My work in munitions plants was interrupted toward the end of 1917 by a summons to Washington The complaint which led to my being sent on this new job came from the limestone cutters of Bedford Indiana. The condition of which the men complained – and doubtless still do – is a spastic anaemia of certain fingers, the ones most tightly cramped around the tool (...). There is a clear line of demarcation between the dead part and the normal part. I had provided myself with outlines on paper of right and left hands and when I examined a man I would make his record with a blue pencil on one of the sheets.

Alice Hamilton

Thomas C Erren calls for identification of research challenges in occupational and environmental medicine during the two coming decades, and suggests useful criteria for it (see page 5).1 We will also focus on the occupational aspects, as a recent commentary suggested coming issues in the environmental area.2 But we advocate a broader approach: occupational medicine must take in an international perspective to “understand what is happening to work itself”.3

We propose that the following global trends should be considered:

• Diverse demographic change over the continents with an extremely young population in many industrialising countries (like Central America), an ageing population in many industrialised countries, and lack of the middle-aged generation in sub-Saharan Africa. There is an increased proportion of women in salaried work and the economically active population in developing countries constitutes an increasing proportion of the global workforce.

• • Implication for occupational and environmental medicine: a shift of interest towards women’s work and work in industrialising countries seems reasonable. Child labour remains a concern in developing countries, as do the large differences in expected survival of work ability in the …