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

2. 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

3. 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

4. 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)

5. Importance of Occupational Health
The ILO estimates that each year 2.3 million persons die from work-related accidents and diseases including 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)

6. 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,…

7. 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

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

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

10. 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$ or more)

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

12. History of occupational medicine
Occupational medicine was founded by the Italian physician Bernardino Ramazzini ( ). 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?”

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

14. 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!

15. and other disciplines Psychologist Hygienist Engineer Worker Doctor
Nurse

16. 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

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

18. EWCS survey 2010

19. EWCS survey 2010

20. 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)

21. 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

22. 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

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

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

25. 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.”

26. 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 people die in the European Union as a consequence of work-related accidents, according to EUROSTAT figures

27. Accidents at work
(EUROSTAT )

28. Occupational diseases
Besides that, the International Labour Organisation estimates that an additional 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.

29. Occupational diseases

30. 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.

31. 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

32. 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

33. 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

34. 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?

35. 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?

36. Key organisations http://www.who.int/en