2. OCCUPATIONAL SAFETY & HEALTH
(OSH)
Health effect on Work
Work effect on Health
OH is concerned with Safety, Health and Welfare of
workers & other persons at place of work.
Work may have both positive and negative effects.
Positive : Income, active, stimulation, socialisation,
access to healthcare
Negative: Occupational injuries, Occupational Disease,
Work related diseases 2
3. Occupational safety & health is the application of
biology, medicine, epidemiology, engineering,
economics, education, politics, the law and other
disciplines to protect workers form diseases of the
workplace.
Anthony RobbinsFormer
Director, NIOSH USA
3
4. History of Occupational Health
Agricola (1494-1555) – workers in mines and
involved in smelting gold – lung diseases –
Paracelsus (1493-1541) – diseases related to mining
and smelting of metals (Austria)
Ramazzini (1633-1714) – “Father of occupational
medicine” – “De Morbis Artificum Diatriba” (Italy)
Percival Pott (1713-1788) scrotal cancer among
chimney sweeps (United Kingdom)
4
5. Some International Organizations
Involved In Occupational Health
International Labor Organisation (ILO, UN)
• Tripartite Representation: government, employers and
employees at General Assembly.
• Formulates conventions, recommendations and
guidelines.
World Health Organisation (UN) :Healthy workplaces program
International Agency for Research on Cancer (IARC) – work
to classify carcinogenicity of various substances
International Program for Chemical Safety (IPCS)
5
6. Disciplines under Occupational Safety and Health
Occupational medicine
Safety engineering
Industrial hygiene
Ergonomics
Toxicology
Occupational epidemiology
Occupational health nursing
6
7. Concept of Occupational Health Hazards In
The Workplace
Physical – noise, radiation, heat, pressure
Chemical- solvents, pesticides, heavy metals
Biological – virus, bacteria, snakes, insects
Psychosocial – stress, overtime
Ergonomic – manual handling, shift work
7
9. Some Surveillance Concepts Used
Occupational Health Surveillance
Environmental surveillance (monitoring)
Medical surveillance (monitoring)
Biological monitoring
Biological effects monitoring
Health effects monitoring
9
10. Objectives and Goals of a Health Program
• Objective: Is planned end-point of all activities
– Is precise
– Is concerned with the problem itself
• Target: A discrete activity which helps measure the extent of attainment of
objectives
– Is a concept of achievement
– Is concerned with the factors involved in a problem
• Goal: Ultimate desired state towards which objectives and resources are
directed
– Is not constrained by time or existing resources
– Is not necessarily attainable
• Mission: Is a description of fundamental principle of existence of a
programme
– Is usually time bound
– Is a statement of purpose
• Impact: Is an expression of the positive effect of a programme, service or
institution on the overall health development and on related social and
economic development 10
11. Steps of Planning Cycle
• Pre-planning:
– Government interest
– Legislation
– Organization for planning
– Administrative capacity
• Step 1: ‘Analysis of health situation’
• Step 2: Establishment of goals and objectives
• Step 3: Assessment of resources
• Step 4: Fixing priorities
• Step 5: Write-up of formulated plan
• Step 6: Programming and implementation
• Step 7: Monitoring
• Step 8: Evaluation
11
12. Communicable Diseases
Introduction
Communicable Diseases are the major cause of
morbidity and mortality , particularly so in complex
emergencies.
Main causes of morbidity and mortality in
emergencies are diarrhoeal diseases, acute respiratory
infections, measles and in areas where it is endemic
malaria.
12
13. Introduction
Other communicable diseases that have also in the
past caused epidemics amongst population affected by
emergencies are meningococcal disease, tuberculosis,
relapsing fever and typhus.
Malnutrition and trauma are additional causes of
illness and death amongst populations affected by
emergencies.
13
14. What is needed during an emergency?
Provision of shelter, water, sanitation, food and basic
health care are the most effective means of protecting
health of those affected by emergencies.
A systematic approach to control of communicable
diseases is a key component of humanitarian response
and crucial for the protection of the health of the
population.
14
15. Fundamental principles of Control of
Communicable Diseases
Rapid Assessment
Prevention
Surveillance
Outbreak Control
Disease Management
15
16. Rapid Health Assessment
The objectives should be :
.1
To assess the extent of the emergency and the
threat of communicable diseases in the
population
.2
To define the type and size of interventions and
priority activities
.3
To plan the implementation of these activities
.4
To provide information to international
community, donors and the media to mobilize
resources both human and financial.
16
17. Prevention
Communicable diseases can be prevented by
appropriate preventive measures which include:
Good site planning
Provision of basic clinical services
Provision of appropriate shelter
Clean water supply
Sanitation
Mass vaccination against specific diseases
Regular and sufficient food supply
Control of vectors
17
18. Surveillance
Surveillance is the ongoing systematic collection,
analysis and interpretation of data in order to plan,
implement and evaluate public health intervention.
Surveillance system should be simple, flexible,
acceptable and situation specific
18
19. Objectives of a surveillance system
in an emergency
.1
Identify public health priorities
.2
Monitor the severity of an emergency by
collecting and analyzing mortality and
morbidity data
.3
Detect outbreaks and monitor response
.4
Monitor trends in incidence and case fatality
from major diseases
.5
Provide information to ministry of health,
donors to assist in health programme planning,
implementation and resource mobilization.
19
20. Outbreak Control
An outbreak is occurrence of a number of cases
of a disease that is unusually large or
unexpected for a given place and time.
Outbreaks and epidemics refer to the one and
same thing.
Outbreaks in emergency situations can spread
rapidly giving rise to high morbidity and
mortality rates.
Aim should be to detect and control the
outbreak as early as possible.
20
21. Disease control
The term “disease control” describes operations
aimed at reducing
The incidence of disease
The duration of disease, and consequently the
risk of transmission
The effects of infection, including both the
physical and psychosocial complication .
The financial burden to the community.
Control activity may focus on primary
prevention or secondary prevention or both .
21
22. Disease control
Control measures are taken for :
Reservoirs of infection : man (cases, carriers)
Contacts (home, school, work, institute, camp
contacts)
The community
22
23. Disease elimination
Between control and eradication , an
intermediate goal has been described “regional
elimination”.
The term elimination is used to describe
interruption of transmission of disease, as for
example , elimination of measles , polio and
diphtheria from large geographic regions or
areas.
23
24. Disease eradication
Eradication literally means to “ tear out by
roots”.
Eradication of disease implies termination of
all transmission of infection by Extermination
of the infectious agent
Eradication is an absolute process , and not a
relative goal. It is “all or none phenomenon”.
Today smallpox is the only disease that has
been eradicated.
24
25. CONCEPT OF PREVENTION
The goals of medicine are to promote health,
to preserve health to restore health when it is
impaired and to minimize suffering and
distress.
These goals are embodied in the word
“prevention”.
Successful prevention depends upon
knowledge of causation, dynamics of
transmission, identification of risk factors
and risk groups; Availability of prophylactic or
early detection and treatment measures.
25
26. LEVELS OF PREVENTION
Primary prevention: can be defined as “action
taken prior to the onset of disease, which
removes the possibility that a disease will ever
occur”. It signifies intervention in the
prepathogenesis phase of a disease or health
problem.
26
27. Levels of prevention
Primary prevention can be achieved by general and
specific measures
.1
General preventive measures :
Sanitation of the environment : clean, pollution-
free
Clean ,proper behavior and habits of the public,
through health education
Health promotion of the public ,with adequate
nutrition ,to raise the general body resistance.
27
28. Levels of prevention
2. Specific prevention
It is specific protection against the causative organisms
and exotoxins, by :
Immunization active and seroprophylaxis
Chemoprophylaxis, by antimicrobials
3. International prevention : to prevent imported
disease.
28
29. LEVELS OF PREVENTION
Secondary prevention: can be defined as “action,
which halts the progress of a disease at its
incipient stage and prevents complications”. The
specific interventions are early diagnosis and
adequate treatment
29
30. LEVELS OF PREVENTION
Tertiary prevention: when the disease
process has advanced beyond its early
stages, it is still possible to accomplish
prevention by what might be called “tertiary
prevention”. It signifies intervention in the
late pathogenesis phase. It can be defined as
“all measures available to reduce or limit
impairments and disabilities, minimize
suffering caused by existing departures from
good health and promote the patient’s
adjustment to irremediable conditions”.
30
31. Methods of control of communicable
diseases
.1
Preventive measures
.2
Control of patient, contact, and the immediate
environment
.3
Epidemic measure
.4
Disaster implication
.5
International measures
31
32. Methods of control of communicable
diseases
1. Preventive measures
Applicable generally to individuals and groups
when and where the disease may occur in
sporadic, endemic or epidemic form and
whether or not the disease is an active threat
at the moment.
Example: - chlorination of water supplies,
pasteurization of milk, control of rodents and
arthropods, animal management,
immunization procedures and health
education of the public.
32
33. Methods of control of communicable
diseases
2. Control of patient, contacts, and the immediate
environment:
Those measures designed to prevent spread of the
disease to other persons, arthropods or animals from
infected individuals, recommendations on the
appropriate management of contacts to assure earliest
possible preventive measures or management to
prevent disease dissemination during the incubation
period, and to detect any carriers and their
management to minimize disease spread. Specific or
best current treatment is outlined to minimize the
period of communicability and to reduce morbidity
and mortality.
33
34. Methods of control of communicable
diseases
3. Epidemic measures
Those procedures of emergency character
designed to limit the spread of communicable
disease, which has developed widely in a
group or community, or within an area, state
or nation. These measures are not applicable
when the disease occurs sporadically among
widely separated individuals or separated by
considerable intervals of time.
34
35. Methods of control of communicable
diseases
4. Disaster implication
The likelihood that the disease might constitute a
major problem in a disaster or catastrophic
situation and wether there would be need for
specific preventive actions
5. International measures
Applicable to travelers, immigrant, goods and
animals.
35
36. Reporting of communicable diseases:
The first step in the control of communicable disease is
its rapid identification, followed by notification to the
local authority that the disease exists within the
particular jurisdiction. Administrative practices on
the diseases to be reported and how they should be
reported may vary from one region to another because
of different conditions and different disease
frequencies. The purpose is to provide necessary and
timely information to permit the institution of
appropriate control measures by responsible health
authorities, as well as to encourage uniformity in
morbidity repotting so that data different health
jurisdictions within a country and between nations
can be validly compared.
36
37. Reporting of communicable diseases:
A reporting system functions at four levels (
INTERNATINAL ):
The first is the collection of basic data in the local
community where the diseases occurs
The second is data assembled at the district
The third is the aggregation of the information
under national auspices.
Finally, reporting by the national health authority
to the WHO
Consideration here is limited to the first level of the
reporting system – collection of the basic data at the
local level, which is the fundamental part of any
reporting scheme.
37
38. 1st). Repot of cases:
Case report of communicable diseases.
Provide minimal identifying data of name,
address, diagnosis, age sex and data of report
for each patient.
Collective report are the assembled number
of cases by diagnosis occurring within a
prescribed time without individual data e.g.
20 cases of malaria by the last week of
November 2004.
Reporting of communicable diseases.
The collection of basic data at local health
authority
38
39. 2nd). Report of epidemic
For reporting purposes the epidemic diseases listed into
following five classes according to the practical benefit, which
can be derived from reporting:
Class 1:
Required by international health regulation QUARANTINE or a
DISEASES UNDER SURVIELANCE by WHO
Group one: INTERNATIONAL QUARANTINABLE disease by
WHO
Plague, cholera, yellow fever and small pox.
Group two: UNDER SURVIALANCE BY WHO
Typhus (louse-born), relapsing fever, paralytic poliomyelitis,
malaria, and viral influenza.
Reporting of communicable diseases.
The collection of basic data at local health
authority
39
40.
Class 2:
Case report regularly required wherever the
disease occurs.
Based on urgency as a case report to local health
authority for investigation of contact and
source of infection or for starting control
measures
Example: typhoid fever, diphtheria,
brucellosis, and leprosy.
Reporting of communicable diseases.
The collection of basic data at local health authority
40
41. Reporting of communicable diseases.
The collection of basic data at local health authority
Class 3.
Selectivity reportable in recognized endemic areas,
in many countries diseases of this class not
reportable but as a collective report to local
health authority.
Example: tularemia, phlebotomus fever, scrub
typhus, fasciolopsiasis
41
42. Reporting of communicable diseases.
The collection of basic data at local health authority
Class 4
Obligatory report of epidemics (no case report
required).
Report of outbreak
Example: - rift valley fever, food poisoning or
unidentified syndrome
42
43. Reporting of communicable diseases.
The collection of basic data at local health authority
Class 5
Official report not ordinarily justifiable.
Diseases a of this class are of two general
kinds:
One): - typically sporadic and uncommon
often not directly transmissible from person
to person. Example: chromomycosis
Two): - epidemiological nature as to offer no
special practical measures for control.
Example: common cold.
43
44. Limitations of the
Notifiable Disease Reporting System
Although surveillance systems need not be
perfect to be useful, such systems do suffer
from limitations that sometimes compromise
their usefulness.
Underreporting,
lack of representative ness,
lack of timeliness,
and inconsistency of case definitions
are just four of the limitations of some present
surveillance systems
44
45. System of communicable diseases
control and notification in Yemen
Group one: -
QUICKLY AND RAPID NOTIFICATION
ACUTE POLIOMYLITIES
CHOLERA
TETANUS NEONATAL
MENINGOCOCCAL MENINGITIS
DRANCULIASIS (GUINEA WARM DISEASES)
SARS
Viral hemorrhagic fever (RVFV, Dengue fever, etc…)
45
46. System of communicable diseases
control and notification in Yemen
(cont.)
Group two:
DIPHTHERIA
MEASLES
WHOOPING COUGH
BLOODY DIARRHEA
46
47. System of communicable diseases
control and notification in Yemen
(cont.)
MALARIA
VIRAL HEPATITIS
TB
ACUTE DIARRHEA
SCHISTOSOMIASIS
INTESTINAL PARASITES
47
48. NON-COMMUNICABLE DISEASE:
HEALTH IN TRANSITION
Chronic diseases
■ Mental health
■ Occupation: health and disease
■ Genetics and health
■ Heat disorders
In the past few decades, significant changes have occurred in
the pattern of health and disease in many developing
countries. These changes have resulted from the effects of
social, economic and technological developments as well as
from specific public health and population programmes.
48
49. NON-COMMUNICABLE DISEASE:
EPIDEMIOLOGICAL TRANSITION
As communicable diseases, malnutrition and problems
associated with pregnancy and childbirth come under control.
DEMOGRAPHIC TRANSITION
With reduction in fertility and child mortality, people in
developing countries are living longer. Hence, the health
problems of older people are assuming increasing importance.
CHANGES IN ECOLOGY AND
LIFESTYLE
In addition to the demographic changes which bring the health
problems of the elderly into prominence, ecological changes in
developing countries contribute to the changing pattern of
disease.
49
50. NON-COMMUNICABLE DISEASE:
Industrialization, urbanization and the wider use of motor
vehicles have increased the incidence of occupational diseases,
respiratory problems associated with atmospheric pollution
and road traffic accidents. Changes in diet, a more sedentary
life, use of tobacco products, alcohol and other drugs have
increased the risk of heart disease, stroke and other diseases
associated with the altered lifestyle.
In 1998, an estimated 43% of all DALYs globally were
attributable to non-communicable diseases. In low- and
middle-income countries the figure was 39%, while in high-
income countries it was 81%. Among these diseases, the
following took a particularly heavy toll:
■ neuropsychiatric conditions, accounting for 10% of the
burden of disease measured in DALYs in low- and middle-
income countries and 23% of DALYs in high-income countries;
50
51. NON-COMMUNICABLE DISEASE:
■ cardiovascular diseases, responsible for 10% of DALYs in low-
and middle-income countries and 18% of DALYs in high-
income countries;
■ malignant neoplasms (cancers), which caused 5% of DALYs
in low- and middle-income countries and 15% in high-income
countries.
EPIDEMIOLOGICAL PATTERNS OF DISEASE
Developing countries can be classified into three broad groups
on the basis of their health profiles.
Traditional epidemiological pattern
In these countries, parasitic and infectious diseases, acute
respiratory-tract diseases and malnutrition occur frequently as
major causes of morbidity and mortality; child and maternal
mortality rates are high; fertility rate is high and expectation of
life at birth is low. 51
52. NON-COMMUNICABLE DISEASE:
Transitional pattern
These countries are undergoing rapid demographic and
epidemiological change: infant, child and maternal mortality
rates are declining, fertility rates are high but falling, life
expectancy is rising; parasitic and infectious diseases are still
prevalent but chronic degenerative diseases and non-
communicable diseases associated with modern lifestyles and
ageing populations are increasing. In some cases, countries
carry a double burden: they are acquiring modern health
problems whilst traditional ones persist.
CHRONIC DISEASES: Non-infectious diseases take an enormous
toll in lives and health worldwide. Nearly 60% of deaths globally are
now due to heart disease, stroke, cancer and lung diseases. The
growing problem of chronic diseases can be illustrated by a brief
review of the rising trend in the prevalence of diabetes and by an
examination of the tobacco problem as an important risk factor. 52
54. 54
What is Policy?
A series of more or less related activities and their
intended and unintended consequences for those
concerned
A purposive course of action followed by actors or
set of actors in dealing with a problem or matter
of concern
Anderson (1974)
55. 55
What is Health Policy?
Health Policy embraces courses of
actions that affect a set of
institutions, organizations,
services and funding arrangement
of the health care system
Gill Walt (1994)
56. 56
Policy vs Decisions
Policy differs from “Decisions” in a
number of ways:
Policy is broader than decisions
Policy involved a series of more specific
decisions
Policy involved a bundle of decisions
and how they are put into practice
58. 58
Health Policy
Policy process is pluralist rather than elitist
Usually attract many different interest group
Strong interest group (Doctors, Nurses, etc)
Weak interest group (consumers, patients with
specific needs: diabetic, renal failure patients)
Some health policies are not low politics
Health Sector Reform or Health Financing System
59. 59
Models of Policy Process
Three models of policy process
.1
Rational Model
.2
Incrementalist Model
.3
Mixed Scanning Model
60. 60
Rational Model
Believe that policies are made in a
rational way
Policy makers go logically through
certain stages to reach the best
possible policy
61. 61
Stages involved
Policy maker faced with a clear or distinct problem
The goals, values or objectives that guide policy makers
are clarified and ranked according to their importance
(E.g: Equity goal is more important than
efficiency goal)
Various alternative for dealing with the problem are
considered
The consequences of following from selection of each
alternatives are investigated
Each alternatives and its consequences are compared
with other alternatives
The policy maker chooses the alternative that maximise
the goals, values and objectives
62. 62
Rational Model
Critique of Rational Model
Considered to be an ideal model
Policy makers may not always face concrete and define
problem
It may be difficult to identify the specific problem
Policy makers may not have the time and information to
assess all alternatives
Policy makers may not be value-free
They may favour certain solutions
Past policy determine present policy
List of alternatives may be influenced by past experience
63. 63
Incrementalist Model
The selection of goals or objectives and means of
implementation are closely allied
Not distinct from one another
Policy makers avoid spelling out objectives which would
precipitate conflicts rather than agreement
Policy makers look at a small number of alternatives
for dealing with the problem
The choose alternative that differ marginally from
existing policies
64. 64
Incrementalist Model
For each alternatives, only the most important
consequences are considered
No optimal policy option.
The one they choose is what they agreed upon ; not
necessarily be the best option.
Policy makers focus on small changes to existing
policies.
Policy making is a serial process: you have to keep
coming back to problems as mistakes are corrected.
65. 65
Incrementalist Model
Critiques of Incrementalist Model
Incrementalist are conservative
They content to make small changes and
maintain the status-quo
Useful in status of high social stability
Not appropriate when social changes are
needed
66. 66
Mixed Scanning Model
In middle position between rational
and incrementalist model
Idea from military operation
First scan the whole area for enemy by
looking at major signs
Then examine more detail in suspected
area
67. 67
Mixed Scanning Model
Policy makers divide their decisions into
Macro (Fundamental)
Micro (Small)
They undertake broad view of the field
without engaging into detail exploration
Then concentrate in great details areas
needed to be addressed
68. 68
Setting the Policy Agenda
How does issue gets into policy agenda?
Become enshrined (protected) in laws, regulations or
policy statement
Some issues are ignored
What is policy agenda:
The list of subjects or problems to which government
officials and people outside of government closely
associated with those officials, are paying some
serious attention at any given time
Kingdon, 1984
70. 70
Setting the Policy Agenda
The Hall Model
Use three concepts
Legitimacy
Feasibility
Support
When an issue become high in all
these three concepts, it become a
policy agenda
71. 71
The Hall Model
Legitimacy
Issues with which the government feel that they
should be concerned and have right to
intervene
Feasibility
Refer to potential to implement the policy
Looks at capacity to ensure implementation
E.g. Technical and theoretical knowledge, financial
resources, skilled personnel, adequate administrative
structure
Support
Refers to public support or trust in government
Support from interest group is important
72. 72
Setting the Policy Agenda
The Kingdon Model
Three streams approach
Problem Stream
Politics Stream
Policies Stream
73. 73
Setting the Policy Agenda
The Kingdon Model
Problem Stream
Some issues occupy attention of
government when they are recognised as
problem
Officials learn about the problems through
health statistics or media reports e.g: on
outbreaks of diseases
74. 74
The Kingdon Model
Politics Stream
Visible and hidden participants - highlight the
issues to government
Visible Participants
Highlight specific agenda and use mass-media to
get attention of policy makers
E.g: Politicians inside and outside the government
& Interest groups
Hidden Participants
Work on proposing alternatives to solving
problems that get into policy agenda
Work less on getting issues into agenda
E.g. Academicians, researchers, consultants
75. 75
The Kingdon Model
Policies Stream
Select issues from politics and
problem stream to become public
policy
Policy makers use a number of
different criteria:
Technical feasibility
Congruence with existing values
Anticipation of future constrains e.g.
financial limitations
Public and politicians acceptability
76. 76
Setting the Policy Agenda
The Kingdon Model
Issues float around in these three
streams
Issues will be taken up by government
usually when these three streams
combined
