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BACKGROUND Environmental and occupational diseases encompass a broad range of human illness. 3'4 They include lung cancer and mesothelioma in individuals exposed to asbestos; cancer of the b~acicler in dye workers; leukemia in persons exposed to benzene; asthma and chronic bronchitis in persons exposed to organic dusts; lung cancer in persons exposed to radon; chronic disorclers of the nervous system in workers exposed to certain solvents; kidney failure and hypertension in persons chronically exposed to lead; heart disease in persons exposed to carbon disulfide; impairment of reprocluctive functions in persons exposed to certain solvents and pesticides; and chronic conditions and disorders of the musculoskeletal system in workers engaged in repetitive motion. The full nature and extent of the health burden resulting from occupational and environmental exposures remain to be elucidated. The data used to quantify occupational diseases have long been recognized as

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8 inadequate Moreover, there are simply no estimates available to quantify the total burden of disease caused by exposures in the non-occupational environment--exposures that are generally at much lower levels than those in the workplace but to which a much larger and often more susceptible population is potentially exposed for longer durations and at periods of reduced susceptibility However, a widespread consensus has emerged that occupational and environmental diseases are a serious but insufficiently recognized problem 526'7~8 From its annual survey, the Bureau of Labor Statistics (BES) estimated about 125,000 new cases of occupational diseases in the United States in 1984; 9 in 198S, the BES reported 240,900 new cases, an increase largely due to a marked rise in disorders attributed to repetitive motion, such as carpal tunnel syndrome and tendonitis, which constituted 48 percent of the cases 7 For a number of reasons, BES statistics are fell to be significant underestimates of the extent of occupational diseases ~ Using a combination of data sources, including the BES, a study in New York State estimated 35,000 new cases of occupational disease per year in that state alone, which by extrapolation based on relative workforce size would suggest about 350,000 new cases of occupational disease per year in the United States ~ Occupational illnesses, injuries, and deaths are costly events, responsible for (~) direct medical costs; (2) indirect costs resulting from lost production, postponecl opportunities, and diminished investment; and (3) non-economic costs, resulting from pain and suffering, disrupted careers, and devastated families Estimates of the direct and indirect costs of occupational disease have

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9 been developed in New York State for five categories of illness (occupational cancer, chronic respiratory disease and the pneumoconioses, cerebrovascular and cardiovascular disease, and end-stage renal failure). 77 These estimates by extrapolation based on relative workforce size suggest that annual costs for occupational disease in the United States exceed $6 billion, with workers' compensation contributing less than 10 percent and tort suit awards less than 5 percent of the total cost. The morbidity and mortality attributable to non-occupational environmental exposures are simply unknown, as are the associated costs.