Occupation and Disease: How Social Factors Affect the Conception of Work-Related Disorders.

By Allard E. Dembe. New Haven: Yale University Press, 1996

Reviewed by Carolyn L. Wiener

As the number of injuries considered to be work-related has risen dramatically in the twentieth century, health care providers, insurance companies, lawmakers, employers, and America's workforce all have become stakeholders in the debate surrounding occupational disease. Allard E. Dembe's Occupation and Disease is not only timely but essential to our understanding of this phenomenon. Dembe examines three ailments commonly considered to be work-related - cumulative trauma disorder of the hands and wrists (particularly carpal tunnel syndrome), back pain, and noise-induced hearing loss - in an effort to present a theory of the determinants of occupational disease and an analysis of how social factors exert their influence within that framework. With, unfortunately, only a nod to the sizable body of work on the social construction of health and illness but deserved respect for Fleck's and Kuhn's insights regarding how social forces affect the production of scientific "facts," Dembe provides a social history of these three illnesses. His goal is to reveal how scientific observations and theories are always embedded in a social context or "paradigm" that fundamentally shapes the way that scientists understand and apply available data. And this he does successfully.

Dembe brings to his endeavor a winning combination: first-hand knowledge of the subject …