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MAETIS ARBO. WERKEN IS GEZOND




The 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
MAETIS ARBO. WERKEN IS GEZOND




The 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
MAETIS ARBO. WERKEN IS GEZOND




Is 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
MAETIS ARBO. WERKEN IS GEZOND




   What is work?
MAETIS ARBO. WERKEN IS GEZOND




                       What is work?


Work is of two kinds: first, altering the position of matter at or
near the earth's surface relatively to other such matter; second,
telling other people to do so. The first kind is unpleasant and ill
paid; the second is pleasant and highly paid.

Bertrand Russell. In Praise of Idleness, 1932
MAETIS ARBO. WERKEN IS GEZOND



Predicted 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
MAETIS ARBO. WERKEN IS GEZOND




                        Paradigm shift! (GPA 2007)

The Labour Approach                                      The Public Health Approach

                                                             Workers’ Health
 Occupational Health
                                                                    All workers
Employees with labour contract                              Responsibility of everybody
   Employer's responsibility                                  Beyond the workplace
    Only at the workplace                                     All health determinants
Only 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
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.
MAETIS ARBO. WERKEN IS GEZOND




   Occupational Health Interventions
   environmental                       behavioural                  clinical
Worksite visits                       Health promotion          Health surveillance
Employer consultation                     Training              Treatment
Exposure elimination                                            Rehabilitation




   Exposure Change                    Behaviour change          Disease Change


                                        Worker’s Health
                                          Behaviour




Risk factor at work                                              Disease, Disability

                           Verbeek J et al., Scand J WEH 2004
MAETIS ARBO. WERKEN IS GEZOND


            Workers covered by OHS in Europe
                          (Source: Hämäläinen et al 2001, Rantanen 2002)

      %
100                                       95
                                                      90
90                                                                                           86
                            80                  80
80
                                    70
70
60     More than 80% of the workers in the world do 60 60
                                                       not have access
      50
50     to OHS. The proportion of workers50 50workplaces with access
              50
                                           and                                                          48


40     to occupational health services is diminishing. In developing
                  34
                                                               39


30     countries, where production often occurs in small and medium
          28


20     sized enterprises and frequently at home, 15
                                                  traditional tools like
10     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
MAETIS ARBO. WERKEN IS GEZOND




basic 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
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
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
MAETIS ARBO. WERKEN IS GEZOND




       Example 1
MAETIS ARBO. WERKEN IS GEZOND
MAETIS ARBO. WERKEN IS GEZOND




                      Inleiding (3)
ArboAntwoord.com
MAETIS ARBO. WERKEN IS GEZOND




Incorporating work outcomes into clinical
           practice guidelines


                            Don’t you work a
                            little too hard?
MAETIS ARBO. WERKEN IS GEZOND



 Integration of work-related aspects in practice
guidelines 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?
MAETIS ARBO. WERKEN IS GEZOND




                                            Health Condition



Function                                           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
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
MAETIS ARBO. WERKEN IS GEZOND
MAETIS ARBO. WERKEN IS GEZOND



Sometimes evidence on a more aggregated
            or general level
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
MAETIS ARBO. WERKEN IS GEZOND



OHC                                   PHC

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

  • 1. MAETIS ARBO. WERKEN IS GEZOND The 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 GEZOND The 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 GEZOND Is 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 or near the earth's surface relatively to other such matter; second, telling other people to do so. The first kind is unpleasant and ill paid; the second is pleasant and highly paid. Bertrand Russell. In Praise of Idleness, 1932
  • 6. MAETIS ARBO. WERKEN IS GEZOND Predicted 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 workers Employees with labour contract Responsibility of everybody Employer's responsibility Beyond the workplace Only at the workplace All health determinants Only 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 clinical Worksite visits Health promotion Health surveillance Employer consultation Training Treatment Exposure elimination Rehabilitation Exposure Change Behaviour change Disease Change Worker’s Health Behaviour Risk 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 90 90 86 80 80 80 70 70 60 More than 80% of the workers in the world do 60 60 not have access 50 50 to OHS. The proportion of workers50 50workplaces with access 50 and 48 40 to occupational health services is diminishing. In developing 34 39 30 countries, where production often occurs in small and medium 28 20 sized enterprises and frequently at home, 15 traditional tools like 10 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 GEZOND basic 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
  • 14. MAETIS ARBO. WERKEN IS GEZOND Example 1
  • 15. MAETIS ARBO. WERKEN IS GEZOND
  • 16. MAETIS ARBO. WERKEN IS GEZOND Inleiding (3) ArboAntwoord.com
  • 17. MAETIS ARBO. WERKEN IS GEZOND Incorporating 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 practice guidelines 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 Condition Function 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
  • 21. MAETIS ARBO. WERKEN IS GEZOND
  • 22. MAETIS ARBO. WERKEN IS GEZOND Sometimes 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
  • 24. MAETIS ARBO. WERKEN IS GEZOND OHC PHC