I can boast a little that I have conducted more than 450 health hazard evaluations during my career. Most were initiated after more than one individual complained of symptoms or showed signs of health problems when working at a particular job or location.

I can also boast that I helped bring almost every evaluation to a successful conclusion. But I'll let you in on a secret: I only found a specific, clearly identifiable cause - overexposure to a specific hazard for a particular health problem - in less than five percent of the evaluations.

This is not to say that I walked away from nearly every evaluation without offering advice or making suggestions for improvements. On the contrary. Advice, or risk communication, was provided 100 percent of the time and suggestions for improvements - better ventilation, processes changes, remediation activities - were provided for nearly every case.

Don't get me wrong. I have discovered significant threats to immediate and long-term health. One evaluation alone led me to find more than 400 employees overexposed to a known human carcinogen. But the initial evaluation was not because cancer was evident or even considered.

I think my lack of success at finding a specific, clearly identifiable cause for health problems or disease places me in pretty good company. Consider the Centers for Disease Control and all the other health agencies in the U.S. Over the many years of investigating cancer clusters these groups have only found one study where a neighborhood cluster investigation led to the discovery of an environmental carcinogen.

The job gets harder

When you start with an illness or disease and then follow strict epidemiological processes, finding the specific, clearly identifiable cause for the problem is very difficult. This is true whether the evaluation takes place in the field or in a clinical setting.

Only when you find rare diseases, or clearly associated factors such as food poisonings or infectious agents, does the epidemiological process routinely find a specific cause for a particular illness or disease.

My experiences are not unique. There are fewer overexposures to health hazards in almost all settings. But illness and disease still pops up in people. Rather than admit that we truly don't know the specific cause for a specific ailment, most environmental health and safety pros provide risk communication, modify environments (such as improving ventilation) or seek to totally eliminate the most probable contributing factors to the illness or disease.

In most cases this does the trick. But this trick is getting harder to pull off because there are few physical improvements to be made at most workplaces. Good job. Risk communication then becomes the primary tool to help resolve illness and disease concerns.

Constant communication

There is evidence to support this position. ISHN's 2002 "White Paper" report (see January 2002 issue or search at www.ishn.com) finds that among all EHS pros and each size facility, hazard communication is listed as a top priority.

It's not that EHS pros and business are still struggling 17 years after the passage of the standard on how it needs to be implemented. They are struggling with how to effectively communicate health risk associated with chemical hazards.

The problem is also being exacerbated outside the workplace. Every public health department in the U.S. is on high alert to watch out for and investigate unusual illness patterns or disease clusters that may be linked to terrorist actions. Neighborhood pharmacists, family physicians, and other people in the public health community are being recruited to help in this effort, too. (For more information on this topic see my December 2001 column in ISHN).

Since on average 80 percent of Americans report being ill each month, epidemiological studies will find many unusual patterns of illness and numerous hot spots and clusters of disease. Probability theory supports this conclusion. Consider just one disease. There may be nearly 5,000 chance cancer clusters now in the U.S.

But like my experiences, I believe most of the studies will not find a specific, clearly identifiable cause for problems. This uncertainty will lead to controversy. And unresolved controversy may lead to conflict among various stakeholders.

Disrupting business

Conflict leads to many problems. And some problems can create severe business disruptions. Last year I was hired to help a company determine the cause of illness complaints among a group of workers. The company made initial investigations themselves but they did not find a specific cause for the health problems. When the company stalled on effective risk communication, the entire third shift, more than 200 employees, walked out of the plant. This downtime in production could have sent ripple effects to other businesses that depended upon the plant's flow of products.

Conflicts that grow out of illness and disease investigations are already sending ripple effects through the EHS consulting community. If you haven't heard, professional liability insurance for EHS consultants has been turned on its head. Rates may skyrocket, more exclusions in policies are likely and new or renewed policies will not be issued unless all work with clients is conducted under written contracts or agreements. What's going on?

A big part relates to indoor air quality and toxic mold consultants getting sued quite a bit lately. Why? Illness and disease causation is very weak. Because there are no exposure standards for microbes and toxic mold, nor are there standards for controls or remediation, overkill and underkill recommendations are being provided by consultants. This creates controversy among the various parties (for an example of how this happens see my October 2001 column in ISHN). When controversy is unresolved, conflict arises. And lawyers love conflict.

Whose views prevail?

The future will not be just "them" vs. "us." We are going to see more "us" vs. "us." We're being pitted to fight against each other to see whose professional views prevail. This is a natural progression in controversy and conflict resolution.

What can be done to limit problems? You can only report what you find, not what you believe; only issue recommendations necessary to comply with legal or professional standards; or, only provide services according to the letter of legal contracts, agreements, or within the narrow scope of your job description. Neither of these options really solves problems, however. And the fun is stretching for solutions and making your views count.

You also must become more skilled at effective risk communication. We'll deal with that topic in next month's column.