The Future of Occupational and Environmental Medicine


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Handouts from presentation given to the International Occuaptioanl Medicine Society Collaborative on Saturday, 28 June, 2014 by John Harrison, MD, FRCP, FRCP (Edin), FFOM .

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The Future of Occupational and Environmental Medicine

  1. 1. International Occupational Medicine Society Collaborative: “The Future of Occupational and Environmental Medicine” John Harrison, MD, FRCP, FRCP (Edin), FFOM Saturday, 28 June, 2014 1 The Future of Occupational and  Environmental Medicine  International Occupational Medicine  Collaborative Bloomsbury, London UK 2014. Have we got the terminology right? Medicine or Health? Occupational  Health ? What are we talking about? WHO – Occupational Health • Global Plan of Action on Workers’ Health* – devising and implementing policy instruments on  workers' health; – protecting and promoting health at the  workplace; – improving the performance of and access to  occupational health services; – providing and communicating evidence for action  and practice; and – incorporating workers' health into other policies. * 2008 ‐ 2017 WHO – Occupational Health 3 Key Areas: 1. Healthy Workplaces 2. Occupational and work‐related diseases 3. Essential interventions for workers’ health * 2008 ‐ 2017
  2. 2. International Occupational Medicine Society Collaborative: “The Future of Occupational and Environmental Medicine” John Harrison, MD, FRCP, FRCP (Edin), FFOM Saturday, 28 June, 2014 2 Healthy workplaces: a WHO global  model for action   Work‐related physical and psychosocial risks;  Promotion and support of healthy behaviours;   Broader social and environmental determinants. “WHO considers workplace health programmes as one of the best‐buy options  for prevention and control of non‐communicable diseases and for mental  health. Such programmes can help achieving the WHO objective of reducing the  avoidable deaths of NCDs and the burden of mental ill health and to protect  and promote health at the workplace as stipulated in the Global Plan of Action  on Workers’ health 2008‐2017. “ WHO – Occupational Health 3 Key Areas: 1. Healthy Workplaces 2. Occupational and work‐related diseases 3. Essential interventions for workers’ health * 2008 ‐ 2017 WHO – Occupational and Work‐related  Diseases • Carrying our estimates of the global burden of disease  from major occupational risks, such as injuries,  airborne exposures, carcinogens, ergonomic stressors,  noise and other specific risks. • Incorporating occupational diseases and their causes in  the 11th revision of the International Statistical  Classification of Diseases and Related Health Problems. • Working with ILO to develop diagnostic and exposure  criteria for occupational diseases and to enable  primary and secondary health care providers to detect  and report such diseases. WHO – Occupational Health 3 Key Areas: 1. Healthy Workplaces 2. Occupational and work‐related diseases 3. Essential interventions for workers’ health * 2008 ‐ 2017 WHO – Interventions for workers’  health “Currently only 15% of workers worldwide have access to specialized  occupational health services carrying out prevention of occupational risks,  health surveillance, training in safe working methods, first aid and advising  employers in occupational health and safety. WHO’s work on extending access to the most essential health interventions and  services for workers’ health includes: • Enabling primary care centres to deliver preventive, curative and rehabilitation  people‐centred care according to the specific health needs of working people,  particularly those who do not have access to occupational health services. • Strengthening the specialized occupational health services – multidisciplinary and  basic and improving their link to primary care centres and the rest of the health  systems. • Stimulating international efforts to build human resource capacities for workers’  health, both in primary care and occupational health specialists.”
  3. 3. International Occupational Medicine Society Collaborative: “The Future of Occupational and Environmental Medicine” John Harrison, MD, FRCP, FRCP (Edin), FFOM Saturday, 28 June, 2014 3 Stage I Starting level Stage II Basic Service Stage III International Standard Service Stage IV Comprehensive Service Field nurse Safety agent Physician and nurse with short special training Multidisciplinary team with special training Multidisciplinary specialists' team • Advice in OH • Accidents and ODs • Acute ill-health • PHC • PHC Infrastructure • Basic OHS content • Toolboxes • OHS Infrastructure • ILO No. 161, 155 • Multidisciplinary content • Prevention plus curative services • In-company or external special OHS units • Comprehensive content: prevention, curative and promotion & develop- ment services Objective for all! SMEs,SSEs,SEs,IFS SMEs,SSEs,SEs,IFS Starting point for Big industries and well organised SMEs Big industries and Big OHS Centres B.O.H.S. The BOHS cycle Surveillance of WE WE Risk Assessment Initiatives Accident prevention Prevention of OH hazards Emergency preparedness Evaluation Record keeping Surveillance of worker's health Assessment of individual's health risk Health education and health information Dg of ODs and WRDs First aid General health service Workers health Worker Information Education Individual health record Work environment Work Organization Orientation and planning Grand challenges of work life in the 21st century • Globalization: MNCs 70 % of world economies • New enterprise structures: Fragmentation • New technologies: Nanomaterials • New work organizations: Ameba organizations • New forms of work: Employee entrepreneurship • Ageing: Work life expectancy • New morbidity: Work-related diseases • Mobility of workers: Migrant workers • New working times: Flexibility, 24/7 • New competence requirements: Multi-skills • New management systems: Autonomous units • New working contracts: Precariocity THE PARADIGM SHIFT OCCUPATIONAL HEALTH Health, Wellbeing & Productivity • Health and Productivity Management.  Simply defined, Health and Productivity Management,  or HPM, is a concept that directs corporate investment  into interventions that improve employee health and  business performance. It can also be described as the  integrated management of health risks, chronic illness,  and disability to reduce employees' total health‐related  costs, including direct medical expenditures,  unnecessary absence from work, and lost performance  at work ‐ also known as "presenteeism."  ACOEM
  4. 4. International Occupational Medicine Society Collaborative: “The Future of Occupational and Environmental Medicine” John Harrison, MD, FRCP, FRCP (Edin), FFOM Saturday, 28 June, 2014 4 OH Workforce  How can OH ensure it will be  relevant to the health needs  of the UK working population  in 2015 and 2030? Where are we now? Where are we going? How do we get there? Philosophy Good work is good for health, good for business and good for national prosperity Vision Universal access to  multidisciplinary OH resources delivers good health and good business in the working  age population Principles 1. OH arrangements include people and other resource ‐ they  address non‐medical and medical  barriers to  remain  in  or return to work. 2. Effective leadership is essential to ensure the appropriate positioning, marketing and delivery of  Occupational Health. 3. The multidisciplinary OH workforce  are trained in unified core competencies including leadership ‐ they are accredited to a standard that reassures the public  4. The need for an Occupational Health resource is such that there is a demand for it by a public who  understand it, value it, and know how to access it. 5. OH  resources are affordable and sustainable 6. An Occupational professional input on functional capability is an integral part of health decision‐ making in people of working age 7. Decisions on the design of work systems and workplaces take account of current occupational  health knowledge and standards. The public includes……. People of working age, their employers and advisers  (medical and non‐ medical) who we work in partnership with to achieve this philosophy. Implications of the Strategic Analysis Carrying on as normal will not be an option Opportunity • prevention and  management of chronic conditions,  • incorporate preventative wellbeing strategies into its arsenal.  • Workplace health and safety and health risk management is part of a holistic  approach to workplace health and wellbeing. Review the knowledge and skills required of the multidisciplinary workforce including  behavioural psychologists, therapists, physiotherapists, etc. to embrace care rather  than treatment. • The dominant model for healthcare is becoming the integrated care pathway. Implications of the Strategic Analysis Positioning within Public Health to promote wellbeing and tackle long term  conditions, such as obesity, and other lifestyle issues.  Support for healthcare: • 7 day working’ for GPs and hospitals  • Demand from employers for 24/7 support. Precision medicine: • Investment in education and training in genomics.  Support employment of people with cancer. Implications of the Strategic Analysis Make best use of this emerging technology: • Tele/video conferencing will become ubiquitous  • Smart phones, tablets and other communication devices.  Embrace Informatics and health informatics. • Websites such as PatientsLikeMe are pioneering patient‐driven data.  • Develop strategies to collect and use data to meet the demands of stakeholders  and improve service delivery. Build capability for multi‐disciplinary services  • Adapt to technological and demographic changes and function • Mitigate and prevent illness caused or made worse by work.  • Abandon silo working and become a fully fledged and integrated specialty
  5. 5. International Occupational Medicine Society Collaborative: “The Future of Occupational and Environmental Medicine” John Harrison, MD, FRCP, FRCP (Edin), FFOM Saturday, 28 June, 2014 5 Case Study 1 Case Study 1 The Evidence Case Study 1 The Solution Case Study 10 Case Study 10 The Evidence Case Study 10 The Solution
  6. 6. International Occupational Medicine Society Collaborative: “The Future of Occupational and Environmental Medicine” John Harrison, MD, FRCP, FRCP (Edin), FFOM Saturday, 28 June, 2014 6 Academic OH • Essential for future of OH • Research agenda must support (lead?) the  paradigm shift • Funding agencies need to fully understand OH  and the research priorities • Need for high quality training of multi‐ professional workforce.  AND FINALLY....... Occupational health needs to move beyond the prevention of  work‐related disease and health surveillance but develop a  broader remit, which encompasses the needs of all working‐age  people, and the aim should be of contributing to maximizing the  functional capacity of each individual. In doing so, it can be argued that occupational health  professionals have the potential to make a greater contribution  to improving population health than any other group of health  professionals. Occupational Health Services Now and in the Future: The Need  for a Paradigm Shift Macdonald, Ewan B.; Sanati, Kaveh A.   Journal of Occupational & Environmental Medicine. 52(12):1273‐ 1277, December 2010.