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Occupational epidemiology final
- 1. OCCUPATIONAL EPIDEMIOLOGY BY - DR. MICHI MONYA DR. YASMEEN CHAUDHARI
- 2. CONTENTS • INTRODUCTION • SITUATIONAL ANALYSIS • WHAT IS OCCUPATIONAL EPIDEMIOLOGY? • WHY ? • HOW ? • WHEN ? • WHERE ? • WHO ? • CHALLENGES • CONCLUSION
- 3. INTRODUCTION Bernardino Ramazzini father of occupational health Wrote a book “De Morbis Artificum Diatriba” (1700) Said “an ounce of prevention is worth a pound of cure” S.S Bangalee Indian father of occupational health The 1st Factories Act 1881
- 4. SITUATIONAL ANALYSIS • According to the latest ILO estimates for the year 2015 there are 2.34 million work-related deaths per year • WHO estimates that there are only 10-15% of workers who have access to a basic standard of occupational health services • Estimated job-related deaths caused by disease are 60,300 • Workplace fatalities, injuries and illnesses remain at unacceptably high levels and involve an enormous and unnecessary health burden, suffering, and economic loss amounting to 4–5% of GDP http://www.ilo.org/global/statistics-and-databases/lang--en/index.htm
- 5. INDIAN SCENARIO • There are 487 million workers in India out of which over 94% involved in un- incorporated, un-organized enterprises • Annual incidence of occupational diseases in India is 9,24,700 • Non fatal injuries are 17% of that of the world & Fatal injuries are 45% of that of the world • Occupational deaths incidence in India is 19,02,300 annually http://www.ijph.in/article.asp?issn=0019-557X;year=2017;volume=61;issue=3;spage=153;epage=154;aulast=Raghav http://www.ilo.org/global/statistics-and-databases/lang--en/index.htm
- 6. http://www.ies.gov.in/pdfs/CII%20EM-october-2014.pdf FORMAL-INFORMAL EMPLOYMENT IN ORGANISED-UNORGANISED SECTORS (IN MILLION)
- 8. INDIAN SCENARIO • There are 487 million workers in India out of which over 94% involved in un- incorporated, un-organized enterprises • Annual incidence of occupational diseases in India is 9,24,700 • Non fatal injuries are 17% of that of the world & Fatal injuries are 45% of that of the world • Occupational deaths incidence in India is 19,02,300 annually http://www.ijph.in/article.asp?issn=0019-557X;year=2017;volume=61;issue=3;spage=153;epage=154;aulast=Raghav http://www.ilo.org/global/statistics-and-databases/lang--en/index.htm
- 9. WHAT ? EPIDEMIOLOGY: The study of distribution & determinants of health-related states or events in specified populations, & the application of this study to the control of health problems OCCUPATIONAL EPIDEMIOLOGY: According to Encyclopedia of Occupational Health & Safety - “The study of the effects of workplace exposures on the frequency and distribution of diseases and injuries in the population” is Occupational Epidemiology
- 10. OCCUPATIONAL HEALTH: The Joint International Labor Organization committee on occupational health, 1950 defined occupational health as - “The highest degree of physical, mental and social well-being of workers in all occupations” EXPOSURE: “In epidemiology exposure denotes any of a subject’s Attributes or any agent with which he or she may come into contact that may be relevant to his or her health”
- 11. WHY ? • According to international labor organization (ILO) estimates, out of 2.34 million occupational fatalities every year, only 3,21,000 are due to accidents. The remaining 2.02 million deaths are caused by various types of work-related diseases, which correspond to a daily average of more than 5500 deaths • Occupational accidents and diseases can have a major impact on the productivity, competitiveness, and reputation of individual enterprises, as well as on the livelihoods of individuals and their families http://www.ilo.org/global/statistics-and-databases/lang--en/index.htm
- 12. WHY IN INDIA ? • Rapid industrialization and use of modern technologies • Most work-related deaths and nonfatal occupational accidents occur in low- and middle-income countries in south-east Asia and the western pacific region. These countries possess most of the world's working population, and additionally, the proportion of workers occupied in risky jobs is also higher • According to ILO, the great majority of workplace accidents and diseases are preventable, and prevention is the key to tackle the growing number of work-related diseases
- 13. • It is now more than 300 years since Bernardino Ramazzani, the father of occupational medicine (OM), advised the doctors to ask, “what your occupation is?” to their patients, however, nowadays occupational history is just followed as the ritual by the person sitting at the reception Date of Web Publication 15-Sep-2017 Strengthening occupational medicine to address challenges of occupational diseases: A priority Pankaja Raghav Professor and Head, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
- 14. When ? • Investigate and assess hazards and give expert assistance for eliminating them • Estimate employees’ working ability and monitor their health condition • Maintaining working ability, working environment and working community, in this way affecting productivity • Prevent premature incapacity for work, reduce pension costs • Reduce absenteeism due to sickness
- 15. HOW ?
- 16. DESCRIPTIVE OCCUPATIONAL EPIDEMIOLOGY • To elucidate etiology of diseases • Identify hazards • Formulation of principles for the effective prevention & control of these diseases & hazards • 2 approaches- a) Description b) Comparison
- 17. • Percivall Pott 1775 Cancer Occupation Cancer of the scrotum Chimney-sweepers a description of the disease • CHIMNEY SWEEP'S CANCER, also called SOOT WART, is A Squamous cell carcinoma of the skin of the Scrotum
- 19. CASE REPORT
- 20. CASE REPORT
- 21. CROSS-SECTIONAL STUDY • Find prevalence of disease in the population
- 22. CROSS SECTIONAL
- 24. COHORT STUDIES • A cohort study encompasses research participants sharing a common event, the exposure • Start with a defined group of people • Follow-up to date • Classify exposure • Enumerate causes of death • Standardize mortality in relation to larger population group (SMR)
- 27. CASE-CONTROL STUDY • People with the disease being studied (cases) matched with controls • Exposures estimated for each subject • Risk of disease
- 29. WHERE? • Planning health policy • Developing legislations
- 30. POLICY & LEGISLATION • OH is under 2 ministries- Health ministry : health care & health education - Ministry of labor : main responsibility of OSH • Major legal provisions for the protection of health & safety are contained in 2 acts • The Factories Act 1948 • The Mines Act 1952
- 31. NATIONAL PROGRAM FOR CONTROL AND TREATMENT OF OCCUPATIONAL DISEASES • Ministry of health & family welfare, govt. of India launched a scheme entitled “National Program for control & treatment of occupational diseases" in 1998-99 • The National Institute of Occupational Health (NIOH), Ahmedabad (ICMR) is the nodal agency
- 32. NATIONAL INSTITUTE OF OCCUPATIONAL HEALTH • NIOH, Ahmedabad, was established by the ICMR, New Delhi • Started functioning as “Occupational Health Research Institute" (OHRI) at the B. J. Medical college, Ahmedabad, in the year 1966. Rechristened as "national institute of occupational health" (NIOH) in 1970 • To cater local needs of the southern and eastern regions, the institute established two Regional occupational health centers (ROHC) at Bangalore (1977) and Kolkata (1980)
- 33. NATIONAL INSTITUTE OF OCCUPATIONAL HEALTH • Objectives: • To promote intensive research to evaluate environmental stresses/factors at the workplace • To promote the highest quality of occupational health through fundamental and applied research • To develop control technologies and health programmes through basic and fundamental research and to generate human resources in the field • Scientific reports • Occupational health & safety profile - India 2017 • Environment, health and safety issues in coal fired thermal power plants • Procedure of implementation of recommendation of expert committee on occupationHttp://www.Nioh.Org/publications.Html
- 34. NATIONAL POLICY ON SAFETY, HEALTH & ENVIRONMENT AT WORK PLACES • February 2009 • DGFASLI (Directorate General of Factory Advice Service & Labor Institute) Headquarter- Mumbai Office of the Chief Advisor of factories Assist ministry in formulating national policy Advices central & state Governments on administration of the Factories act Coordinates the factory inspection services in the states
- 35. NATIONAL POLICY ON SAFETY, HEALTH & ENVIRONMENT AT WORK PLACE (CONT…) • Goals: • Providing a statutory framework on occupational safety and health • Providing administrative and technical support services • Establishing and developing the research • Improving data collection system on work related injuries and diseases • Objectives: • Decrease incidence of work related injuries fatalities, disease, disaster & loss of national assets • Improve coverage • Create community awareness regarding safety, health & environment • Creation of “green jobs”
- 36. NATIONAL HEALTH POLICY 2002 • 2.24 environmental and occupational health • 2.24.2 Work conditions in several sectors of employment in the country are sub- standard. As a result, workers engaged in such employment become particularly vulnerable to occupation-linked ailments. The long-term risk of chronic morbidity is particularly marked in the case of child labour. NHP-2002 will address the risk faced by this particularly vulnerable section of society
- 37. NATIONAL HEALTH POLICY 2017 • 3. Policy thrust • 3.2 preventive and promotive health the policy articulates to institutionalize inter-sectoral coordination at national and sub-national levels, through constitution of bodies that have representation from relevant non-health ministries. This is in line with the emergent international “health in all” • The policy identifies coordinated action on seven priority areas for improving the environment for health: • Swachh Bharat Abhiyan o balanced, healthy diets and regular exercises. • Tobacco, alcohol and substance abuse • Yatri Suraksha – preventing deaths due to rail and road traffic accidents • Nirbhaya Nari –action against gender violence • reducing stress and improving safety in the work place • Reducing indoor and outdoor air pollution
- 38. NATIONAL HEALTH POLICY 2017 • Promotion of healthy living and prevention strategies from AYUSH systems and yoga at the work-place, in the schools and in the community would also be an important form of health promotion that has a special appeal and acceptability in the Indian context. • Recognizing the risks arising from physical, chemical, and other workplace hazards, the policy advocates for providing greater focus on occupational health. Work-sites and institutions would be encouraged and monitored to ensure safe health practices and accident prevention, besides providing preventive and promotive healthcare services. • 3.3.5 urban health care: • An important focus area of the urban health policy will be achieving convergence among the wider determinants of health – air pollution, better solid waste management, water quality, occupational safety, road safety, housing, vector control, and reduction of violence and urban stress.Http://164.100.158.44/showfile.Php?Lid=4275
- 39. THE FACTORIES ACT, 1948 Defines factory Worker- 1976 amendment- contract labor employed in the manufacturing process also covered under ‘worker’ Age- >14 Space- minimum of 500 cu ft for each worker Welfare- canteen- wherein >250 workers are employed Hours of work- 48 hours a week, 9 hours per day with ½ hour break Notification- notifiable diseases : byssinosis, asbestosis, occupational dermatitis and noised induced hearing loss
- 40. INTERNATIONAL LABOR ORGANIZATION • U.N. Agency, since 1919 the ILO brings together governments, employers and workers of 187 member states, to set labour standards, develop policies and devise programs promoting decent work for all • Head quarter : Geneva, Switzerland • 2 important ILO guidelines in OSH area – • Safety in the use of asbestos 1986 • Safety in the use of chemicals at work 1990
- 41. NATIONAL INSTITUTE OF OCCUPATIONAL SAFETY & HEALTH - Washington DC • NIOSH has developed a priority list of 10 leading work-related illnesses and injuries • Three criteria to develop the list: A) the frequency of occurrence of the illness or injury B) its severity in individual cases C) its potential for prevention • On the list – Occupational lung disease Occupational cancer Cardio-vascular diseases Disorder of reproduction Neurotoxicity Noise induced hearing loss Dermatological conditions Psychological disorders
- 42. WHO? Role of epidemiologists in occupational health – 1. Research as an aid to decision making 2. Epidemiology & planning I. Goal setting II. Planning 3. Implementation
- 43. MAN POWER OF INDIA
- 44. • 21 Institutes – capacity for training 460 specialist (this no. Is inadequate considering the population of India’s working class) • There are around 1000 qualified occupational health professionals in India and only around 100 qualified hygienists • The current estimated need for occupation health specialists in the country is much higher and there is a significant gap in the demand and supply of this specialist service • A wider dissemination of the principles of occupational health into the routine curriculum could help create a strong background in the doctors for this fieldhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862446/
- 45. OCCUPATIONAL SURVEILLANCE • The joint ILO/WHO committee on occupational health at its 12th session in 1995 defined an occupational health surveillance system as “a system which includes a functional capacity for data collection, analysis and dissemination linked to occupational health programmes” • Worker health surveillance- • Tracking diseases, injuries and workplace exposures for further study • Identifying new and emerging problems in the workplace • Providing evidence used to direct intervention and prevention activities • Monitoring the overall impact of occupational health research
- 46. • AIM : Not only to carry out tests, questionnaires or examinations, but to interpret these results and take action to eliminate or control further risk where necessary. Also to evaluate efficacy of control measures • Two broad groups of surveillance—health surveillance and hazard surveillance • Health surveillance Periodic clinical and/or physiological assessment of individual workers The findings from health surveillance can be used to indicate the presence/absence of a significant hazard, the adequacy of control measures, individuals at increased risk, baseline medical data, benchmarks for preventive action, and opportunities to provide health education. Another function is to quantify the incidence and prevalence of occupational and work related disease
- 47. • Hazard surveillance “The process of assessing the distribution of, and the secular trends in, use and exposure levels of hazards responsible for disease and injury” • Periodic national occupational exposure surveys are done • Recording of hazardous occurrences in specific occupational groups, such as needlestick or sharps injuries among health care workers
- 48. NATIONAL SAFETY COUNCIL, 1966 • Ministry of labor • HQ – Navi Mumbai • Promote safety, health & environment at national level • Conferences, training programs, safety publications, posters, campaigns etc. • Computerized MIS service set up for data collection, retrieval & dissemination of information on HSE aspects
- 49. OCCUPATIONAL HEALTH BENEFITS IN INDIA • ESI (Employee State Insurance Scheme) • CGHS (Central Government Health Scheme)
- 50. THE EMPLOYEES STATE INSURANCE ACT, 1948 Medical benefit Sickness benefit – 91 days Maternity benefit Disablement benefit Funeral expenses Rehabilitation allowance
- 51. ESI COVERAGE
- 52. EMPLOYEES STATE INSURANCE ACT 1948 https://www.google.co.in/search?rlz=1C1NHXL_enIN767IN767&q=esi&npsic=0&rflfq=1&rlha=0&rllag=19057590,72871955,7379&tbm=lcl&ved=0ahUKEwjTmpitqZbYAhWM6Y8 KHZlhDyUQjGoIVQ&tbs=lrf:!2m1!1e3!3sIAE,lf:1,lf_ui:4&rldoc=1#rlfi=hd:;si:;mv:!1m3!1d18561538.783219222!2d79.71523068863792!3d21.261293502783026!3m2!1i946!2i468!
- 53. ESI AMENDMENT • ESI corporation has enhanced wage ceiling for the coverage of employees under the ESI act from Rs 15000/- to 21000/- per month • Benefit of ESI scheme extended to the workers deployed on the construction site located in the implemented areas under ESI scheme • Date for payment for ESI contribution is changed to 15th of the month instead of 21st • Employer 4.75% of the wages payable to employee • Employees contribute at the rate of 1.75% of the wages payable • Those earning less than 137Rs/- as daily wages are exempted from their share of contribution https://www.india.gov.in/spotlight/employees-state-insurance-scheme#tab=tab-5
- 54. CENTRAL GOVERNMENT HEALTH SCHEME, 1954 • MoHFW • Providing comprehensive medical care to the central government employees pensioners & their dependents • CGHS caters to the healthcare needs of eligible beneficiaries covering all four pillars of democratic set up in India namely legislature, judiciary, executive and press • CGHS is unique of its kind due to the large volume of beneficiary base
- 56. OCCUPATIONAL EPIDEMIOLOGY IN AN INDIAN PRIVATE CORPORATE COMPANY
- 57. QUALITY MONITORING AUDIT MOCK DRILLS DATA MANAGEMENT SYSTEM
- 58. WORKPLACE SURVEILLANCE WORK PLACE SURVEILLANCE AREA MONITORINGPERSONAL MONITORING PERIODIC HEALTH CHECK- UP PHYSICAL HAZARDS CHEMIC AL HAZARD S INDOOR AIR QUALITY
- 59. MEDICAL SURVEILLANCE • Pre employment checkups • Should be job specific • It gives baseline data of the person • Periodic medical checkup (PME) • Data should be compared with baseline data • Note any deviation, appropriate counseling for deviations • Pre retirement medical checkup • Assure fitness before retiring • Helps in post retirement claims and sues • Pre placement medical checkup • Ensure that place & job which has been assigned to employee during PEM/on job shifting is suitable to him
- 60. HIGH ALERT CHART FOR PERIODIC MEDICAL EVALUATION PARAMETERS LIMIT VALUE Systolic BP >180 Diastolic BP >120 FBS >250 PPBS >350 Hb <5.5 TLC >20,000 Platelet count <36,000 Total cholesterol >350 Triglyceride >500 Serum creatinine >2.0 SGPT >500 SGOT >500 PSA >9.5 HBA1C >8.5
- 61. DATA MANAGEMENT SYSTEM • Customer feedback • Customer satisfaction index • Partnership index • Reporting – leading & lagging indicators report • Monthly to HSE council • Quarterly/annually to HSE board • Health management system (HMS) • Robust databank • Accessibility at any location • Generate various required reports pertaining tpo medical & occupational health services
- 63. CHALLENGES • Growing population & increasing working population • Industrialization & modern machines • Large population in informal occupational sector • Occupational health is focused mainly towards factories • Under-reporting of occupational accidents and diseases is a major obstacle in raising the awareness of the need to place work safety higher in the political agenda • Occupational health surveillance is not operational in all sectors of work • Occupational health is not as firmly advocated or recognized as infant and child health or maternal health or nutrition
- 64. CONCLUSION • The world day for ‘Safety and Health at work’ - April 28 ‘Optimize the collection & use of Occupational Safety & Health data’ • As suggested by the ILO Director General Guy Ryder- • Need for prevention of occupational diseases is both obvious and urgent. It must remain a high priority for all stakeholders to make workplaces safer and healthier around the globe It is high time that we should initiate OH surveillance and generate correct data. The statistics on occupational diseases generated will attract the attention of different stakeholders and it hopefully will find a place in political agenda
- 65. THANK YOU
- 66. REFERENCES • Http://www.Ilo.Org/global/statistics-and-databases/lang--en/index.Htm (accessed on 14.12.17) • Http://onlinelibrary.Wiley.Com/doi/10.1111/j.1749-6632.1972.Tb40244.X/abstract (accessed on 16.12.17) • Http://www.Ijph.In/article.Asp?Issn=0019- (accessed on 16.12.17) 557x;year=2017;volume=61;issue=3;spage=153;epage=154;aulast=raghav (accessed on 17.12.17) • Http://www.Ilocis.Org/documents/chpt28e.Htm (accessed on 17.12.17) • Https://www.Jstage.Jst.Go.Jp/article/indhealth/50/3/50_MS1366/_pdf (accessed on 19.12.17) • Planning commission of india (2007). "Labour laws and other labour regulations" (PDF).
Editor's Notes
- & occ epi will be covered around Kiplings six honest serving laborers ie what
- Occupational hazards have long been recognized. For example, Hippocrates recommended other physicians consider patients' vocational backgrounds when diagnosing and treating disease & should also be asked: ‘What work does he do?’.” The 1st person who paid attention to occupational diseases was B. Ramazzini an Italian physician……….. In 1700 who outlined many occupational diseases in his book ““De Morbis Artificum Diatriba”” (diseases of workers)…………. This was one of the founding works of occupational medicine & played an important role in its development……. Ramazzini suggested that "it is much better to prevent than to cure, and so much easier to foresee future harm and avoid it rather than have to get rid of it after having fallen prey“………… SS. Bangaali…. Indian father of occupational health by whose agitation the 1st factories act in india was passed in 1881……
- Occupational accidents & diseases are responsible for loss of 4-5% of gdp………
- **AS PER SURVEY CARRIED OUT BY THE NATIONAL SAMPLE SURVEY ORGANISATION 2009-10…. Organised sector- 2.8 crore & unorganised sector – 43.7 crore …….. UNORGANISED SECTOR – HANDLOOM WORKER, PLANTATION, TODDI TEPER, FISHERMAN, BIDI MAKER ETC……
- ** this is a recent study carried out in july 2016 on -------- It was found that workers in informal sectors were exposed to congested workplaces, restricted work area, poor illumination, high noise levels (80–90 dB) and extreme environmental conditions of high temperatures and humidity .. & upon that Workers were not using protective devices and that aggravated their exposures. ..
- **AS PER SURVEY CARRIED OUT BY THE NATIONAL SAMPLE SURVEY ORGANISATION 2009-10…. Organised sector- 2.8 crore & unorganised sector – 43.7 crore …….. UNORGANISED SECTOR – HANDLOOM WORKER, PLANTATION, TODDI TEPER, FISHERMAN, BIDI MAKER ETC……
- Lets see what our 1st servant says……
- EXPOSURE BY Armstrong, white and saracci (1990)
- Lets see what ‘why’ says about need of occupational epidemiology……..
- The use of modern technologies has posed the workers with high rate of accidents and occupational diseases. With rapid industrialization, factories with unhealthy environment are built; workers are exposed to dangerous materials without the necessary protective measures leading to increase in overall burden of occupational diseases, especially in developing countries……. this clearly shows a need for developing Occupational Medicine with an effective occupational disease surveillance program to address various issues related to occupations.
- When we use occu. Epid or when it is required?…….
- Lets see how we study the distribution & determinants of occupational diseases…..
- A historical example of descriptive epidemiology in occupational disease…… Percivall Pott- English surgeon, one of the founders of orthopedy was 1st to report the possible relation between Cancer and Occupation…... His observations on cancer of the scrotum among chimney-sweeper began with a description of the disease …….. It has the distinction of being the first reported form of occupational cancer……
- One more descriptive study was published on “OCCUPATIONAL EXPOSURE TO HIV IN HEALTH CARE PROVIDERS” which was a retrospective analysis………. In that 103 healthcare providers reported an occupational exposure to blood & body fluids…… & the reason was found to be failure to follow universal precautions…….
- This is a case report of occupation related chromium toxicity which lead to renal failure & rhabdomyolysis…….. generally chronic exposure chromium toxicity causes sinusitis, nasal septum perforation, allergic and irritant dermatitis, skin ulcers, respiratory irritation, bronchitis, asthma, and lung cancer But This case report, reported a rare case of renal failure & rhabdomyolysis………..
- The another case report is on……. Most known disease caused by cotton dust is byssinosis butttt in this case report occupational bronchiolitis induced by cotton dust exposure is reported which gives us a different view……
- This is a cross-sectional study to screen for excessive sleepiness, coping practices, & post-shift sleep hygiene in night bus driver…… This study demonstrated that there is a high incidence of nocturnal sleepiness & daytime sleep disruption among night bus drivers…… They have shown the importance of need for education about shift work & alertness testing among shift workers in critical professions……..
- A cross-sectional study was performed to assess the musculoskeletal morbidities among construction workers……. They found…. The prevalence of musculoskeletal morbidity was very high among construction workers,….. So immense attention in the form of appropriate prevention measures is needed to address this public health problem effectively………..
- A classical cohort study identifies a defined group of exposed people, and then everyone is followed up and their morbidity or mortality experience is registered………
- This is a cohort study from 1979-2005 in new mexico of Uranium Millers & Miners……. Overall, mortality from all causes & all cancers was greater among underground miners & not among the non-miners working in the same mill……….
- This is a study of viscose rayon workers exposed to carbon disulphide to see the association between exposure of carbon disulphide & occurance of CHD……… Here 2 cohorts of workers were formed one cohort comprises viscose rayon workers exposed to disulphide (CS2) & other cohort consisted of workers with no such exposure……… 5 year follow up was done…….. 4% in the exposed cohort died of coronary heart disease compared to only 0.9% of control cohort……….. This justified for lowering the threshold limit of 20ppm recommended by the American conference of governmental industrial hygienists…..
- This is a case-control study of……… Cases were pt. with confirmed parkinsons disease & controls were similar in sex & age without the disease,…….. Occupational exposure to industrial chemicals was studied….. Organic solvents are identified as significant risk factors for PD……. This supported the role of occupational & environmental factors in the etiology of parkinsons disease……… Now dr. michi will lead you to meet our next honest labourer……..
- **till now we have seen what, why, how & when Now let us see WHERE- , where we apply or use the knowledge from the epidemiological studies to control the occupational diseases So, occ epidemiology is useful for --- XXX….Policy- outlines methods & principles that the govt or any entity, will use to achieve its directive. - document that outlines what a govt is going to do & what it can achieve for the society as whole Legislation – statutory law. Enacted by a legislature or the governing body.
- XX OSH- Occupational Safety & Health is implemented & monitored at state level through the directorate of industrial safety & health who employ engeneers and med staff to inspect the factories.
- XX..Occupational health was one of the components of the national health policy 1983 and national health policy 2002..XX
- ##So the objective is mainly focused aorund research as an aid to improve occupational health These are the Recent scientific reports published from the NIOH which can be accessed by this link
- *ministry of labor & employment on february 2009 devloped the National Policy on Safety, Health & Environment at work place.
- green-collared jobs are, "work in agricultural, manufacturing, research and development (R&D), administrative, and service activities which contributes to preserving or restoring environmental quality. XX(according to the United Nations Environment Program), Specifically, but not exclusively, this includes jobs that help to protect ecosystems and biodiversity; reduce energy, materials, and water consumption through high efficiency strategies; de-carbonize the economy; and minimize or altogether avoid generation of all forms of waste and pollution."
- **Occupational health also had a place in the national health policy 1983 and 2002 & also in the recent amendment of 2017 In NHP 2002 it was mentioned under the clause of Environmental & Occupational health particularly focusing on the vulnerable section ie child labor And in NHP 2017- 2.24.1 The ambient environmental conditions are a significant determinant of the health risks to which a community is exposed. Unsafe drinking water, unhygienic sanitation and air pollution significantly contribute to the burden of disease, particularly in urban settings. The initiatives in respect of these environmental factors are conventionally undertaken by the participants, whether private or public, in the other development sectors. In this backdrop, the policy initiatives, and the efficient implementation of the linked programmes in the health sector, would succeed only to the extent that they are complemented by appropriate policies and programmes in the other environment-related sectors.
- **& in NHP 2017 it found place under the policy thrust, where along with Swach Bharat Abhiyan, Tobacco, Alcohol & substance abuse and issues of air pollution among others, reducing stress & improving safety in the work place is also mentioned. Increase health expenditure by government as a percentage of GDP from the existing 1.15% to 2.5 % by 2025. Increase state sector health spending to > 8% of their budget by 2020
- **also regarding promotion of healthy living, yoga at work place, schools & in community has been noted as an important form of health promotion. # & under the clause of urban health care : occupational safety has also been mentioned as an important focus area. XX…The policy lays greater emphasis on investment and action in school health- by incorporating health education as part of the curriculum, promoting hygiene and safe health practices within the school environs and by acting as a site of primary health care.
- ** Now coming to the legislation regarding occupational health, The factories act 1948 is the Major legal provision for the protection of occupational health & safety covering Whole of india except J&K The factories act provide us the clause as to who is regarded as a worker, the minimum age of employment, sapce requirement, legislations regarding the welfare of the workers & hours of work, among many others. Notifiable disaeses under this act are – It is obligatory part of factory management to give information about work related accidents causing death or serious bodily injury XX…Factory- >10 with power , >20 without power Age- 15-18 adolescents- needs to be certified by certifying surgeons regarding fitness
- **At the global level WE HAVE THE - INTERNATIONAL LABOR ORG A U.N. agency, ESTABLISHED IN 1919 & brings together governments, employers and workers of 187 member States , with an objevtive to set labour standards, develop policies and devise programs promoting decent work for all It gives important guidelines regarding use of potentially hazardous agents in the workplace. 2 important ILO guidelines are regarding the -
- **the NIOSH - with CDC as its parent agency & its headquarters in Washington DC has developed-… This is THE LIST ACCORDING TO THE LEVEL OF PRIORITY- & we can see that occupational lung dis is the topmost priority followed by occupational cancer, cardiovascular disease & so on… xx….Silicosis, asbestosis and byssinosis are still prevalent in many parts of the world. The prevalence of Occupational Asthma varies from 10% to nearly all of the workers in certain high-risk occupations…xXX
- Research which will act as an aid in decision making – we can see that the measures which is taken to improve work safety are based on hard epidemiological data A typical Eg would be ; how a descriptive study came about to show the existence of pneumoconiosis. And how it is now a high priority disease among occupational diseases 2. Epi & planning First We have to set the goals which requires Sound epidemiological data once the goals we have to make decisions on how to attain them which requires good data management & also planning is done keeping in mind the measures of health promotion, prevention, treatment & rehabilitation s which is an inherent quality of an epidemiologist 3. for implementation of the strategies a wide spectrum of skills is required to which an epidemiologist have an important contribution XX..1. the 3 partners in the labor market are workers, management & govt. A source serving all 3 is the International Labor Office with WHO in the advisory role ; XX like case histories of accidents, engineering techniques and cost effectiveness have been the main determinants.XX
- **NOW, how much of such epidemiologists do we have?? Or how much of capacity do we have? This is a Systematic review done in dec – 2009 examining the current status of occupational health training in the country, with a focus on the variety of courses offered and the capacity for the production of trained man-power at the national level.
- **So there are 21 institutes providing courses in occupational health in the country with a capacity for training 460 speacialist XX…Courses provided industrial health, occupational health, occupational and environmental medicine, occupational safety and health, ergonomics, industrial safety, and environmental management,……… Medical graduates are eligible for a Certificate course in Industrial health, conducted by the Regional Labor Institutes. The basic requirement is the possession of a M.B.B.S. degree, recognized by the Medical Council…… There no definitive data on the exact number of doctors working in occupational health services on a full time/part time status or the level of qualification/training, is available for India, this number is expected to be low………
- **This concept is relatively new to occupational health and is frequently confused with medical screening. Like occ surveillance means periodic medical checkup. But occupational surveillance is not only medical screening but a continuous scrutiny of safety, health & environment as well Occ surv helps us in….. XX..(It involves watching out for early signs of work-related ill health in employees exposed to certain health risks
- Like Pre-placement examinations followed by the periodic examinations This helps us to quantify------
- For this periodic …….. XX..While the focus of the former is health of a person of group of workers, the latter type of surveillance pertains to the hazards at the workplace.
- **we have the National Safety Council under the MoL with its HQ in Navi Mumbai to promote…. They also have a computerised Management Info System XX…..IHSE, Dubai- organization providing health & safety training, consultancy & advisory services training rooms, workshops…XX
- Now looking at the occupational health benefits provided in India – ESI & CGHS are the schemes providing healthcare coverages to the Government employees in India
- **applies to factories and other establishment's viz. Road Transport, Hotels, Restaurants, Cinemas, Newspaper, Shops, and Educational/Medical Institutions wherein 10 or more persons are employed. & these are the benefits given under it
- ** as on 31st march 2016, ESI covers around 12.37 crores of beneficiaries
- These are the ESI hospitals across the country and mumbai There are total of 151 ESI hospitals in India and 14 hospitals & dispensories in mumbai
- ESI was last ammended in 2010. under the amendment- Reagarding the contribution -
- **CGHS – was started under the MoHFW in 1954 with the objective of providing……. Legislature – assembly with the authority to make laws Judiciary – system of courts that interprets & applies the laws in the name of the state Executive – organ exercising authority in & holding responsibility for the governance Press -
- These are the Cghs hospitals across india & mumbai CGHS is present in 27 cities in india & there are 16 CGHS wellness centers in mumbai CGHS City 1 AHMADABAD 2 ALLAHABAD 3 BENGALURU 4 BHOPAL 5 BHUBANESHWAR 6 CHANDIGARH 7 CHENNAI 8 DEHRADUN 9 DELHI & NCR 10 GUWAHATI 11 HYDERABAD 12 INDORE 13 JABALPUR 14 JAIPUR 15 JAMMU 16 KANPUR 17 KOLKATA 18 LUCKNOW 19 MEERUT 20 MUMBAI 21 NAGPUR 22 PATNA 23 PUNE 24 RANCHI 25 SHIMLA 26 SHILLONG 27 THIRUVANATHAPURAM
- ***Let us have a glance at the …..
- **We will take the eg of the Reliance Industries Limited. Quality monitoring is done by – audit Carrying out mock drills & By having an efficient data management system
- **the workplace surv is carried out under personal moni & area moni
- **In medical surveillance --
- **this is a high alert chart for PME These are the parameters & the limit values if the values are found above or below the limit value, high alert is generated & the worker is followed up till parameter comes to normal & the Records are maintained in HMIS
- **They have an effective data management system They have customer feedback They have reporting of leading & lagging indicators & they have a robust Health Management System ## so this was occupational epidemiology in a pvt company
- # is the major challenge for occupational health Rapid industrialization and use of modern machines are posing workers with high rates of accidents & occ diseaes (dev of many industries in hazardous conditions) Large population in informal sector, as we have seen 94% of the working population is engaged in informal sector Occ health is focused mainly towards factories & other sector workers have less or no focus Under reporting of occ accidents & diseases is a major obstacle. There is less data so there is less evidence and so less awareness of the need to place safe work higher in the political agenda. it is a global challenge Globally, more than half of all countries do not provide statistics for occupational diseases. Surv # as we have seen that it is robust only in the pvt sectors
- XX…As suggested by the ILO Director, in a statement issued for the World day for safety and health, “significantly reducing the incidence of occupational disease is not simple, it may not be easy, and it will not happen overnight, but progress is certainly feasible.