An Introduction to Work and Health

Chapter 1

Lutgart Braeckman, MD, PhD, UGent, BelgiumVersion 3/8/2012

Module Aims

• To increase awareness and

• To provide a practical understanding of work and health related issues

• To inform and enthuse students about the field of occupational medicine and health

Learning Objectives

At the end of chapter 1 students will be able to :

• Explain the two-ways relationship of work and health• Understand the socio-economic impact of

(un)employment • Recognize the range of health hazards encountered in

the workplace• Understand the value and the role of occupational

health services and physicians• Find reliable sources on work and health related issues

What is Occupational Health?

• The promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs.

(ILO/WHO 1950)

Importance of Occupational Health• The ILO estimates that each year 2.3 million persons

die from work-related accidents and diseases including 360.000 fatal accidents and an estimated 1.95 million fatal work-related diseases.

• In economic terms, roughly 4% of the annual GDP is siphoned off by direct and indirect costs of occupational accident and diseases.

(FACTS ILO 2009)

Importance of Occupational Health• Most adults spend a third of their lives at work• Multitude of health hazards at work

Chemical agents Liquids, gases, dusts,…Physical agents Noise, vibration,

radiation,…Biological agents Bacteria, viruses,…Ergonomic factors Lifting, repetitive

motion,…Psychosocial factors Stress, shift work,…

Hazards and risks

A B

• A = Hazard : anything that can cause harm • B = Risk : the chance, high or low, that somebody will be harmed by the hazard

Deaths attributed to 19 leading factors,by country income level, WHO 2004

Percentage of disability-adjusted life years (DALYs) attributed to 19 leading risk factors, by country income level, WHO 2004

Ranking of selected risk factors: 10 leading risk factor causes of death in high-income countries*, 2004

* Countries grouped by gross national income per capita – low income (US$ 825 or less), high income (US$ 10.066 or more)

DEATHs (millions)

0 2 4 6 8 10 12 14 16 18 20

1.1

1.6

2.5

2.5

5.8

7

7.7

8.4

16.8

17.9Tobacco useHigh blood pressureOverweight and obesityPhysical inactivityHigh blood glucoseHigh cholesterolLow fruit and vegetable intakeUrban outdoor air pollu-tionAlcohol useOccupational risks

Percentage of total

Ranking of selected risk factors: 10 leading risk factor causes of DALYs by income group*, 2004

DALYs (millions)

0 2 4 6 8 10 12

1.3

1.5

2.1

3.4

4.1

4.9

6.1

6.5

6.7

10.7Tobacco useAlcohol useOverweight and obesityHigh blood pressureHigh blood glucosePhysical inactivityHigh cholesterolIllicit drugsOccupational risksLow fruit and vegetable intake

Percentage of total

History of occupational medicine

• Occupational medicine was founded by the Italian physician Bernardino Ramazzini (1633-1714). His De Morbis Artificium (On Artificially Caused Diseases) published in 1700 was the first systematic study of occupational diseases.

• When taking a patient’s history, he added the question “what is your occupation?”

EU Safety and Health at Work law

• Directive 89/391/EEC• Each member country decides precisely how

they implement the directive.

Multiple key actors

• Government - Legislation • Employers• Workers and their representatives - Trade unions• Occupational health services

A multidisciplinary approach: safety, health, industrial hygiene, ergonomics, health promotion, psychosocial aspects,…

• And YOU!

Nurse

WorkerEngineer

PsychologistHygienist

Doctor

and other disciplines

Role and tasks of OHS and the occupational physician

• Identification, assessment and control of the risks from health hazards at work

• Providing training and education • Surveillance of workers' health in relation to

work • Contributing to occupational rehabilitation• Organising first aid

European labour market• In 2010, the EU-27 labour force counted 235

million peopleEmployment by economic activity, %

EWCS survey 2010

EWCS survey 2010

Changing world of work• Europe’s workforce is:– ageing– becoming more female– employing an increasing proportion of migrant

workers, both legal and undeclared– using more temporary and part-time workers– making increasing use of new technology.

(Fifth European Work Conditions Survey – EWCS 2010)

Two-ways relationship

• The effect of work on health– Work as a causative factor– Work as an aggravating factor– Work as a contributory factor

• The effect of health on work– Incapacity and disability

Two-ways relationship• Effect of work on health

a) Negative : accidents, occupational diseases, work-related diseases, absenteeism,

effects on family and offspring

b) Positive :Self-esteem, income, learning, meet new people and make friends

Two-ways relationship• Effect of health on work

a) Negative : incapacity and disability

b) Positive :high quality, increased productivity

Workload models - balance

WORKLOAD INDIVIDUAL CAPACITIES

•SEX•AGE•LIFE STYLE•EXISTING DISEASES•HERITABILITY, ….

•SHIFTHOURS•TYPE OF WORK•ENVIRONMENT•…

Accidents at work

• An accident at work is defined as “a discrete occurence in the course of work which leads to physical or mental harm.”

Accidents at work

• According to the Labour Force Survey 6.9 million persons in the EU27 (15-64 years) had one or more accidents the past year (2007)

• Every year 5.580 people die in the European Union as a consequence of work-related accidents, according to EUROSTAT figures

Accidents at work

(EUROSTAT )

Occupational diseases• Besides that, the International Labour

Organisation estimates that an additional 159.500 workers in the EU die every year from occupational diseases.

• These are “conditions for which occupational exposure is the sole or the major cause”, for example: mesothelioma from exposure to asbestos.

Occupational diseases

Iceberg Metaphor

• Cases of illness correctly diagnosed by clinicians in the community often represent only the “tip of the iceberg.”

• Many additional cases may be too early to diagnose or may remain asymptomatic.

Recognized as Being Related to

Work

Medical Attention Received, But Relationship of Illness to Work

Not Recognized

Symptoms, But No Medical Attention Sought

Affected, But No Symptoms

Reported

Not Reported

The “iceberg” of Occupational Diseases

Absenteeism

According to the Labour Force Survey (2007):• 5 million persons in the EU27 sick for at least

one day due to an accident • 1.5 million of them prolonged sick (one month

or more)• 12.5 million were sick for at least one day due

to work-related diseases

Future Action Plan

• General physicians and medical specialists are usually the first point of health care contact for many employees

• All physicians and nurses should consider the work factor and pay attention to the effects of work on health and vice-versa– Key questions : WARP– Key screening questions for occupational history

taking

Key Questions : WARP

• Work : could the work of the patient be (part of) the cause or the aggravation of his/her complaint or disease?

• Activities : could the complaint / disease of the patient have consequences for his/her activities and participation in work

• Referral : should I refer my patient to an occupational physician or another specialist

• Prevention : Can I do something to prevent the (return of the) complaint or disease?

Key Screening Questions• What type of work do you do? • Do you think your health problems might be related

to your work? • Are your symptoms different at work and at home? • Are you currently or in the past exposed to noise,

chemicals, dusts, metals, radiation, shiftwork, …? • Are any of your co-workers experiencing similar

symptoms?• Is there an occupational health doctor or nurse at

your workplace who I could speak to?

Key organisations

http://www.who.int/en

http://www.ilo.org/global/lang--en/index.htm

http://osha.europa.eu/en

http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home