The Scottish anomaly: Occupational health and occupational medicine since 1945

1
The Scottish anomaly Occupational health and
occupational medicine since 1945

• Ronnie Johnston Arthur McIvor
• Centre for the Social History of Health and
  Healthcare
• Glasgow Caledonian University / University of
  Strathclyde

2
The Scottish anomaly

• 1. Patterns of occupational health and safety
• 2. Explanations for the relatively high rates of
  ill-health and injury in the Scottish workplace
• Structural
• Cultural

3
The Scottish anomaly

• The HSE perspective
• HSE, Brit Partnership in Health and Safety -
  paper 2006 supports view that statistically
  Scotland worse
• 2005-6 1.2 per 100,000 fatal injuries Scotland
• Compared to 0.7 in GB as whole
• Woolfson and Beck trace this significant
  disparity back to 1980s

4
Comparative perspectives Scotland worse than
England?

• Industrial accident rates, 1951
• Employed Accidents Rate
• England 19940024 160666 0.806
• Wales
• Scotland 2194665 22778 1.038
• Note Scotland injury rate 29 higher.
• Accidents as reported in FIR 1951 and defined
  as necessitating more than 3 days off
• Employment from CH Lee, Brit Reg Empl Stats (1979)

5
Comparative perspectives Scotland worse than
England?

• Evidence (FIRs / HSE sources)
• 1970s Scottish fatalities from accidents at work
  were 37 higher than the British average and all
  industrial accidents were 20 higher. 87 were
  male.
• Dust respiratory disease too.
• 1980s/90s Scotlands SMR from
• mesothelioma was 31 above UK average
• (Clydeside near double). 90 men.
• From 1950-75, Scotland had double the UK
• average death rate from pneumoconiosis

6
Mesothelioma age standardised death rates for
males per million 1983-88(HSE figures)

• England 25.03
• Wales 13.19
• Scotland 32.05
• HSE figures
• Note Scotland rate was 28 higher than England

7
Putting the Scottish anomaly in perspective

• UK trends in fatal occupational injury rates

• Note 1950 around 2,000 fatalities

8

• Industrial accident rate by region, 1968-9
• Incidence per 1000
• Scotland 47
• Glasgow 33
• Lanarkshire 58
• Clydeside 45
• London region 24
• Midlands 30
• South West England 32
• North West 38
• Yorkshire 51
• North East 63
• Wales 66
• Source Factory Inspectors Reports, 1969 1970

9
Class and gendering of occupational health risks

• Working class most obviously affected
• (though some exceptions eg cirrosis)
• Scotland had a larger working class than
  England
• In all industries covered by the Factory Acts,
  injury incidence of male workers ran at 2.5 x the
  rate of female injuries in 1950s
• Occupational disease incidence for male workers
  was around 4x higher than female

10

• Table 1. Employment in main industries on
  Clydeside by gender 1951
• I. II.
• Clydeside male age
• total total column II
• (000s) (000s) to col 1
• Mining 37.5 36.9 98.4
• Shipbuilding 58.2 55.5 95.4
• Construction 71.8 68.4 95.3
• Iron and steel 44.2 41.6 94.1
• Vehicles 29.4 27.3 92.9

11
Regional variation

• Pneumoconiosis rate
• per 1000 in Scottish coalfields,
• 1944-49
• Certifications Rate
• Central 823 4.6
• Lothians 179 3.7
• Ayr 134 2.3
• Fife 179 2.0
• Black, BJIM, 1953

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Regional variation
13
(No Transcript)
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Owen Lilly on TNs asbestos factory Clydebank in
the 1960s Ill never forget til the day I die
the first impression of that place. It was like
walking into Dantes inferno without the fire. It
was just hell. The noise was unbelievable Dust
was flying through the air everywhere, clouds of
dust nae masks, just overalls. Clouds of stoor
dust everywhere. It just filled the air. And it
was settling just as fast as they were sweeping
it. And then it was dumped. Shovelled into wheel
barras, taken out to the side of the Clyde and
dumped Interview Ronnie Johnston (Scottish
Oral History Centre)
15
(No Transcript)
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Autobiographical evidence

• In his autobiography Growing Up in the Gorbals,
  Ralph Glasser recalled listening to the men at
  Dixons Blazes (a large iron and steelworks,
  closed 1958 9 on map) relating
• Grim anecdotes of terrible things of men
  crippled for life, or killed outright. The
  concluding words of one of these tales gave me
  nightmares for a long time there was nothing
  left of the poor bugger but his feet

17
Oral evidence

• An industrial nurse (Dorothy Radwanski)
  described these intimidating conditions in the
  North British Locomotive works in the late 1950s
  in Springburn, Glasgow (14 on map)
• They took me into the foundry and I was
  frightened. The air was very black, the men were
  absolutely black and they said hello hen or
  whatever was the Glasgow way. I was absolutely
  shocked and I said to somebody its like Dantes
  Inferno
• Oral interview Neil Rafeek, 22 October 2001.

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Explaining the Scottish anomaly

• Structural factors
• HSE view that this is not a reflection of any
  intrinsically higher risk, but a product of
  Scotlands economy and labour market profile in
  short with a higher proportion of workers
  employed in the more dangerous jobs

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Explaining the Scottish anomaly

• Employment in dangerous occupations, 1951
• (by age total employed)
• England Scotland Clydeside
• Most dangerous 30 38 44
• Least dangerous 41 36 33
• Source Census of Scotland, 1951
• Includes coal mining, metals, mech.
  engineering, shipbuilding, textiles, timber,
  construction, transport.
• Includes shop work insurance, banking,
  professionals, scientific, public administration,
  other services
• Note Approx. 50 of the Scottish labour force
  were employed in the Clydeside industrial
  conurbation

20
Identifying the structural problems

• An industrial hygienist (Ian Kellie) noted of
  the steelworks at Ravenscraig in the late 1970s
• A lot of the time for the old plants you were
  really patching up problems. You werent really
  addressing the real problems, I mean plants where
  you had massive problems of fumes and dust and
  noise etc., you knew very well that the only real
  solution was to start again.
• Oral interview with Neil Rafeek, 5 Dec 2001

21
Explaining the Scottish anomalyCultural
factors

• The structural differences do not account for all
  of this anomaly and there are some commentators
  who dispute that the English and Scottish
  economies were significantly different (such as
  McCrone and even Foster).
• Moreover the structural differences have
  narrowed, yet the anomaly still remains evident
  in early 21st century Scotland

22
Health cultures1. Did employers / big business
care?

• The profit before health argument
• A kind of Blue Clydeside?

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Range of attitudes across industry in Scotland

• Paternalist state
• (Local authorities
• Mines Medical Service Docks MS)
• Progressive / welfarist private (Collins ICI
  Stewart Lloyds)
• Negligent authoritarian (TN CSA)
• Small firm ambivalence (1953 Govan study)

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On employers health cultures

• Prof Thomas Ferguson (Public Health, U Glasgow
  in BJIM, 1948)
• The traditional heavy industry of Scotland -
  and especially of Clydeside - is apt to be
  spartan in its outlook employers and work-people
  alike have been bred in a hard school. It would
  be idle to pretend that Clydeside is accustomed
  to regard industrial health as a high priority'.

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Health cultures2. The workers and trade unions

• Hiding ill-health
• GB If youre talking about dust for example,
  obviously it affected, we were all affected - you
  became less fit, handicapped by dust, but for as
  long as possible you cover it up
• DC You see we didnae bother about any illnesses.
  Youre on about different illnesses such is TB
  and things like that, well, that was never
  discussed in the pit. You carried men as they
  got older.
• Interview C23 (Scottish Oral History Centre)

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Health cultures

• Taking risks
• Clydeside sheet metal worker
• The filth that we worked in right fae 14 years
  of age, and being a man with no education - the
  only thing you had was the muscle in your arm and
  what experience you got with metal, and a very
  willingness to work. I would go in and say to
  people Yes Ill do that in that time. And
  whatever it took to do that I would do it. Silly
  now, looking back through the years, you know.
• Interview C7 (Scottish Oral History Centre)

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Health cultures

• Taking risks
• Safety Officer, Scott Lithgows Shipyard, 1977
• Somehow we have to persuade people to taker a
  safe attitude to their work. It is easier said
  than done in a traditional industry like
  shipbuilding where men are set in their ways
• Cited in M. Bellamy, The Shipbuilders

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What role did the TUs play?

• Range of health strategies
• Proactive MFGB / NUM
• Slow to react asbestos
• No presence, contributing to poor OHS standards
  (eg North Sea Oil Piper Alpha tragedy 1988 with
  167 deaths see Foster, Woolfson, Beck)
• Might have done more?

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The state occupational medicine in Scotland

• Was there an effective protective
• matrix?
• FI and HSE Coverage? Under-
• resourced and poorly enforced
• (1971 50 FIs covering 25,000 workplaces)
• Local authority provision (but patchy)
• The Universities and OHS (Dundee, Mair and SOHS)
  weaker in Glasgow?
• Problem No integration of NHS / OHS

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Conclusion

• The Scottish anomaly worse OHS standards and
  higher rates of injury, death and disease - has
  long historical antecedents
• Conditions varied widely, but were better in
  public than private sector and esp. poor in the
  private sector heavy industries on Clydeside
• This was a product of both structural and
  cultural factors