PL10 FROM RAMAZZINI TO ROBOTS: THE IMPACT OF NEW TECHNOLOGIES ON OCCUPATIONAL HEALTH
Authors: Sim Malcolm 
Published: July 2024

Abstract
Bernardino Ramazzini (1633-1714) is the author of the famous treatise De morbis artificum diatriba (Diseases of Workers) and is widely acknowledged as the founder of occupational medicine. In his writings, he set out groundbreaking and innovative principles for identifying and controlling hazards causing diseases in workers at a time when technologies were poorly developed. Since Ramazzini’s time there has been a series of different industrial revolutions, each bringing with it major new technologies. These new technologies have introduced advanced industrial processes, which have contributed to improvements in economic productivity and social wellbeing for the community. They have also introduced many new hazards which can adversely affect the health of workers. The first industrial revolution began in Britain in the mid 18th century with the development of coal power generation and the rise of machines to manufacture a wide range of goods. An example of one important hazard to workers from this new form of power was coal workers’ pneumoconiosis. Despite the introduction of control measures during the 19th and 20th centuries, this occupational disease persists in many parts of the world to the present day. The second industrial revolution from the late 19th century revolved around the development of electrical power, which led to greater mechanisation of industrial processes. The rapid increase in the use of production lines in industrial processes brought with it a rise in musculoskeletal conditions in workers, due to poor ergonomic design. The 2nd industrial revolution also involved a dramatic expansion in chemical processes, including the production of pesticides, solvents and synthetic dyes. Many of these chemicals have subsequently been found to cause a wide range of malignant and non-malignant diseases in the workers who produce them and in those who use them, such as agricultural workers. The 3rd industrial revolution is widely known as the digital revolution, which started in the latter parts of the 20th century. This revolution introduced many digital technologies into workplaces, such as the internet and advanced communication technologies, which brought with it concerns about the hazards of radiofrequency and other non-ionising radiation. Currently, we are in the midst of the 4th industrial revolution, which is sometimes referred to as the Cyber-Physical revolution. This industrial revolution has introduced novel technologies leading to greater automation of industrial processes, robotic manufacturing systems, machine learning and the rise of artificial intelligence. These new technologies have also led to major changes in work organisation, such as the 24 hour work cycle, increasing introduction of shift work arrangements and the rise of the Gig economy. Such work organisation changes have had significant health impacts on workers, such as the rise in work stressors and associated mental health conditions related to work. As we head into what is considered the 5th industrial revolution, we are seeing a rise in machine-human interaction. One example of this is the rise in the number and sophistication of robots used in industry, as well as in community settings. One of the concerns which has been raised is whether this will lead to a reduction in employment opportunities for humans. Being in gainful and hazard-free employment is considered to be an important source of health and wellbeing for workers and society more broadly. The rising use of robots has the potential to undermine this prompting considerable debate about the balance between beneficical and adverse events. The rise in the use of digital platforms is leading to a rapid increase in the Gig economy, which has been demonstrated to increase the risk of injury in those involved in delivery services. This technology can also lead to blurring of the line between work and non-work life for workers, especially with the rise of work-from-home arrangements. These arrangements increased dramatically during the COVID-19 pandemic and have persisted since then. One further consideration about the introduction of new technologies is the potential for old hazards to return in newly developed products. A good example of this is the introduction, and rapid increase in use, of artificial stone over the past two decades. Artificial stone can contain up to 95% crystalline silica. Recent research has demonstrated that the use of this material has led to an epidemic of an accelerated form of silicosis among stonemasons. As well as considerations of rising hazards and other possible negative impacts due to the introduction of new technologies, we need to consider the impact on the provision of occupational health services. The increase in the use of digital communication technologies, such as telehealth, has been beneficial in making health services, including occupational health services, more accessible. This can be beneficial for workers in remote work locations and help to improve the current low rate of occupational health service coverage in many countries. Not only can telehealth be beneficial in performing clinical consultations, but it can also be used to facilitate workplace inspections from a distant location. Greater sophistication of artificial intelligence in healthcare also has the potential to increase efficiency in occupational health service provision. This will be particularly beneficial where the occupational health workforce is scarce and/or only has basic training. Therefore, the introduction of new technologies during the various industrial revolutions can result in a wide range of beneficial and potentially adverse impacts on workers. What is very important is that any potential negative impacts are anticipated and/or detected at an early stage and suitable control measures put in place early. It is just over 300 years since the death of Ramazzini, who worked and wrote about workplaces and workers who were involved with very basic technologies at that time. The world and workplaces have gone through dramatic changes over those three centuries with the introduction of new technologies way beyond the wildest imagination of Ramazzini. Nevertheless, the important principles which he advocated in his writings to protect the health of workers and to benefit society as a whole still apply today in the modern workplace and will continue to guide occupational health programs and activities into the future.