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

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