The publication of the previous (ninth) edition of Hunter’s coincided with the millennium, when in celebratory mood the preface referred to how in the previous 40 years a revolution in biomedical knowledge had led to a transformation of workplace health and safety, accelerating a decline of occupational diseases in advanced economy countries that ranked as one of the greatest triumphs of preventive health of the twentieth century. This success would not have been possible without governments legislating and providing resources to enforce controls in the workplace, with the most radical changes occurring in the 1970s.
The tenth edition goes to press at a very different time, however, with the world reeling in financial crisis and with voices calling for the regulatory ‘burden’ of health and safety on industry in the richest countries to be lifted. On the world scale, the concern is that the existing huge disparities in life expectancy between high and low income countries will get worse. These health inequalities stem from the circumstances in which people are born, grow, live, work and age. Despite the impressive improvements in advanced industrialized countries at the end of the twentieth century, the millennium predictions were for an increase in the global burden of occupational diseases, especially in those economies with large populations and undergoing rapid industrialization, such as Brazil, Russia, India and China, where the basic protections are still mostly lacking.
The need for an updated and comprehensive reference text on occupational diseases is therefore as great as ever. The early detection and diagnosis of occupational diseases depends upon knowledge of the workplace and the likely risks of exposure to workplace hazards, while the elimination of occupational diseases depends upon an effective regulatory framework, adequate risk assessments, and putting in place effective measures to control hazardous exposures. The tenth edition has new chapters on exposure and risk, and on the attribution of disease. The predominant types of work-related ill health have indeed changed over recent years in high income countries. Not all conditions encountered in the modern workforce fit the traditional pattern of defined exposures leading to specific diseases, and the sections on mental health and musculoskeletal disorders have been expanded to take into account their huge rise in prevalence and the sparse evidence base for their successful management. At the same time, it is shocking that classic ‘industrial’ diseases due to asbestos and silica that dominated occupational medicine in the twentieth century, including cancers, still remain as worldwide scourges, and new chapters have been included on their clinical epidemiology to highlight the continuing and serious problems they present.