Adoption of occupational disease compensation in early workers' compensation statutes

The history of the APHA Occupational Health and Safety section runs parallel to the efforts in the US to create a state regulatory and compensation system that would be a progressive force for injury and illness prevention.  Despite early 20^th century recognition and study of many specific hazardous exposures at work, prevention efforts were often either nonexistent or ineffective.  Alice Hamilton, MD, recognized that occupational diseases were cheap for economic, political, and social reasons: There was no system of compensation to equate social and private costs; there were few "factory inspectors expert and courageous enough" to impose compliance costs; and most of the factory workers and injury victims were foreign born and non-English speaking, and were thus less able to protect themselves.  Early workers’ compensation systems in the US restricted coverage to cases of accidental injury.  While many workers were afflicted with chronic diseases, long latency conditions, and cumulative trauma disorders, the initial laws and regulations, both at federal and state levels, did not include ways to cover these conditions.  In order to provide incentive to employers to reduce the amount of such injury and illness, mechanisms began to define what which conditions would be made compensable.  New epidemiological and actuarial knowledge needed to be developed to price the coverage from an insurance underwriting viewpoint, and determine how to handle disease in administrative courts from an evidence and proof perspective. This paper attempts to understand these early efforts, and contrast those efforts with contemporary challenges of similar importance and urgency.