Transcript Work and health

An Introduction to
Work and Health
Chapter 1
Lutgart Braeckman, MD, PhD, UGent, Belgium
Version 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
Physical agents
Biological agents
Ergonomic factors
Psychosocial factors
Liquids, gases, dusts,…
Noise, vibration,
radiation,…
Bacteria, viruses,…
Lifting, repetitive
motion,…
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
DEATHs (millions)
Percentage of total
17.9
Tobacco use
High blood pressure
Overweight and obesity
Physical inactivity
High blood glucose
High cholesterol
Low fruit and vegetable intake
Urban outdoor air pollution
Alcohol use
Occupationalrisks
16.8
8.4
7.7
7
5.8
2.5
2.5
1.6
1.1
0
2
4
6
8
10
12
14
16
18
* Countries grouped by gross national income per capita – low income (US$ 825 or less), high income (US$ 10.066 or more)
20
Ranking of selected risk factors: 10 leading risk factor causes
of DALYs by income group*, 2004
DALYs (millions)
Percentage of total
10.7
Tobacco use
6.7
Alcohol use
6.5
Overweight and obesity
6.1
High blood pressure
High blood glucose
4.9
Physical inactivity
4.1
High cholesterol
3.4
Illicit drugs
2.1
Occupational risks
1.5
Low fruit and vegetable intake
1.3
0
2
4
6
8
10
12
History of occupational medicine
• Occupational medicine was founded by the
Italian physician Bernardino Ramazzini (16331714). 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!
Psychologist
Engineer
and other
disciplines
Hygienist
Worker
Nurse
Doctor
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 people
Employment 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
•SHIFTHOURS
•TYPE OF WORK
•ENVIRONMENT
•…
INDIVIDUAL CAPACITIES
•SEX
•AGE
•LIFE STYLE
•EXISTING DISEASES
•HERITABILITY, ….
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.
The “iceberg” of Occupational Diseases
Reported
Not Reported
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
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