worker health and safety training. In the United States, the major vehicle for worker right to know is the Occupational Safety and Health Administration’s Hazard Communication Standard, finalized in 1986. This federal regulatory standard requires labelling of hazardous chemicals in all private-sector workplaces. Employers must also provide workers access to a detailed Materials Safety Data Sheet (MSDS) on each labelled chemical, and provide worker training in safe chemical handling. Figure 1 shows a typical US right-to-know warning label.
Figure 1. Right-to-know chemical warning label
It should be noted that as a policy direction, the provision of hazard information differs greatly from direct regulatory control of the hazard itself. The labelling strategy reflects a philosophical commitment to individual responsibility, informed choice and free market forces. Once armed with knowledge, workers are in theory supposed to act in their own best interests, demanding safe working conditions or finding different work if necessary. Direct regulatory control of occupational hazards, by contrast, assumes a need for more active state interventions to counter the power imbalances in society that prevent some workers from making meaningful use of hazard information on their own. Because labelling implies that the informed workers bear ultimate responsibility for their own occupational safety, right-to-know policies occupy a somewhat ambiguous status politically. On the one hand, they are cheered by labour advocates as a victory enabling workers to protect themselves more effectively. On the other hand, they can threaten workers’ interests if right to know is allowed to replace or weaken other occupational safety and health regulations. As activists are quick to point out, the “right to know” is a starting point that needs to be complemented with the “right to understand” and the “right to act”, as well as with continued effort to control work hazards directly.
Local organizations play a number of important roles in shaping the real-world significance of worker right-to-know laws and regulations. First and foremost, these rights often owe their very existence to public interest groups, many of them community based. For example, “COSH groups” (grass-roots Committees on Occupational Safety and Health) were central participants in the lengthy rule-making and litigation that went into establishing the Hazard Communication Standard in the United States. See box for a more detailed description of COSH groups and their activities.
Organizations in the local community also play a second critical role: assisting workers to make more effective use of their legal rights to hazard information. For example, COSH groups advise and assist workers who feel they may suffer retaliation for seeking hazard information; raise consciousness about reading and observing warning labels; and help bring to light employer violations of right-to-know requirements. This help is particularly important to workers who feel intimidated in using their rights due to low education levels, low job security, or lack of a supportive trade union. COSH groups also assist workers in interpreting the information contained on labels and in Material Safety Data Sheets. This kind of support is badly needed for workers with limited literacy. It can also help workers with good reading skills but insufficient technical background to understand the MSDSs, which are often written in scientific language confusing to an untrained reader.
Worker right to know is not only a matter of transmitting factual information; it also has an emotional side. Through right to know, workers may learn for the first time that their jobs are dangerous in ways they had not realized. This disclosure can stir up feelings of betrayal, outrage, dread and helplessness—sometimes with great intensity. Accordingly, a third important role that some community-based organizations play in worker right to know is to provide emotional support for workers struggling to deal with the personal implications of hazard information. Through self-help support groups, workers receive validation, a chance to express their feelings, a sense of collective support, and practical advice. In addition to COSH groups, examples of this kind of self-help organization in the United States include Injured Workers, a national network of support groups that provides a newsletter and locally available support meetings for individuals contemplating or involved in workers’ compensation claims; the National Center for Environmental Health Strategies, an advocacy organization located in New Jersey, serving those at risk of or suffering from multiple chemical sensitivity; and Asbestos Victims of America, a national network centred in San Francisco that offers information, counselling, and advocacy for workers exposed to asbestos.
A special case of right to know involves locating workers known to have been exposed to occupational hazards in the past, and informing them of their elevated health risk. In the United States, this kind of intervention is called “high-risk worker notification”. Numerous state and federal agencies in the United States have developed programmes of worker notification, as have some unions and a number of large corporations. The federal government agency most actively involved with worker notification at present is the National Institute for Occupational Safety and Health (NIOSH). This agency carried out several ambitious community-based pilot programmes of worker notification in the early 1980s, and now includes worker notification as a routine part of its epidemiological research studies.
NIOSH’s experience with this kind of information provision is instructive. In its pilot programmes, NIOSH undertook to develop accurate lists of workers with probable exposure to hazardous chemicals in a particular plant; to send personal letters to all workers on the list, informing them of the possibility of health risk; and, where indicated and feasible, to provide or encourage medical screening. It immediately became obvious, however, that the notification did not remain a private matter between the agency and each individual worker. On the contrary, at every step the agency found its work affected by community-based organizations and local institutions.
NIOSH’s most controversial notification took place in the early 1980s in Augusta, Georgia, with 1,385 chemical workers who had been exposed to a potent carcinogen (β-naphthylamine). The workers involved, predominantly African-American males, were unrepresented by a union and lacked resources and formal education. The community’s social climate was, in the words of programme staff, “highly polarized by racial discrimination, poverty, and substantial lack of understanding of toxic hazards”. NIOSH helped establish a local advisory group to encourage community involvement, which quickly took on a life of its own as more militant grass-roots organizations and individual worker advocates joined the effort. Some of the workers sued the company, adding to the controversies already surrounding the programme. Local organizations such as the Chamber of Commerce and the county Medical Society also became involved. Even many years later, echoes can still be heard of the conflicts among local organizations involved in the notification. In the end, the programme did succeed in informing the exposed workers of their life-long risk for bladder cancer, a highly treatable disease if caught early. Over 500 of them were medically screened through the programme, and a number of possibly life-saving medical interventions resulted.
A striking feature of the Augusta notification is the central role played by the news media. Local news coverage of the programme was extremely heavy, including over 50 newspaper articles and a documentary film about the chemical exposures (“Lethal Labour”) shown on local TV. This publicity reached a wide audience and had enormous impact on the notified workers and the community as a whole, leading the NIOSH project director to observe that “in actuality, the news media perform the real notification”. In some situations, it may be useful to regard local journalists as an intrinsic part of right to know and plan a formal role for them in the notification process to encourage more accurate and constructive reporting.
While the examples here are drawn from the United States, the same issues arise worldwide. Worker access to hazard information represents a step forward in basic human rights, and has properly become a focal point of political and service effort for pro-worker community-based organizations in many countries. In nations with weak legal protections for workers and/or weak labour movements, community-based organizations are all the more important in terms of the three roles discussed here—advocating for stronger right-to-know (and right-to-act) laws; assisting workers to use right-to-know information effectively; and providing social and emotional support for those who learn they are at risk from work hazards.
The heterogeneity of disability is mirrored in the diversity of legal provisions and benefits that most countries have introduced and codified over the last hundred years. The example of France is chosen because it has perhaps one of the most elaborate regulatory frameworks regarding the classification of disability. While the French system may not be typical compared with those of many other countries, it has—with respect to the topic of this chapter—all the typical elements of an historically grown classification system. Therefore, this case study reveals the fundamental issues that have to be tackled in any system that grants to disabled persons rights and entitlements which are subject to legal recourse.
The twentieth anniversary of the law of 30 June 1975 regarding disabled persons has triggered a renewed interest in the lot of the disabled in France. Estimates of the number of disabled French nationals range from 1.5 to 6 million (equivalent to 10% of the population), although these estimates suffer from a lack of precision in the definition of disability. This population is all too often relegated to the margins of society, and despite progress over the last two decades, their condition remains a serious societal problem with painful human, moral and emotional ramifications that transcend collective considerations of national solidarity.
Under French law, disabled persons enjoy the same rights and freedoms as other citizens, and are guaranteed equality of opportunity and treatment. Unless specific support mechanisms are implemented, this equality is, however, purely theoretical: disabled individuals may, for example, require specialized transportation and city planning to allow them to come and go as freely as other citizens. Measures such as these, which allow disabled persons to enjoy equal treatment in fact, are designed not to confer privilege, but to remove disadvantages associated with disability. These include legislation and other state-initiated measures that guarantee equitable treatment in education, training, employment and housing. Equality of treatment and palliation of the disability constitute the prime objectives of social policy concerning disabled persons.
In most cases, however, the various measures (usually termed political discriminatory measures) prescribed by French law are not available to all persons suffering from a given disability, but rather to selected subgroups: for example, a specific allowance or programme designed to favour occupational reintegration is available only to a specific category of disabled persons. The variety of disabilities and the multiple contexts in which disability may occur have necessitated the development of classification systems that take into account an individual’s official status as well as his or her level of disability.
Variety of Disabilities and Determination of Official Status
In France, the context in which disabilities arise constitutes the fundamental basis for classification. Classifications based on the nature (physical, mental or sensory) and degree of disability are also relevant to the treatment of disabled persons, of course, and are taken into account. These other classification systems are particularly important in determining whether health care or occupational therapy is the best approach, and whether guardianship is appropriate (persons suffering from mental disabilities may become wards of the state). Nevertheless, classification on the basis of the nature of the disability is the primary determinant of a disabled person’s official status, rights and eligibility for benefits.
A review of the body of French law applicable to disabled persons reveals the multiplicity and complexity of support systems. This organizational redundancy has historical origins, but persists to this day and remains problematic.
Development of “official status”
Until the end of the nineteenth century, care of the disabled was essentially a form of “good works” and usually took place in hospices. It was not until the beginning of the twentieth century that the ideas of rehabilitation and income replacement developed against the backdrop of a new cultural and social view of disability. In this view, the disabled were seen as damaged persons who needed to be rehabilitated—if not to the status quo ante, at least to an equivalent situation. This change in mentality was an outgrowth of the development of mechanization and its corollary, occupational accidents, and of the impressive number of First World War veterans suffering permanent disability.
The law of 8 April 1898 improved the occupational-accident compensation system by no longer requiring proof of employer liability and establishing a flat-fee compensation payment system. In 1946, management of the risk associated with occupational accidents and diseases was transferred to the social security system.
Several laws were passed in an attempt to correct prejudices suffered by injured or disabled First World War veterans. These include:
The interwar period saw the development of the first large-scale associations of civilian disabled persons. The most noteworthy of these are: the Fédération des mutilés du travail (1921), the Ligue pour l’adaptation des diminués physiques au travail (LADAPT) (1929) and the Association des Paralysés de France (APF) (1933). Under pressure from these associations and from unions, victims of work accidents, and eventually all the civilian disabled, progressively benefited from support systems based on those established for war invalids.
A disability insurance system was established for workers in 1930 and reinforced by the 1945 Decree creating the social security system. Under this system, workers receive a pension if their ability to work or earn a livelihood is significantly reduced by disease or accident. The right of victims of occupational accidents to retraining was recognized by a 1930 law. A training and retraining system for the blind was established in 1945 and extended to all seriously disabled persons in 1949. In 1955, the obligation to hire a minimum percentage of war invalids was extended to other disabled persons.
The development of the concept of occupational integration led to the promulgation of three laws which improved and reinforced existing support systems: the law of 27 November 1957 concerning occupational reclassification of disabled workers, the law of 30 June 1975 concerning disabled persons (the first to adopt a global approach to the problems faced by disabled persons, especially that of social reintegration), and the law of 10July 1987 favouring the employment of disabled workers. However, these laws in no way eliminated the specific dispositions of the systems responsible for war invalids and the victims of occupational accidents.
Multiplicity and diversity of regimes supporting disabled persons
Today, there are three quite distinct regimes providing support to disabled persons: one for war invalids, one for victims of occupational accidents, and the common-law system, which deals with all other disabled persons.
A priori, the coexistence of multiple regimes that select their clientele on the basis of the origin of disability does not appear to be a satisfactory arrangement, especially since each regime provides the same type of support, namely integration-support programmes, particularly those aimed at occupational reintegration, and one or more allowances. Accordingly, there has been a concerted effort to harmonize employment-support systems. For example, the vocational training and medical rehabilitation programmes of all the systems aim as much at distributing costs through society as at providing financial compensation for disability; the specialized training and medical rehabilitation centres, including the centres operated by the Office des anciens combattants (ONAC), are open to all disabled persons, and the reservation of positions in the public sector for war invalids was extended to disabled civilians by the Decree of 16 December 1965.
Finally, the law of 10 July 1987 united the private- and public-sector minimum-employment programmes. Not only were the conditions of these programmes extremely complex to apply, but they also differed depending on whether the individual was a disabled civilian (in which case the common law system applied) or a war invalid. With the coming into force of this law, however, the following groups are entitled to consideration for minimum-employment programmes: disabled workers recognized by the Commission technique d’orientation et de réinsertion professionnelle (COTOREP), victims of occupational accidents and diseases receiving a pension and suffering from a permanent disability of at least 10%, recipients of civilian disability allowances, former members of the armed forces and other recipients of military disability allowances. COTOREP is responsible, under the common law system, for the recognition of disabled status.
On the other hand, the actual allowances provided by the three regimes differ widely. Disabled persons benefiting from the common-law system receive what is essentially a disability pension from the social security system and a complementary allowance to bring their total benefit up to the adult disabled pension level (as of 1July 1995) of FF 3,322 per month. The amount of the state pension received by war invalids depends on the degree of disability. Finally, the monthly amount (or a lump-sum payment if the permanent disability is below 10%) received by victims of occupational accidents and diseases from the social security system depends on the recipient’s degree of disability and previous salary.
The eligibility criteria and amounts of these allowances are entirely different in each system. This leads to significant differences in the way individuals with disabilities of different organs are treated, and to anxiety that may interfere with rehabilitation and social integration (Bing and Levy 1978).
Following numerous calls for the harmonization, if not unification, of the various disability allowances (Bing and Levy 1978), the Government established a task force in 1985 to study solutions to this problem. To date, however, no solution has been forthcoming, in part because the different goals of the allowances constitute a serious obstacle to their unification. Common-law allowances are subsistence allowances—they are intended to allow recipients to maintain a decent standard of living. In contrast, the war disability pensions are intended to compensate for disabilities acquired while in national service, and allowances paid to victims of occupational accidents and diseases are intended to compensate for disabilities acquired while earning a living. These last two allowances are therefore generally significantly higher, for a given level of disability, than those received by individuals with disabilities that are either congenital or resulting from non-military, non-occupational accidents or illnesses.
Effect of Official Status on Assessments of the Degree of Disability
Different disability-compensation regimes have evolved over time. This diversity is reflected not only in the different allowances each pays to disabled persons but also in each system’s eligibility criteria and system for evaluating the degree of disability.
In all cases, eligibility for compensation and evaluation of the extent of disability is established by an ad hoc committee. Recognition of disability requires more than a simple declaration by the applicant—applicants are required to testify before the commission if they desire to be granted official status as a disabled person and receive eligible benefits. Some people may find this procedure dehumanizing and counter to the goal of integration, since individuals who do not wish to have their differences “officialized” and refuse, for example, to appear before the COTOREP, will not be granted official disabled-person status and will thus be ineligible for occupational reintegration programmes.
Disability eligibility criteria
Each of the three regimes relies on a different set of criteria to determine whether an individual is entitled to receive disability benefits.
The common-law regime pays disabled persons subsistence allowances (including the adult disability allowance, a compensatory allowance, and the educational allowance for disabled children), to allow them to remain independent. Applicants must suffer from a serious permanent disability—an 80% disability is required in the majority of cases—to receive these allowances, although a lower level of disability (of the order of 50 to 80%) is required in the case of a child attending a specialized institute or receiving special education or home care. In all cases, the degree of disability is evaluated by reference to an official disability scale contained in Appendix 4 of the Decree of 4 November 1993 concerning the payment of various allowances to disabled persons.
Different eligibility criteria apply to applicants for disability insurance, which, like the common-law allowances, includes a subsistence component. To qualify for this pension, applicants must be receiving social security and must suffer from a disability that reduces their earning capacity by at least two thirds, that is, that prevents them from earning, in any occupation, a salary greater than one third of their pre-disability salary. The pre-disability salary is calculated on the basis of the salary of comparable workers in the same region.
There are no official criteria for the determination of eligibility, which instead is based on the individual’s overall situation. “The degree of disability is evaluated on the basis of residual fitness for work, overall condition, age, physical and mental faculties, aptitudes, and occupational training”, according to the social security law.
As this definition makes clear, disability is considered to include the inability to earn a living in general, rather than being limited to physical disability or the inability to exercise a given occupation, and is evaluated on the basis of factors likely to affect the occupational reclassification of the individual. These factors include:
To be eligible for specific occupational reintegration programmes, disabled adults must satisfy the following legal criterion: “a disabled worker is any person whose ability to obtain or maintain a job is reduced in fact as a result of inadequate or reduced physical or mental capacities”.
This definition was greatly influenced by the Vocational Rehabilitation of the Disabled Recommendation, 1955 (No. 99) (ILO 1955), which defines a disabled person as “an individual whose prospects of securing and retaining suitable employment are substantially reduced as a result of physical or mental impairment”.
This pragmatic approach nevertheless leaves room for interpretation: what does “in fact” mean? What is the standard to be used in determining whether fitness for work is “inadequate” or “reduced”? The absence of clear guidelines in these matters has resulted in widely divergent evaluations of occupational disability by different commissions.
To accomplish their primary goal of reparation and compensation, these regimes pay the following allowances and pensions:
The degree of permanent disability is established using an official disability scale that takes into account the nature of the disability, and the applicant’s general condition, physical and mental faculties, aptitudes and occupational qualifications.
Disability evaluation scales
While eligibility for each regime’s benefits depends on administrative decisions, the medical evaluation of disability, established through examination or consultation, remains critically important.
There are two approaches to the medical evaluation of the degree of disability, one involving the calculation of compensation on the basis of the degree of permanent partial disability, the other based on the reduction in fitness for work.
The first system is used by the war disability system, while the occupational accident and common-law systems require the examination of the applicant by the COTOREP.
The degree of permanent partial disability in war invalids is established using standards contained in the official disability scale applicable to cases covered by the Code des pensions militaires d’invalidité et victimes de guerre (updated 1 August 1977 and including the scales of 1915 and 1919). For the victims of occupational accidents, a scale of occupational accidents and diseases established in 1939 and revised in 1995 is used.
The classification systems used in these two regimes are organ- and function-specific (such as blindness, renal failure, cardiac failure) and establish a level of permanent partial disability for each type of disability. Several possible classification systems for mental disability are suggested, but all of them are imprecise for these purposes. It should be noted that these systems, apart from their other weaknesses, may assess different levels of permanent partial disability for a given disability. Thus, a 30% reduction of bilateral visual acuity is equivalent to a permanent partial disability rating of 3% in the occupational-accident system and 19.5% in the war- disability system, while a 50% loss is equivalent to permanent partial disabilities of 10 and 32.5%, respectively.
Until recently, the COTOREP used the disability scale established in the Code des pensions militaires d’invalidité et victimes de guerre to determine compensation and benefits such as disability cards, adult disability allowances, and third-party compensatory allowances. This scale, developed to ensure fair compensation for war injuries, is not well suited to other uses, especially to birth rate. The absence of a common reference has meant that different sittings of the COTOREP have arrived at significantly different conclusions concerning the degree of disability, which has created serious inequities in the treatment of disabled persons.
To remedy this situation, a new scale of deficiencies and disabilities, which reflects a new approach to disability, came into force on 1 December 1993 (Appendix to Decree No.93-1216 of 4 November 1993, Journal Officiel of 6 November 1993). The methodological guide is based on concepts proposed by the WHO, namely impairment, disability and handicap, and is used primarily to measure disability in family, school and occupational life, regardless of the specific medical diagnosis. While the medical diagnosis is a critical predictor of the condition’s evolution and the most effective case management strategy, it nevertheless is of limited usefulness for the purposes of establishing the degree of disability.
With one exception, these scales are meant to be only indicative: their use is mandatory for the evaluation of permanent partial disability in recipients of military pensions who have suffered amputation or organ resection. Several other factors affect the evaluation of the degree of disability. In occupational accident victims; for example, the establishment of the degree of permanent partial disability must also take into account medical factors (general condition, nature of the disability, age, mental and physical faculties) and social factors (aptitudes and occupational qualifications). The inclusion of other factors allows physicians to fine-tune their evaluation of the degree of permanent partial disability to take into account therapeutic advances and the potential for rehabilitation, and to counteract the rigidity of the scales, which are rarely updated or revised.
The second system, based on the loss of working capacity, raises other questions. The reduction in working capacity may need to be evaluated for different purposes: evaluation of the reduction in working capacity for the purposes of disability insurance, recognition of the loss of working capacity by COTOREP, evaluation of an occupational deficit for the purposes of recognizing a worker as disabled or placing such a worker in a special workshop.
No standards can exist for the evaluation of the loss of working capacity, since the “average worker” is a theoretical construct. In fact, the whole field of working capacity is poorly defined, as it relies not only on an individual’s inherent aptitudes but also on the needs and adequacy of the occupational environment. This dichotomy illustrates the distinction between the capacity at work and the capacity for work. Schematically, two situations are possible.
In the first case, the degree of the loss of working capacity relative to the applicant’s recent and specific occupational situation must be objectively established.
In the second case, the loss of working capacity must be evaluated in disabled persons who are either not currently in the workforce (e.g., individuals with chronic illnesses who have not worked for a long time) or who have never been in the workforce. This last case is frequently encountered when establishing adult disability pensions, and eloquently illustrates the difficulties that physicians responsible for quantifying the loss of working capacity are faced with. Under these circumstances, physicians often refer, either consciously or unconsciously, to degrees of permanent partial disability for establishing working capacity.
Despite the obvious imperfections of this disability-evaluation system and the occasional medico-administrative contortions it imposes, it nevertheless allows the level of disability compensation to be established in most cases.
It is clear that the French system, involving official classification of disabled persons on the basis of the origin of their disability, is problematic on several levels under the best of circumstances. The case of individuals suffering from disabilities of different origins and who are therefore ascribed multiple official statuses is even more complex. Consider for example the case of a person suffering from a congenital motor disability who suffers an occupational accident: the problems associated with the resolution of this situation can easily be imagined.
Because of the historical origins of the various official statuses, it is unlikely that the regimes can ever be made completely uniform. On the other hand, continued harmonization of the regimes, especially their systems for the evaluation of disability for the purpose of the awarding of financial compensation, is highly desirable.
The articles in this chapter have thus far concentrated on training and education regarding workplace hazards. Environmental education serves multiple purposes and is a useful complement to occupational safety and health training. Worker education is a critical and often overlooked aspect of a broad and effective environmental protection strategy. Environmental issues are frequently viewed as purely technological or scientific matters that stand outside the purview of workers. Yet worker knowledge is critical to any effective environmental solutions. Workers are concerned as citizens and as employees about environmental matters because the environment shapes their lives and affects their communities and families. Even when technological solutions are required that use new hardware, software or process approaches, worker commitment and competence are necessary for their effective implementation. This is true for workers whether involved directly in environmental industries and occupations or in other kinds of jobs and industrial sectors.
Worker education can also provide a conceptual foundation to enhance workers’ participation in environmental improvement, health and safety protection, and organizational improvement. The UNEP Industry and Environment Programme notes that “many companies have found that worker involvement in environmental improvement can yield important benefits” (UNEP 1993). The Cornell Work and Environment Initiative (WEI) in a study of US enterprises found that intense worker participation yielded triple the source reduction of technical or external solutions alone and boosted yields of some technological approaches even higher (Bunge et al. 1995).
Worker environmental education comes in a variety of forms. These include trade union awareness and education, occupational training and orientation, connecting environment to workplace health and safety concerns and broad awareness as citizens. Such education occurs in a range of venues including worksites, trade union halls, classrooms and study circles, using both traditional and newer computer-based delivery systems. It is fair to say that workers’ environmental education is an underdeveloped field, especially in comparison with managerial and technical training and school-based environmental education. At the international level, education of front-line workers is often mentioned in passing and is overlooked when it comes to implementation. The European Foundation for the Improvement of Living and Working Conditions has commissioned a series of studies on the educational dimension of environmental protection, and in its next programme of work will directly look at the shop-floor workers and their environmental educational needs.
What follows are several examples gathered through the WEI at Cornell University that illustrate both practice and possibility in worker environmental education.The WEI is a network of managers, trade unionists, environmentalists and government policy officials from 48 countries in all parts of the world, committed to finding ways that workers and the workplace can contribute to environmental solutions. It addresses a wide range of industries from primary extraction to production, service and public-sector enterprises. It provides a means for education and action on environmental matters that seeks to build knowledge at the workplace and in academic institutions that can lead to cleaner and more productive workplaces and better connection between internal and external environments.
Australia: Eco-Skills Modules
The Australian Council of Trade Unions (ACTU) has developed new approaches to workers’ education for the environment that provides both broad social awareness and specific competencies for employment, especially among young workers.
The ACTU has organized an Environment Training Company with a broad mandate to address a variety of sectors but with an initial focus on land management issues. This focus includes teaching ways to handle reclamation work safely and effectively but also ways to assure compatibility with indigenous peoples and natural environments. With input from trade unionists, environmentalists and employers, the training company developed a set of “Eco-Skills” modules to establish basic environmental literacy among workers from an array of industries. These are integrated with a set of skill competencies that are technical, social and safety oriented.
Eco-Skills modules 1 and 2 contain a broad base of environmental information. They are taught alongside other entry-level training programmes. Levels 3 and higher are taught to people who specialize in work focused on reduction of environmental impacts. The first two Eco-Skills modules are composed of two forty-hour sessions. Trainees attain skills through lectures, group problem-solving sessions and practical hands-on techniques. Workers are assessed through written and oral presentations, group work and role plays.
Concepts covered in the sessions include an introduction to the principles of ecologically sustainable development, efficient resource use and cleaner production and environmental management systems. Once Module 1 is completed workers should be able to:
Module 2 expands upon these initial objectives and prepares workers to begin applying pollution prevention and resource conservation methods.
Some industries are interested in connecting environmental impact skills and knowledge to their industry standards at every level. Awareness of environmental issues would be reflected in the day-to-day work of all industry workers at all skill levels. An incentive for workers lies in the fact that pay rates are linked to industry standards. The Australian experiment is in its infancy, but it is a clear attempt to work with all parties to develop competency-based activities that lead to increased and safer employment while enhancing environmental performance and awareness.
Linking Occupational Health and Safety and Environmental Training
One of the most active unions in the United States in environmental training is the Laborers International Union of North American (LIUNA). US government regulations require that hazardous-waste abatement workers receive 40 hours of training. The union along with participating contractors have developed an intensive 80-hour course designed to provide potential hazardous-waste workers with greater awareness of safety and the industry. In 1995, over 15,000 workers were trained in lead, asbestos and other hazardous-waste abatement and other environmental remediation work. The Laborers–Associated General Contractors programme has developed 14 environmental remediation courses and associated train-the-trainer programmes to assist nationwide efforts at safe and quality remediation. These are conducted at 32 training sites and four mobile units.
In addition to providing safety and technical training, the programme encourages participants to think about larger environmental issues. As part of their classwork, trainees gather materials from local papers on environmental issues and use this local connection as an opening to discuss broader environmental challenges. This joint environmental training fund employs a full-time equivalent staff of 19 at its central office and spends over US$10 million. The materials and training methods meet high quality standards with extensive use of audio-visual and other training aids, specific competency focus, and quality commitment and assessment built in throughout the curricula. A “learn-at-home” video is used to help meet literacy concerns and environmental and basic literacy training are connected. For those who desire it, six of the courses are transferable into college credit. The programme is active in serving minority communities, and over half of the participants come from minority population groups. Additional programmes are developed in partnership with minority consortiums, public housing projects and other training providers.
The union understands that a great deal of its future membership will come in environmentally related businesses and sees the development of worker education programmes as building the foundation for that growth. While both safety and productivity are better on jobs using trained workers, the union also sees the broader impact:
The most interesting impact environmental training has had on members is their increased respect for chemicals and harmful substances in the workplace and at home. … Awareness is also increasing with respect to the consequences of continued pollution and the cost involved with cleaning up the environment. … The true impact is much greater than just preparing people for work (LIUNA 1995).
In the United States, such hazardous-materials training is also conducted by the Operating Engineers; Painters; Carpenters; Oil, Chemical and Atomic Workers; Chemical Workers Union; Machinists; Teamsters; Ironworkers and Steelworkers.
LIUNA is also working internationally with the Mexican Confederation of Workers (CTM), federal and private training groups and employers to develop training methodologies. The focus is on training Mexican workers in environmental remediation work and construction skills. The Inter-American Partnership for Environmental Education and Training (IPEET) held its first training course for Mexican workers during the summer of 1994 in Mexico City. A number of labour leaders and workers from local industries, including paint manufacturing and metal plating, attended the one-week course on environmental safety and health. Other LIUNA partnerships are being developed in Canada with French editions of the materials and “Canadianization” of the content. The European Institute for Environmental Education and Training is also a partner for similar training in Eastern European and CIS countries.
Zambia: Educational Manual on Occupational Health and Safety
In Zambia, too often occupational health and safety is taken seriously only when there is an incident involving injury or damage to company property. Environmental issues are also ignored by industry. The Manual on Occupational Health and Safety was written in an effort to educate employees and employers on the importance of occupational health and safety issues.
The first chapter of this manual outlines the importance of education at all levels in a company. Supervisors are expected to understand their role in creating safe, healthy working conditions. Workers are taught how maintaining a positive, cooperative attitude relates to their own safety and work environment.
The manual specifically addresses environmental issues, noting that all major towns in Zambia face
threats of increasing environmental damage. In specific, the Zambia Congress of Trade Unions (ZCTU) identified environmental hazards in the mining industry through strip mining and air and water pollution that results from poor practices. Many factories are responsible for air and water pollution because they discharge their waste directly into nearby streams and rivers and allow smoke and fumes to escape unchecked into the atmosphere (ZCTU 1994).
Though many African trade unions are interested in further education on the environment, lack of adequate funding for worker education and the need for materials that link environmental, community and workplace hazards are major barriers.
Employer-Based Worker Environmental Education and Training
Employers, especially larger ones, have extensive environmental education activities. In many cases, these are mandated training linked to occupational or environmental safety requirements. However, an increasing number of companies recognize the power of broad worker education that goes well beyond compliance training. The Royal Dutch/Shell Group of companies have made health, safety and environment (HSE) part of their overall approach to training, and environment is an integral part of all management decisions (Bright and van Lamsweerde 1995). This is a global practice and mandate. One of the company’s goals is to define HSE competencies for appropriate jobs. Worker competence is developed through improved awareness, knowledge and skill. Appropriate training will increase worker awareness and knowledge, and skills will develop as new knowledge is applied. A wide range of delivery techniques helps share and reinforce the environmental message and learning.
At Duquesne Light in the United States, all 3,900 employees were successfully trained “on how the company and its employees actually affect the environment.” William DeLeo, Vice-President of Environmental Affairs said:
To develop a training programme that enabled us to meet out strategic objectives we determined that our employees needed a general awareness of the importance of environmental protection as well as specific technical training relative to their job responsibilities. These two points became the guiding strategy for our environmental education program (Cavanaugh 1994).
Worker and Union-Based Environmental Education Programmes
The Workers’ Education Branch of the ILO has developed a six-booklet set of background materials to spark discussion among trade unionists and others. The booklets address workers and the environment, the workplace and the environment, the community and the environment, world environmental issues, the new bargaining agenda, and provide a guide to resources and a glossary of terms. They provide a broad, insightful and easy-to-read approach that can be used in both developing and industrial countries to discuss topics relevant to workers. The materials are based on specific projects in Asia, the Caribbean and Southern Africa, and can be used as a whole text or can be separated in a study circle format to promote general dialogue.
The ILO in a review of training needs pointed out:
Trade unionists must increase their awareness about environmental concerns in general and the impact their employing firms are having on the environment, including the safety and health of their workers, in particular. Trade unions and their members need to understand environmental issues, the consequences that environmental hazards have on their members and the community at large, and be able to develop sustainable solutions in their negotiations with company management and employers’ organizations. (ILO 1991.)
The European Foundation for the Improvement of Living and Working Conditions has observed:
Local trade unions and other employee representatives are in a particularly difficult situation. They will have the relevant knowledge of the local situation and the workplace but will, in most cases, not be sufficiently specialised in complex environmental and strategic issues.
They will, therefore, be unable to exercise their functions unless they received additional and specialised training. (European Foundation for the Improvement of Living and Working Conditions 1993.)
A number of national unions have urged increased workers’ education on the environment. Included among them is the LO in Sweden, whose 1991 Environmental Programme called both for more education and action at the workplace and for additional study circle material on the environment to promote awareness and learning. The Manufacturing Workers Union in Australia has developed a training course and set of materials to assist the union in providing environmental leadership, including how to address environmental issues through collective bargaining.
Good worker-based environmental education provides both conceptual and technical information to workers that assists them in increasing environmental awareness and in learning concrete ways to change work practices that are damaging to the environment. These programmes also learn from workers at the same time to build on their awareness, reflection and insight about workplace environmental practice.
Workplace environmental education is best done when it is connected to community and global environmental challenges so that workers have a clear idea of how the ways they work are connected to the overall environment and how they can contribute to a cleaner workplace and global ecosystem.
Formed in the wake of the US Occupational Safety and Health Act of 1970, committees on occupational safety and health initially emerged as local coalitions of public health advocates, concerned professionals, and rank-and-file activists meeting to deal with problems resulting from toxics in the workplace. Early COSH groups started in Chicago, Boston, Philadelphia and New York. In the south, they evolved in conjunction with grass roots organizations such as Carolina Brown Lung, representing textile mill workers suffering from byssinosis. Currently there are 25 COSH groups around the country, at various stages of development and funded through a wide variety of methods. Many COSH groups have made a strategic decision to work with and through organized labor, recognizing that union-empowered workers are the best equipped to fight for safe working conditions.
COSH groups bring together a broad coalition of organizations and individuals from unions, the public health community and environmental interests, including rank-and-file safety and health activists, academics, lawyers, doctors, public health professionals, social workers and so on. They provide a forum in which interest groups that do not normally work together can communicate about workplace safety and health problems. In the COSH, workers have a chance to discuss the safety and health issues they confront on the shop floor with academics and medical experts. Through such discussions, academic and medical research can get translated for use by working people.
COSH groups have been highly active politically, both through traditional means (such as lobbying campaigns) and through more colorful methods (such as picketing and carrying coffins past the homes of anti-labor elected officials). COSH groups played a key role in the struggles for local and state right-to-know legislation, building broad-based coalitions of union, environmental and public interest organizations to support this cause. For example, the Philadelphia area COSH group (PHILAPOSH) ran a campaign which resulted in the first city right-to-know law passed in the country. The campaign climaxed when PHILAPOSH members dramatized the need for hazard information by opening an unmarked pressurized canister at a public hearing, sending members of the City Council literally diving under tables as the gas (oxygen) escaped.
Local right-to-know campaigns eventually yielded more than 23 local and state right-to-know laws. The diversity of requirements was so great that chemical corporations ultimately demanded a national standard, so they would not have to comply with so many differing local regulations. What happened with COSH groups and right to know is an excellent example of how the efforts of labor and community coalitions working at the local level can combine to have a powerful national impact on occupational safety and health policy.
Most persons with disabilities who are of working age can and want to work, yet they often encounter major obstacles in their quest for access to and equality in the workplace. This article highlights the principal issues concerning the inclusion of persons with disabilities in the world of work, with reference to social policy and human rights concepts.
First, the overall extent and consequences of disability, as well as the extent to which disabled persons have traditionally been excluded from full participation in both social and economic life, will be described. Human rights concepts will then be presented in terms of a process to overcome the obstacles to equitable employment faced by persons with disabilities. Such obstacles to full participation in the workplace and national life are often due to attitudinal and discriminatory barriers, rather than to causes relating to one’s disability. The end result is that persons with disabilities often experience discrimination, which is either deliberate or is a result of inherent or structural barriers in the environment.
Finally, a discussion of discrimination leads to a description of ways in which such treatment may be overcome through equitable treatment, workplace accommodation and accessibility.
Extent and Consequences of Disability
Any discussion of social policy and human rights concepts about disability must begin with an overview of the global situation persons with disabilities face.
The exact extent of disability is subject to wide interpretation, depending upon the definition used. The United Nations Disability Statistics Compendium (1990) (also referred to as the DISTAT Compendium) reports results of 63 surveys of disability in 55 countries. It notes that the percentage of disabled persons is between 0.2% (Peru) and 20.9% (Austria). During the 1980s, approximately 80% of disabled persons lived in the developing world; due to malnutrition, and disease, disabled persons form approximately 20% of the population of these nations. It is not possible to compare the percentage of the population that is disabled as reflected in various national surveys, due to the use of different definitions. From the overall but limited perspective provided by the DISTAT Compendium, it may be noted that disability is largely a function of age; that it is more prevalent in rural areas; and that it is associated with a higher incidence of poverty and lower economic status and educational attainment. Moreover, statistics consistently show lower labour-force participation rates for persons with disabilities than for the population in general.
With respect to employment. a graphic description of the situation faced by persons with disabilities was given by Shirley Carr, a member of the Governing Body of the ILO and a past president of the Canadian Labour Congress, who noted during a parliamentary forum on disability held in Canada in 1992 that disabled persons experience a “cement ceiling” and that “Disabled persons suffer from the three ‘U’s: under-employment, unemployment and under-utilization”. Unfortunately, the situation persons with disabilities face in most places in the world is at best like what exists in Canada; in many cases, their circumstances are far worse.
Disability and Social Exclusion
For a variety of reasons, many persons with disabilities have historically experienced social and economic isolation. However, since the end of the Second World War, there has been a slow but steady movement away from segregating disabled persons from the general population, and away from the view that “the disabled” need care, philanthropy and charity. Persons with disabilities are increasingly insisting on their right not to be excluded from the workplace but rather to be treated in an inclusive manner, equitable to other, non-disabled members of society, including the right to participate as active members of the economic life of the nation.
Disabled persons should participate fully in the labour force because it makes economic sense for them to have the opportunity to engage in remunerative employment to the fullest extent of their capacities, instead of drawing social assistance. However, disabled persons should first and foremost participate in the mainstream of the labour force and thus national life because it is ethically and morally the correct thing to do. In this regard, one is mindful of the remarks of the UN Special Rapporteur Leandro Despouy, who stated in his report to the Economic and Social Council of the United Nations (1991) that “the treatment given to disabled persons defines the innermost characteristics of a society and highlights the cultural values that sustain it”. He goes on to state what is, unfortunately, not obvious to all, that:
persons with disabilities are human beings—as human as, and usually even more human than, the rest. The daily effort to overcome impediments and discriminatory treatment they regularly receive usually provides them with special personality features, the most obvious and common are integrity, perseverance, and a deep spirit of comprehension in the face of a lack of understanding and intolerance. However, this last feature should not lead us to overlook the fact that as subjects of law they enjoy all the legal attributes inherent in human beings and hold specific rights in addition. In a word, persons with disabilities, as persons like ourselves, have the right to live with us and as we do.
Disability and Societal Attitudes
The issues raised by the UN Special Rapporteur point to the existence of negative societal attitudes and stereotypes as a significant barrier to equitable workplace opportunities for persons with disabilities. Such attitudes include the fear that the cost of accommodating persons with disabilities in the workplace will be too high; that persons with disabilities are not productive; or that other vocational trainees or employees and customers will be uncomfortable in the presence of persons with disabilities. Still other attitudes relate to the assumed weakness or sickness of persons with disabilities and the impact this has on “their” ability to complete a vocational training programme or to succeed in a job. The common element is that they are all founded on assumptions based on one characteristic of a person, the presence of a disability. As noted by the Province of Ontario (Canada) Advisory Council for Disabled Persons (1990):
Assumptions about the needs of persons with disabilities are often premised on notions about what the person cannot do. The disability becomes the characterization of the whole person rather than one aspect of the person.… Incapacity is seen as a generalized condition and tends to incorporate notions of incompetence.
Disability and Empowerment: The Right of Choice
Inherent in the principle that persons with disabilities have the right to participate fully in the mainstream of the social and economic life of the nation is the notion that such individuals should be empowered to exercise free choice as to their vocational training and choice of occupation.
This basic right is set forth in the Human Resources Development Convention, 1975 (No. 142) (ILO 1975), which states that vocational training policies and programmes shall “encourage and enable all persons, on an equal basis and without discrimination whatsoever, to develop and use their capabilities for work in their own best interests and in accordance with their own aspirations”.
Learning to make choices is an intrinsic part of personal development. However, many individuals with disabilities have not been given the opportunity to make meaningful selections concerning their choice of occupational training and placement. Persons with severe disabilities may lack experience in skills needed to identify personal preferences and to make effective choices from a series of options. However, the lack of self-direction and power is not related to impairments or limitations. Rather, as noted above, it is often due to negative attitudes and practices. Often, disabled persons are presented with options that are artificially preselected or restricted. For example, they may be pressured to participate in a vocational training course that happens to be available, without other options being seriously considered. Or the “choices” may merely be the avoidance of undesirable alternatives, such as agreeing to live in a group setting or with roommates not of one’s choice, to avoid even more unpleasant situations, such as having to live in an institution. Unfortunately for many disabled persons, the chance to express a vocational interest, to choose vocational training options or to seek a job is often determined by a person’s disability label and other people’s assumptions about the capabilities of the individual. This lack of choice also frequently stems from a historical attitude that as involuntary users of the social welfare system, “beggars can’t be choosers”.
This issue is of great concern. Research has shown that the degree of influence which individuals have on decisions that affect their working lives has a significant impact on job satisfaction, and hence on the success of integration strategies. Every person, notwithstanding the severity of his or her disabilities, has the right and ability to communicate with others, express everyday preferences, and exercise at least some control over his or her daily life. Inherent in liberty is the right to have freedom of vocational choice, the necessary training based on available technology, and respect for and encouragement to work. For disabled persons at all levels of severity and ability, including those who have intellectual and psychosocial disabilities, making choices is key to establishing one’s identity and individuality. It must also be recalled that it is part of the human experience to make mistakes and to learn from them.
It must be stressed again that disabled persons are human beings. It is a matter of basic respect of human dignity to provide disabled persons with opportunities to make those decisions in life that non-disabled persons routinely make.
Disability and Social Justice: The Issue of Discrimination
Why have negative stereotypes developed and how do they relate to discrimination? Hahn (1984) notes the apparent contradiction between the vast sympathy displayed toward individuals with disabilities and the fact that, as a group, they are subjected to patterns of discrimination more severe than any other recognized minority. This can be explained by the fact that persons with disabilities often display physical and behavioural characteristics that set them apart from the non-disabled population.
Without these identifiable physical differences, disabled persons could not be subjected to the same processes of stereotyping, stigmatizing, bias, prejudice, discrimination, and segregation that plague every minority group. Moreover, when such traits are coupled with adverse social labelling, the effects of discrimination are compounded.
Hahn also suggests that there is a positive correlation between the amount of discrimination experienced by persons with disabilities and the visibility of their disability.
The key, then, for persons with disabilities to attain equitable treatment in society and the workplace is the reduction and elimination of negative attitudes and stereotypes which result in discriminatory behaviour, coupled with the institution of practices and programmes that accommodate the special needs of disabled persons as individuals. The remainder of this article explores these concepts.
What Is Meant by Discrimination?
In the course of our lives, we “discriminate” on a daily basis. Choices are made concerning whether to go to the cinema or the ballet, or whether to buy the more expensive article of clothing. To discriminate in this sense is not problematic. However, discrimination does become troublesome when negative differentiations are made on the basis of immutable characteristics of persons, or groups of persons, such as on the basis of disability.
The International Labour Conference adopted a definition of the discrimination which is contained in the Discrimination (Employment and Occupation) Convention, 1958 (No. 111):
For the purpose of this Convention, the term “discrimination” includes—
(a) any distinction, exclusion or preference made on the basis of race, colour, sex, religion, political opinion, national extraction or social origin, which has the effect of nullifying or impairing equality of opportunity or treatment in employment or occupation;
(b) such other distinction, exclusion or preference which has the effect of nullifying or impairing equality of opportunity or treatment in employment or occupation as may be determined by the Member concerned after consultation with representative employers’ and workers’ organisations, where such exist, and with other appropriate bodies.
Three Forms of Discrimination
The above-noted definition is best understood in light of the three forms of discrimination that have arisen since the end of the Second World War. The following three approaches, first conceptualized in the United States, have now received widespread acceptance in many countries.
Evil motive or animus
Initially, discrimination was seen strictly in terms of prejudicial treatment, that is, harmful acts motivated by personal antipathy towards the group of which the target person was a member. These acts consisted of deliberate denials of employment opportunities. It was necessary to prove not only the act of denial, but also a motive based on prejudice. In other words the definition was based upon the evil-motive, mens rea, or state-of-mind test. An example of such discrimination would be an employer indicating to a disabled person that he or she would not be hired because of fear of negative customer reaction.
During the 1950s and in the mid-1960s after the passage of the Civil Rights Act, agencies in the United States came to apply what is called the “equal protection” concept of discrimination. In this approach discrimination was seen to cause economic harm “by treating members of a minority group in a different and less favourable manner than similarly situated members of the majority group” (Pentney 1990). Under the differential treatment approach, the same standards are seen to apply to all employees and applicants without the need to demonstrate discriminatory intent. Discrimination in this context would include requiring disabled employees to undergo a medical examination to receive group health insurance benefits when such examinations are not required for non-disabled employees.
Indirect or adverse effect discrimination
Although the differential treatment model of discrimination mandates that employment policies and practices be equally applied to all, many superficially neutral requirements, such as education and testing, had unequal effects on various groups. In 1971, the United States Supreme Court dealt with this issue by articulating a third definition of employment discrimination in the famous case Griggs vs. Duke Power. Prior to the passage of the Civil Rights Act, Duke Power discriminated against Blacks by restricting them to the low-paying labour department. After passage of the legislation, completion of high school and successful completion of aptitude tests were made prerequisites to transfer out of the labour department. In the candidate catchment area, 34% of Whites but only 12% of Blacks had the necessary education. In addition, while 58% of Whites passed the tests, only 6% of Blacks were successful. These requirements were imposed despite evidence that showed that employees without these qualifications, hired before the policy change, continued to perform satisfactorily. The Supreme Court struck down the educational and test requirements that screened out a greater percentage of blacks, on the grounds that such practices had the consequence of excluding Blacks and because they bore no relationship to job requirements. The intent of the employer was not at issue. Rather, what was important was the effect of the policy or practice. An example of this form of discrimination would be the requirement to pass an oral examination. Such a criterion might have an adverse impact on deaf or orally impaired candidates.
Equal versus Equitable Treatment
The model of adverse impact or indirect discrimination is the most problematic for persons with disabilities. For if disabled persons are treated the same as everyone else, “how can it be discrimination?” Central to an appreciation of this concept is the notion that to treat all people the same is, sometimes, a form of discrimination. This principle was most eloquently put forth by Abella in her report (Canada Royal Commission 1984), when she noted:
Formerly, we thought that equality only meant sameness and that treating persons as equals meant treating everyone the same. We now know that to treat everyone the same may be to offend the notion of equality. Ignoring differences may mean ignoring legitimate needs. It is not fair to use the differences between people as an excuse to exclude them arbitrarily from equitable participation. Equality means nothing if it does not mean that we are of equal worth regardless of the differences in gender, race, ethnicity, or disability. The projected, mythical, and attributed meaning of these differences cannot be permitted to exclude full participation.
To underscore this notion, the term equitable is used increasingly, as opposed to equal treatment.
Disability and the Environment: Accessibility and Workplace Accommodation
Flowing from concepts of adverse impact discrimination and equitable treatment is the idea that in order to treat persons with disabilities in a non-discriminatory manner, it is necessary to ensure that the environment and workplace are accessible, and that efforts have been made to reasonably accommodate the individual workplace requirements of the disabled person. Both concepts are discussed below.
Accessibility does not just mean that a building entrance has been ramped for use by wheelchair users. Rather it requires that persons with disabilities are provided with accessible or alternative transportation systems to allow them to get to work or school; that sidewalk curbs have been lowered; that Braille indications have been added to elevators and buildings; that washrooms are accessible to persons who use wheelchairs; that carpets whose pile density provides an obstacle to wheelchair mobility have been removed; that visually impaired persons are provided with technical aids such as large-print manuals and audiocassettes, and hearing-impaired persons are provided with optical signals, among other measures.
Reasonable workplace accommodation
Equitable treatment also means that attempts should be made to reasonably accommodate the individual needs of disabled persons at the workplace. Reasonable accommodation can be understood as the removal of barriers which prevent persons with disabilities from enjoying equity of opportunity in vocational training and employment. Lepofsky (1992) notes that accommodation is:
tailoring of a work rule, practice, condition or requirement to the specific needs of an individual or group.… An accommodation can include such steps as an exemption of the worker from an existing work requirement or condition applicable to others.… The litmus test of the accommodation’s necessity is whether such a measure is needed to ensure that the worker can fully and equally participate in the workplace.
Actually, the list of possible accommodations is theoretically endless, since each disabled person has specific needs. Moreover, two persons who experience the same or similar disabilities may have quite different accommodation needs. The important thing to recall is that accommodation is based on the needs of an individual, and the person requiring the adjustments should be consulted.
However, it must be recognized that there are circumstances in which, despite the best of intentions, it is not possible to reasonably accommodate persons with disabilities. Accommodation becomes unreasonable or an undue hardship:
In ascertaining the risks to safety and health, consideration must be given to the willingness of a disabled person to accept the risk that providing the accommodation would engender. For example, it may not be possible for a person who must wear an orthopaedic prosthesis to use safety boots as part of a training programme. If no other safety footwear can be found, the requirement to use the boots should be waived, if the individual is prepared to accept the risk, based on an informed decision. This is known as the doctrine of dignity of risk.
Determination must be made as to whether accommodation poses a serious risk to persons other than the disabled individual, based on the accepted levels of risk tolerated within society.
Assessments of the degree of risk must be made on the basis of objective criteria. Such objective criteria would include existing data, expert opinions and detailed information about the employment or training activity to be undertaken. Impressions or subjective judgements are not acceptable.
Accommodation also is an undue hardship when the costs would substantially adversely affect the financial viability of the employer or training facility. However, many jurisdictions provide funds and grants in order to facilitate modifications that promote the integration of disabled persons.
Disability and Social Policy: Obtaining the Viewpoint of Disabled Persons’ Organizations
As already observed, persons with disabilities should have the inherent right of choice in all aspects of life, including vocational training and occupational placement. This implies, at the level of the individual, consulting with the person concerned as to his or her wishes. Similarly, when policy decisions are made by the social partners (employers’ and workers’ organizations and government), voice must be given to organizations that represent the views of persons with disabilities. Simply put, when considering vocational training and employment policies, persons with disabilities individually and collectively know their needs and how best to meet them.
In addition, it should be recognized that while the terms disability and persons with disabilities are often used generically, individuals who have physical or motor impairments have accommodation and vocational training needs that are different from those of people with intellectual or sensory impairments. For example, while ramped sidewalks are of great benefit to wheelchair users, they may present formidable obstacles to blind people who may not be able to ascertain when they have placed themselves in danger by leaving the sidewalk. Hence, the views of organizations that represent persons with various types of disabilities should be consulted whenever contemplating policy and programme changes.
Additional Guidance Concerning Social Policy and Disability
Several important international documents provide useful guidance on concepts and measures concerning equalization of opportunities for persons with disabilities. These include the following: the United Nations World Programme of Action Concerning Disabled Persons (United Nations 1982), the Vocational Rehabilitation and Employment (Disabled Persons) Convention, 1983 (No.159) (ILO 1983) and the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities (United Nations 1993).
Following a brief review of the development of educational contributions to worker health and safety and of the first attempts to establish the foundations of management education, this article will address curriculum development. The two career paths along which future senior managers develop will be considered as an issue relevant to the educational needs of managers. The curriculum content for managerial issues will be set forth first, to be followed by that pertinent to an understanding of injury causation.
Education for occupational safety and health has been directed, in the main, to people such as safety managers and occupational physicians, and more recently, to occupational health nurses, ergonomists and hygienists—people who have been appointed to specialist staff positions in organizations.
The advisory roles of these specialists have incorporated tasks such as the administration of pre-employment medical examinations, health surveillance, monitoring employee exposures to a range of hazards and environmental examination. Their activities moreover include contributing to job and task design in order to adjust engineering or administrative controls by way of minimizing if not eliminating (for example) the harmful effects of postural demands or of exposure to toxic hazards.
This specialist-oriented educational approach has tended to ignore the central fact that the provision of safe and healthy workplaces requires an extraordinarily broad scope of operational knowledge necessary to make them a reality. It must be borne in mind that managers carry the responsibility for planning, organizing and controlling work activities in public and private enterprises across all industry sectors.
During the decade of the 1970s many initiatives were taken to offer study programmes at the tertiary level to provide a professional education with practical training for the range of specialist engineers, scientists and health care workers entering the field of occupational safety and health.
In the 1980s it was recognized that the people most directly concerned with occupational safety and health, the managers, the workers themselves and their associations, were the most significant entities in the move to reduce workplace injury and ill health. Legislation in many jurisdictions was introduced to provide education for workers serving on safety committees or as elected safety and health representatives. These changes highlighted for the first time the very limited education and training facilities then available to managers.
An early initiative to address management education
Several steps were taken to overcome this problem. The most widely known is Project Minerva, an initiative of the US National Institute for Occupational Safety and Health (NIOSH), which represented an early effort to inculcate that body of specific managerial skills which is necessary to ensure workplace safety and which “generally exceeds that which is offered through courses in the traditional business curriculum” (NIOSH 1985). Teaching materials intended to address the more urgent safety and health concerns were provided for business schools. The resource guide comprised instructional modules, case studies and a book of readings. Module topics are listed in figure 1.
Figure 1. Modular curriculum content, Project Minerva resource guide.
The Canadian Society of Safety Engineers has recommended this structure to business schools seeking to incorporate occupational safety and health materials into their curricula.
Fundamentals of Managing: General Rather Than Specific Needs
Any job responsibility entails the acquisition of relevant knowledge and appropriate skills in order to discharge it. Responsibility for managing occupational safety and health within any organization will be placed increasingly upon line managers at each level in the job hierarchy. Associated with that responsibility ought to be commensurate accountability and the authority to command the necessary resources. The knowledge and skills needed to discharge this responsibility form the curriculum for occupational safety and health management education.
At first sight, it would seem necessary that a curriculum of this sort be developed with the aim of meeting all the special demands of the whole range of management functions as they relate to such a diversity of positions as office administrator, nurse manager, operations director, supplies and purchasing superintendent, fleet coordinator and even ship’s captain. The curricula need also, perhaps, address the whole range of industries and the occupations found within them. However, experience strongly suggests that this is not so. The necessary skills and knowledge are, in fact, common to all management functions and are more fundamental than those of the specialists. They are operative at the level of basic management expertise. However, not all managers arrive at their position of responsibility by taking similar paths.
Managerial Career Paths
The usual path to a managerial career is through either supervisory or specialist functions. In the former case, career development is dependent on work experience and job knowledge and in the latter it ordinarily presupposes off-the-job college education and postgraduate study, for example as an engineer or nurse manager. Both streams need to develop occupational safety and health (OSH) skills. For the latter this may be done in graduate school.
It is usual today for successful managers to acquire the degree of Master of Business Administration (MBA). For this reason the Minerva Project directed its attention to the 600 or more graduate management schools in the United States. By incorporating into MBA curricula such aspects of occupational safety and health as were determined to be critical for successful management of the field, it was believed that this material would be integrated into the formal studies of middle management.
Given the extremely high rate of technological invention and scientific discovery, undergraduate courses, particularly in engineering and scientific disciplines, have only limited opportunities to integrate broadly-based safety theory and practice into design, process and operation studies.
Since managerial roles begin fairly soon after graduation for those with specialist education, there is a need to provide the knowledge and skills that will support the safety and health responsibility of both specialist and generalist managers.
It is important that an awareness of the content of any curriculum devoted to occupational safety and health objectives among management be promoted among other personnel having related responsibilities. Thus, the training of such key employees as safety and health representatives should be designed to keep them current with such curricular developments.
Curriculum for Managing Occupational Safety and Health
There are two broad classes of knowledge into which the discipline of occupational safety and health falls. One is that relating to the functions and principles of management and the other deals with the nature and proactive control of hazards. The model of curriculum development set forth below will follow this division. Both the supervisory path to management and the specialist path will require their own particular coverage of each of these classes.
The question of what level of complexity and technological detail needs to be provided to students may be determined by the purpose of the course, its length and the intention of the providers regarding subsequent education and skills development. These issues will be addressed in a later section.
Specifically, curricula should address machinery and plant safety, noise, radiation, dust, toxic materials, fire, emergency procedures, medical and first aid arrangements, workplace and employee monitoring, ergonomics, environmental hygiene, workplace design and maintenance and, most importantly, the development of standard operating procedures and training. This last is an essential component of managerial understanding. Not only must tasks and processes be the subject of operator training but the requirement for continuous improvement of people and processes makes training and retraining the most critical step in improving the quality of both. Adult learning theory and practice needs to be applied in the development of the curricular materials that guide this continuing training process.
The functions and principles of management
The fundamental purposes of management embrace the planning, organizing and control of workplace activities. They also embrace the incorporation of practices which maximize opportunities for workforce participation in goal setting, team operation and quality improvement. Furthermore, successful management requires the integration of occupational safety and health into all the organization’s activities.
It is rare for undergraduate programmes, outside those of colleges of business, to cover any of this knowledge. However, it is a most essential component for the specialist practitioners to have incorporated into their undergraduate study.
The mission statement, strategic plan and structure set up to guide and facilitate the attainment of the organization’s objectives must be understood by the managers to be the basis for their individual activities. Each division of the organization whether it is a hospital, trucking business or coal mine, will in turn have its own goals and structure. Each will reflect the need to achieve organizational goals, and, taken together, will drive the organization towards them.
Policies and procedures
The primary embodiment of an organization’s goals are comprised by policy documents, the guides for individual employees on specific topics. (In some jurisdictions, the publication of an organization’s overall policy is required by law.) These documents ought to include reference to the range of occupational safety and health programmes designed with regard to the activities and processes which occupy the working time of employees. A sample of some general policy statements might include documents on emergency evacuation, fire fighting, purchasing procedures, injury reporting and accident and incident investigation. On the other hand, specific hazards will require their own process-specific policy materials concerning, for example, hazardous substances management, ergonomic interventions or entry into confined spaces.
After establishing policy, an activity preferably carried out with worker representative participation and union involvement, detailed procedures would then be put in place to give effect to them. Again, participative practices will contribute to the wholehearted acceptance of them by the workforce as a valuable contribution to their safety and health.
Figure 2. A health and safety management system.
Organizational structures defining key roles
The next stage in the management process is to define an organizational structure which characterizes the roles of key people—for example, the chief executive—and professional advisors such as safety advisors, occupational hygienists, the occupational health nurse, the physician and the ergonomist. In order to facilitate their roles, the relationships of these people and elected safety and health representatives (required in some jurisdictions) and worker members of safety committees to the organizational structure need to be explicit.
The planning and organizing functions of management will integrate structures, policies and procedures into the operational activities of the enterprise.
Control activities—establishing processes and goals, determining standards of acceptable achievement and measuring performance against those standards—are the operational steps which bring to realization the intentions of the strategic plan. They also need to be established through co-determination. The tools for control are workplace audits, which may be continuous, frequent, random or formal.
An understanding of these activities is an important component of a management education syllabus, and skills should be developed in carrying them out. Such skills are as essential to the success of an integrated safety and health plan as they are to the discharge of any other management function, whether purchasing or fleet operation.
Organizational development and curriculum
Since the introduction of new organizational structures, new equipment and new materials is occurring at a rapid pace, special attention must be given to the processes of change. The employees who will be affected by these changes can have a deciding influence on their effectiveness and on the efficiency of the work group. An understanding of the psychosocial factors influencing the activities of the organization must be acquired and skills must be developed in using this knowledge to reach organizational objectives. Of particular importance is the delegation of the authority and the accountability of the manager to work groups formed into autonomous or semi-autonomous work teams. The management education curriculum must place at the disposal of its students the tools necessary to carry out their obligation to ensure not only process improvement and quality but the development of the multiple skills and quality awareness of personnel with which the issue of safety is so closely involved.
There are two further components of the management curriculum requiring examination. One of these is the activity of incident investigation and the other, on which the whole of this activity rests, is an understanding of the accident phenomenon.
The accident phenomenon
The work of Derek Viner (1991) in clearly expounding the significance of energy sources as the potential hazards in all workplaces has defined half of the accident equation. In conjunction with Viner’s work, the contribution of Dr. Eric Wigglesworth (1972) in identifying human error, the crucial element in managing workplace safety activities, completes its definition. An emphasis on the process of each damaging occurrence has been shown by Benner (1985) when considering accident investigation methods to be the most productive approach to managing worker safety and health.
Wigglesworth’s visualization of the sequence of events which results in injury, damage and loss appears in figure 3. It highlights the role of nonculpable human error, as well as the essential element of loss of energy containment and the potential for the injury outcome where this occurs.
Figure 3. The error/injury process.
The implications of the model for management become clear when planning for work processes takes account of the behavioural inputs which affect those processes. This is so in particular when the role of design is given its rightful place as the initiating mechanism for both equipment and process development. When planning takes account both of the design of plant and equipment and of the human factors influencing work activity, coordination and control mechanisms can then be implemented to assure containment of the identified hazards.
A model may be used to illustrate the significance of the interaction between the worker, the equipment, tools and machines employed to further the task objectives and the environment within which the activity takes place. The model highlights the need to address factors within all three elements which may contribute to damaging events. Within the workstation environment, which encompasses the thermal, aural and lighting components, among others, the worker interacts with the tools and equipment necessary to get the work done (see figure 4).
Figure 4. Representation of workstation elements relevant to injury causation and control.
Accident investigation and analysis
Accident investigation serves a number of important functions. First, it can be a proactive process, being used in situations where an incident occurs which results in no damage or injury but where there is a potential for harm. Studying the sequence of events can uncover features of the work process which could lead to more serious consequences. Second, one may gain an understanding of the process by which the events unfolded and thus can identify the absence of, or weakness in, process or task design, training, supervision or controls over energy sources. Third, many jurisdictions legally require investigations of certain types of incidents, for example, scaffolding and trench collapses, electrocutions and failures of hoisting equipment. The work of Benner (1985) illustrates well the importance of having a clear understanding of the accident phenomenon and an effective protocol for investigating injury and damage events.
The nature and control of hazards
All injury results from some form of energy exchange. The uncontrolled release of physical, chemical, biological, thermal, or other forms of energy is a source of potential harm to a variety of workers. Containment by suitable engineering and administrative mechanisms is one essential aspect of suitable control. Identifying and evaluating these energy sources is a prerequisite for control.
A management education curriculum would thus contain topics covering a range of activities which includes establishing objectives, planning the work, developing policy and procedures, undertaking organizational change and installing controls over work processes (and specifically the energy sources utilized in carrying out that work), all aimed at injury prevention. While curricula designed for the technical areas of operations need address only fundamental principles, organizations that make use of very hazardous materials or processes must have in their employ a senior member of management with sufficient training in the specific modes of handling, storage and transport of such technology to ensure the safety and health of workers and members of the community.
Larger enterprises and small business
Managers who work in larger organizations employing, say, a hundred or more people usually have one or only a few functional responsibilities and report to a senior manager or a board of directors. They have occupational safety and health responsibility for their own subordinates and act within established policy guidelines. Their educational needs may be addressed by the formal programmes offered in business schools at the undergraduate or graduate level.
On the other hand, the sole managers or partners in small enterprises are less likely to have had graduate education, and, if they have, it is more likely to be of a technological than managerial sort, and it is more difficult to address their needs for the management of occupational health and safety.
Small business needs
Providing training programmes for these managers, who often work very long hours, has represented a difficulty of long standing. Although a number of large legislative jurisdictions have produced guidance booklets setting out minimum performance stands, the more promising approaches are being made available through industry associations, such as the Ontario Industrial Accident Prevention Associations funded by levies placed by the Workers’ Compensation Board upon all businesses in the given industrial sector.
A body of knowledge and skills which addresses the needs of managers at the first-line supervisory level, middle management and senior executives is outlined in figure 5 by topic. Individual short-form syllabuses follow in figure 6. These have been collated from the syllabuses of a number of university graduate study programmes.
Figure 5. Syllabus for an OSH study programme.
The needs of first-line supervisors will be met through the acquisition of knowledge and skills covered by those topics that relate to operational demands. The training of senior executives will concentrate on such topics as strategic planning, risk management and compliance matters as well as initiating policy proposals. The allocation of hours for each course of study should reflect student needs.
Management education for occupational safety and health demands an eclectic approach to the broadest range of issues. It shares with quality the imperative of being integrated into every management and worker activity, into every employee’s job description and should be a part of the performance appraisal of all.
As a rule disabled people have far fewer opportunities for occupational integration open to them than does the general population, a situation confirmed by all available data. However, in many countries political initiatives have been developed to improve this situation. Thus we find, for example, legal regulations requiring business enterprises to employ a specific percentage of disabled people, as well as—often in addition to this—financial incentives for employers to hire disabled people. Moreover, recent years have also seen the creation of services in many countries providing support and assistance to disabled people making their way into working life. The following contribution aims to describe these services and their specific tasks in the context of vocational rehabilitation and the integration of disabled people into employment.
We are concerned with services which become active, providing advice and support, during the rehabilitation phase—the preparatory phase prior to the disabled person’s entry into working life. Whereas support services used to limit themselves almost exclusively to this area, modern services have, in view of the continued existence on a global scale of employment problems of the disabled, turned their attention increasingly towards the stages dealing with placement and integration in an enterprise.
The increase in importance achieved by these services for the promotion of occupational integration has come about not least by growing community-based rehabilitation activities and, from a practical viewpoint, ever more numerous and successful approaches to the social integration of the disabled into the community. The continuing tendency towards the opening and overcoming of care institutions as mere places of confinement for disabled individuals has made the occupational and employment requirements for this group of people really visible for the first time. We are thus confronted with a growing variety of these support services because the growing demand for the integration of all disabled people into the community brings with it an increase in the associated tasks.
Rehabilitation and Integration
Only when disabled people are integrated into the community is the real aim and purpose of rehabilitation actually achieved. The objective of vocational rehabilitation programmes thus ultimately remains the finding of a job and hence participation in the local labour market.
As a rule, measures for medical and vocational rehabilitation lay the foundations for the (re)integration of disabled persons into working life. They aim to put the disabled individual in a position to be able to develop his or her own abilities in such a way that a life with no, or with a minimum of limitations in society at large becomes possible. The services which are active in this phase and which accompany the disabled person during this process are termed rehabilitation support services. Whereas one used to be able to assume that a completed course of medical rehabilitation and a well-founded vocational rehabilitation were, if not guarantees, then at least key factors for occupational integration, these elementary conditions are no longer adequate in view of the changing situation on the labour market and the complex requirements of the workplace. Of course solid vocational qualifications still form the basis of occupational integration, yet under today’s conditions many disabled people require additional assistance in looking for work and in integration into the workplace. The services active during this phase can be summarized under the name employment support services.
Whereas medical and vocational rehabilitation measures take as their primary point of departure the disabled persons themselves, and attempt to develop their functional capacities and vocational skills, the main emphasis of the employment support services lies on the side of the working environment and hence on the adaptation of the environment to the requirements of the disabled individual.
General Perspectives for Vocational Integration
In spite of the importance of the support services it should never be forgotten that rehabilitation should never, in any phase, be a merely passive form of treatment, but a process actively directed by the disabled person. Diagnosis, counselling, therapy and other forms of support can at best be an aid in the pursuit of self-defined objectives. Ideally the task of these services is still to outline the various options for action available, options which disabled people should ultimately decide for themselves, as far as possible.
Another no less significant parameter for occupational integration is to be seen in the holistic character which should be a hallmark of this process. That means that rehabilitation should be comprehensive and not just deal with the overcoming of impairment. It should involve the whole person and provide him or her with support in finding a new identity or in coping with the social consequences of disability. The rehabilitation of disabled people is in many cases far more than a process of physical stabilization and the extension of skills; if the course of rehabilitation is to run successfully and satisfactorily it must also be a process of psychosocial stabilization, identity formation and integration into everyday social relationships.
An important area of work for support services, and one which is unfortunately all too often ignored, is the field of the prevention of serious disabilities. For working life in particular it is crucial that rehabilitation and employment services are open not just to people who are already disabled but also to those who are threatened by disability. The earlier the reaction to a commencing disability, the sooner that steps towards occupational reorientation can be taken, and the earlier that serious disabilities can be avoided.
These general perspectives for vocational rehabilitation also provide an outline of the essential tasks and parameters for the work of the support services. Furthermore, it should also be clear that the complex tasks described here can best be fulfilled by the interdisciplinary collaboration of experts from various professions. Modern rehabilitation can thus be seen as cooperation between the disabled person and a team of professional trainers as well as qualified medical, technical, psychological and educational personnel.
Medical rehabilitation measures usually take place in hospitals or in special rehabilitation clinics. The task of the support services in this phase consists of initiating first steps towards coping psychologically with a disability which has been suffered. However, occupational (re)orientation should also take place as soon as possible, practically at the patient’s bedside, since the construction of a new vocational perspective often helps to lay decisive motivational foundations which can also facilitate the medical rehabilitation process. Other measures such as motor and sensory training programmes, physiotherapy, movement and occupational or speech therapy can also contribute during this phase towards accelerating the natural regenerative process and reducing or avoiding the creation of dependencies.
The decision concerning the vocational perspectives of a disabled person should under no circumstances be taken from a purely medical point of view by a doctor, as is unfortunately still often the case in practice. The basis of any decision on the vocational future of a disabled person should be formed not just by deficits which can be medically diagnosed but rather by existing abilities and skills. The rehabilitation support services should therefore undertake together with the disabled person an extensive review of the client’s vocational background and an inventory of potential abilities and existing interests. Building on this an individual rehabilitation plan should then be drawn up which takes into account the potentialities, interests and requirements of the disabled person as well as the potential resources in his or her social environment.
A further area of work for the rehabilitation support services in this phase lies in the counselling of the disabled person with regard to any technical assistance, equipment, wheelchairs, artificial limbs, and so on which may be required. Use of this kind of technical assistance may at first be accompanied by rejection and refusal. Should a disabled person fail to receive the proper support and instruction during this initial phase, he or she may run the risk of the initial rejection escalating into a phobia which may later make it difficult to obtain the full benefit of the apparatus in question. In view of the wide variety of technical assistance nowadays available, the choice of such equipment must be made with the greatest care, tailored as far as possible to the individual needs of the disabled person. Ideally the selection of technical equipment required should also take into account both the disabled person’s vocational perspective and—as far as possible—the demands of the future workplace, given that the latter will also determine the purpose which the technical assistance must fulfil.
In the ILO “Convention (159) concerning vocational rehabilitation and employment (disabled persons)” adopted in 1983, the purpose of vocational rehabilitation is considered “as being to enable a disabled person to secure, retain and advance in suitable employment and thereby to further such person’s integration or reintegration into society”.
The past 30 years have seen rapid developments in vocational rehabilitation services for disabled persons. They include vocational assessment, which aims to get a clear picture of the person’s potential abilities; orientation courses to help the person to restore lost confidence in his or her abilities; vocational guidance, to develop a (new) vocational perspective and to choose a certain occupation; vocational training and retraining opportunities in the chosen field of activity; and placement services, designed to assist the disabled person in finding employment adapted to his or her disability.
A disabled person’s (re)entry into employment usually takes place via individual or combined vocational rehabilitation programmes, which can be carried out in different locations. It is the task of the rehabilitation support services to discuss with the disabled person whether the vocational qualification measure should be carried out in a mainstream institution for vocational training, in a specialized institution for vocational rehabilitation, by making use of community-based facilities or even directly in a normal workplace. The latter option is especially suitable when the previous job is still available and the workplace management have demonstrated their readiness in principle to rehire their former employee. However, in other cases cooperation with a regular workplace may already be a recommended option during the course of the vocational training, given that experience has shown that such cooperation also improves the chances of the participant subsequently being taken on by the firm. Thus in the case of vocational training in a vocational rehabilitation centre, it goes without saying that the support services should undertake the task of assisting disabled people in the search for possibilities of on-the-job practical training.
Of course these options for carrying out vocational rehabilitation measures cannot be seen separately from certain parameters and conditions which vary from country to country. Furthermore, the actual decision on the location of the vocational rehabilitation activity also depends on the kind of work envisaged and the type of disability, as well as on the disabled person’s social environment and the natural support potential available within it.
Wherever vocational rehabilitation takes place, it remains the task of the rehabilitation support services to accompany this process, to discuss together with the disabled person the experiences gained and to further extend the individual rehabilitation plan, adapting it to new developments as necessary.
Employment Support Services
Whereas medical and vocational rehabilitation in many countries can count on the support of a more or less extensive system of institutional settings, a comparable infrastructure for the promotion of the integration of disabled people into employment does not as yet exist even in some highly industrialized countries. And although various countries do have a number of quite successful models, some of which have been in existence for a number of years, employment services in most countries, with the exception of certain approaches in Australia, the United States, New Zealand and Germany, still do not form an integral part of national policy for disabled persons.
While the placement of disabled people into employment is an obligatory part of general labour administration in many countries, in view of the growing number of unemployed these institutions are less and less in a position to fulfil their obligations to place disabled people in work. This is exacerbated in many cases by a lack of appropriately qualified staff capable of doing justice to the abilities and wishes of the disabled person as well as to the requirements of the world of work. The creation of employment support services is also a reaction to the increasing lack of success of the traditional “train and place” approach implicit in institutionalized vocational rehabilitation. In spite of elaborate and often successful medical and vocational rehabilitation measures, integration into employment without additional assistance is becoming increasingly difficult.
It is at this point that the requirement for specific employment support services expresses itself. Wherever such services have been installed, they have been met by enormous demand from disabled persons and their families. This kind of service is particularly necessary and successful at the institutional interfaces between schools, rehabilitation institutions, sheltered workshops and other facilities for disabled persons on the one hand and the workplace on the other. However, the existence of employment support services also reflects the experience that many disabled people also require support and accompaniment not just in the phase of placement in employment, but also during the adjustment phase in the workplace. A number of larger firms have their own, internal employee assistance service, responsible for the integration of newly employed disabled people and for maintaining the jobs of disabled workers already employed.
Tasks of Employment Support Services
The primary intervention focus of the employment support services is on the critical threshold of entry into working life. Generally speaking, their task consists of creating links between the disabled person and the firm in question, that is, with the direct superior and future colleagues in the workplace.
Employment support services must on the one hand provide support for the disabled person in finding work. This takes place by means of self-confidence and (video supported) job interview training and assistance in the writing of letters of application, but also and primarily in placement in on-the-job practical training. All experiences have shown that such practical on-the-job training forms the most important bridge into the firm. Where necessary the services accompany the disabled person to job interviews, providing assistance with official paperwork and in the initial adjustment phase in the workplace. Lack of capacity means that most employment support services are unable to provide support beyond the confines of the workplace. However, in theory such support is also undesirable. To the extent that further assistance in the private sphere, whether psychological, medical or life-skills related in nature, is also required, it is usually provided by referral to the appropriately qualified facilities and institutions.
On the other hand, with regard to firms, the most important tasks of the support services consist initially of motivating an employer to take on a disabled person. Although many firms do have broad reservations about employing disabled people, it is still possible to find firms prepared to enter into continual cooperation with vocational rehabilitation facilities and employment support services. Once such a general readiness for cooperation has been identified or established, it is then a case of locating suitable jobs within the firm. Before any placement in the firm, there should of course be a comparison of the requirements of the job with the abilities of the disabled person. However, the time and energy occasionally spent in model projects which use supposedly “objective” procedures to compare differentiated ability and requirement profiles in order to work out the “optimal” job for a specific disabled person, usually bears no relation to the chances of success and the practical efforts involved in actually finding the job. It is more important to turn disabled persons into the agents of their own vocational development, since in terms of psychological significance we cannot place too high a value on the involvement of the persons concerned in the shaping of their own vocational future.
Placement approaches already elaborated attempt to build on detailed analyses of organizational structure and working procedure by making suggestions to the firm regarding the reorganization of certain working areas and hence to create work opportunities for disabled people. Such suggestions can include a reduction in certain working requirements, the creation of part-time work and flexible work times as well as the reduction of noise and stress in the workplace.
Employment support services also offer to assist firms in applying for public subsidies, such as wage subsidies, or in overcoming bureaucratic hurdles when applying for state grants for technical compensation for disability-related limitations. However, support for the disabled person in the workplace must not necessarily be only of a technical nature: people with visual impairment may under certain circumstances require not only a Braille keyboard for their computer and an appropriate printer, but also someone to read aloud for them; and persons with hearing impairment could be assisted through a sign-language interpreter. Sometimes support in acquiring the qualifications required for the job or in social integration into the firm will be necessary. These and other similar tasks are often undertaken by an employment support services worker designated as a “job coach”. The individualized support provided by the job coach decreases over time.
People with mental or psychiatric disabilities usually require a step-by-step integration with a gradual increase in work requirements, working hours and social contact, which has to be organized by the support services in cooperation with the firm and the disabled person.
For every form of support the maxim applies that it must be tailored to the individual requirements of the disabled person as well as harmonized with the firm’s own resources.
The Example of Supported Employment
Supported employment for persons with disabilities is a concept in which wage subsidies for the firms involved and individualized support services for disabled persons are connected with each other in order to achieve full integration into working life. This concept is particularly widespread in Australia and New Zealand, in various European countries and in the United States. It has so far primarily been used for the workplace integration of mentally and psychiatrically disabled people.
Employment support services undertake the placement of disabled people in a firm, organize the financial, technical and organizational support required by the firm and provide a job coach who accompanies the job-related and social integration of the disabled person into the firm.
The employer is thus relieved of all normally anticipated problems related to the hiring of disabled persons. As far as possible and necessary, the employment support services also undertake the required adaptations in the workplace and the disabled person’s immediate working environment. Occasionally it will be necessary for the applicant to receive additional training outside the firm, although instruction usually takes the form of on-the-job training by the job coach. It is also the job coach’s task to orient the colleagues and superiors in the technical and social support of the disabled person, since the aim in principle is to gradually reduce the professional assistance of the employment support service. It is, however, absolutely necessary that in the case of acute problems the employment support service should be present to provide continual assistance to the extent required. This means that support both for the disabled person and for the employer, the superior and colleagues, must be individualized and correspond to specific needs.
Cost-benefit analyses of this approach carried out in the United States have shown that although the initial integration phase is very intensive in terms of support provided and hence costs, the longer employment lasts, the more this investment is also justified from a financial point of view, not just for the disabled person, but also for the employer and the public budget.
Placement of disabled people by supported employment approaches is most common in relatively undemanding jobs, which tend to run the risk of being eliminated. The future of the supported employment approach will be decided not just by developments in the labour market but also by the further development of the concept.
Challenges for the Future of Employment Support Services
The following sections contain descriptions of a number of critical points whose significance for the further development of the concepts and for the practical work of employment support services should not be underestimated.
Networking with Vocational Rehabilitation Facilities and Firms
If employment support services are not to miss the mark in terms of what is actually required, a central task everywhere will be to create organic links with the existing vocational rehabilitation facilities. Integration services with no links to rehabilitation facilities run the risk—as experience has shown—of functioning primarily as instruments of selection and less as services for the vocational integration of disabled persons.
However, support services require not only networking and cooperation with vocational rehabilitation facilities, but also and more importantly, a clear positioning with regard to cooperation with firms. Under no circumstances should employment support services function merely as counselling services for disabled persons and their families; they must also be active in work-finding and placement services. Proximity to the labour market is the key to access to firms and ultimately to the possibilities of finding employment for disabled individuals. If these services’ access threshold to the firm is to be maximized, they must be situated as close as possible to actual economic activity.
Connections Between Qualification, Placement and Employment
An important part of all vocational integration efforts, and hence a central challenge for employment support services, is the coordination of vocational preparation and qualification with the requirements of the workplace—an aspect often still neglected. As justified as a criticism of the traditional “train and place” model may be, in practice just to first place and then provide training in the required skills is not enough either. Working under today’s conditions means not only having the so-called secondary working virtues at one’s disposal—punctuality, concentration and speed—but also a number of technical qualifications which are always required and which must already be present before employment can be started. Anything else would be asking too much, both of the persons to be placed and of the firms prepared to take them on.
Mobilizing Natural Support
The chances of the successful vocational integration of disabled people into the labour market increase with the possibility of organizing help and support, either in parallel to the work process or directly in the workplace. Especially in the initial adjustment phase it is important both to assist the disabled person in coping with the demands of work and also to provide support for those who make up the working environment. This form of accompanying assistance is usually provided by the employment support services. The integration of a disabled person will be all the more successful in the long term, the more this kind of professional help can be replaced by a mobilization of natural support in the firm, whether by colleagues or superiors. In a project recently carried out in Germany for the mobilization of natural support by so-called foster workers in the workplace, 42 disabled people were successfully integrated in the course of 24 months; over 100 firms were asked to participate. The project showed that few employees had the required level of knowledge and experience in dealing with disabled people. It thus appeared to be of strategic importance for the employment services to develop a conceptual framework in order to organize the replacement of professional support and the mobilization of natural support in the workplace. In the UK for example, employees prepared to act as foster workers for a certain time receive recognition in the form of a small financial reward.
Success Orientation and User Control
Finally, employment support services should also offer their own employees incentives to go into firms and bring about the placement of disabled people, for it is on these placement efforts within the firms that the central focus of the services must lie. Yet the placement of disabled people can be secured in the long term only when the funding of the employment support services and their employees is to a certain extent related to their success. How can service employees be motivated in a continual way to leave their institution, only to undergo the frustration of rejection in the firms? The placement of disabled people in employment is a difficult business. Where is the impetus to come from to battle doggedly and constantly against prejudice? All organizations develop their own interests, which are not necessarily in accord with those of their clients; all publicly funded institutions run the risk of becoming divorced from the needs of their clients. For this reason a corrective is required which creates general incentives—not just for employment support services but also for other social facilities—in the direction of the desired result.
A further necessary modification of the work of publicly funded social facilities consists of the users and their organizations having a say in matters relating to them. This culture of participation should also find an echo in the concepts behind the support services. In this context the services, like all other publicly funded institutions, should be subjected to regular control and evaluation by their clients—their users and their families—and last but not least by the firms cooperating with the services.
Which and how many disabled persons can ultimately be integrated into the labour market by the activities of vocational rehabilitation and employment support services cannot be answered in the abstract. Experience shows that neither the degree of disability nor the situation on the labour market can be regarded as absolute limitations. The factors determining development in practice include not just the support services’ way of working and the situation on the job market, but also the dynamics arising within institutions and facilities for disabled persons, when this kind of employment option becomes a concrete possibility. In any case, experiences from various countries have shown that collaboration between employment support services and sheltered facilities tends to have considerable effect on the internal practices within these facilities.
People need perspectives, and motivation and development arise to the extent that perspectives exist or are created by new options. Important as the absolute number of placements realized by the employment support services is, of equal importance is the opening up of options for the personal development of disabled people made possible by the very existence of such services.
Categories of Occupational Safety and Health Professionals Requiring Training and Education
The delivery of occupational safety and health services requires a highly-trained and multidisciplinary team. In a few less-developed countries, such a team may not exist, but in the vast majority of countries in the world, experts in different aspects of OSH are usually at least available though not necessarily in sufficient numbers.
The question of who belong to the categories of OSH professionals is fraught with controversy. Usually there is no dispute that occupational physicians, occupational nurses, occupational hygienists and safety professionals (sometimes referred to as safety practitioners) are OSH professionals. However, there are also members of many other disciplines who can make a plausible claim to belonging to the OSH professions. They include those ergonomists, toxicologists, psychologists and others who specialize in the occupational aspects of their subjects. For the purpose of this article, nevertheless, the training of these latter types of personnel will not be discussed, as the main focus of their training is often not on OSH.
In most countries, specific OSH training is of fairly recent origin. Until the Second World War, most OSH professionals received little or no formal training in their chosen calling. Few schools of public health or universities provided formal OSH courses, though some such institutions offered OSH as a subject in the context of a wider degree course, usually in public health. Segments of OSH were taught at the postgraduate level for physicians training in disciplines such as dermatology or respiratory medicine. Some engineering aspects of safety, such as machine guarding, were taught in technological and engineering schools. In most countries, even training in individual components of occupational hygiene courses were hard to find before the Second World War. The development of occupational nursing training is even more recent.
In the developed countries, OSH training received a boost during the Second World War, just as OSH services did. The mass mobilization of whole nations for the war effort led to greater emphasis on protecting the health of workers (and therefore their fighting capability or productivity with respect to the manufacturing of more munitions, warplanes, tanks and warships). At the same time, however, wartime conditions and the drafting of both university teachers and students into the armed forces made it extremely difficult to set up formal courses of OSH training. After the Second World War, however, many such courses were established, some with the help of the generous study grants for demobilized servicemen awarded by grateful governments.
After the Second World War, most colonies of European empires achieved independence and embarked upon the path of industrialization to a greater or lesser extent as a means to national development. Before long, such developing countries found themselves confronting the ills of the industrial revolution of nineteenth-century Europe, but within a much telescoped time span and on an unprecedented scale. Occupational accidents and diseases and environmental pollution became rampant. This led to the development of OSH training, although even today there are large variations in the availability of such training in these countries.
Review of Current International Initiatives
International Labour Organization (ILO)
There have been several initiatives of the ILO in recent years which relate to OSH training. Many of them relate to practical training for interventive measures at the worksite. Some other initiatives are carried out in collaboration with national governments (Rantanen and Lehtinen 1991).
Other ILO activities since the 1970s have been carried on largely in developing countries throughout the world. Several such activities relate to the upgrading of training of factory inspectors in countries such as Indonesia, Kenya, the Philippines, Tanzania, Thailand, and Zimbabwe.
The ILO, together with other United Nations agencies such as the United Nations Development Programme, has also assisted in the establishment or upgrading of national institutes of OSH, the training functions of which are usually among their top priorities.
The ILO has also produced several practical monographs which are very useful as training materials for OSH courses (Kogi, Phoon and Thurman 1989).
World Health Organization (WHO)
The WHO has held in recent years a number of important international and regional conferences and workshops on OSH training. In 1981, a conference entitled “Training of Occupational Health Personnel” was held under the auspices of the Regional Office for Europe of the WHO. In the same year, the WHO convoked with the ILO a Joint ILO/WHO Committee on Occupational Health which focused on “educational and training in occupational health, safety and ergonomics” (WHO 1981). That meeting assessed the needs for education and training at different levels, developed policies in education and training and advised on methodology and programmes for education and training (WHO 1988).
In 1988 a WHO Study Group published a report entitled Training and Education in Occupational Health to address particularly the new policies on primary health care strategies adopted by the WHO member states, new needs resulting from technological developments and new approaches to health promotion at work (WHO 1988).
International Commission on Occupational Health (ICOH)
In 1985, the ICOH established a Scientific Committee on Education and Training in Occupational Health. This Committee has organized four international conferences as well as mini-symposia on the subject in the International Congresses on Occupational Health (ICOH 1987). Among the conclusions of the second conference, the need to develop training strategies and training methodologies received prominent mention in the list of priority issues (ICOH 1989).
A main feature of the third conference was the methodology of OSH training, including such functions as learning by participation, problem-based learning and evaluation of courses, teaching and students (ICOH 1991).
In different parts of the world, regional bodies have organized training activities in OSH. For example, the Asian Association of Occupational Health, established in 1954, has a Technical Committee in Occupational Health Education which conducts surveys on training of medical students and related subjects.
Types of Professional Programmes
Degree-granting and similar programmes
Probably the prototype of degree-granting and similar programmes is the sort which was developed in schools of public health or equivalent establishments. Higher education for public health is a relatively recent development. In the United States, the first school dedicated to this purpose was established in 1916 as the Institute of Hygiene at Johns Hopkins University. At that time, the overriding public health concerns centred around the communicable diseases. As time went on, education about the prevention and control of man-made hazards and about occupational health drew increasing emphasis in the training programmes of schools of public health (Sheps 1976).
Schools of public health offer OSH courses for a postgraduate diploma or for the degree of Master of Public Health, allowing students to concentrate in occupational health. Usually entry requirements include the possession of a tertiary educational qualification. Some schools insist upon relevant prior experience in OSH as well. The duration of training on a full-time basis is usually one year for the diploma and two years for the Master’s course.
Some of the schools train the different OSH personnel together in core courses, with training in the specific OSH disciplines (e.g., occupational medicine, hygiene or nursing) being offered to students specializing in these areas. This common training is probably a great advantage, as trainees of the different OSH disciplines could develop a greater understanding of each other’s functions and a better experience of team work.
Especially in recent years, schools of medicine, nursing and engineering have offered courses similar to those in schools of public health.
A few universities are offering OSH courses at the basic or undergraduate level. Unlike the traditional OSH tertiary courses, admission to which is usually dependent upon the acquisition of a previous degree, these newer courses admit students who have just graduated from high school. Much controversy still surrounds the merits of this development. Proponents of such courses argue that they produce more OSH professionals in less time and at lower cost. Their opponents argue that OSH practitioners are more effective if they build their OSH training on a basic discipline into which they integrate their special OSH practice, such as occupational medicine or nursing. Knowledge of basic sciences may be acquired at the specialization level if they have not been taught as part of undergraduate training.
Training courses in OSH for physicians vary in their clinical component. The conference, mentioned above, on the training of occupational health personnel organized by the WHO/Regional Office for Europe emphasized that “occupational medicine is fundamentally a clinical skill and its practitioners must be fully competent in clinical medicine”. It must also be stressed that the diagnosis of chemical intoxication among workers is largely clinical, as is the differentiation between “occupational disease” and other diseases and their management (Phoon 1986). It has become, therefore, a worldwide trend to insist upon postings to different clinics as part of the training of the occupational physician. In the United States and Canada, for example, trainees undergo a four-year residency programme which includes a substantial clinical component in such subjects as dermatology and respiratory medicine in addition to the curriculum required for the degree of Master of Public Health or its equivalent.
Formal training for occupational nurses probably varies even more in different parts of the world than that for occupational physicians. These differences hinge on the variations of responsibilities and functions of occupational nurses. Some countries define occupational health nursing as “the application of nursing principles in conserving the health of workers in all occupations. It involves prevention, recognition, and treatment of illness and injury and requires special skills and knowledge in the fields of health education and counselling, environmental health, rehabilitation and human relations” (Kono and Nishida 1991).On the other hand, other countries understand occupational nursing as the role of the nurse in an interdisciplinary occupational health team, who is expected to participate in all the fields of general health management, delivery of health services, environmental control, healthy and safe working procedures and OSH education. A survey in Japan showed, however, that not all the graduates from an occupational nursing staff took part in all these activities. This was probably due to a lack of understanding of the nurse’s role in OSH and to inadequate training in some of the fields (Kono and Nishida 1991).
The discipline of occupational hygiene has been defined by the American Industrial Hygiene Association as the science and art devoted to the recognition, evaluation and control of those environmental factors and stresses, arising in or from the workplace, which may cause sickness, impaired health and well-being, or significant discomfort and inefficiency among workers or among the citizens of the community. Speciality training has also emerged within the general field of occupational hygiene, including that in chemistry, engineering, noise, radiation, air pollution and toxicology.
Curricula for Occupational Safety and Health Personnel
The detailed contents of the curricula for the training of occupational physicians, nurses, hygienists and safety personnel, as recommended by the 1981 Joint ILO/WHO Committee an Occupational Health mentioned above will be represented in the pages to follow. As regards the main subject areas to be taught, the Committee recommends:
According to the profile of the personnel, the educational programmes will go more or less deeply into different subjects to meet the demands of the respective professions, as discussed below for several categories.
It is difficult to comment in detail what should go into the curricula of OSH courses. It is generally agreed that such courses should have a greater input of behavioural sciences than is now the case, but such input should be relevant to the sociocultural milieu of a particular country or region for which a course is designed. Moreover, OSH should not be taught in isolation from the general health services and the community health situation in a given country or region. The fundamentals of management science should be included in OSH curricula to improve the understanding of organizational structures and practices in enterprises as well as to enhance administrative skills of OSH professionals. The art of communication and the ability to conduct an investigation of OSH problems scientifically and to formulate solutions were also recommended for inclusion in all OSH curricula (Phoon 1985b).
Physicians and nurses
All medical students should be taught some occupational health. In some countries, there are separate courses; in others, occupational health is dealt with in such courses as physiology, pharmacology and toxicology, public health, social medicine and internal medicine. Nevertheless, medical students do not, as a rule, acquire sufficient knowledge and skill to allow them to practice occupational health independently, and some postgraduate training in occupational health and safety is necessary. For further specialization in occupational health (e.g., occupational diseases, or even more narrow fields, like occupational neurology or dermatology), postgraduate training programmes should be available. For nurses active in occupational health services, both long-term and short-term courses need to be organized, depending on their range of activities.
Figure 1. Postgraduate training syllabus for physicians and nurses.
Safety and health engineers and safety officers
The practice of occupational safety is concerned with such failures of materials, machines, processes and structures as may give rise to dangerous situations, including the release of harmful agents. The aim of education in this field is to enable students to foresee danger, both at the planning stage of projects and in existing situations, to quantify the danger and to design measures to combat it. Training in occupational safety involves the student in a substantial study of selected topics from engineering and materials science, particularly those related to mechanical, civil, chemical, electrical and structural engineering.
Separate curricular units would be concerned, for example, with the structure and strength of materials, in mechanical engineering; with forces in structures, in civil engineering; with handling and transportation of chemicals, in chemical engineering; with design standards, protective equipment and the theory of preventive maintenance, in electrical engineering; and with the behaviour of strata, in mining engineering.
Safety engineers, in addition to acquiring a basic knowledge, should also undergo a course of specialization. The 1981 Joint ILO/WHO Committee recommendations for a specialized safety engineering course of study are listed in figure 2.
Figure 2. A syllabus for specialization in safety engineering.
Courses can be either full-time, part-time or “sandwich courses”—in the lattermost case, periods of studying are interspersed with periods of practice. The selection of which courses to take is very much a matter of individual circumstances or preference. This is especially true since many safety practitioners have extensive knowledge gained through on-the-job experience in particular industries. However, within a large community or a country, there should preferably be a large range of choices to cater for all these different needs.
The recent enormous advances in communications technology should enable the greater usage of distance-learning courses which can be delivered both to remote areas of a country or even across national frontiers. Unfortunately, such technology is still quite expensive, and countries or areas which need such distance-learning capabilities most may be the very ones least able to afford them.
Primary health care practitioners
There is a severe shortage of OSH professionals in developing countries. In addition, among primary health care practitioners and health professionals as a whole, there is a tendency to direct their main activities to curative services. This should be counterbalanced with the help of appropriate training to emphasize the great value of instituting preventive measures at the workplace in collaboration with other responsible parties such as workers and managers. This would help, to a certain extent, to alleviate the problems caused by the present shortage of OSH personnel in developing countries (Pupo-Nogueira and Radford 1989).
A number of developing countries have recently embarked on short courses of OSH training for primary health care and public health personnel. There is a wide spectrum of organizations which have undertaken such training. They include national productivity boards (Phoon 1985a), farmers’ associations, national safety councils, national institutes of health, and professional bodies such as medical and nurses’ associations (Cordes and Rea 1989).
A scarcity of OSH professionals affects not only developing countries, but many developed ones as well. In the United States, one response to this problem took the form of a joint report by a preventive medicine and internal medicine study group that recommended that training programmes in internal medicine emphasize controls of hazards in the workplace and in the environment, since most patients seen by internists are members of the workforce. Furthermore, the American Academy of Family Physicians and the American Medical Association have published several monographs on occupational health for the family physician. A study by the American Institute of Medicine reaffirmed the role of the primary care physician in occupational health, outlined the basic skills required and emphasized the need to enhance occupational health activity in basic training and continuing education (Ellington and Lowis 1991). In both developed and developing countries, however, there is still an inadequate number of OSH training programmes for primary health care personnel and an insufficient number of trained personnel.
Training in the multidisciplinary nature of OSH can be enhanced by making sure that everyone who trains is fully familiar with the roles, activities and areas of concern of the other OSH personnel. In an OSH course in Scotland, for example, members of the different OSH professions participate in the teaching programme. The students are also provided with self-instruction packages designed to give them detailed knowledge of and insight into the different OSH professional areas. Extensive use is also made of experiential learning techniques such as role-playing simulations and participative case studies. For example, students are asked to complete personal checklists on how each particular area of occupational health activity is likely to affect them in their own work situations, and on how they can cooperate effectively with other occupational health professionals.
In the running of a multidisciplinary OSH course, a key element is the mix of learners of different professional backgrounds in the same class. The course material, such as group exercises and essays, must be carefully selected without any bias to a particular discipline. Lecturers must also receive training in the setting of multidisciplinary questions and problems (D’Auria, Hawkins and Kenny 1991).
In professional education as a whole, there is an increasing awareness of the need for continuing education. In the field of OSH, new knowledge concerning old hazards and new problems arising from changes in technology are developing so rapidly that no OSH practitioner could hope to keep up to date without making a systematic and constant effort to do so.
Continuing education in OSH can be formal or informal, voluntary or obligatory in order to maintain certification. It is essential for every OSH practitioner to keep up with reading the key professional journals, at least in his or her own disciplines. When a new hazard is encountered, it would be very useful to mount a literature search on that subject through a library. If such a library is unavailable, the CIS service of the ILO could be asked to undertake that service instead. Moreover, having continual and direct access to at least a few up-to-date texts on OSH is essential to any kind of OSH practice.
More formal kinds of continuing education could take the form of conferences, workshops, lectures, journal clubs or seminars. Usually tertiary institutions of learning or professional organizations can provide the means of delivery of such programmes. Whenever possible, there should be annual events in which a broader range of views or expertise could be canvassed than is usually available within the framework of a small community or town. Regional or international conferences or seminars can provide extremely useful opportunities for participants, not only to take advantage of the formal programme but also to exchange information with other practitioners or researchers outside the formal sessions.
Nowadays, more and more OSH professional organizations require members to attend a minimum number of continuing education activities as a condition for extension of certification or membership. Usually only the fact of attendance at approved functions is required. Attendance by itself is, of course, no guarantee that the participant has benefited from being present. Alternatives such as subjecting OSH professionals to regular examinations are also fraught with problems. Within a single OSH discipline, there is such a wide diversity of practice even within the same country that it is extremely difficult to devise an examination equitable to all the OSH practitioners concerned.
In every OSH training course there should be emphasis on the need for self-learning and its continuing practice. To this end, training in information retrieval and critical analysis of published literature is imperative. Training on the use of computers to facilitate obtaining of information from the many excellent OSH resources around the world would be also beneficial. Several courses have been developed in recent years to promote self-learning and information management through microcomputers (Koh, Aw and Lun 1992).
There is an increasing demand on the part of trainees and the community to ensure that curricula are constantly evaluated and improved. Many modern curricula are competency-based. A series of professional competencies required is first compiled. Since competence may be defined by different groups in different ways, extensive consultations on this matter should be held with faculty members and OSH practitioners (Pochyly 1973). In addition, there is a need for consultations with “consumers” (e.g., students, workers and employers), an inbuilt evaluation programme and well-defined but flexible educational objectives (Phoon 1988). Sometimes the establishment of advisory committees on curriculum or teaching programmes, which normally include faculty and student representatives, but sometimes also involve members of the general community, can provide a useful forum for such consultations.
Infrastructure is often ignored in discussions on OSH training and education. Yet supporting facilities and human resources such as computers, libraries, efficient administrative staff and procedures and safe and convenient access are among the host of infrastructure considerations which could be crucial to the success of training courses. Proper monitoring of students’ progress, counselling and assistance of students with problems, health care of students and their families (where indicated), minding of students’ children, canteen and recreational facilities and provision of lockers or cupboards for the storage of personal possessions of trainees are all important details which should receive careful attention.
Faculty Recruitment and Development
The quality and popularity of a training programme are often vital factors in determining the quality of staff applying for a vacant position. Obviously, other factors such as satisfactory service conditions and opportunities for career and intellectual development are also important.
Careful consideration should be given to job specifications and job requirements. Faculty should have the necessary OSH qualifications, though flexibility should be exercised to allow the recruitment of staff from non-OSH disciplines who may be able to make special contributions to teaching or especially promising applicants who may have the capability but not all the qualifications or experience normally required for the job. Whenever possible, faculty should have practical OSH experience.
After recruitment, it is the responsibility of the leadership and senior members of the school or department to make sure that new staff are given as much encouragement and opportunity to develop as possible. New staff should be inducted into the culture of the organization but also encouraged to express themselves and to participate in decision-making processes related to teaching and research programmes. Feedback should be given to them concerning their teaching performance in a sensitive and constructive manner. Whenever necessary, offers of help to remedy identified limitations should be given. Many departments have found the regular holding of teaching or evaluation workshops for staff to be extremely useful. Cross-postings to industries and sabbatical leave are other important measures for staff development. Some extent of consultancy work, which could be either clinical, worksite or laboratory (depending on the discipline and areas of activity of the faculty member) helps to make academic teaching more practical.
Classrooms should be designed and furnished according to appropriate ergonomic principles and equipped with audio-visual aid equipment and video projection facilities. The lighting and acoustics should be satisfactory. Access to an exit should be located in such a way as to minimize the disturbance of an ongoing class.
Proper principles of OSH should be applied to the design and construction of laboratories. Such safety equipment as showers, eye washing facilities, first aid supplies and resuscitation equipment and fume cupboards should be installed or made available where indicated, and laboratories should be bright, airy and odourless.
Venues for field visits should be chosen to provide a wide range of OSH experiences for the trainees. If possible, worksites with different levels of OSH standards should be chosen. However, on no account should the safety or health of trainees be compromised.
Locations for clinical work would very much depend on the nature and level of the training course. In some circumstances, bedside teaching may be indicated to demonstrate the appropriate clinical approach to skills in history taking. In some other circumstances, presentation of cases with or without patients could serve the same purpose.
Examinations and Assessment
The recent trend has been to seek alternatives to administering an all-important and single final examination at the end of a course. Some courses have abolished formal examinations altogether and replaced them with assignments or periodic assessments. Some other courses have a combination of such assignments and assessments, open book examinations and closed book examinations as well. It is nowadays increasingly understood that examinations or assessments are as much measures of the quality of courses and teachers as of the trainees.
A feedback of trainees’ opinions concerning the entire course or components thereof through questionnaires or discussions is invaluable in the evaluation or revision of a course. As far as possible, all courses should be constantly evaluated, at least on an annual basis, and revised if necessary.
Insofar as modes of examination are concerned, essay questions can test organization, integrating ability and writing skills. The precision and validity of essay examinations, however, have been found to be weak. Multiple-choice questions (MCQs) are less subjective, but good ones are difficult to formulate and do not allow a display of practical knowledge. Modified essay questions (MEQs) differ from essays or MCQs in that the candidate is presented with a progressive amount of information about a problem. It avoids cueing by requesting short-answer responses rather than presenting candidates with alternatives from which to choose the appropriate answer. Oral examinations can measure problem-solving skills, professional judgement, communication skills and ability to retain composure under stress. The main difficulty with the oral examination is the potential for so-called “lack of objectivity”. The oral examination can be made more reliable by imposing some structure on it (Verma, Sass-Kortsak and Gaylor 1991). Perhaps the best alternative is to use a battery of these different types of examination rather than to rely on one or two of them only.
Certification and Accreditation
The word certification usually refers to the conferment upon a professional of authorization to practise. Such certification could be conferred by a national board or a college or an institution of practitioners of an OSH discipline. Usually, the OSH professional is given certification only after fulfilling a stipulated period of training in connection with an approved course or positions and also upon passing an examination. In general, such “global certification” is valid for life, unless there is proven professional negligence or misconduct. However, there are other forms of accreditation which require periodic renewal. They include such accreditation as that required in some countries to either conduct special statutory medical examinations or to report on radiographs of asbestos-exposed persons.
Accreditation, on the other hand, refers to the recognition of OSH courses by a national board or professional organization or a scholarship-granting body. Such accreditation should be subject to periodic reappraisal to ensure that courses keep to an appropriate level of currency and effectiveness.
* Portions of this article have been adapted from Shrey and Lacerte (1995) and Shrey (1995).
Employers are faced with increasing societal and legislative pressure to integrate and accommodate people with disabilities. Increasing workers’ compensation and health care costs are threatening the survival of business and draining resources otherwise allocated to future economic development. Trends suggest that employers can be successful in the effective management of injury and disability problems. Impressive disability management programme models are prominent among employers that assume control and responsibility for injury prevention, early intervention, injured worker reintegration and worksite accommodation. Current disability management practice in industry reflects a paradigm shift from services provided in the community to interventions occurring at the worksite.
This article offers an operational definition of disability management. A model is presented to illustrate the structural components of an optimal worksite-based disability management programme. Effective disability management strategies and interventions are outlined, including key organizational concepts that strengthen service delivery and successful outcome. This article also includes a focus on joint labour-management collaboration and the use of interdisciplinary services, which are considered by many to be essential to the implementation of optimal disability management programmes in industry. Promoting respect and dignity between workers with disabilities and the professionals who serve them is emphasized.
Definition of Disability Management
Disability management is operationally defined as an active process of minimizing the impact of an impairment (resulting from injury, illness or disease) on the individual’s capacity to participate competitively in the work environment (Shrey and Lacerte 1995). The basic principles of disability management are as follows:
Successfully managing the consequences of illness, injury and chronic disease in the workforce requires:
Disability management practices are based on a comprehensive, cohesive and progressive employer-based approach to managing the complex needs of people with disabilities within a given work and socio-economic environment. Despite rapidly escalating costs of injury and disability, rehabilitation technologies and disability management resources are available to facilitate immediate and recurrent savings among business and industry. Disability management policies, procedures and strategies, when properly integrated within the employer’s organization, provide the infrastructure which enables employers to effectively manage disability and continue to compete in a global environment.
Controlling the cost of disability in business and industry and its ultimate impact on employee productivity is not a simple task. Complex and conflicting relationships exist between employer goals, resources and expectations; the needs and self-interests of workers, health care providers, labour unions and attorneys; and the services available in the community. The ability of the employer to participate actively and effectively in this relationship will contribute to the control of costs, as well as to the protection of the worker’s sustained and productive employment.
Disability Management Objectives
Employer policy and procedure, as well as disability management strategies and interventions, should be designed to accomplish realistic and attainable objectives. Disability management programmes at the worksite should enable the employer to:
Essential Disability Management Conceptsand Strategies
Both labour and management have vested interests in protecting the employability of workers while controlling industry’s injury and disability costs. Labour unions want to protect the employability of the workers they represent. Management wants to avoid costly worker turnover, while retaining productive, reliable and experienced employees. Research suggests that the following concepts and strategies are important when developing and implementing effective worksite-based disability management programmes:
Joint labour-management involvement
Disability management requires employer and union involvement, support and accountability. Both are key contributors in the disability management process, participating actively as decision-makers, planners and coordinators of interventions and services. It is important for both labour and management to assess their joint capacities for responding to injury and disability. This often requires an initial analysis of joint strengths and weaknesses, as well as an assessment of the resources available to properly manage accommodation and return-to-work activities among workers with disabilities. Many unionized employers have successfully developed and implemented on-site disability management programmes under the guidance and support of joint labour- management committees (Bruyere and Shrey 1991).
Organizational structures, worker attitudes, management intentions and historical precedents contribute to the corporate culture. Prior to developing a disability management programme in industry, it is important to understand the corporate culture, including the motivations and self-interests of labour and management regarding injury prevention, worksite accommodation and injured worker rehabilitation.
Injury and disability patterns
Disability management programmes in industry must be customized to address the unique patterns of injury and disability in the employer’s workforce, including types of impairments, ages of workers, lost-time statistics, accident data and costs associated with disability claims.
Interdisciplinary disability management team
Disability management requires an interdisciplinary disability management team. Members of this team often include employer representatives (e.g., safety managers, occupational health nurses, risk managers, human resources personnel, operations managers), labour union representatives, the worker’s treating physician, a rehabilitation case manager, an onsite physical or occupational therapist and the worker with a disability.
Perhaps the most important principle of disability management is early intervention. Rehabilitation policy and practice among most disability benefit systems recognizes the value of early intervention, in light of compelling empirical evidence resulting from disability management research over the past decade. Employers have substantially reduced disability costs by promoting early intervention concepts, including the systematic monitoring of workers with work restrictions. Early intervention strategies and programmes for an early return to work result in decreased lost time, increased employer productivity and decreased workers’ compensation and disability costs. Whether the disability is work related or not, early intervention is considered to be the primary factor upon which the foundation of medical, psychosocial and vocational rehabilitation is established (Lucas 1987; Pati 1985; Scheer 1990; Wright 1980). However, the successful management of disability also requires early return to work opportunities, accommodations and supports (Shrey and Olshesky 1992; Habeck et al. 1991). Typical early-return-to-work programmes in industry include a combination of disability management interventions, facilitated by an employer-based multidisciplinary team and coordinated by a skilled case manager.
Proactive interventions at individual and work environment levels
Disability management interventions must be directed at both the individual and the work environment. The traditional approach to rehabilitation often ignores the fact that occupational disability may originate as much from environmental barriers as from the worker’s personal traits. Workers dissatisfied with their jobs, supervisor-worker conflicts and poorly designed workstations rank high among the many environmental barriers to disability management. In short, to maximize rehabilitation outcomes among injured workers, an equally balanced focus on the individual and the work environment is needed. Job accommodations, as required under the Americans with Disabilities Act and other employment equity legislation, often expand the range of transitional work options for an injured worker. Redesigned tools, ergonomically correct workstations, adaptive devices, and work-schedule modifications are all effective disability management methods that enable the worker to perform essential job tasks (Gross 1988). These same interventions can be utilized in a preventive manner to identify and redesign jobs which are likely to cause future injuries.
Benefit plan design
Employee benefit plans often reward workers for remaining disabled. One of the strongest negative forces impacting on unacceptable lost time and associated costs is economic disincentives. Benefit plans should not create an economic disincentive to work, but should reward workers who have disabilities for returning to work and remaining healthy and productive.
There are two basic ways to reduce disability costs in industry: (1)prevent accidents and injuries; and (2) reduce unnecessary lost time. Traditional light duty programmes in industry have been less than fully effective in returning injured workers to their jobs. Employers are increasingly using flexible and creative work return transition options and reasonable accommodations for workers with restrictions. The transitional work approach enables employees with disabilities to return to work before they fully recover from their injuries. Transitional work typically includes a combination of temporary assignment to modified work, physical conditioning, safe work practices education and work adjustment. Reduced lost time through transitional work translates into lower costs. The injured worker is enabled to perform temporary alternative productive work while gradually transitioning back to the original job.
Promotion of positive labour relations
Relationships between workers and work environments are dynamic and complex. Compatible relationships often lead to job satisfaction, enhanced productivity and positive labour relations, all of which are mutually rewarding for the worker and the employer. However, relationships characterized by unresolved conflicts can lead to mutually destructive consequences for workers and employers. Understanding the dynamics of person-environmental interactions in the workplace is an important first step in resolving injury and disability claims. The responsible employer is one that supports positive labour relations and promotes job satisfaction and worker involvement in decision making.
Psychological and social aspects of disability
Employers need to be sensitive to the psychological and social consequences of injury and disability and the overall impact of work disruption on the worker’s family. Psychosocial problems that are secondary to the initial physical injury typically emerge as lost work time increases. Relationships with family members often deteriorate rapidly, under the strain of excessive drinking and learned helplessness. Maladaptive behaviours resulting from work disruption are common. However, when other family members become adversely affected by the consequences of a worker’s injuries, pathological relationships within the family emerge. The disabled worker undergoes role changes. Family members experience “role change reactions”. The once independent, self-supporting worker now takes on a role of passive dependency. Resentment abounds when the family is disrupted by the presence of an ever-demanding, sometimes angry and often depressed individual. This is the typical outcome of unresolved labour relations problems, fuelled by stress and ignited by litigation activity and intense adversarial proceedings. Although the relationship among these forces is not always understood, the damage is usually profound.
Accident prevention and occupational ergonomics programmes
Many employers have experienced significant reductions in accidents by establishing formal safety and ergonomics committees. Such committees are typically responsible for safety surveillance and monitoring risk factors such as exposures to dangerous chemicals and fumes, and establishing controls to reduce the incidence and magnitude of accidents. More frequently, joint labour-management safety and ergonomics committees are addressing problems such as repetitive motion injuries and cumulative trauma disorders (e.g., carpal tunnel syndrome). Ergonomics is the application of technology to assist the human element in manual work. The overall objective of ergonomics is to fit the task to humans in order to enhance their effectiveness in the workplace. This means that ergonomics aims at:
Ergonomic interventions can be considered preventive as well as rehabilitative. As a preventive approach, it is important to analyse ergonomically jobs that cause injuries and to develop effective ergonomic modifications that prevent future work disabilities. From a rehabilitation viewpoint, ergonomic principles can be applied to the jobsite accommodation process for workers with restrictions. This may involve exerting ergonomic administrative controls (e.g., rest periods, job task rotation, reduced work hours) or by ergonomically engineering the job tasks to eliminate re-injury risk factors (e.g., changing the table height, increasing illumination, repackaging to reduce lift loads).
Employer responsibility, accountability and empowerment
Employer empowerment is a basic principle of disability management. Except for the worker with a disability, the employer is the central figure in the disability management process. It is the employer who takes the first step in initiating early intervention strategies subsequent to an industrial accident and injury. The employer, being intimately familiar with work processes, is in the best position to implement effective safety and injury prevention programmes. Likewise, the employer is best positioned to create work return options for persons with lost-time injuries. Unfortunately, history has revealed that many employers have relinquished control and responsibility for disability management to parties external to the work environment. Decision making and problem solving, as relates to the resolution of work disability, have been assumed by insurance carriers, claims managers, workers’ compensation boards, physicians, therapists, case managers, rehabilitation professionals and even attorneys. It is only when employers become empowered in disability management that the lost-time trends and associated costs of workplace injury are reversed. However, employer empowerment over disability costs does not occur by chance. Not unlike persons with disabilities, employers often become empowered upon recognition of their internal resources and potentials. It is only with a new awareness, confidence and guidance that many employers are able to escape the relentless forces and consequences of workplace disability.
Case management and return-to-work coordination
Case management services are necessary to facilitate the development and implementation of disability management strategies and return-to-work plans for workers with disabilities. The case manager serves as a central disability management team member by functioning as a liaison between employers, labour representatives, injured workers, community health care providers and others. The case manager may facilitate the development, implementation and evaluation of an on-site transitional work or worker retention programme. It may be desirable for an employer to develop and implement such programmes, in order to: (1)prevent work disruptions among employees with medical impairments that effect work performance; and (2) promote a safe and timely return to work among impaired workers on medical leave, workers’ compensation or long-term disability. In the administration of an on-site transitional work programme, the case manager may take on direct rehabilitative responsibilities, such as: (1)objective worker evaluations; (2) classification of the physical job demands; (3) medical surveillance and follow-up; and (4) planning for placement in an acceptable permanent modified-duty option.
Disability management policy and procedure: creating expec-tations among supervisors, labour representatives and workers
It is important for employers to maintain a balance between worker and union expectations and the intentions of managers and supervisors. This requires joint labour-management involvement in the development of formal disability management policies and procedures. Mature disability management programmes have written policy and procedure manuals that include mission statements reflecting the interests and commitments of labour and management. Written procedures often delineate the roles and functions of internal disability management committee members, as well as the step-by-step activities from the point of injury to the safe and timely return to work. Disability management policies often define the relationships between the employer, health care providers and rehabilitation services in the community. A written policy and procedures manual serves as an effective communication vehicle among the various stakeholders, including physicians, insurance carriers, unions, managers, employees and service providers.
Enhancement of physician awareness of jobs and work environments
A universal problem in work injury management involves the lack of employer influence over the physician’s return-to-work determination. Treating physicians are often reluctant to release an injured employee to work with no restrictions prior to a full recovery. Physicians are often asked to make return-to-work judgements without adequate knowledge of the worker’s physical job demands. Disability management programmes have been successful in communicating with doctors regarding the employer’s willingness to accommodate workers with restrictions through transitional work programmes and the availability of temporary alternate duty assignments. It is essential for employers to develop functional job descriptions that quantify the exertional demands of job tasks. These tasks can then be reviewed by the treating physician to make a determination of the compatibility of the worker’s physical abilities and the functional demands of the job. Many employers have adopted the practice of inviting doctors to visit production sites and work areas to increase their familiarity with job demands and work environments.
Selection, utilization and evaluation of community services
Employers have realized substantial savings and improved work return outcomes by identifying, utilizing and evaluating effective medical and rehabilitation services in the community. Workers who become ill or injured are influenced by someone to make treatment provider choices. Poor advice often leads to extended or unnecessary treatment, higher medical costs and inferior results. In effective disability management systems, the employer takes an active role in identifying quality services that are responsive to the needs of workers with disabilities. When the employer “internalizes” these external resources, they become a vital partner in the overall disability management infrastructure. Workers with disabilities can then be guided to responsible service providers that share mutual return-to-work goals.
Utilization of independent medical evaluators
Occasionally an injured worker’s medical report fails to substantiate objectively the worker’s alleged impairments and medical restrictions. Employers often feel that they are held hostage to the treating physician’s opinions, particularly when the doctor’s rationale for determining the employee’s work restrictions are unsubstantiated by objective medical tests and measurable assessments. Employers need to exercise their right to independent medical and/or physical capacity evaluations when evaluating questionable disability claims. This approach requires that the employer take the initiative to explore objective and qualified medical and rehabilitation evaluators in the community.
Essential Components of an Optimal Disability Management System
An employer’s foundation for an optimal disability management system has three major components (Shrey 1995, 1996). First, a worksite-based disability management programme requires a human resource component. A major part of this component is the development of the employer’s internal disability management team. Joint worker-management teams are preferred, and they often include members representing the interests of labour unions, risk management, occupational health and safety, employer operations and financial management. Important criteria for the selection of disability management-team membership may include:
Gaps often exist with respect to the assignment and delegation of responsibilities for resolving disability problems. New tasks must be assigned to ensure that the steps from injury to work return are properly orchestrated. The human resource component includes knowledge and skill supports or training which enable managers and supervisors to perform their designated roles and functions. Accountability is essential, and it must be built into the organizational structure of the employer’s disability management programme.
The second component of an optimal disability management system is the operations component. This component includes activities, services and interventions which are implemented at the pre-injury, during injury and post-injury levels. Pre-injury operations components include effective safety programmes, ergonomic services, pre-placement screening mechanisms, loss prevention programmes and the development of joint labour-management committees. A strong pre-injury operations component is oriented towards injury prevention, and it may include health promotion and wellness services such as weight loss programmes, smoking cessation groups and aerobic conditioning classes.
The during-injury level of an optimal disability management system includes early intervention strategies, case management services, formalized transitional work programmes, worksite accommodations, employee assistance programmes and other health services. These activities are designed to resolve the disabilities that are not prevented at the pre-injury level.
The post-injury level of an optimal disability management system includes worker retention services. Worker retention services and interventions are designed to facilitate the worker’s adjustment to work performance within the context of the worker’s physical or mental restrictions and environmental demands. The post-injury level of a disability management system should also include programme evaluation, financial management for cost-effectiveness, and programme enhancements.
The third component of an optimal disability management system is the communications component. This includes internal and external communications. Internally, the operational aspects of the employer’s disability management programme must be consistently and accurately communicated among employees, managers, supervisors and labour representatives. The policies, procedures and protocols for return-to-work activities should be communicated through labour and management orientations.
External communications enhance the employer’s relationship with treating physicians, claims managers, rehabilitation service providers and workers’ compensation administrators. The employer can influence an earlier return to work by providing treating physicians with functional job descriptions, job safety procedures and transitional work options for injured workers.
Workplace disability management and transitional work programmes represent a new paradigm in the rehabilitation of workers with illnesses and injuries. Trends reflect a shift in rehabilitative interventions from medical institutions to the worksite. Joint labour-management initiatives in disability management are commonplace, creating new challenges and opportunities for employers, unions and rehabilitation professionals in the community.
The interdisciplinary members of the worksite-based disability management team are learning to harness existing technologies and resources within the work environment. The demands on employers are essentially limited to their creativity, imagination and flexibility to adapt disability management interventions to the work environment. Job accommodations and temporary non-traditional job options expand the range of transitional work alternatives for workers with restrictions. Redesigned tools, ergonomically correct workstations, adaptive devices and work schedule modifications are all effective disability management methods that enable the worker to perform essential job tasks. These same interventions can be utilized in a preventive manner to identify and redesign jobs which are likely to cause future injuries.
Protecting the rights of injured workers is an important component of disability management. Every year thousands of workers become disabled through industrial accidents and occupational diseases. Without transitional work options and accommodations, workers with disabilities risk discrimination similar to that faced by other individuals with disabilities. Thus, disability management is an effective advocate tool, whether advocating for the employer or the person with a disability. Disability management interventions protect the employability of the worker as well as the economic interests of the employer.
The profound impact of rapidly escalating workers’ compensation costs will be experienced worldwide by business and industry throughout the next decade. Just as this crisis offers a challenge to industry, disability management interventions and transitional work programmes create an opportunity. With a decreasing labour pool, an ageing workforce and increased worldwide competition, employers in industrialized societies must seize the opportunities to control the personal and economic costs of injury and disability. An employer’s success will be determined by the extent to which he is able to shape positive attitudes among labour and management representatives, while creating an infrastructure supportive of disability management systems.