Introducing occupational health

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Introducing occupational health
Grant McMillan Hon Senior Clinical Lecturer
Institute of Occupational and Environmental
Health University of Birmingham Number 3 of a
series of lectures and tutorials for medical
undergraduates - handout
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Learning Points

• Scope of occupational health
• Interactions between work and health
• Extent of work-related ill health and deaths in
  GB
• Basic tasks of an occupational health service
• Concept of hazard and risk
• Hazards of some specific occupations
• Matching people to jobs jobs to people
• Assisting return to work of sick and injured
• Keeping patients at work during treatment
• Promoting health at work
• Additional handouts on taking and using an
  occupational history

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What is Occupational Health ?
The promotion and maintenance of the highest
degree of physical, mental and social well being
of workers in all occupations by preventing
departures from health, especially those due to
work, and promoting good health through
activities at the workplace
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Why bother?

• Have fitter, healthier workers -
• who are happy - and at work
• Return ill and injured workers sooner
• Increase productivity and profitability
• Retain trained workers longer
• Gain economic advantage
• Comply with legislation

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Interactions between work and health
To ignore the two way interactions between work
and health is to risk misdiagnosis,
mismanagement and overall failure to do your best
for your patients and society at large.
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Interactions between work and health

• Work can improve health
• Work can harm health
• Health can adversely effect work.

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Interactions between work and health

• Work can improve health
• Work can harm health
• Health can adversely effect work.
• Is your patient fit for work?

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Extent and effects of work-related ill-health

• 2.3 million people in UK believe their ill-health
  has been caused or aggravated by work
• 700,000 new cases a year
• 23,000 seen by specialist doctors

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Descending order of new cases of work-related
illnesses seen by specialist doctors

• Musculoskeletal disorders
• Mental ill health
• Skin diseases
• Respiratory diseases incl asthma
• Infections

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Extent and effects of work-related ill-health

• 39 million working days lost
• Cost of 10 billion
• Plus deaths

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Work-related deaths

• 235 fatal injuries at work in 2003/04
• Estimated 6000 cancer deaths
• related to work
• Latency of effects as in mesothelioma

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Latency of work-related diseases

• Asbestos exposure causally linked to mesothelioma

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Latency of work-related diseases

• Occupational exposure to asbestos started to
  cease in late 1960s ub UK
• UK Mesothelioma deaths still rising because of
  latency of effect. 1968 153 2002 1862
• Mesothelioma death rates in males under 45 now
  steadily decreasing. Why?

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Basic tasks of an Occupational Health Service

• Hazard identification and risk assessment
• Risk control or management
• Matching people to jobs jobs to people
• Assist return to work of sick and injured
• Promote wellbeing at work

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Risk assessment and management

• Identify hazards
• Assess risks to health in the circumstances
• Consider workers and general population
• Control risks to an acceptable level

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Hazard Any exposure that might cause harm
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Risk The chance of that harm occurring in given
circumstances
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Classes of hazards

• Chemical
• Physical
• Mechanical and ergonomic
• Biological
• Psycho-social/organisational

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Where can exposure to a hazard occur?

• Confined within workplace
• Vented from workplace
• Carried from workplace
• Domestic
• Leisure

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Chemical exposures at work

• Hairdressers
• Farmers
• Cleaners
• Builders
• Healthcare workers

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Physical exposures at work

• Heat welders, soldiers, ex-pats
• Cold fishermen, storemen
• Noise airport workers, road repairs
• Vibration construction workers
• Radiation radiographers, welders
• Lifting nurses

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What hazards a medical student might meet at work
?

• Sources of hazards patients,
  investigations, therapeuti
  c agents
• environment
• Most important include infectious agents
• anaesthetic agents
• antineoplastic drugs
• ionising radiation
• violence

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Matching jobs and people

• People health, fitness/disability,
  susceptibilities
• use evidence-based fitness
  standards
• Jobs Ergonomics minimising risks
• Psychosocial work organisation
• work-life balance
• Common sense

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Should you be assisting your patient to stay at
or return to work?

• What work does the patient do?

• Are there patient factors which might impede
  remaining or returning?
• Do you have a meaningful measurement of
  performance?

• Work factors?

• What useful interventions may be made?
• Can you utilise occupational health staff?

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• Help workers to be fit

• Promote healthy lifestyle
• smoking cessation
• diet and obesity control
• exercise
• reduce stress-causing pressures

• Improve self-perception of health and fitness

• Encourage leisure exercise

• Encourage exercise at work - stairs vs lifts,
• changing rooms and showers, gym

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Learning Points Check

• Scope of occupational health
• Interactions between work and health
• Extent of work-related ill health and deaths in
  GB
• Basic tasks of an occupational health service
• Concept of hazard and risk
• Hazards of some specific occupations
• Matching people to jobs jobs to people
• Assisting return to work of sick and injured
• Keeping patients at work during treatment
• Promoting health at work
• Additional handouts on taking and using an
  occupational history