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The contribution of occupational health to primary health care (prof Carel Hulshof)


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Presnetation by prof dr Carel Hulshof of the Coronel Institute of Occupational Health, AMC Netherlands Society of Occupational Medicine(NVAB) at the WHO/TNO/Dutchgovernment Congres 'Connecting Health …

Presnetation by prof dr Carel Hulshof of the Coronel Institute of Occupational Health, AMC Netherlands Society of Occupational Medicine(NVAB) at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012

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  • 1. MAETIS ARBO. WERKEN IS GEZONDThe contribution of occupational health to primary health care Prof dr Carel Hulshof • Coronel Institute of Occupational Health, AMC • Netherlands Society of Occupational Medicine (NVAB) • Chair ICOH Scientific Committee on Health Services Research and Evaluation in Occupational Health
  • 2. MAETIS ARBO. WERKEN IS GEZONDThe relation between Work and Health • Work  Health – Prevention of occupational and work- related diseases • Health  Work (ability) – Maintaining the work ability: management of sickness absence and disability – Health promotion • Together  sustained workability
  • 3. MAETIS ARBO. WERKEN IS GEZONDIs Work Good for your Health and Wellbeing? (Waddell & Burton, 2006, Schuring 2007) YES: • Strong evidence: Work is generally good for physical and mental health and wellbeing and can help recovery • Reverses the adverse health effects of unemployment • Beneficial effects depend on the nature and quality of work and its social context: jobs should be safe and accommodating • Workplace is a setting for health promotion • Moving off benefits without entry in to work associated with deterioration in health and wellbeing
  • 4. MAETIS ARBO. WERKEN IS GEZOND What is work?
  • 5. MAETIS ARBO. WERKEN IS GEZOND What is work?Work is of two kinds: first, altering the position of matter at ornear the earths surface relatively to other such matter; second,telling other people to do so. The first kind is unpleasant and illpaid; the second is pleasant and highly paid.Bertrand Russell. In Praise of Idleness, 1932
  • 6. MAETIS ARBO. WERKEN IS GEZONDPredicted 12-month change in mental health scores (and SEs) for transitions from unemployment, by subsequent employment circumstances Butterworth P et al. Occup Environ Med 2011;68:806-12
  • 7. MAETIS ARBO. WERKEN IS GEZOND Paradigm shift! (GPA 2007)The Labour Approach The Public Health Approach Workers’ Health Occupational Health All workersEmployees with labour contract Responsibility of everybody Employers responsibility Beyond the workplace Only at the workplace All health determinantsOnly work-related health issues Wider social dialogue with Negotiation between workers stakeholders: insurance, health and employers and environment authorities Health protection not subject to collective negotiation
  • 8. MAETIS ARBO. WERKEN IS GEZOND What determines workers’ health?• Working environment • Work-related health practices – mechanical – individual risk-taking behaviour – physical – physical exercise, sedentary work – chemical – diet and nutrition – biological – unhealthy habits – smoking, – ergonomic alcohol – psycho-social risks • (Access to) health services• Social factors – preventive occupational health services – occupational status, employment conditions – specialized curative care and rehabilitation – income – health and accident insurance – inequities in gender, race, age, etc.
  • 9. MAETIS ARBO. WERKEN IS GEZOND Occupational Health Interventions environmental behavioural clinicalWorksite visits Health promotion Health surveillanceEmployer consultation Training TreatmentExposure elimination Rehabilitation Exposure Change Behaviour change Disease Change Worker’s Health BehaviourRisk factor at work Disease, Disability Verbeek J et al., Scand J WEH 2004
  • 10. MAETIS ARBO. WERKEN IS GEZOND Workers covered by OHS in Europe (Source: Hämäläinen et al 2001, Rantanen 2002) %100 95 9090 86 80 8080 707060 More than 80% of the workers in the world do 60 60 not have access 5050 to OHS. The proportion of workers50 50workplaces with access 50 and 4840 to occupational health services is diminishing. In developing 34 3930 countries, where production often occurs in small and medium 2820 sized enterprises and frequently at home, 15 traditional tools like10 inspection are not feasible. So, many workers in the world are 4 0 underserved in terms of OHS PT GR DK GB BE SE NL FR FI IT NOR EST BULG HUNG POL SLOV SL TURK
  • 11. MAETIS ARBO. WERKEN IS GEZONDbasic occupational health care/services • Bring occupational health ‘as close as possible to where people live and work’ • Including elements of occupational health in Primary Health Care • Integration of OHC and PHC
  • 12. MAETIS ARBO. WERKEN IS GEZOND What?• prevention of occupational health hazards• diagnosis, treatment and rehabilitation of occupational or work- related diseases• surveillance of work environments and workers’ health• health education and promotion• risk assessment• maintenance of work ability
  • 13. MAETIS ARBO. WERKEN IS GEZOND How?• Consultation of OH professionals in PHC• Training of PHC personnel in OH activities• Organizing support services, e.g. (inter)national/regional OH institutes (OH clinics, laboratory, technical support)• OH care can support local or regional health systems in prevention and therapy of life threatening diseases such as malaria, HIV AIDS and tuberculosis.• Including work (outcomes) in clinical practice guidelines
  • 16. MAETIS ARBO. WERKEN IS GEZOND Inleiding (3)
  • 17. MAETIS ARBO. WERKEN IS GEZONDIncorporating work outcomes into clinical practice guidelines Don’t you work a little too hard?
  • 18. MAETIS ARBO. WERKEN IS GEZOND Integration of work-related aspects in practiceguidelines in primary and secondary health care• Many chronic diseases in PHC have an impact on work  opportunity for work-related interventions• Guidance Document of NVAB and CBO based on answering three questions:  are work-related disorders or disability related to the subject of this guideline? (“doctor, is my work causing this?; can I work with this?”)  are work-related interventions possible and effective?  what is the role of occupational health care?
  • 19. MAETIS ARBO. WERKEN IS GEZOND Health ConditionFunction Activity Participation Personal factors External factors Clinical Behavorial Environmental interventions interventions interventions ICF model* and intervention options Adapted by PBA Smits and JHAM Verbeek s. EMUTOM project, August 2011 * ICF model, International Classification of Functioning, disability and health. ICF © World Health Organization 2001
  • 20. MAETIS ARBO. WERKEN IS GEZOND Involvement ‘work and health’ in many multidisciplinary guidelines in NL• Carpal tunnel syndrome • Needle stick injuries• COPD • Lyme’s disease• Alcohol abuse • Low back pain• Inflammatory bowel diseases • Anxiety disorder• Whiplash • Depressive disorder• Obesity • Chronic fatigue syndrome• Cystic fibrosis • Cardiovascular risk management• Early interventions after disasters • Heart failure• Obstructive sleep apnoea syndrome • Adjustment disorder/burnout• Atopic dermatitis • Complex regional pain syndrome• Herniated lumbar disk • Chronic rhino sinusitis• Somatoform disorders • Sub fertility• Problematic use of drugs • Rheumatic arthritis• Multiple sclerosis • Domestic violence• Ankle injury • Treatment smoking addiction• Oncologic rehabilitation • Complaints of arm, neck, shoulder• Urine incontinence • Lower extremity amputation
  • 22. MAETIS ARBO. WERKEN IS GEZONDSometimes evidence on a more aggregated or general level
  • 23. MAETIS ARBO. WERKEN IS GEZOND Collaboration between professional associations: ICOH - Wonca• ICOH SC on Rural Health: Agriculture, Pesticides and Organic Dusts and Wonca already had a history of collaboration• In Milan 1996, presidents of ICOH and Wonca met and a joint working group was established• The aim of the group was: bringing together and discussing experiences from GPs and OPs in several European countries with providing sufficient coordinated care to working people with health problems