Inventing the Right to Know

Abstract

In the 1980s, the right-to-know movement won American workers unprecedented access to information about the health hazards they faced on the job. The precursors and origins of these initiatives to extend workplace democracy remain quite obscure. This study brings to light the efforts of one of the early proponents of wider dissemination of information related to hazard recognition and control. Through his work as a state public health official and as an advisor to organized labor in the 1950s, Herbert Abrams was a pioneer in advocating not only broader sharing of knowledge but also more expansive rights of workers and their organizations to act on that knowledge.

The late 1970s witnessed the emergence of a movement to force American employers to disclose various forms of information regarding the occupational health risks faced by their employees. Right-to-know activists, operating primarily through a network of newly formed local and regional committees on occupational safety and health, the so-called COSH groups, demanded and in the 1980s won rights for individual workers, and in some circumstances for their unions and other designated parties, to see records previously concealed from them. These included the findings of employee medical examinations, the identities and known health effects of the toxic chemicals to which workers were exposed, and the results of management’s monitoring of chemicals and other types of hazards in the working environment. Thus far, historians and others have captured salient aspects of these liberating developments, which included the promulgation of the federal Occupational Safety and Health Administration Hazard Communication Standard in 1983 and similar reforms at the state and local levels.¹

Yet the existing literature does little to illuminate the precursors and origins of the right-to-know movement. The period before the 1970s is described as a dark age of abject victimization amid manufactured ignorance. A number of studies have brought to light the ways in which industry gathered evidence of occupational disease, either through its own collection of clinical data or through sponsorship of biomedical research, but suppressed publication or other distribution of information regarding adverse outcomes. The aim here is not to overturn that interpretation but rather only to qualify it by calling attention to one of a small number of voices that challenged the autocratic regime and its secretive nature. Along with Anthony Mazzocchi of the Oil, Chemical and Atomic Workers Union and Lorin Kerr and some of his colleagues at the United Mine Workers Welfare and Retirement Fund (and probably others yet to be found by historians), Herbert Abrams precociously raised and persistently asserted in the 1950s a number of the main concerns articulated in the right-to-know campaigns of the decade from the mid-1970s to the mid-1980s.²

SOCIAL MEDICINE, THE STATE, AND WORKERS’ RIGHTS

Born in Chicago, Illinois, in 1913, Abrams came of age in the turbulent, depressed 1930s. As with many others of his cohort who became medical activists, the sufferings of the destitute working class during the Great Depression made a strong impression on him, particularly during the year in which he suspended his undergraduate studies to take a job as a social worker dealing with the unemployed poor in Chicago. Abrams received a medical degree from the University of Illinois in 1940. After a stint with the US Public Health Service, he first immersed himself in occupational health matters in 1947 when he became head of the Bureau of Adult Health in the California Department of Public Health. He accepted the appointment in California immediately upon completion of a master’s degree in public health at Johns Hopkins University. At Hopkins, his mentor Henry Sigerist had offered an original and compelling perspective on both the social determinants of health problems and the possibilities for medical professionals to advance social justice in helping to solve those problems. As Abrams recalled in his memoirs, Sigerist forcefully “conveyed a vision of a sane and compassionate society.” Like many of Sigerist’s other protégés, Abrams pursued a radical approach that attacked an important manifestation of social inequality—workers’ disproportionate victimization by occupational disease. Unlike some other proponents of social medicine in mid-20th-century America, he avoided an elitist stance, instead embracing a more democratically participatory method. The most obvious manifestation of that inclusive class-bridging orientation was a willingness to work with the labor movement at a time when few physicians chose to do so.³

Abrams came to California at a moment of ferment in progressive thought on social policy as it applied to public health. Traditional principles of state responsibility for protecting the well-being of the citizenry had always carried an admixture of paternalism. Since the 1930s, a new, often militant, rights-claiming perspective had begun to challenge that protective notion and its underlying sense of noblesse oblige. In the immediate postwar period, ascendant concepts of human rights were reframing many questions. While in the Public Health Service, Abrams became acquainted with innovative interpretations of social rights through his involvement with the boldly participatory health care projects launched by the US Farm Security Administration. Introducing himself and his bureau’s mission to the public health community in California in 1948, he began by quoting an excerpt from Milton Rosenau’s classic Preventive Medicine and Hygiene:

Industrial Hygiene is one of the most important topics in preventive medicine and hygiene, as it deals with the health, the welfare, and the human rights of the vast majority of the adult population.

This invocation of the human rights at stake in the regulation of occupational health came from a standard textbook by a much-respected Harvard professor, no leftist ideologue. It thus served to legitimate a subversively democratic mission of expanding workers’ rights to knowledge about the risks they faced.⁴

Investigations of pesticide intoxication in California’s agricultural sector occupied much of Abrams’s attention as he began his service as a state health official. These exercises provided a fortuitous orientation toward right-to-know issues because these “economic poisons,” as they were then commonly known, were among the few workplace chemicals subject to systematic government labeling regulations. The newly enacted Federal Insecticide, Fungicide, and Rodenticide Act obligated manufacturers of highly toxic pesticides to label them as poisonous and to display a skull-and-crossbones warning image on their containers. At the 1949 meeting of the American Conference of Governmental Industrial Hygienists, Abrams called for “a labeling law by which all economic poisons are clearly labeled according to their content and amount of each ingredient.” This proposal meant identification of the actual chemical ingredients comprising a pesticide, not merely provision of a sometimes-meaningless trade name, as mandated by the federal statute. Recognizing the limited value of placing labels on containers, Abrams also used this occasion to encourage his colleagues to “disseminate appropriate educational material for farmers and . . . the employees engaged in handling and manufacturing economic poisons.” In a 1950 review of illnesses induced by agricultural chemicals in California during the previous year, he pointed out that the regulations issued by the state Department of Agriculture went beyond federal law in their requirement that labels name all active ingredients and indicate protective measures. Underscoring this observation, Abrams urged that

workmen in actual contact with hazardous chemicals should be made aware of the dangers of improper handling, and should be kept informed of effective control methods.⁵

In attempting to prevent occupational disease in California farming, Abrams and his colleagues in the state government had to rely heavily on their own difficult-to-enforce rules. At far-flung rural worksites where no unions stood watch on a day-to-day basis, this guaranteed frustration. This state of affairs increased Abrams’s appreciation of the potential value of the labor movement as a partner in vigilant enforcement of rights. At the American Public Health Association meeting in San Francisco, California, in October 1951, Abrams described a recent experience in which the (unidentified) union at a lead smelter had requested state assistance in dealing with lead poisoning of its members. In the past, the company had refused to divulge the results of periodic employee medical testing for lead intoxication. In arranging the medical phase of the state study, Abrams and his team negotiated these concessions from management:

The fundamental right of each employee to decide to what medical personnel his findings should be made available was established and safeguarded from the outset.

Accordingly, workers who underwent medical examinations in this study had the option of having their findings sent to their own physician. In addition, the union was informed of the results of the environmental monitoring of lead levels done at the smelter. Abrams indicated that his bureau’s general policy was that “identical reports of findings are delivered both to management and to the union” in those instances in which the union had requested a study.⁶

The democratic policy thus created in California appears to have been exceptional. At a time when the states held virtually the only real regulatory authority over unhealthful working conditions, the information gathered by their inspectors and investigators often remained inaccessible to workers and their unions. In fact, many states during the pre–Occupational Safety and Health Administration era had laws or legally binding regulations that forbade government officials from revealing to anyone other than the employer the information gained in the course of inspections and investigations or that barred the admission of their findings into workers’ compensation cases or lawsuits. In the context of widespread solicitude for the privileges of industry, the Abrams approach stood out as innovative.⁷

This model of sharing knowledge faced a stern test not long after Abrams’s 1951 presentation. Since the 1920s, the Johns-Manville Products Corporation had mined and processed diatomaceous earth, a substance used as a filtering medium and in other commercial applications, in Lompoc, California. In 1932, Robert Legge and Esther Rosencrantz published a report demonstrating that the mineral extracted and refined at this specific site had caused silicosis among a sizable share of the largely Latino workforce. Despite this warning of the existence of a risk of dust disease, Johns-Manville refused to let an investigator from the state health department enter its facilities in 1940. When granted access 4 years later, the state found numerous poorly controlled dust-generating operations. Subsequent attempts to mount a follow-up study in Lompoc were thwarted by the company and its allies at Metropolitan Life Insurance, as was an attempt to publish an additional medical report on pneumoconiosis cases there. Given this legacy of obstruction, the Johns-Manville plant in Santa Barbara County, California, presented a setting inhospitable to the democratic style of intervention being forged by Abrams and his colleagues.⁸

Creative maneuvering to generate and disseminate information overcame the limits of state authority. Late in 1951, Abrams encouraged Robert Goe, an editor of the state tuberculosis association’s magazine, to explore the situation confronting the 600 workers in Lompoc. Goe’s investigation eventually dug up more than a hundred workers’ compensation cases related to this condition. The article he published in his magazine in January 1952, entitled “Death by Dust,” offered graphic details of autopsy findings and other facts contained in compensation proceedings. It also indicted the damming up of information about this hazard:

Industry has not, as far as can be determined, carried on a realistic program to educate the employee to accept effective disease prevention measures or to acquaint him with the hazards. A somewhat leaky lid has been placed over all activities relating to hazard, preventive measures, case histories, and employment practices.

Goe’s recommendations for both further medical research and employee education became, in effect, a work order for Abrams. His group immediately began planning a survey of the Lompoc workplace.⁹

Deepening controversy at the plant itself drew Abrams and his team further into this matter. On March 17, 1952, Local 146 of the International Chemical Workers Union (ICWU), an affiliate of the American Federation of Labor (whose counterpart in the Congress of Industrial Organizations at that time was the Oil, Chemical and Atomic Workers) began a work stoppage against Johns-Manville. Contention centered on a performance pay system that gave workers a perverse incentive to refuse to wear respirators that diminished their productivity. The union sought the elimination of this unhealthful compensation scheme, and held out for more than 7 months to that end. In the midst of the dispute, Abrams issued a report on the 32 workers’ compensation cases he had located himself and on the numerous instances in which Johns-Manville employees had been hospitalized with work-related respiratory conditions. He offered a straightforward right-to-know rationale for this exercise: “The chief reason this investigation was done was because of information that had come to us indicating that knowledge of this disease was being suppressed.” The growing body of revelations about the dust hazard and its denial cast Manville’s representations in a harsh light and strengthened the Lompoc workers’ determination to persevere in their strike. Although the eventual settlement left the objectionable speedup system in place, the dispute lent urgency to demands for an improved flow of information to at-risk employees.¹⁰

LESSONS OF LOMPOC

The battle in Southern California prompted ICWU leaders to increase their organization’s capacity to protect its members. When later in 1952 Abrams left California to set up a clinic for the Building Service Employees Union in Chicago, he also agreed to become a consultant for the ICWU. From this seemingly marginal position, he proceeded to give the union a wealth of guidance on a range of health matters, and made the right to know a cardinal principle of the organization’s approach to occupational health. Reflecting on the meaning of the diatomaceous earth affair in the July 1953 issue of the ICWU newspaper, Abrams drew this lesson for the union’s rank-and-file:

In motivating employees for health, first of all is the necessity of informing workers of the facts. Have the workers know what they are doing and know the potential hazards of the job and know how to protect themselves and fellow employees against these hazards.

He noted that in the aftermath of the strike Johns-Manville management had adopted a more cooperative attitude and was participating in a joint health and safety committee with Local 146, a new channel of communication regarding risks on the job. Taking on this consultancy placed Abrams within a very small group of occupational health professionals assisting the labor movement. Before the substantial staffing commitments undertaken in the 1970s, only a handful of unions retained any expertise in this area. As late as 1973, the American labor movement employed only one full-time physician and three industrial hygienists. Two decades earlier, Lorin Kerr and a few of his comrades at the Welfare and Retirement Fund of the United Mine Workers of America (not employees of the union itself) may have been virtually the only voices in or around organized labor strongly advocating greater attention to occupational disease recognition and prevention.¹¹

In an effort to bring the meaning of the ICWU’s experience in Southern California to a broader audience, Abrams advised his medical colleagues to eschew a superior attitude, with its assumption that workers had little or nothing to contribute to the systematic recognition and control of workplace hazards. As he put it in a 1953 article in the American Medical Association Archives of Industrial Hygiene and Occupational Medicine, “We are prone to conclude quickly that the worker is unintelligent, and the destructive germ of cynicism begins to replace a healthy constructive approach.” The conflict in Lompoc had, in his view, brought about a transformation there:

Today there is a new attitude on the part of management; the workers are informed, an active union-management health committee has been organized, and now there is a genuine motivation for health.

He fervently endorsed a bottom-up approach:

Perhaps most important, give working people an opportunity to participate in the health program. No amount of exhortation and pontification from above about safety will do the job as well as just permitting the working man to help himself and his fellows.

Abrams closed his appeal with a concrete proposal for the creation of jointly controlled workplace committees whose functions would extend to soliciting workers’ ideas for eradicating hazards. Rather than conceive of workers only as the recipients of information, this approach looked to blue-collar employees as producers of much of the knowledge to be used in managing risks. In 1953, a time when corporate interests very much dominated occupational medicine, the antielitist, proworker perspective expressed by Abrams stood out as exceptional.¹²

CONFRONTING MYRIAD NEW HAZARDS

In his capacity as the ICWU’s medical consultant, Abrams struggled to meet mounting demands for information, training, and guidance on a long and ever-lengthening list of workplace hazards. By the 1950s, few hazardous substances were naturally occurring minerals like diatomaceous earth. Instead, most were recently developed and often mysterious synthetic materials. With a membership of roughly 80 000 across a wide range of risk-filled industries, the ICWU needed more than a part-time consultant to address this problem area. By 1957, there was growing interest, undoubtedly encouraged by Abrams, in the establishment of a health and safety department at the union headquarters. This proposition was seriously considered by the 1958 ICWU convention but rejected as unaffordable.¹³

Commencing in March 1953, Abrams wrote a column for the union’s monthly newspaper, The International Chemical Worker. The articles displayed an ability to weave together specific facts of practical value to union activists and rank-and-file members with broader insights into the social determinants of health. The right of workers to a fuller understanding of the manifold risks—occupational and nonoccupational—facing them was a major theme underlying these journalistic contributions. The first entry in the series, “Facts of Life for Working People,” bluntly warned, “Nobody really knows how many occupational diseases occur because reporting is not required in many parts of the United States.” This sort of criticism of the shortcomings of governmental protection would be a refrain from the former state and federal public health official. Against the prevailing midcentury tendency to deny the reality of class difference, Abrams closed this inaugural column with the sweeping observation that

if you are a low income industrial worker, and especially if your skin is not white, your chances for health and long life are not as good as your fellow men in the higher income brackets.

Several months later in his first speech at the union’s annual convention, Abrams encouraged the audience to give him suggested topics for his articles.¹⁴

Attendance at that convention fortuitously, if sadly, provided the material for his next column thereafter. Two delegates described to Abrams how their employer had recently dealt with a cluster of bladder cancer cases at a Monsanto plant in St Louis, Missouri. Management examined more than 50 employees and sent six to a surgeon it had retained, who operated on them. Abrams reported himself

shocked to learn that although the operations were performed several months ago, these men were not aware of the findings of the operation or the prognosis of their disease. In discussions with these and other workers, it was apparent that many persons are not aware of their rights to medical information.

He proceeded to enlighten his readership regarding the physician’s or surgeon’s primary obligation to the well-being of the patient. To that end, he cited a relevant excerpt of the formal ethical code of the American Medical Association:

The Principles declare that the physician “should assure himself that the patient, his relatives or his responsible friends have such knowledge of the patient’s condition as will serve the best interests of the patient and the family.”

The task of extending the frontiers of the right to know brought with it quite elemental challenges in the 1950s, a time when the right to manage employees could extend to such extreme prerogatives over the control of information, even in matters of life and death.¹⁵

The necessity of ready access to meaningful information was a recurrent theme in the newspaper articles that discussed recognition and control of chemical hazards. Though no panacea, warning labels constituted one potentially valuable informational resource. In December 1958, Abrams endorsed the American Medical Association’s initiative for federal legislation to require labels on containers of industrial materials. Among other provisions, the American Medical Association’s model bill would mandate the prominent listing of the chemical names of all harmful substances and all harmful ingredients in mixtures. In support of this progressive plan, Abrams advised his ICWU readers that under the current patchwork of state protections “many thousands of hazardous chemicals today come under no regulatory laws.” (Chemical manufacturers’ opposition doomed that section of the medical association’s proposal. In 1960, the US Congress passed a watered-down bill covering household hazards.¹⁶)

Seeing that workers became truly knowledgeable required more than attaching labels to barrels and other containers. Abrams pressed the message that disease prevention depended critically on systematically educating and training workers at risk. In August 1954, he contended that “unless the worker himself knows what he is doing and handling and how to protect himself, all other measures will fail.” In his view, plant-level health and safety committees should play the primary role in delivering the imperative lessons.¹⁷

In promoting the creation and successful operation of plant committees and in a variety of other chores related to the right to know, Abrams did more than engage in journalistic advocacy. He participated in training programs for health and safety committees and other local union leaders. He wrote pamphlets and other educational literature for the ICWU to distribute. His congressional testimony in support of stricter federal regulation of atomic radiation hazards in 1959 included a plea for a greater commitment of public administrators to worker education. He made the most of his regular participation in the organization’s annual conventions. For the 1954 convention, in the wake of the revelations about bladder cancer at Monsanto, he arranged for the National Cancer Institute to set up an exhibit on occupational cancer that included a large supply of Wilhelm Hueper’s booklet surveying the problem. At the 1955 convention, he assured chemical workers that they possessed “a store of knowledge, believe it or not, that many of the physicians don’t have.” He went on to warn that “eternal vigilance is the price of health, just as it is the price of liberty.” This vigilance could entail forcing employers to divulge information not usually made available. Four years later, he maintained that

the person in the best position to know about industrial health conditions is the man on the line himself, the worker himself. And history shows that many of the discoveries in the industrial health field were really called to the attention of the medical profession by workers themselves.

He buttressed this claim by pointing to the early complaints of European uranium miners about their elevated rates of lung disease.¹⁸

In the following decade, the ICWU found ways to shift some occupational health responsibilities off their medical consultant’s shoulders. In 1960, after Abrams had acquainted the union with the more ambitious commitment of the United Auto Workers to addressing its members’ unhealthful working conditions, the ICWU expanded its research operation to become a Department of Research, Education, and Health and Safety. The designated functions of the department very much centered on the pursuit of right-to-know matters such as dispensing of hazard information and training of workplace committees. Throughout the 1960s, Abrams continued to assist the Chemical Workers, contributing his regular columns and serving as a liaison with public health agencies. His 1962 guidance for rank-and-file members with an occupational health problem started with using the local health and safety committee and then, if necessary, requesting a state investigation. Here again, the presumption of a right to know came through in Abrams’s advice to ask that state agents “provide the union as well as management with a copy of their findings and recommendations.”¹⁹

Simultaneously, in his primary assignment as medical director of the Union Health Service in Chicago from 1952 to 1966, Abrams found similar openings to promote a right-to-know orientation among the janitors and other building-services workers he served. His frequent contributions in the local Building Service Employees International Union newspaper warned of the hazards of toxic cleaning products and other chemicals. He also used that forum to urge the formation of workplace committees, rally support for stricter labeling requirements, and press for the extension of union educational activities to encompass recognition and control of occupational health hazards. However, his opportunities for right-to-know intervention as the administrator of a wide-ranging health care program with a strong commitment to disease prevention were limited by the legal environment. In Illinois, employees with occupational injuries or illnesses were required to obtain care from providers selected by their employers, so that medical centers such as the Union Health Service were restricted to offering only emergency treatment and thus were cut off from the clinical interactions that held potential for productive exchanges of information. Despite these constraints, Abrams engaged in significant outreach and advocacy to help raise awareness and mobilize collective action on occupational health matters among these low-income service workers, largely African Americans and recent Polish immigrants.²⁰

HUMAN RIGHTS AT WORK

Near the end of his long career, which included creating the Arizona Center for Occupational Safety and Health at the University of Arizona during the 1970s, Abrams had occasion to distill some of the basic principles that had guided his work in occupational health. He believed that these principles should continue to inform progressive work in the field, especially as a burgeoning right-to-work movement advanced its agenda. When Abrams presented grand rounds at Baltimore City Hospital on June 24, 1981, his chosen topic was “Human Rights at Work.” His enumeration of fundamental entitlements of working people included the right to know, for which he posed a series of questions:

Should the worker know the characteristics of the chemical he is handling? Should he know the findings on the X-ray film and the physical exam performed by the company physician?

Realizing that by the 1980s these might seem to have become merely rhetorical questions, he hastened to add, “These may seem elementary to us but these issues are fought over viciously.” He made it clear that he viewed the laity as partners, not wards. Exaggerating to make his point, Abrams claimed that “as occupational health workers, the source of all our knowledge is the worker.” The much-experienced veteran elaborated on these themes the following year at a conference in San Francisco, in an article entitled “The Worker as Teacher.” His reflection on the diatomaceous earth case as he first encountered it in the early 1950s conveyed the basic paradox:

At that time one had to read the work of the Italians and the Germans in European journals in order to find a report of this serious and often fatal disease. Yet the workers in the industry could tell you about it.

Indeed, this democratic approach consistently facilitated the free flow of information in both directions between workers and health professionals. In Abrams’s expansive formulation, the workers’ right to contribute to society’s fund of knowledge represented an integral part of the effort to prevent work-induced illness.²¹

Abrams envisioned rank-and-file workers as mainly responsible for and capable of their own self-protection. Rooted in the progressive ideals of social medicine, his broad conception of a right to generate, disseminate, and use knowledge about workplace hazards, largely developed in the 1950s, helped to point the way to the subsequent movements for rights to know and to act on those threats. Certainly, those movements displayed some of the class-bridging attributes that Abrams brought to the challenges of preventing occupational disease.²²