Workplace hazards affecting vulnerable populations of low-wage and immigrant workers present a special challenge to the practice of occupational health. Unions, Coalition for Occupational Safety and Health (COSH) groups, and other organizations have developed worker-led approaches to promoting safety. Public health practitioners can provide support for these efforts.

This article describes a successful multiyear project led by immigrant cleaning workers with their union, the Service Employees International Union (SEIU) Local 615, and with support from the Massachusetts COSH (MassCOSH) to address exposure to hazardous chemicals. After the union had identified key issues and built a strategy, the union and MassCOSH invited staff from the Massachusetts Department of Public Health’s Occupational Health Surveillance Program (OHSP) to provide technical information about health effects and preventive measures. Results included eliminating the most hazardous chemicals, reducing the number of products used, banning mixing products, and improving safety training. OHSP’s history of public health practice regarding cleaning product enabled staff to respond promptly. MassCOSH’s staff expertise and commitment to immigrant workers allowed it to play a vital role.

Vulnerable populations, including low-wage and immigrant workers, frequently work in the most hazardous environments and also have the fewest resources to address workplace dangers.1,2 As global economic and political forces move large numbers of immigrant workers into at-risk jobs, labor unions, Coalition for Occupational Safety and Health (COSH) groups, and workers’ centers have led creative efforts to combat occupational hazards. These methods involve workers as leaders in identifying priority hazards, health effects, and solutions, as well as building power to promote change.3–5

Public health practitioners and people with technical expertise can support these workers and their organizations by contributing to efforts to increase mutual support for labor and public health regarding issues that are important to everyone.6 This article describes a successful occupational health campaign led by janitors and their union with a COSH group, Massachusetts Department of Public Health (MDPH), and academics contributing valuable skills and information.

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Janitorial work in the U.S. is characterized by low wages, few benefits, and limited opportunities.7 Union density is low and some workers are employed “off the books.”8 Building cleaning has largely become the invisible work of newcomers to this country, both documented and undocumented.9,10

In comparison with other occupations, janitors suffer high rates of a number of occupational diseases.11 Janitors can be at risk of contracting hepatitis B, hepatitis C, and human immunodeficiency virus from needlesticks and other sharps injuries;12 potential cardiovascular and psychological diseases from discrimination and shift work;13–17 violence-related injuries and stress due to isolation; strain and sprain injuries from awkward and repetitive motions;18,19 dermatitis, rhinitis, and irritation or burns of the nose, throat, and eyes from acidic, caustic, or otherwise irritating chemicals; and asthma and allergies from sensitizing ingredients in cleaning product.20,21 These risks can be exacerbated by mixing chemicals, which produces still more dangerous compounds.

Janitors are among the occupational groups reporting the highest rates of work-related asthma (WRA),22–30 and cleaning product have been identified as the exposures most frequently associated with their symptoms.31–41 Of 1,915 people with WRA identified in four states from 1993 to 1997, 12% reported an association between their symptoms and exposure to cleaning products.38 Cleaning products were also the leading exposures reported by workers with reactive airway dysfunction syndrome (RADS).42 A consensus statement recently released by the American College of Chest Physicians cited cleaning as a work exposure associated with occupational asthma, RADS, and work-exacerbated asthma.