Simon Pickvance knew that identifying and finding the solutions to workplace health problems was about more than information and consultation; he knew it was about worker participation and power.
His faith in workers irked many in official health and safety agencies and the occupational medicine establishment, but then it was an approach that frequently exposed their failings.
Epidemiology had become a blunt tool for assessing health risks in rapidly evolving workplaces which no longer provided jobs for life. Occupational doctors were too often the medical arm of the hire-and-fire human resources department. Both were better at burying the evidence.
In 1972 Simon graduated in natural sciences from Cambridge University before embarking on research on the nematode worm Caenorhabditis elegans, which later achieved fame as the first multi-cell organism to have its DNA fully sequenced. Simon’s contribution to the research was noted in John Sulston’s 2002 Nobel Prize lecture.
But Simon’s appetite for lab-based research was waning. He became preoccupied with the politics of science and by the mid-1970s he had sought out other dissenters at Cambridge and was part of the editorial collective of the Radical Science Journal.
It was a time when the British Society for Social Responsibility in Science (BSSRS) had offices in Soho, London, attracting academics like Simon who were concerned that science was more interested in profits and products than people. They wanted to see science used for the public good.
He abandoned research and trained as a bricklayer, working on site for the next 10 years. The job, he said, taught him about work. It also gave him the income that allowed him to pursue a new vocation, a form of grassroots occupational health service operating in communities where it was accepted that work could and frequently did kill.
In Sheffield’s industrial heyday ‘a bad chest’ and ‘a bit of deafness’ was a part of the job neither the industries nor the authorities were inclined to address. In any practical, preventive sense, ‘health’ hadn’t as yet made an appearance in workplace ‘health and safety’. Scarcely any workers had access to occupational health services, and those that had frequently found a visit to the company doctor could be a prelude to the sack.
Simon believed the workforce could identify both the causes and the solutions to health problems caused by their jobs, but needed the opportunity to do so without fear for their jobs. In 1978 he sought out others with a formal scientific background and complemented this team with former union reps intimate with the working conditions and methods prevalent in local industries.
Setting up shop first in working men’s clubs and then in GPs’ waiting rooms in Sheffield, these pairings of blue-collar and white-coat occupational health workers would kick off conversations about conditions at work. These occupational histories formed part of the medical record but also produced health profiles of jobs and workplaces; as well as the obvious, it identified unanticipated problems by perming knowledge across workplaces and occupations.
Thanks to sympathetic GPs, the approach attracted official health service support, leading to the creation of Sheffield Occupational Health Project. It became a model copied elsewhere in the UK and that influenced approaches far beyond.
The ask-the-worker approach proved a uniquely effective way to conduct seat-of-your-pants epidemiology, quickly providing intelligence on the jobs, exposures and work methods responsible for a large slice of ill-health. The inside knowledge and industrial savvy of workplace hardened union reps gave the approach its real edge, bridging the gulf between diagnosing a sick worker and tackling a sick workplace. It became apparent there were a lot of sick workplaces out there.
Audiometers tested the typically noise-deafened ears of tens of thousands of miners and steelworkers. Aesthesiometers, medical devices used to check nerve sensitivity, checked for damage caused by vibration, solvents and repetitive work. Spirometers measured lung damage caused by dust, fumes and chemicals. All were powerful instruments in the hands of a new breed of occupational health worker who could tell you not only that you were cloth-eared and wheezing, but why you were and what to do about it.
Simon and his co-workers didn’t leave it there. Meetings were called in pubs and clubs adjacent to problematic workplaces. Health screening sessions were arranged. Mosques and community centres were turned into makeshift clinics, run in conjunction with local Pakistani, Yemeni and Afro-Caribbean groups, uncovering an expected but previously unquantified or officially addressed racial inequality in occupational health.
In the early 1990s, a group from the Yemeni and Pakistani communities carrying placards in Arabic and Urdu - but not English - protested outside the offices of the Health and Safety Executive (HSE), demanding it produce materials in community languages, something the official safety watchdog had insisted was the responsibility of employers. HSE relented; it now produces basic materials in 30 languages.
Audiometers, aesthesiometers and spirometers were provided to union safety reps, to pass around the works canteen or for union-led screening sessions. Workers diagnosed their own work-caused problems. Long denied occupational health epidemics were being dragged into the daylight.
When in 1988 the UK Health and Safety Executive (HSE) declared Hard Metal Disease – a debilitating lung condition caused by workplace exposure to cobalt and tungsten carbide – a condition of the “fairly distant past”, Simon knew better. He already had evidence from the shopfloor via the waiting room proving the condition remained a real and extensive problem (Hazards 20). A trade union campaign and extensive media coverage saw the authorities embarrassed into action.
On one occasion, HSE records showed in the preceding year there were only a handful of cases of chrome ulcers, a notifiable condition and a red flag the person had experienced damaging exposures to potentially carcinogenic chromium salts. Simon, though, could point to twice as many cases in a single small Sheffield chrome plating factory.
It’s not that work wasn’t making people sick, it was that outside of Sheffield scarcely anyone was looking.
The official view that occupational asthma was a relatively rare condition caused by a small group of workplace substances was undone by a simple surgery-based survey. Simon showed that hundreds of sensitisers and irritants used at work could be responsible for up to one in every five adult asthma cases (Hazards 39). The findings were dismissed by the UK authorities and disputed by the medical establishment.
Not any more – the survey and another high-profile campaign led to the official UK industrial injuries benefits rules being modified to reflect the full range of potential causes. The medical literature is now replete with studies confirming his prevalence estimates to have been correct all along.
This became a familiar pattern. Whether it was obstructive lung diseases in welders and steelworkers, vibration white finger in fettlers or dermatitis in dinner ladies, the workers provided the answers and Simon was on hand to hear them and act on them.
The project was not dealing solely with a legacy of the declining dirty, difficult and dangerous jobs or a long-gone era of industrial lawlessness. New jobs and new exposures were putting new generations at risk, and health and safety laws and their enforcement, at least when it came to work-related ill-health, were doing precious little to protect them.
Keeping up with rapidly evolving technologies, processes and substances at work was a challenge. Simon realised he’d have to harness the collective knowledge of likeminded activists worldwide if he was to be equipped to tackle the devastating array of occupational hazards confronting workers.
He networked furiously. Sanjiv Pandita in Hong Kong and Ted Smith in California knew about microelectronic hazards; Jadgish Patel in Gujarat was running travelling silicosis clinics; a couple of Davids in the US, Egilman and Michaels, were up on beryllium; Jim Brophy and Margie Keith in Canada were cutting edge on occupational cancer and its prevention. Name a topic, he knew a name.
This information exchange became the basis of Hazards’ sister publication, Workers’ Health International Newsletter, which survived for a decade until 1999 and nurtured a still active global network of workplace health campaigners, trade unionists, and academics.
His work was recognised by his peers, with awards from the grassroots Hazards Campaign and the Construction Safety Campaign. In November 2012, Simon was elected an Emeritus Fellow of the Collegium Ramazzini, effectively his induction into occupational medicine’s global Hall of Fame.
Two factors fashioned Simon’s approach – his experience on the tools as a jobbing bricklayer and a respect for the greatly under-estimated knowledge held by working class men and women who have faced and challenged hazards in the workplace.
It was though his time as a bricklayer that was to kill him. Asbestos exposures three decades earlier led to his diagnosis two years ago with mesothelioma, an inevitably fatal and especially cruel cancer.
Simon continued working until the weeks before his death, his last two years concentrating on occupational bladder cancer (Hazards 117). This was an interest that long preceded his diagnosis, and came out of his interviews in surgeries.
He saw workers from very different jobs, ranging from clerical work to metal testing, presenting with bladder cancer. By this stage he had retired from surgery-based work and was a research fellow at Sheffield University’s School of Health.
The research, which is ongoing, had already established official estimates of work-related bladder cancer overlook most of the causes and many of the at risk occupations.
Quietly, but tellingly, he had once again proved what the authorities had little interest in seeing.
Simon Pickvance
born 9 April 1949;
died 23 November 2012
Simon Pickvance quietly exposed the extent of this hidden epidemic of work-related ill-health and proved the solution must lie in workers’ own hands. Hazards remembers a friend and brilliant colleague, who has died aged 63 of a work-related cancer.
