BACKGROUNDwww. ilo.org 4• An estimated 2.34 million people die each year from work-related accidents and diseases.• Of these, the vast majority—an estimated 2.02 million—die from a wide range of work-relateddiseases.• This means that 5,500 of the estimated 6,300 work-related deaths that occur every day arecaused by various types of work-related diseases.• The ILO also estimates that a further 160 million cases of nonfatal work-related diseasesoccur annually.
5• Over the last two decades, societies have undergone significant changesand developments, with important repercussions for issues of health at work,• Both private and public sectors of economic life operate under pressure fordevelopment, and often in highly competitive markets• The increasing speed and volume of work, pressures for flexibility inorganizations and people, and the slimming of organizations, lead to strainsand stresses on the staff of enterprises and organizations.• Physical workplace hazards are increasingly controlled and managed,but are progressively being replaced by psychological strain at work,and health disorders related to mental stress
6• These changes have health effects on the individual employee level, organization level andsociety level.• Individual - suffering and loss of quality of life; economic loss and insecurity inemployment; loss of control with regard to individual and family life.• Organization - loss in production capacity; constant needs to recruit new staff• Society - increasing social security costs for sickness benefits and pensions; paymentsof compensation for occupational disease
7• Enterprises in the 21st century are under pressure to develop into learning organizations.The workplace constitutes a major setting where available knowledge may be used todevelop OH services to:• Protect health• Promote health through appropriate work culture and work organization• Promote wellbeing and mental health and, on the individual level, healthy life style• Sustain the health and maintain the work ability of all staff• Reduce health care and national insurance costs of injuries, diseases, illnesses andpremature retirement, caused by a combination of occupational, environmental, lifestyle and social health determinants
OCCUPATIONAL HEALTH SERVICES9• The ILO Occupational Health Services Convention (No. 161; 1985) defines ―occupationalhealth services‖ as services entrusted with essentially preventive functions and responsiblefor advising the employer, the workers and their representatives on the requirements forestablishing and maintaining a safe and healthy working environment which will facilitateoptimal physical and mental health in relation to work and the adaptation of work to thecapabilities of workers (in the light of their state of physical and mental health)‖.• Ratified by 33 countries thus far; only one Caribbean (Antigua and Barbuda)
10• Provision of occupational health services means carrying out activities in the workplacewith the aim of:• protecting and promoting workers‘ safety, health and well-being• improving working conditions and the working environment• These services are provided by occupational health professionals functioning individuallyor as part of multi-disciplinary units of the enterprise or of external (contracted) services.
11• In order to establish an Occupational Health action plan tailored to company need, it isnecessary to agree upon the base-line situation of the organization, to set common goals,plan procedures and intervention strategies, and to decide on how and when to evaluatethe results.• What should we look at when developing an action plan?• Regulations• Results of workplace surveys and risk assessments• Health surveillance records• Sickness and accident statistcs• The expectations from the OHS• The concerns and needs of the employees
KEY DELIVERABLES OF AN OH SERVICE12• Health risk assessment of the workplace• Advice on planning and organization of work, including the design of workplaces• Advice on occupational health, safety and hygiene and on ergonomics• Surveillance of workers health in relation to work• Contribution to measures of vocational rehabilitation• Collaboration in providing information, training and education in the field of occupationalhealth• Organizing of first aid and emergency treatment• Participation in analysis of occupational accidents and occupational diseases.
OH SERVICES: GENERAL PRINCIPLES13• In health and safety law, the ultimate responsibility for protecting the health and welfare ofemployees and the public lies with the employer• Employers may choose whether to take and how to implement OH advice• The OH professional seeks to advise and influence key decision makers• Best achieved by getting ―buy in‖ from the top down
OH PHYSICIAN15• Specialized in Occupational Medicine• Part-time or full-time• May be the service manager, with overall responsibility for occupational health and(sometimes) safety• Dual responsibility of OH professionals to provide advice for both employers and employees
OCCUPATIONAL HEALTH PHYSICIAN16• Advise on occupational health, safety and hygiene responsibilities• Fitness for specific jobs, ill health retirement and health surveillanceprogrammes• Rehabilitation• Ensure that workplace health and safety standards are maintained• Workplace visits• Advise on risk management• Input on health policy, planning, research
OH NURSE17• Registered nurse with occupational health nursing training• May provide services in industry with or without supervision by a OHP• Health screening, health surveillance (audiometry, spirometry, drug testing, skinsurveillance), immunizations• Advisory role in risk management, health promotion, counseling, first aid training
OCCUPATIONAL HYGIENIST18• Specialists in assessing and monitoring workplace exposures• Fundamental role in identification, evaluation and Mx of work-related hazards• Mostly uneconomical to employ full time for SME• BOHS definition: ‗the applied science concerned with the identification, measurement,appraisal of risk and control to acceptable standards of physical, chemical and biologicalfactors arising in or from the workplace, which may affect the health or well-being of those atwork, or in the community‘
ERGONOMIST19• Specialized in fitting the task to the human, and may be involved in assessing andadvising on tasks, processes, products and work systems• Their advice should be sought at the process or plant design stage in an effort to designout potential problems
FACTORS INFLUENCING MODELS OF OHSERVICES21• Legal – in some countries the model is prescribed ( Germany, Italy, Austria)• Most countries have laws governing the provision of occupational health services, butthe structure of the legislation, its content and the workers covered by it vary widely(Rantanen 1990; WHO 1989c)• Locally, instead of stipulating what might be regarded as programmes, the legislationstipulates the responsibility of employers to provide risk assessments, healthexaminations of workers and other individual activities related to workers‘ health andsafety• Type of industry & risks involved – the services that are needed by an office population in largecity will require a different skill mix to those in a steel foundry or shipyard• Priorities of the employer - health promotion may be only considered in large profitableorganizations• Human resources – trained OH personnel may not be available; few OHPs
22Model Advantages DisadvantagesSingle OHP or OHN Autonomy Difficult to maintain clinicalcompetence and establishclinical governance;Auxillary staff may be neededOHP and OHN TeamworkAppropriate use of resourcesSame as aboveIn-house service Understanding of theorganization‘s needsKnowledge of other members ofthe extended OH teamCan become institutionalizedand inward looking; loss ofindependence (actual orperceived)Group OH service; providingservices to a number ofenterprisesAdequate resources andexperience of different sectors;More likely to have QAprocessesMay experience shareholderpressure for profit maximization;may result in distorted advice toorganizations; may not be multi-disciplinaryMulti-disciplinary service Potentially best service Uneconomical for SMEs
MEASURING PERFORMANCEOCCUPATIONAL HEALTH SERVICES23
QUALITY & AUDIT IN OH PRACTICE24• OH professionals must be able to show benefit, constantly seek to justify and improvewhat they do, and demonstrate the use of evidence-based best practice guidelines• Standards can be derived from a number of sources:• The purchaser of services (contract specifications)• The professional body ( e.g. good OH practice guidelines• The statutory enforcing authority (e.g. standards for legal compliance)
AUDIT25• Essential part of professional practice• Informs need for change in either the practice or the standardSetstandardObservepracticeComparewithstandardImplementchange
DATA COLLECTION IN OH26Outcome SourceMorbidity Sickness absence by location, occupation, functionMortality In service; pensionersOccupational disease Sickness absence by causeAccidents and incidents Reported A&I statisticsHealth Health survey dataStress Employee Assistance Programme, surveys etc.Litigation Analysis of compensation claims
QUALITY & AUDIT27• An effective OHS will be able to demonstrate positive change in some or all of thefollowing:• Attitudes, knowledge or behaviour• Health status or self-rated health• Morbidity• Mortality• Occupational health process and practice
28• Good data provide a basis for designing an effective prevention strategy• Data on occupational accidents and diseases are mainly obtained through three channels:• reporting by employers to labour ministries• claims accepted by employment injury compensation schemes• information from medical practitioners• Globally, more than half of countries do not provide statistics for occupational diseases
CHALLENGES IN DATA COLLECTION29• Lack of adequately trained OH professionals• Weak or absent National OSH programmes• Workers in SMEs and the informal economy tend to be outside national OSH monitoringsystems• Migration, ageing of the workforce, increasing contract workers• Difficulty with diagnosis of Occupational Diseases
TRINIDAD OH&S STATISTICSPAHO/WHO Country Cooperation Strategy Report 2006-2009 30• ―Laboratory and testing equipment needed to support occupational health presently do notexist‖• ―There has been a steady increase in the number of claims paid by the National InsuranceBoard (NIB) for injury and disablement benefits due to workplace incidents‖• ―Deaths due to workplace accidents are consistently high‖
32• No of persons employed 2005: 574,000 - Central Statistical Office T&T• No of deaths in 2005: 36• No of deaths per 100,000 workers: 6.3• No of deaths per 100,000 workers (UK): 0.8 – Health and Safety Executive UK
WHAT IS THE MINISTRY OF HEALTH DOING?33• Occupational disease reporting systems and data are weak• The MOH recently engaged a committee to develop an occupational disease reportingform for physicians to complete for notification of an occupational disease• The Ministry of Health as a responsible employer and in complying with the TT OSH Acthas :• Developed an umbrella Health and Safety Management Policy for the MOH andRHAs• Mandated the set up of OH units at SWRHA, NCRHA and NWRHA• These OH units have been staffed with OH physicians who are developing OHservices for the > 10000 collective employees they serve at the RHAs
35• Occupational health services are available to only 10%–15% of workers worldwide.• In industrialized countries, the coverage varies between 15% and 90% and in developingcountries between a few percent and 20%• The needs of occupational health services grow continuously
36• Occupational health care activities, therefore, should not be regarded as unrelatedactions, but rather as integral parts of an ongoing process, that:• start with the assessment of the company-specific need for OHS• continue with the planning and follow-up of applicable services and• end with documenting and assessing the achieved results including evaluation ofprogramme efficiency, quality management and further continuous improvement
37• The fight against occupational diseases is at a critical point• Prevention is the key, since it is more effective and less costly than treatment andrehabilitation; and it involves protecting the lives and livelihoods of workers and theirfamilies and contributes to ensuring economic and social development.