Introducing Introducing occupational healthoccupational health

Grant McMillanGrant McMillan

Hon Senior Clinical LecturerHon 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

Learning PointsLearning Points

• Scope of occupational healthScope of occupational health• Interactions between work and healthInteractions between work and health• Extent of work-related ill health and deaths in GBExtent of work-related ill health and deaths in GB• Basic tasks of an occupational health serviceBasic tasks of an occupational health service• Concept of hazard and riskConcept of hazard and risk• Hazards of some specific occupationsHazards of some specific occupations• Matching people to jobs & jobs to people• Assisting return to work of sick and injured• Keeping patients at work during treatmentKeeping patients at work during treatment• Promoting health at workPromoting health at work

Additional handouts on taking and using an occupational Additional handouts on taking and using an occupational history history

What is Occupational Health ?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

Why botherWhy 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

Interactions between work and health Interactions between work and health

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

Interactions between work and healthInteractions between work and health

• Work can improve health

• Work can harm health

• Health can adversely effect work.

Interactions between work and healthInteractions between work and health

• Work can improve health

• Work can harm health

• Health can adversely effect work.

““Is your patient fit for work?”Is your patient fit for work?”

Extent and effects of work-related ill-healthExtent 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

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

specialist doctorsspecialist doctors

• Musculoskeletal disorders

• Mental ill health

• Skin diseases

• Respiratory diseases incl asthma

• Infections

Extent and effects of work-related ill-healthExtent and effects of work-related ill-health

• 39 million working days lost

• Cost of £10 billion

• Plus deaths

Work-related deathsWork-related deaths

• 235 fatal injuries at work in 2003/04235 fatal injuries at work in 2003/04

• Estimated 6000 cancer deathsEstimated 6000 cancer deaths related to workrelated to work

• Latency of effects – as in mesotheliomaLatency of effects – as in mesothelioma

Latency of work-related diseasesLatency of work-related diseases

Asbestos exposure causally linked to mesotheliomaAsbestos exposure causally linked to mesothelioma

Latency of work-related diseasesLatency of work-related diseases

• Occupational exposure to asbestos started to Occupational exposure to asbestos started to cease in late 1960s ub UKcease in late 1960s ub UK

• UK Mesothelioma deaths still rising because of UK Mesothelioma deaths still rising because of latency of effect. 1968 = 153 2002 = 1862latency of effect. 1968 = 153 2002 = 1862

• Mesothelioma death rates in males under 45 now Mesothelioma death rates in males under 45 now steadily decreasing. Why?steadily decreasing. Why?

Basic tasksBasic tasks of an Occupational Health Serviceof 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

Risk assessment and managementRisk assessment and management

• Identify hazards

• Assess risks to health in the circumstances

• Consider workers and general population

• Control risks to an acceptable level

HazardHazard

Any exposure that might cause harmAny exposure that might cause harm

RiskRisk

The chance of that harm occurringThe chance of that harm occurringin given circumstancesin given circumstances

Classes of hazardsClasses of hazards

Chemical

Physical

Mechanical and ergonomic

Biological

Psycho-social/organisational

Where can exposure to a hazard occur?Where can exposure to a hazard occur?

Confined within workplace

Vented from workplace

Carried from workplace

Domestic

Leisure

Chemical exposures at workChemical exposures at work

Hairdressers Farmers

Cleaners

Builders

Healthcare workers

Physical exposures at workPhysical exposures at work

Heat welders, soldiers, ex-pats

Cold fishermen, storemen

Noise airport workers, road repairs

Vibration construction workers

Radiation radiographers, welders

Lifting nurses

What hazards a medical What hazards a medical student might meet at work ?student might meet at work ?

Sources of hazards Sources of hazards patients, patients, investigations,investigations,

therapeutic therapeutic agentsagents

environmentenvironment Most important include infectious agentsMost important include infectious agents

anaesthetic agentsanaesthetic agentsantineoplastic drugsantineoplastic drugsionising radiationionising radiationviolenceviolence

Matching jobs and peopleMatching jobs and people

• People: health, fitness/disability, susceptibilitiesPeople: health, fitness/disability, susceptibilities

: use evidence-based fitness standards : use evidence-based fitness standards

• Jobs: Ergonomics + minimising risksJobs: Ergonomics + minimising risks

• Psychosocial: work organisationPsychosocial: work organisation

: work-life balance: work-life balance• Common senseCommon sense

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

• Are there patient factors which might Are there patient factors which might impede remaining or returning?impede remaining or returning?

• Do you have a meaningful measurement Do you have a meaningful measurement of performance?of performance?

• Work factors?Work factors?

• What useful interventions may be made?What useful interventions may be made?

• Can you utilise occupational health staff?Can you utilise occupational health staff?

• WhatWhat work does the patient do?work does the patient do?

Help workers to be fitHelp workers to be fit

• Improve self-perception of health and fitness

• Encourage leisure exercise

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

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

Learning Points CheckLearning Points Check

• Scope of occupational healthScope of occupational health• Interactions between work and healthInteractions between work and health• Extent of work-related ill health and deaths in GBExtent of work-related ill health and deaths in GB• Basic tasks of an occupational health serviceBasic tasks of an occupational health service• Concept of hazard and riskConcept of hazard and risk• Hazards of some specific occupationsHazards of some specific occupations• Matching people to jobs & jobs to people• Assisting return to work of sick and injured• Keeping patients at work during treatmentKeeping patients at work during treatment• Promoting health at workPromoting health at work

Additional handouts on taking and using an occupational Additional handouts on taking and using an occupational history history