George Davey Smith, BMJ: British Medical Journal Vol. 301
Dr. D. Snashall’s editorial highlights the problems of poor climbing safety and health conditions in the sphere of the construction industry and also notes that there are difficulties in efficiently collecting and interpreting health data regarding construction workers.
The occupational coding used for construction workers, however, does not include the many laborers who are hired and fired as jobs become readily available. This crowd of casual workers is likely to have the jobs most dangerous to sustaining good health. As a consequence the raised standardized mortality ratios in various causes of death reported in building and construction workers in the decennial supplements underestimates the superior mortality in the sphere of this crowd as a whole.
The problems in estimating the extent of the damaging health effects while working in the sphere of the construction industry are difficult to determine the precise causes. Dr. Snashall suggests that “the industry attracts incompetent men who get pleasure from an irregular, physical life and danger.” The reference that proves this assertion is to a study of the behavior of roofers’ -who might be considered an extreme crowd in this regard. In the decennial supplement in the years around 1981 is a 10-fold increase in the mortality rate due to falls from high places amongst roofers, primarily due to a lack of proper roofing products. This is not unexpected and probably reflects the risks of the duty more readily than the behavior of the readyworker. Similarly it would be important to examine the extent and effects of what Dr. Snashall refers to as “the abuses that an all male work force living away from residence seems to indulge in” before deciding that much of the excess poor health is not occupational. A European commune study found that the increased amount of fatal accidents varied widely amongst countries. The British policy, with regulations being issued and supervised by a central body, is not succeeding. The enforcement of safety regulations ought to be supervised by neighborhood bodies, with efficient representation of workers. West Germany and The Netherlands have arranged policies closer to this ideal, which might explain the low mortality rate amongst construction workers within these countries. Improving the health and safety of construction workers openly requires structural changes. Yet Dr. Snashall’s plea for employers’ federations to combine efforts with trade unions to lobby the government sits uncomfortably with the response of the employers as soon as a concerted effort was made by building workers to conclude the “lump” system of insecure casual labor. Several trades’ unionists ended up in prison, and the legacy of 1972 is reflected in the sphere of the fact that the building industry still relies on this pernicious and health damaging system.