The fact that some types of work can be harmful to health has been known for a very long time. Agricola (1494–1555), an official town physician in Bohemia, and Paracelsus (1493–1541), a physician in Austria, both made observations about the high risk of injury and disease associated with mining. Agricola made the interesting observation that in the mining areas, he had met women who had married seven husbands, all of whom had died prematurely from diseases related to mining. However, it is Bernardino Ramazzini (1633–1714), a physician in Italy, who is generally referred to as the father of occupational health. His book about the dangers to health of different types of work, De Morbis Artificum, is still a fascinating read, available in translation as Diseases of Workers (1993) and it contains advice to occupational health practitioners which is still relevant, and sadly often not followed. First published in 1715, Ramazzini’s book also describes conditions which seem more modern, such as stress and repetitive strain injury.

Despite the understanding of the harmful effects of some types of work, there was not great regard paid to occupational health in the United Kingdom until the First World War. Prior to this there was either general indifference, or a fatalistic attitude to the harmful effects of some types of work. Dirty jobs such as mining had to be done, and it was inevitable that the poor people who did such jobs eventually ended up with illness or injury caused by their work.

It is likely that the US Declaration of Independence in 1776, based on the premise ‘that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty, and the pursuit of happiness’, and the motto adopted by the French Revolution, promising liberté, égalité, fraternité, played some part in influencing employers and governments to consider the health of workers. It is also significant, that following the Russian Revolution in 1917, the Bolshevik party formulated a health policy with the principle that health services should be free to all and should concentrate particularly on prevention (Schilling 1981).

It was only after the start of the industrial revolution, towards the end of the 16th century, when cotton textiles and then other manufacturing factories began spreading through Europe and North America, that people with influence in government and some enlightened employers started taking a close interest in the health of workers (Schilling 1981). Industrialization had a profound effect on community health, with family life being disrupted as men moved away from their families in rural areas to work in industrial areas. Severe overcrowding and poor sanitation caused epidemics, and there was a rise in malnutrition, alcoholism and prostitution. There was also poverty and unemployment resulting from fluctuations in the economy.

Thomas Percival (1740–1804), a Manchester physician, when investigating an epidemic of typhus, went beyond his remit and produced a report on hours of work and conditions of young persons. This influenced Sir Robert Peel, a mill owner and member of parliament, to produce the Health and Morals of Apprentices Act of 1802. This led to more acts of parliament which, over the ensuing years, reduced the working hours of women and children, prohibited the employment of children under 14, and provided for education, hygiene and sanitation in the workplace.

Charles Turner Thackrah (1795–1833), a Leeds physician who is renowned for the work he did in persuading the government to record occupations in the recording of deaths and calculations of mortality, is also recognized as a great pioneer in occupational medicine. His text, The Effects of the Principal Arts, Trades and Professions and of Civic States and Habits of Living on Health and Longevity (1832) is still often quoted. He also was instrumental in setting up the first medical school outside the capital cities of London and Edinburgh: all remarkable achievements, considering that he died of pulmonary tuberculosis at the age of 38.

For many years after the first laws to address health at work were enacted in the early 1800s, the health of women at work was largely ignored. This was partly because there were very few women employed in the occupations perceived as being dangerous, and the working roles that women did undertake, such as domestic service, nursing and teaching, were not covered by the legislation. It was during the First World War, when women were thrust into factories as many men went off to fight on the front, that the health of women at work began to come into focus. During the war, about 50 000 workers, most of them women, were employed in the munitions factories to manually fill shells with trinitrotoluene (TNT), a highly toxic substance. The work was very hard, with a high risk of explosion, and the Ministry of Munitions described the work as ‘particularly suitable for women, as they were not seen as minding its unskilled, monotonous and dead-end nature – it suited their temperament’ (Ineson and Thom 1985: 90). Exposure to TNT caused many symptoms in the women, including a yellow staining of the skin, leading them to be referred to as canaries, and although neither factory doctors nor trade unions did anything to help at the time because the war effort and the need to get the shells to the front took precedence over any health issues, this did lead, at the end of the war, to the first in-depth examination of the impact of work on women’s health.

The large number of trade unions which were created in the latter half of the 1800s were concerned primarily with reducing hours of work and raising wage levels in their early years (Schilling 1981). It was a lot later that they started taking an interest in workers’ health and safety. During the 20th century, trade unions became more directly involved in health and safety in many countries. Thomas Morison Legge (1863–1932) was appointed as the first Medical Inspector of Factories, and a few years before his death he became Medical Adviser to the Trades Union Congress, where he wrote his classic text, Industrial Maladies, published after his death in 1934.

Today, in Britain, it is obligatory for workers to be represented in the workplace in safety committees through safety representatives. Through this role, and by working closely with occupational health nurses, trade unions have continued to have an important influence on the work of occupational health nurses. Currently, the Trades Union Congress in the United Kingdom (http://www.tuc.org.uk/), the European Trade Union Confederation, with headquarters in Brussels (http://www.etuc.org/), and the International Labour Organization (ILO), based in Geneva (http://www.ilo.org), all play an important part in ensuring that occupational health and safety remains high on governments’ agenda.

The ILO, through its Promotional Framework for Occupational Safety and Health Convention 2006 (ILO 2008), is urging all member countries to ‘promote continuous improvement of occupational safety and health to prevent occupational injuries, diseases and deaths’ (Article 2). There is some discussion in government about whether the United Kingdom should finally make it an obligation on all employers to provide occupational health services for their workers (see Chapter 8 for further information on workplace health).

It was after the NMC established the third part of the NMC register for specialist community public health nurses in 2004 that occupational health nursing was formally recognized as being a specialty within public health. However, the roots of occupational health nursing as a public health specialty go back to a meeting attended in 1932 by thirty industrial nurses at the College of Nursing (later to become the RCN), where a resolution was passed, that industrial nurses should be encouraged to join the public health section of the college, and that special training should be arranged for new entrants to the service. The first course was held in 1934, and a Miss D.A. Pemberton was the only student that year to graduate with a certificate in industrial nursing (Charley 1954: 106).

In September 1950, a United Nations committee made up of representatives from the World Health Organization (WHO) and the ILO met in Geneva to report on different aspects of health in relation to work. The committee also wrote down a definition of the aims of occupational health, which remains relevant today (Box 17.1). Following the United Nations declaration, in 1952, the Royal College of Nursing (RCN) decided to change the name of its Certificate in Industrial Nursing to the Occupational Health Nursing Certificate (Charley 1954).

Most nurses in the community, whether they are employed in the NHS or by the independent sector, have their roles and functions through the Department of Health, or one of its many branches, such as NHS Management. Standards of care are set by the National Institute for Health and Clinical Excellence (NICE), and their adherence to clinical governance and quality are audited by the Care Quality Commission. Occupational health nurses, like all other nurses, whatever their field of practice are regulated by the NMC, and responsible to their professional code of practice (NMC 2004b). The roles and functions, and day-to-day activities of occupational health nurses, however, are informed by many different agencies, and often are dependent on the nature of their employers’ undertakings. Many occupational health nurses working in industry can feel quite disconnected from activities directly governed by the Department of Health or the NHS. For their activities and decisions, they are as likely to be held accountable under employment law and their employers’ policies and protocols, and answerable to employment tribunals, the Health and Safety Executive or the Department for Work and Pensions (DWP), as they are to nursing and health regulatory bodies.

The fact that the role and functions of occupational health nursing have been so ill defined, until recently, can seem bizarre to other community nurses. However, there are good reasons for this. In the first place, although occupational health nursing has been around as a profession for 150 years and as an educational qualification for over 75 years, there has never been a statutory requirement for occupational health nurses in any industry in the United Kingdom, although there are some regulations which stipulate input from doctors qualified in occupational health. Second, the professional requirements and day-to-day duties of an occupational health nurse are as likely as not to be set by the nurse’s employer. While the fundamental principles, outlined by the ILO (1985) remain the same, the job of an occupational health nurse can vary from one organization to another. A nurse working in a manufacturing plant has little in common with a nurse working for a foundry, or local government, or bank, or hospital.

The lack of a clear framework for practice has had both benefits and drawbacks. The lack of a framework has enabled occupational health nurses to respond rapidly to the changing nature of work. As large national industries have given way to smaller ones, and the manufacturing base has largely been replaced by service industry, the health needs of workers have changed, and occupational health nurses have adapted to these changes in a way that would have been impossible had their role been written on slabs of stone.