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TRANSMITTING OCCUPATIONAL RISKS
1193 TRANSMITTING OCCUPATIONAL RISKS can affect employees’ mental and health and life expectancy,I,2 but there is statistical evidence that occupational risks may have unexpected effects on the health of those not so employed. Specifically, we have found a remarkably close association between the occupationally derived standardised mortality ratios (SMRs) of men and those of married women classified by their husbands’ occupation, not their own. The analysis is based on 1088 995 deaths of persons aged 15-64 in the eight years 1959-63 and 1970-72, obtained from the Registrar General’s occupational mortality data. Mortality statistics are available for more than two hundred occupation units (e.g., personnel managers, sales managers, machine tool setters, machine tool operators) divided into twenty-seven general occupational orders (e.g., administrators and managers, engineering and allied trades
SIR,-The work environment
physical
workers). Analysis of these data reveals correlations of the order of 0 - 9 between the SMRs of men classified at death registration by their occupation unit and the SMRs of married women classified by their husbands’ occupation, not their own (see table). CORRELATIONS BETWEEN SMRs FOR MEN, MARRIED WOMEN HUSBAND’S OCCUPATION), AND SINGLE WOMEN, ACROSS
(BY
OCCUPATIONAL UNITS
transferred to the marital partner. The close physical proximity of the partners makes possible the transfer of certain chemical and physical occupational risks and diseases.3 However, such an explanation is inadequate because many jobs do not carry toxic and chemical risks, and men and women die from different diseases.44 The transfer theory could be extended to encapsulate the psychological factors which have an aetiology based in the husband’s working environment, but which indirectly affect married women’s SMRs. One such explanation is a bereavement effect: the death of the husband (occupationally linked) has profound psychological effects on the widow and produces concomitant changes in her psycho-endocrinal functions resulting in premature death. Parkes et al.,for example, report evidence of such an effect which produced a 40% elevation in the death rate of widowers. The effect, however, disappeared after 12 months. Furthermore, it is unclear whether a similar pattern occurs for widows and would, in any case, account for only a small proportion of the variance here. Whilst it is probable that each of the preceding factors do have their own independent effects on the associated life expectancies of men and married women, they cannot collectively account for the association reported here. Any explanation of the observed relationship must centre on the occupational risks present in the males’ work environment. The mechanisms responsible for the transmission of these occupational risks between marital partners can only be guessed at. The important consequences of this finding does, however, warrant further investigation. This work
was
financed
Psychology Department, Hatfield Polytechnic, Hatfield, Herts AL10 9AB The figures m parentheses are the number of ts
by the Medical Research Council. BEN C. FLETCHER D. GOWLER R. L. PAYNE
occupational units upon which the correlation
based.
A number of commonsense explanations might be offered for this close association. First, married partners live in similar environmental conditions. They share the same socioeconomic circumI stances and the variations in life expectancy between social classes affect both partners. The geographic region in which people live also markedly affects the mortality of both men and women. Furthermore, married women are likely to be engaged in broadly similar types of work to their husband, and therefore exposed to similar risks. These explanations, however, do not explain the correlations reported here. First, there is a great variation in the SMRs between occupation units (range 26-314, representing a l2.4year difference in life expectancy for men aged 45). Second, this variation is present within each particular occupational order, although the strong association of SMRs for men and married women is still present. There is, therefore, strong evidence of independent and specific occupational effects on the males’ SMRs (and, indirectly, on those of married women who do not do those jobs). Third, the variety of SMRs between occupational unts transcends the broad socioeconomic/environmental variable. For example, the corresponding SMRs for men and married women for unit 046 (coke oven and gas workers) is 46 and 65, for unit 097 (bricklayers labourers) 273 and 241, for unit 066 (textile winders and reelers) 76 and 68, and unit 116 (deck, engine’room ratings, barge and boatmen) 233 and 186. Fourth, in male-worker-only occupation units, the married female SMRs are very similar to the male SMRs. For example, the corresponding SMRs for men and married women for unit 034 (steel erectors, riggers) are 164 and 159, for unit 117 (pilots, navigators and flight engineers) 86 and 83, and unit 001(fishermen) 171 and 177. The second type of explanation accommodates each of these apparent micro level inconsistencies by asserting that the correlation is a function of the male’s occupational risks and that these are being
MARKETING BREAST MILK SUBSTITUTES
SlR,—Mr Ricketts (Nov. 15, p. 1088) has missed the point by trying to hide behind a smoke-screen of interpretation in his discussion of the marketing of breast-milk substitutes. The fact that five years after he claims a Cow and Gate booklet has gone out of print, it is still available to mothers makes his statement that "it is virtually impossible to ensure the complete removal of outdated materials from the market in a short space of time" difficult to swallow. A similar situation was found in Sierra Leone earlier this year, where a leaflet purported to be withdrawn three years ago was still available. The inappropriate marketing of breast-milk substitutes has been under question in these columns and elsewhere for over a decade. That is not a short space of time. A concerned, responsive industry could have by now ensured the removal of all offending items-especially if it refrained from disseminating new propaganda to publicise its products. Yet despite the claim in 1979 by one ofMr Ricketts’ colleagues in Cow and Gate that "in most developing today you will find no advertising whatsoever by use the International Baby Food Action Network has uncovered advertising by Cow and Gate in ten developing -countries this year, including an ad in the Bangladesh Observer in August with the heading: "Cow and Gate, Feed your baby the best baby food". (Undoubtedly, the industry’s defence for such an ad would be that it is "educational" and therefore not harmful.) No-one’is denying that there have been some changes during the past decade. However, given the amount of attention focused on this problem internationally, it is simply the intransigence of the infant food industry which has prevented a much more efficient and effective eradication of dangerous practices.
countries
McLaughlin AIG. Chronic bronchitis and occupation. Br Med J 1966; i: 354. CM, Benjamin B, Fitzgerald RG. Broken heart: a statistical study of increased mortality among widowers. Br Med J 1969, i: 740. 1. Chetley A. The baby killer scandal. London: War on Want, 1979: 61.
3.
1. Fletcher
BC, Payne RL. Stress at work: Personnel Rev 1980; 9 (1): 19-29.
2. Fletcher BC.
Stress, illness
a
review and theoretical
and social class.
Occup Hlth 1979;
framework,
31: 405-11.
part 1.
4. Parkes
SIR,-The work environment
physical
workers). Analysis of these data reveals correlations of the order of 0 - 9 between the SMRs of men classified at death registration by their occupation unit and the SMRs of married women classified by their husbands’ occupation, not their own (see table). CORRELATIONS BETWEEN SMRs FOR MEN, MARRIED WOMEN HUSBAND’S OCCUPATION), AND SINGLE WOMEN, ACROSS
(BY
OCCUPATIONAL UNITS
transferred to the marital partner. The close physical proximity of the partners makes possible the transfer of certain chemical and physical occupational risks and diseases.3 However, such an explanation is inadequate because many jobs do not carry toxic and chemical risks, and men and women die from different diseases.44 The transfer theory could be extended to encapsulate the psychological factors which have an aetiology based in the husband’s working environment, but which indirectly affect married women’s SMRs. One such explanation is a bereavement effect: the death of the husband (occupationally linked) has profound psychological effects on the widow and produces concomitant changes in her psycho-endocrinal functions resulting in premature death. Parkes et al.,for example, report evidence of such an effect which produced a 40% elevation in the death rate of widowers. The effect, however, disappeared after 12 months. Furthermore, it is unclear whether a similar pattern occurs for widows and would, in any case, account for only a small proportion of the variance here. Whilst it is probable that each of the preceding factors do have their own independent effects on the associated life expectancies of men and married women, they cannot collectively account for the association reported here. Any explanation of the observed relationship must centre on the occupational risks present in the males’ work environment. The mechanisms responsible for the transmission of these occupational risks between marital partners can only be guessed at. The important consequences of this finding does, however, warrant further investigation. This work
was
financed
Psychology Department, Hatfield Polytechnic, Hatfield, Herts AL10 9AB The figures m parentheses are the number of ts
by the Medical Research Council. BEN C. FLETCHER D. GOWLER R. L. PAYNE
occupational units upon which the correlation
based.
A number of commonsense explanations might be offered for this close association. First, married partners live in similar environmental conditions. They share the same socioeconomic circumI stances and the variations in life expectancy between social classes affect both partners. The geographic region in which people live also markedly affects the mortality of both men and women. Furthermore, married women are likely to be engaged in broadly similar types of work to their husband, and therefore exposed to similar risks. These explanations, however, do not explain the correlations reported here. First, there is a great variation in the SMRs between occupation units (range 26-314, representing a l2.4year difference in life expectancy for men aged 45). Second, this variation is present within each particular occupational order, although the strong association of SMRs for men and married women is still present. There is, therefore, strong evidence of independent and specific occupational effects on the males’ SMRs (and, indirectly, on those of married women who do not do those jobs). Third, the variety of SMRs between occupational unts transcends the broad socioeconomic/environmental variable. For example, the corresponding SMRs for men and married women for unit 046 (coke oven and gas workers) is 46 and 65, for unit 097 (bricklayers labourers) 273 and 241, for unit 066 (textile winders and reelers) 76 and 68, and unit 116 (deck, engine’room ratings, barge and boatmen) 233 and 186. Fourth, in male-worker-only occupation units, the married female SMRs are very similar to the male SMRs. For example, the corresponding SMRs for men and married women for unit 034 (steel erectors, riggers) are 164 and 159, for unit 117 (pilots, navigators and flight engineers) 86 and 83, and unit 001(fishermen) 171 and 177. The second type of explanation accommodates each of these apparent micro level inconsistencies by asserting that the correlation is a function of the male’s occupational risks and that these are being
MARKETING BREAST MILK SUBSTITUTES
SlR,—Mr Ricketts (Nov. 15, p. 1088) has missed the point by trying to hide behind a smoke-screen of interpretation in his discussion of the marketing of breast-milk substitutes. The fact that five years after he claims a Cow and Gate booklet has gone out of print, it is still available to mothers makes his statement that "it is virtually impossible to ensure the complete removal of outdated materials from the market in a short space of time" difficult to swallow. A similar situation was found in Sierra Leone earlier this year, where a leaflet purported to be withdrawn three years ago was still available. The inappropriate marketing of breast-milk substitutes has been under question in these columns and elsewhere for over a decade. That is not a short space of time. A concerned, responsive industry could have by now ensured the removal of all offending items-especially if it refrained from disseminating new propaganda to publicise its products. Yet despite the claim in 1979 by one ofMr Ricketts’ colleagues in Cow and Gate that "in most developing today you will find no advertising whatsoever by use the International Baby Food Action Network has uncovered advertising by Cow and Gate in ten developing -countries this year, including an ad in the Bangladesh Observer in August with the heading: "Cow and Gate, Feed your baby the best baby food". (Undoubtedly, the industry’s defence for such an ad would be that it is "educational" and therefore not harmful.) No-one’is denying that there have been some changes during the past decade. However, given the amount of attention focused on this problem internationally, it is simply the intransigence of the infant food industry which has prevented a much more efficient and effective eradication of dangerous practices.
countries
McLaughlin AIG. Chronic bronchitis and occupation. Br Med J 1966; i: 354. CM, Benjamin B, Fitzgerald RG. Broken heart: a statistical study of increased mortality among widowers. Br Med J 1969, i: 740. 1. Chetley A. The baby killer scandal. London: War on Want, 1979: 61.
3.
1. Fletcher
BC, Payne RL. Stress at work: Personnel Rev 1980; 9 (1): 19-29.
2. Fletcher BC.
Stress, illness
a
review and theoretical
and social class.
Occup Hlth 1979;
framework,
31: 405-11.
part 1.
4. Parkes