Occupational Health and the Built Environment: Ethical Issues
Abstract and Keywords
The built environment includes many different types of human-made structures, such as houses, apartments, factories, shopping malls, office buildings, schools, roads, sidewalks, airports, parks, cities, dams, waste sites, sewers, electric power lines, pipelines, suburbs, and cities. This chapter provides an overview of ethical issues related to occupational health and the built environment, including property rights versus public health, distribution of health risks and environmental justice, occupational health and safety standards, and housing standards. To address these issues, decision-makers should have access to scientific information concerning the health impacts of the built and workplace environment and should be aware of the basic values at stake. Affected stakeholders, as well as the public at large, should have meaningful input into government decision-making related to these issues.
(p. 718) Introduction
People are often exposed to hazardous environmental agents (e.g., chemicals, toxins, pathogens, allergens) in areas in which they live and work. The design, construction, and location of buildings, bridges, residential communities, waste sites, and workplaces can also impact human health and the environment in various ways. Ethical issues involving conflicts among different stakeholders and basic values sometimes arise in managing these risks. This chapter will address some of these issues.
The built environment can be defined as the environment constructed by human beings for a variety of purposes, such as living, working, shopping, recreating, eating, and attending school. It includes many different types of structures, such as houses, apartments, factories, shopping malls, office buildings, schools, roads, sidewalks, airports, parks, cities, dams, waste sites, sewers, electric power lines, pipelines, suburbs, and cities (Jackson and Kochtitzky, 2009). The built environment plays a key role in supporting human health, as it provides people with basic needs such as shelter, food, water, work, transportation, and so on. However, the built environment can also place human health at risk and harm the (nonhuman) environment (see Box 61.1).
The workplace environment plays an essential role in supporting human health and well-being. Work provides people with important benefits, such as income, self-esteem, life experiences, intellectual or physical challenges, community, comradery, and health insurance. Having a meaningful job is essential to leading a healthy, productive, and rewarding life (Perry and Hu, 2010). Work also benefits society by providing jobs, goods, and services, and by stimulating economic development, but it also poses potential risks for human health and the environment (see Box 61.2). (p. 719) (p. 720)
Ethical Issues Related to Property Rights
(p. 721) Some of the ethical issues related to managing the health risks of the built and workplace environment involve conflicts between the property rights of individuals or businesses and the welfare of neighbors, employees, communities, or society at large. Property owners may want to use or commercialize their land or buildings without any external government restrictions, such as zoning laws, building codes, land development rules, water use laws, wetlands protections, and so on (Shrader-Frechette, 1988; Resnik, 2010). However, the health of individuals, communities, and society at large may be negatively impacted by how individuals and businesses use and commercialize their property. Consider the following example:
People who live in a new housing development built near a hog farm want to stop the farmer from raising hogs because they are concerned about the stench and increased risk of respiratory disease caused by the farm. They petition the state to regulate hog farming and sue hog farmers for creating a public nuisance. The hog farmers argue, however, that they were raising hogs long before these housing developments sprung up in rural areas, and that they should be able to continue what had long been a part of their farming tradition. They also argue that they depend on hog farming for their livelihood and that hog farming makes important contributions to the economy.
How should we think about possible limitation on the farmers’ rights to use their land? Libertarians, such as Robert Nozick (1974), argue that property is a fundamental right and that restrictions on property rights are justified only to prevent people from (p. 722) infringing on the rights of others. If homeowners choose to live near an already existing hog farm, they are voluntarily accepting this risk, and the farmer’s rights to use his land for the hog farm take precedence. Homeowners thus have a cogent argument for preventing a farmer from starting a new hog farm in their neighborhood, because he would be infringing on their property rights, but they have no valid claim against an already existing farm.
One could argue, however, that the libertarian view gives too much weight to property rights. Utilitarians, such as Richard Brandt (1998), offer a perspective on property rights that stands in sharp contrast to libertarianism. According to utilitarians, all rights, including property rights, can be restricted to promote the common good. To determine whether to restrict a right, one needs to ascertain the likely consequences of the restriction for affected stakeholders and society as a whole. For example, a farmer’s rights to use his land for a hog farm could be restricted if the social benefits of the restriction are likely to outweigh the harms. Utilitarians would also need to factor in the benefits of not imposing restrictions in their calculus. For example, a hog farm might benefit the local economy by providing jobs and tax revenue, and these benefits would need to be considered in assessing the likely consequences of a particular restriction.
There are some problems with the utilitarian approach to property, however. A well-known objection to utilitarianism is that it does not offer enough protection for individual rights or welfare (Timmons, 2002). In the domain of property rights, utilitarians would favor extensive restrictions on property rights if those restrictions are likely to maximize overall social good. One might argue that property rights deserve more protection than would be provided by a utilitarian approach. Another well-known objection to utilitarianism is that it does not provide a defensible framework for dealing with the distribution of benefits and harms in society (Timmons, 2002). For example, utilitarianists might endorse a property rights scheme that favors wealthy and powerful individuals and businesses at the expense of people of low socioeconomic status (SES) if the scheme is likely to produce more overall good than alternative schemes.
As an alternative to libertarianism and utilitarianism, consider the views of John Rawls (1971), who defended an egalitarian view of property rights that gives consideration to the distribution of benefits and harms in society. According to Rawls, property is a social institution that should conform to principles of justice, including the difference principle, which holds that unequal distributions of basic goods are acceptable only if they are compatible with equality of opportunity and they benefit the least advantaged members of society, such as people of low SES. Since allowing people to have property rights can result in an unequal distributions of goods, property rights may be restricted to promote equality of opportunity or the interests of the least advantaged members of society. To return to the hog farmer example, Rawls could argue that the hog farmer’s rights could be restricted insofar as the use of his land interferes with equality of opportunity or harms the least advantaged members of society. If the hog farmer’s neighbors are among the least advantaged members of society, then his property right to raise hogs could be restricted to protect his neighbors from harm, under a Rawlsian view. However, a Rawlsian might oppose restrictions on the farmer’s right to raise hogs if the people (p. 723) who work for the hog farmer are among the least advantaged members of society, and the neighbors are affluent, since restricting the farmer’s rights could take away jobs from poor farmworkers.
One might argue, however, that Rawls’s view does not provide enough protection for those rights, because it allows the government to arbitrarily restrict property rights to help the least advantaged members of society. For example, a Rawlsian might endorse a local government’s plan to use eminent domain to take private property from a wealthy landowner to build a public skateboard park to benefit the poor. One could argue that this plan would treat the landowner unfairly because he deserves to have control over his land. At the very least, the government would need to have a more compelling reason for taking this land (e.g., to build a public school), and it would need to pay the landowner the fair market value of the land.
Perhaps the best approaches to property rights would combine insight from all three views. One could argue that property rights are important but that they can be restricted for compelling reasons, such as promoting public health and safety, controlled development, or social justice. Property rights should not be restricted arbitrarily, and the burden of proof should fall on those who would impose restrictions (Resnik, 2012).
Ethical Issues Related to the Distribution of Health Risks
Some issues related to managing the health risks associated with the built and workplace environment involve ethical concerns about the distribution of these risks within society. People face different environmental risks, depending on where they live, work, go to school, recreate, travel, and so on. Consider the following example:
A county is running out of space at its landfill. Last year, voters in the county rejected a motion to ship its waste to another county, so the county needs to find a site for a new landfill. A panel of scientists, civil engineers, sanitation experts, and citizen representatives appointed by the county has identified three potential sites for the new landfill. The first choice for the site is in a rural area in the poorest part of the county. The second choice is also in a sparsely populated rural area but is close to a public school. The third choice is on the edge of an affluent suburban area. People living in the area identified as the first choice learn about the panel’s recommendation and circulate a petition opposing the new landfill.
How should the county decide where to locate this landfill? The outcome of this decision will impact the distribution of health risks, since people living near that landfill will face increased health risks. Locating the landfill at the panel’s preferred site will increase the health risks of a population that is already economically disadvantaged. Would it be fair (p. 724) to require these people to suffer additional hardships for the benefit of the county? Locating the landfill at the second choice will adversely impact school children, who arguably deserve special protection because they are vulnerable to exploitation and still undergoing growth and development. Locating the landfill at the third site would adversely impact the health of the most people because it would be close to a wealthy suburban area.
The three approaches to distributive justice discussed above would provide different answers to these questions. A utilitarian would favor placement of the landfill in the area that produces the most good/least bad consequences for the most people—most likely the first site. A utilitarian would oppose locating the landfill at the third site (on the edge of the suburbs), since this would adversely impact the health of the most people. A utilitarian would also consider the possible benefits of living near the landfill. For example, the landfill might provide job opportunities for the local population that would offset increased health risks. A Rawlsian would argue that placement of the landfill should not adversely impact the least advantaged members of society, and would, therefore, oppose locating it at the first site, which is the poorest part of the county. A Rawlsian would oppose locating the landfill near the school for similar reasons. A libertarian would have little to say about this particular decision, other than it should respect individual rights. For example, if the preferred site is on private property, the county should negotiate with landowners for the land it intends to use, instead of taking it.
In addition to distributive justice issues, this example also raises issues of procedural justice, or questions about how society should make decisions concerning the distribution of benefits and harms. One could argue that procedural justice requires the county to make its decision based on meaningful input from affected stakeholders, scientific experts, and the public at large (Shrader-Frechette, 2002). Its decision-making process should be democratic, open, transparent, inclusive, and publicly accountable (Gutmann and Thompson, 1998). The county should do more than appoint a panel with experts and citizen representatives; it should also hold community meetings and other activities to solicit public input. It is especially important for the government to solicit input from stakeholders who have low SES or are underrepresented minorities, since members of these groups may not be heard unless their opinions are sought (see “Environmental Justice, Ethics, and Public Health,” this volume, for further discussion of environmental justice).
Ethical Issues Related to Occupational Health and Safety Standards
Questions concerning the distribution of risks also arise in developing standards for occupational health and safety. People who work in particular industries face increased health risks (see Box 61.2). Since the beginning of the twentieth century, many countries (p. 725) have adopted occupational health and safety regulations to protect workers from harm. The Occupational Health and Safety Administration (OSHA) develops and enforces standards in the United States. US states may adopt and enforce their own standards as long as they comply with federal standards (Perry and Hu, 2010).
Very often, people who face increased health risks also have low SES and little economic or political power (Perry and Hu, 2010). For example, many nail salon workers are poor immigrants with limited English proficiency. They are exposed to dangerous chemicals, such as dibutyl phthalate, toluene, and formaldehyde, at work, and many have developed illnesses related to these exposures. Nail salon workers may not understand the risks they face (and how to reduce them), or their rights as employees (Nir, 2015). Other workers who may be especially vulnerable to exploitation include migrant workers, adolescent workers, and fast food industry workers. One could argue that providing adequate protections for these workers is a matter of basic fairness.
Health and safety standards that protect workers from harm should be economically feasible. Measures used to maximize occupational health and safety should not be so expensive that they force employers to significantly reduce their operations or go out of business (Cranor, 2011). For example, requiring that workers at battery plants have no exposure to lead would be so expensive that battery companies would go out of business. The benefits of such a policy would not outweigh the costs to the company, its employees, and society. Instead of requiring no lead exposure, OSHA sets acceptable levels of lead exposure for various industries, which take into account the practical and economic realities of the work environment (OSHA, 2015).
Workplace health and safety policies may sometimes conflict with workers’ rights to expose themselves to occupational risks. In 1982 a battery manufacturer, Johnson Controls, decided to exclude all fertile women from working in jobs that exposed them to high levels of lead, after discovering that eight women had become pregnant while maintaining dangerous blood levels of lead, despite careful monitoring from the company. Johnson Controls implemented this policy to protect fetuses from harm and avoid legal liability. In 1984 female employees at Johnson Controls brought a class action lawsuit against the company, alleging that its policy discriminated against women. The company asserted a business necessity defense to this allegation, arguing there was no other way to protect fetuses from dangerous lead exposures. The case went all the way to the US Supreme Court, which ruled that the company’s fetal protection policy violated the Civil Rights Act of 1964, because it applied only to fertile women, even though men may also cause harm to a fetus if they impregnate a woman while they have dangerous levels of lead in their blood (International Union, United Auto Workers, et al. v. Johnson Controls, Inc., 1991). This important ruling supports the idea that workplace policies designed to protect employees or others from harm should not discriminate on the basis of gender, race, or other characteristics not uniquely linked to health risks. The ruling also affirms a worker’s right to decide whether or not to expose oneself to occupational health and safety risks (Bernstein, 1992).
(p. 726) Ethical Issues Related to Housing Standards
Housing standards often reflect a tension between promoting health and safety and affordable housing. One reason why Haiti’s 2010 earthquake was more destructive than Chile’s in that same year is that Chile had stronger housing standards than Haiti (see Box 61.1). However, increasing housing safety often leads to increased costs, which can reduce the availability of affordable housing and have adverse impacts on the overall economy, as a result of depressing the real estate market (Resnik, 2012). Societies must decide whether the benefits of safe housing standards are worth the costs. When new standards are developed as a result of new scientific research on hazards in the home, older homes may need to be brought up to date. For example, hundreds of thousands of homes in the United States containing lead paint have been remediated since the 1970s as a result of housing standards designed to limit lead exposure in the home. Since people of high SES can more easily afford to pay increased housing prices than people of low SES, regulations that inflate the costs of housing raise issues of social justice because they can exacerbate socioeconomic disparities (Resnik, 2012).
Ethical issues in the built environment and occupational health will continue to emerge as scientists learn more about environmental and health impacts of how people live and work. To address these issues, decision-makers should have access to scientific information concerning the health impacts of the built and workplace environment and should be aware of the basic values at stake. Affected stakeholders, as well as the public at large, should have meaningful input into government decision-making related to these issues.
This research was supported by the Intramural Program of the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH). It does not represent the view of the NIEHS, NIH, or US government.
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