Occupational Health

and

Primary Health Care

NOTICES FOR ROUND TABLE 2: PEOPLE-CENTRED CARE

Assoc. Prof. Milan Tuček, M.D., Ph.D.

Czech Society of Occupational Medicine Charles University, First Faculty of Medicine,

Institute of Hygiene and Epidemiology Prague, Czech Republic

e-mail: milan.tucek@lf1.cuni.cz

www.pracovni.lekarstvi-cz

WHO Global Conference on Occupational Health and Primary Health Care, The Hague, Nov.29 – Dec.1, 2011

Occupational health services definition (1) Occupational medicine is a speciality of physicians. Occupational health covers a broader spectrum of different health protective and promotional services. Modern occupational health is a multidisciplinary expert area, which consists of several knowledge domains including occupational medicine (clinical medicine focusing on occupational diseases, their diagnostics, treatment and prevention), occupational health services (protection of workers against hazards at work, protection of their health and promotion of health and work ability), occupational psychology (identification, assessment and prevention of psychological and psycho-social factors at work and their prevention and control), occupational hygiene (measurement of physical, chemical, biological and other hazardous agents at the workplace, risk assessment and advice in preventive actions), ergonomics (identification, assessment and prevention of unphysiological working conditions, such as repetitive movements, their prevention and control), occupational safety including accident prevention and development of safe work environments and working practices

Occupational health services definition (2)

Occupational medicine is one of the major disciplines of

occupational health.

Complex of

- preventive medical examinations,

- workplace inspections/visits,

- consultations and recommendations

provided in the Czech Republic mainly

by medical staff, i.e. by physicians and nurses.

LEGISLATIVE FRAMEWORK (1) ILO Convention Former Czechoslovakia ratified the ILO Convention no 161 in 1988 and no 155 in 1989. Transformation of medical services Primary occupational medical/health services are a part of special health services (valid Special Health Services Act, effective since April 1,2012)

LEGISLATIVE FRAMEWORK (2) Authorized physicians General practitioners without special postgraduate training/education in

occupational medicine!!!! Occupational physicians 2009: Certified postgraduate course in OM (2 years)

after internal medicine, paediatric medicine, general medicine and hygiene and epidemiology !!!!

DISTRIBUTION AND COVERAGE (1) It is very difficult to estimate the coverage of OHSs in the Czech Republic (no precise statistics are at hand): Controls in enterprises were performed (2010), checking existence of a signed contract between an employer and an OHS provider, and provision of OHS services in the full scope as prescribed by the legislature.

2% of employers did not provide OHSs at all 33 % of employers did not provide OHS in the scope prescribed by the legislature Especially the workers in SMEs are rarely covered by OHSs because of the costs of services ensuing for the employers, the lack of providers of these services or an unfavorable geographic location of the enterprise.

DISTRIBUTION AND COVERAGE (2) Concerning the quality assurance system, the development of guidelines and standards in occupational medicine is of primary importance. The standards for preventive examinations define the minimum range and frequency of medical examinations performed by authorized occupational physicians and the kind of consultations which have to be performed in workers at a particular workplace. Instructions or Guidelines are published by the Society of Occupational Medicine. Currently, there is no specific system for quality assurance for OHS. The Czech Society of Occupational Medicine has submitted a project aimed at preparation of such a system in the field of OHS.

MAIN ORIENTATION OF OH (1) Categorization of Work Operations Public Health Protection Act No. 258/2000 Dig. and the Labor Code No. 155/2000 Dig. stipulate the obligation of employers to perform risk assessment, i.e. to identify all health hazards present at the workplace, and to estimate the level of risk (exposure assessment). According to the level of risk, all working activities are classified into four categories (category 1 is the safest) . Based on the categorization of work operations in a particular enterprise, appropriate measures for risk management have to be adopted including frequency and content of different health examinations.

Categorization of working operations 2010 (workplace health risk assessment) (Source : Czech Ministry of Health)

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The working population in the Czech Republic : about 5 million employees. Of them, about 8 % are working at high risk of various risk factors of work or working environment.

Financing structure(s) (1) At present, OHS is funded partly by Health Insurance, partly by employers and some other subjects. The funding is based on the Act on general health insurance No. 48/1997 Dig., and other associated Acts, such as No. 242/1997 Dig. The OHSs paid from the general health insurance include activities within the frame of first aid, periodical preventive examinations of workers at risk, extraordinary examinations performed for medical reasons (§11, 12, 13, 14 of the Directive of the Ministry of Health No

49/1967 Dig), follow-up examinations of workers with notified occupational diseases and check-ups of workers exposed to hazard factors with long-term or delayed effects. The pre-employment examinations, some periodical examinations (e.g. in drivers and firefighters), and extraordinary examinations performed for non-medical reasons are paid by employers/employees.

Problems of OHSs in the Czech Republic (1) The main problems in OHSs in the Czech Republic are At the national level (1): Absence of the effective cooperation between stakeholders

in the field of occupational health. Incomplete legislation (full implementation of EU Directive

89/391/EEC in the part relating to preventive and protective services is lagging).

Ineffective control of employers There are two independent bodies in the field of occupational

health and safety state inspection: (1) occupational health inspection (which belongs to the Ministry of Health) and (2) labor inspection (which belongs to the Ministry of Labor and Social Affairs).

Problems of OHSs in the Czech Republic (2) The main problems in OHSs in the Czech Republic are At the national level (2): Lack of well-educated professionals in occupational health, industrial hygiene, safety engineering, occupational health nurses, etc. Several important enactements have not yet passed, especially Act on Accident Inssurance and Occupational Health Services Act. Lack of unified concepts and practical usage of risk assessment methodology. Limited collaboration and mutual exchange of information between occupational health care providers and general practitioners or other health care specialists. Gaps in the coverage of OHSs, fragmentation of the OHSs system, and the real danger of turning OHSs into a plain commercial business (medical chain services).

Problems of OHSs in the Czech Republic (3) At the enterprise level (1): Safety and health protection at work is not incorporated into the enterprise management system. Employers’ limited knowledge of their duties in occupational health and safety Reduction of an investment in the field of occupational health and safety to the lowest possible level (and its replacement by compensation for hazardous work) Use of outdated machinery and equipment; purchase of the cheapest types of personal protective means. Pushing workers into overtime work, often requiring the staff to take time off. Stress resulting from fear of the staff of losing their job. Consultative functions of OHSs are very limited (more attention is paid to periodic medical examinations)

Problems of OHSs in the Czech Republic (4) At the enterprise level (2): The limited feedback from employees to OHSs provider how satisfied they are, and what are their actual needs and problems. If ethical problems in provision of OHS services occur, they should be dealt with in agreement with the ICOH Code of Ethics, which was adopted by the Czech Society of Occupational Medicine.

Foreseen developments and strategies aiming at development of OHS (1) Modification of the system of social insurance, health insurance and health care, focusing on prevention, and including health care of the working population, is needed. Further restructuring, reorientation and renovation of the national OHSs system should be encouraged, and sufficient resources should be allocated for that purpose. The awareness of policy-makers, employers and workers about the importance of occupational health as a part of socio-economic development should be increased.

POSSIBLE RECOMMENDATIONS Appropriate obligatory postgraduate training in occupational medicine of GP´s. Key knowledge of working conditions for medical aptitude/fitness assessment: Minimum: Hazard identification (risk assessment) during the workplace visits. Occupational health/medical services Directive necessity (EU) Independent financing (injury insurance ) Liberalization of services (chain of medical services) not possible without quality control!