Entertainment and the arts have been a part of human history ever since prehistoric people drew cave paintings of animals they hunted or acted out in song and dance the success of the hunt. Every culture from earliest times has had its own style of visual and performing arts, and decorated everyday objects like clothing, pottery and furniture. Modern technology and more leisure time has led to a major part of the world’s economy being devoted to satisfying the need for people to see or own beautiful objects and to be entertained.

The entertainment industry is a miscellaneous grouping of non-commercial institutions and commercial companies that provide these cultural, amusement and recreational activities for people. By contrast, artists and craftspeople are workers who create artwork or handicrafts for their own pleasure or for sale. They usually work alone or in groups of fewer than ten people, often organized around families.

The people who make this entertainment and art possible—artists and craftspeople, actors, musicians, circus performers, park attendants, museum conservators, professional sports players, technicians and others—often face occupational hazards that can result in injuries and illnesses. This chapter will discuss the nature of those occupational hazards. It will not discuss the hazards to people doing arts and crafts as hobbies or attending these entertainment events, although in many instances the hazards will be similar.

Entertainment and the arts can be thought of as a microcosm of all industry. The occupational hazards encountered are, in most instances, similar to those found in more conventional industries, and the same types of precautions can be used, although costs may be prohibitive factors for some engineering controls in the arts and crafts. In these instances, emphasis should be on substitution of safer materials and processes. Table 1 lists standard types of precautions associated with the various hazards found in the arts and entertainment industries.

Table 1. Precautions associated with hazards in the arts and entertainment industries.

Arts and Crafts

Artists and craftspeople are usually self-employed, and the work is done in homes, studios or backyards, using small amounts of capital and equipment. Skills are often handed down from generation to generation in an informal apprenticeship system, particularly in developing countries (McCann 1996). In industrialized countries, artists and craftspeople often learn their trade in schools.

Today, arts and crafts involve millions of people across the world. In many countries, craftwork is a major part of the economy. However, few statistics are available on the number of artists and craftspeople. In the United States, estimates gathered from a variety of sources indicate there are at least 500,000 professional artists, craftspeople and art teachers. In Mexico, it has been estimated that there are 5,000 families involved in the home-based pottery industry alone. The Pan American Health Organization found that 24% of the workforce in Latin America from 1980 to 1990 were self-employed (PAHO 1994). Other studies of the informal sector have found similar or higher percentages (WHO 1976; Henao 1994). What percentage of these are artists and craftspeople is unknown.

Arts and crafts evolve with the technology available and many artists and craftspeople adopt modern chemicals and processes for their work, including plastics, resins, lasers, photography and so on (McCann 1992a; Rossol 1994). Table 2 shows the range of physical and chemical hazards found in art processes.

Table 2. Hazards of art techniques

Source: Adapted from McCann 1992a.

The arts and crafts industry, like much of the informal sector, is almost completely unregulated and is often exempted from workers’ compensation laws and other occupational safety and health regulations. In many countries, government agencies responsible for occupational safety and health are unaware of the risks facing artists and craftspeople, and occupational health services do not reach out to this group of workers. Special attention is needed to find ways to educate artists and craftspeople about the hazards and precautions needed with their materials and processes, and to make occupational health services available to them.

Health problems and disease patterns

Few epidemiological studies have been done on workers in the visual arts. This is mostly due to the decentralized and often unregistered nature of most of these industries. Much of the data that are available come from individual case reports in the literature.

The traditional arts and crafts can result in the same occupational diseases and injuries found in larger-scale industry, as evidenced by such old terms as potter’s rot, weaver’s back and painter’s colic. The hazards of such crafts as pottery, metalworking and weaving were first described by Bernardino Ramazzini almost three centuries ago (Ramazzini 1713). Modern materials and processes also are causing occupational illnesses and injuries.

Lead poisoning is still one of the most common occupational illnesses among artists and craftspeople, with examples of lead poisoning being found in:

• a stained-glass artist in the United States (Feldman and Sedman 1975)

• potters and their families in Mexico (Ballestros, Zuniga and Cardenas 1983; Cornell 1988) and Barbados (Koplan et al. 1977)

• families in Sri Lanka recovering gold and silver from jeweller’s waste using a molten lead procedure (Ramakrishna et al. 1982).

Other examples of occupational illnesses in the arts and crafts include:

• chromium sensitization in a fibre artist (MMWR 1982)

• neuropathy in a silk-screen artist (Prockup 1978)

• heart attacks from methylene chloride in a furniture refinisher (Stewart and Hake 1976)

• respiratory problems in photographers (Kipen and Lerman 1986)

• mesothelioma in jewellers (Driscoll et al. 1988)

• silicosis and other respiratory diseases in agate workers in India (Rastogi et al. 1991)

• asthma from carving ivory from elephant tusks in Africa (Armstrong, Neill and Mossop 1988)

• respiratory problems and ergonomic problems among carpet weavers in India (Das, Shukla and Ory 1992)

• as many as 93 cases of peripheral neuropathy from the use of hexane-based adhesives in sandal-making in Japan in the late 1960s (Sofue et al. 1968)

• paralysis in 44 apprentice shoemakers in Morocco due to glues containing tri-orthocresyl phosphate (Balafrej et al. 1984)

• leg, arm and back pain and other occupational health problems in home-based workers making ready-made garments in India (Chaterjee 1990).

A major problem in the arts and crafts is the prevalent lack of knowledge of hazards, materials and processes and how to work safely. Individuals who do develop occupational diseases often do not realize the connection between their illness and their exposures to hazardous materials, and are less likely to obtain proper medical assistance. In addition, whole families can be at risk—not only those adults and children actively working with the materials, but also younger children and infants who are present, since these arts and crafts are commonly done in the home (McCann et al. 1986; Knishkowy and Baker 1986).

A proportionate mortality ratio (PMR) study of 1,746 White professional artists by the United States National Cancer Institute found significant elevations in deaths of painters, and to a lesser degree for other artists, from arteriosclerotic heart disease and from cancers of all sites combined. For male painters, rates of leukaemia and cancers of the bladder, kidney and colorectum were significantly elevated. Proportionate cancer mortality rates were also elevated, but to a lesser degree. A case control study of bladder cancer patients found an overall relative risk estimate of 2.5 for artistic painters, confirming the results found in the PMR study (Miller, Silverman and Blair 1986). For other male artists, PMRs for colorectal and kidney cancer were significantly elevated.

Performing and Media Arts

Traditionally, the performing arts include theatre, dance, opera, music, storytelling and other cultural events that people would come to see. With music, the type of performance and their venue can vary widely: individuals performing music on the street, in taverns and bars, or in formalized concert halls; small musical groups playing in small bars and clubs; and large orchestras performing in large concert halls. Theatre and dance companies can be of several types, including: small informal groups associated with schools or universities; non-commercial theatres, which are usually subsidized by governments or private sponsors; and commercial theatres. Performing arts groups may also tour from one location to another.

Modern technology has seen the growth of the media arts, such as the print media, radio, television, motion pictures, videotapes and so on, which enable the performing arts, stories and other events to be recorded or broadcast. Today the media arts are a multi-billion-dollar industry.

Workers in the performing and media arts include the performers themselves—actors, musicians, dancers, reporters and others visible to the public. In addition, there are the technical crews and front office people—stage carpenters, scenic artists, electricians, special effects experts, motion picture or television camera crews, ticket sellers and others—who work backstage, behind the cameras and on other non-performing jobs.

Health effects and disease patterns

Actors, musicians, dancers, singers and other performers are also subject to occupational injuries and illnesses, which can include accidents, fire hazards, repetitive strain injuries, skin irritation and allergies, respiratory irritation, performance anxiety (stage fright) and stress. Many of these types of injuries are specific to particular groups of performers, and are discussed in separate articles. Even minor physical problems can often affect a performer’s peak performance capability, and subsequently end in lost time and even lost jobs. In recent years, the prevention, diagnosis and treatment of injuries to performers has led to the new field of arts medicine, originally an offshoot of sports medicine. (See “History of performing arts medicine” in this chapter.)

A PMR study of screen and stage actors found significant elevations for lung, oesophagus and bladder cancers in women, with the rate for stage actresses 3.8 times that of screen actresses (Depue and Kagey 1985). Male actors had significant PMR (but not proportionate cancer mortality ratio) increases for pancreatic and colon cancer; testicular cancer was twice the expected rate by both methods. PMRs for suicide and non–motor vehicle accidents were significantly elevated for both men and women, and the PMR for cirrhosis of the liver was elevated in men.

A recent survey of injuries among 313 performers in 23 Broadway shows in New York City found that 55.5% reported at least one injury, with a mean of 1.08 injuries per performer (Evans et al. 1996). For Broadway dancers, the most frequent sites of injury were the lower extremities (52%), back (22%) and neck (12%), with raked or slanted stages being a significant contributing factor. For actors, the most frequent sites of injuries were lower extremities (38%), the lower back (15%) and vocal cords (17%). The use of fogs and smoke on stage was listed as a major cause for the last.

In 1991, the United States National Institute for Occupational Safety and Health investigated the health effects of the use of smoke and fogs in four Broadway shows (Burr et al. 1994). All the shows used glycol-type fogs, although one also used mineral oil. A questionnaire survey of 134 actors in these shows with a control group of 90 actors in five shows not using fogs found significantly higher levels of symptoms in actors exposed to fogs, including upper-respiratory symptoms such as nasal symptoms and irritation of mucous membranes, and lower-respiratory symptoms such as coughing, wheezing, breathlessness and chest tightness. A follow-up study could not demonstrate a correlation between fog exposure and asthma, possibly due to the low number of responses.

The motion picture production industry has a high accident rate, and in California is classified as high risk, mostly as a result of stunts. During the 1980s, there were over 40 fatalities in American-produced motion pictures (McCann 1991). California statistics for 1980–1988 show an incidence of 1.5 fatalities per 1,000 injuries, compared to the California average of 0.5 for the same period.

A large number of studies have shown that dancers have high overuse and acute injury rates. Ballet dancers, for example, have high incidences of overuse syndrome (63%), stress fractures (26%) and major (51%) or minor (48%) problems during their professional careers (Hamilton and Hamilton 1991). One questionnaire study of 141 dancers (80 females), 18 to 37 years old, from seven professional ballet and modern dance companies in the United Kingdom, found that 118 (84%) of the dancers reported at least one dance-related injury that affected their dancing, 59 (42%) in the last six months (Bowling 1989). Seventy-four (53%) reported that they were suffering from at least one chronic injury that was giving them pain. The back, neck and ankles were the most common sites of injury.

As with dancers, musicians have a high incidence of overuse syndrome. A 1986 questionnaire survey by the International Conference of Symphony and Opera Musicians of 4,025 members from 48 American orchestras showed medical problems affecting performance in 76% of the 2,212 respondents, with severe medical problems in 36% (Fishbein 1988). The most common problem was overuse syndrome, reported by 78% of string players. A 1986 study of eight orchestras in Australia, the United States and England found a 64% occurrence of overuse syndrome, 42% of which involved a significant level of symptoms (Frye 1986).

Hearing loss among rock musicians has had significant press coverage. Hearing loss is also found, however, among classical musicians. In one study, sound level measurements at the Lyric Theatre and Concert Hall in Gothenberg, Sweden, averaged 83 to 89 dBA. Hearing tests of 139 male and female musicians from both theatres indicated that 59 musicians (43%) showed worse pure tone thresholds than would be expected for their age, with brass wind instrumentalists showing the greatest loss (Axelsson and Lindgren 1981).

A 1994-1996 study of sound level measurements in the orchestra pits of 9 Broadway shows in New York City showed average sound levels from 84 to 101 dBA, with a normal showtime of 2½ hours (Babin 1996).

The carpenters, scenic artists, electricians, camera crews and other technical support workers face, in addition to many safety hazards, a wide variety of chemical hazards from materials used in scene shops, prop shops and costume shops. Many of the same materials are used in the visual arts. However, there are no available injury or illness statistics on these workers.

Entertainment

The “Entertainment” section of the chapter covers a variety of entertainment industries that are not covered under “Arts and Crafts” and “Performing and Media Arts”, including: museums and art galleries; zoos and aquariums; parks and botanical gardens; circuses, amusement and theme parks; bullfighting and rodeos; professional sports; the sex industry; and nightlife entertainment.

Health effects and disease patterns

There are a wide variety of types of workers involved in the entertainment industry, including performers, technicians, museum conservators, animal handlers, park rangers, restaurant workers, cleaning and maintenance personnel and many more. Many of the hazards found in the arts and crafts and performing and media arts are also found among particular groups of entertainment workers. Additional hazards such as cleaning products, toxic plants, dangerous animals, AIDS, zoonoses, hazardous drugs, violence and so forth are also occupational hazards to particular groups of entertainment workers. Because of the disparateness of the various industries, there are no overall injury and illness statistics. The individual articles include relevant injury and illness statistics, where available.

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