Occupational health in the USA in the 21st Century

Comparable to the confusion encountered in the birth of the machine age is the perplexing reconfiguration of the United States' health care system. Pa ralleling the advances in medicine have been the divesting mergers and down sizing of industry. coupled with globalization, which have released million s of long-time workers. The labour contingent is changing, with the additio n of great numbers of women and immigrant workers, and the manufacturing ec onomy has become one of service and information. Serving the occupational h ealth (OH) needs of such a force have been the professional societies of ph ysicians, nurses, and industrial hygienists, with their members providing c are in a broad variety of facilities. It is possible that a national organi zation, including all these disciplines, would have a greater voice in the protection of workers' health. Immediate leadership of an occupational heal th service (OHS) can be rotated among the disciplines, so that competition for primacy among the professionals would end. The new workforce demands cu lture sensitivity among OH personnel and polylingual capabilities may be de manded in the future. Management skills will be required of all in OH, and greater participation of employees in OH policy will characterize the decad es ahead. Nearly neglected up to now, occupational mental health programmin g will be required to meet the real needs of workers, and to counter the mo ve to outsource OH services, where little patient contact results. Behaviou ral safety, total quality management, and application of the rapidly develo ping technologies in health care will define the 21st century efforts in OH . Remaining issues. such as violence, telecommuting injuries, the inclusion of alternative medicine, and women's health, among others, will see carry- over for resolution into the year 2000.