Personal reflections on occupational health in the twentieth century: Spiraling to the future

The history of occupational health in the United States during the twentiet h century demonstrates pendular swings, with periods of rapid progress foll owed by periods of reversal. Happily, the last three decades have witnessed the most impressive gains, with establishment of a neat-universal system f or regulating conditions in the workplace, legitimization and growth of the occupational health professions, a marked increase in scientific research, most notably epidemiology, and the transfer of knowledge about occupationa l health to affected workers and the larger US population. Not surprisingly , rates of injury and illness have fallen. However, analysis of these cyclical historic changes suggests that extrinsi c factors-broad social currents, changes in health care financing, and soci etal perceptions of health and disease-have dominated over enhanced scienti fic knowledge, technologic changes or professional achievements, usually th e determinants of medical or public health advances. Practitioners of occup ational health are not, and have never been, in a particularly advantageous position to fashion future events in their own held, and the current situa tion, however encouraging, is likely no exception.