An Introduction to Work and Health Chapter 1 Lutgart Braeckman, MD, PhD, UGent, Belgium Version 3/8/2012

Module Aims To increase awareness and To provide a practical understanding of work and health related issues To inform and enthuse students about the field of occupational medicine and health

Learning Objectives At the end of chapter 1 students will be able to : Explain the two-ways relationship of work and health Understand the socio-economic impact of (un)employment Recognize the range of health hazards encountered in the workplace Understand the value and the role of occupational health services and physicians Find reliable sources on work and health related issues

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, controlling risks and the adaptation of work to people, and people to their jobs. (ILO/WHO 1950)

Importance of Occupational Health The ILO estimates that each year 2.3 million persons die from work-related accidents and diseases including 360.000 fatal accidents and an estimated 1.95 million fatal work-related diseases. In economic terms, roughly 4% of the annual GDP is siphoned off by direct and indirect costs of occupational accident and diseases. (FACTS ILO 2009)

Importance of Occupational Health Most adults spend a third of their lives at work Multitude of health hazards at work Chemical agents Liquids, gases, dusts,… Physical agents Noise, vibration, radiation,… Biological agents Bacteria, viruses,… Ergonomic factors Lifting, repetitive motion,… Psychosocial factors Stress, shift work,…

Hazards and risks A B A = Hazard : anything that can cause harm B = Risk : the chance, high or low, that somebody will be harmed by the hazard

Deaths attributed to 19 leading factors, by country income level, WHO 2004

Percentage of disability-adjusted life years (DALYs) attributed to 19 leading risk factors, by country income level, WHO 2004

Ranking of selected risk factors: 10 leading risk factor causes of death in high-income countries*, 2004 DEATHs (millions) * Countries grouped by gross national income per capita – low income (US$ 825 or less), high income (US$ 10.066 or more)

Ranking of selected risk factors: 10 leading risk factor causes of DALYs by income group*, 2004 DALYs (millions)

History of occupational medicine Occupational medicine was founded by the Italian physician Bernardino Ramazzini (1633-1714). His De Morbis Artificium (On Artificially Caused Diseases) published in 1700 was the first systematic study of occupational diseases. When taking a patient’s history, he added the question “what is your occupation?”

EU Safety and Health at Work law Directive 89/391/EEC Each member country decides precisely how they implement the directive.

Multiple key actors Government - Legislation Employers Workers and their representatives - Trade unions Occupational health services A multidisciplinary approach: safety, health, industrial hygiene, ergonomics, health promotion, psychosocial aspects,… And YOU!

and other disciplines Psychologist Hygienist Engineer Worker Doctor Nurse

Role and tasks of OHS and the occupational physician Identification, assessment and control of the risks from health hazards at work Providing training and education Surveillance of workers' health in relation to work Contributing to occupational rehabilitation Organising first aid

European labour market In 2010, the EU-27 labour force counted 235 million people Employment by economic activity, %

EWCS survey 2010

EWCS survey 2010

Changing world of work Europe’s workforce is: ageing becoming more female employing an increasing proportion of migrant workers, both legal and undeclared using more temporary and part-time workers making increasing use of new technology. (Fifth European Work Conditions Survey – EWCS 2010)

Two-ways relationship The effect of work on health Work as a causative factor Work as an aggravating factor Work as a contributory factor The effect of health on work Incapacity and disability

Two-ways relationship Effect of work on health a) Negative : accidents, occupational diseases, work-related diseases, absenteeism, effects on family and offspring b) Positive : Self-esteem, income, learning, meet new people and make friends

Two-ways relationship Effect of health on work a) Negative : incapacity and disability b) Positive : high quality, increased productivity

Workload models - balance INDIVIDUAL CAPACITIES SHIFTHOURS TYPE OF WORK ENVIRONMENT … SEX AGE LIFE STYLE EXISTING DISEASES HERITABILITY, ….

Accidents at work An accident at work is defined as “a discrete occurence in the course of work which leads to physical or mental harm.”

Accidents at work According to the Labour Force Survey 6.9 million persons in the EU27 (15-64 years) had one or more accidents the past year (2007) Every year 5.580 people die in the European Union as a consequence of work-related accidents, according to EUROSTAT figures

Accidents at work (EUROSTAT )

Occupational diseases Besides that, the International Labour Organisation estimates that an additional 159.500 workers in the EU die every year from occupational diseases. These are “conditions for which occupational exposure is the sole or the major cause”, for example: mesothelioma from exposure to asbestos.

Occupational diseases

Iceberg Metaphor Cases of illness correctly diagnosed by clinicians in the community often represent only the “tip of the iceberg.” Many additional cases may be too early to diagnose or may remain asymptomatic.

The “iceberg” of Occupational Diseases Reported Not Reported Recognized as Being Related to Work Medical Attention Received, But Relationship of Illness to Work Not Recognized Symptoms, But No Medical Attention Sought Affected, But No Symptoms

Absenteeism According to the Labour Force Survey (2007): 5 million persons in the EU27 sick for at least one day due to an accident 1.5 million of them prolonged sick (one month or more) 12.5 million were sick for at least one day due to work-related diseases

Future Action Plan General physicians and medical specialists are usually the first point of health care contact for many employees All physicians and nurses should consider the work factor and pay attention to the effects of work on health and vice-versa Key questions : WARP Key screening questions for occupational history taking

Key Questions : WARP   Work : could the work of the patient be (part of) the cause or the aggravation of his/her complaint or disease? Activities : could the complaint / disease of the patient have consequences for his/her activities and participation in work Referral : should I refer my patient to an occupational physician or another specialist Prevention : Can I do something to prevent the (return of the) complaint or disease?

Key Screening Questions What type of work do you do? Do you think your health problems might be related to your work? Are your symptoms different at work and at home? Are you currently or in the past exposed to noise, chemicals, dusts, metals, radiation, shiftwork, …? Are any of your co-workers experiencing similar symptoms? Is there an occupational health doctor or nurse at your workplace who I could speak to?

Key organisations http://www.who.int/en http://www.ilo.org/global/lang--en/index.htm http://osha.europa.eu/en http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home