1. EOH3202 Occupational Health Dr. Emilia Zainal Abidin Environmental & Occupational Health Faculty of Medicine and Health Sciences University Putra of Malaysia 1

2. Basic concept of Occupational Health Roles of Professionals Competencies Knowledge areas and skills Challenges Discussion: What went wrong? 2

3. Definition 1: Occupational Health is 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) Definition 2 - Occupational Health is the maintenance and promotion of workers’ health and working capacity, improvement of working environment and work to become conducive to safety and health and the Development of work organisation and working culture – safe, healthy and enhance productivity (ILO-WHO Committee on Occupational Health 1955) 3

4. But not limited to: Occupational physicians Nurses Psychologist Industrial hygienist Epidemiologist Engineer Toxicologist Microbiologist Chemist Information technician Statistician Health promotion specialist 4

5. Hazard: A hazard is any source of potential damage, harm or adverse health effects on something or someone under certain conditions at work Risk: Risk is the chance or probability that a person will be harmed or experience an adverse health effect if exposed to a hazard. It may also apply to situations with property or equipment loss. Surveillance: ? Control measures: ? Health promotion: ? 5

6. Identify and assess the risks from health hazard in environment/workplace Protect and promote public/workers’ health Carry out surveillance of factors which may affect health Improve the conditions that might harm health through sound control measures Maintain health and achieve the highest possible standards of health in the interest of the workers Strengthen health promotion and ensure continuous improvements Develop safe and healthy culture and management 6

7. Primary prevention Risk assessment – determine whether the risk is high or low Hazard control Health promotion Secondary prevention Treatment for injuries and diseases Tertiary prevention Rehabilitation, therapy 7

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9. Adviser – individual, group, organisational Agent of change – worker, environment, process Expert – evaluation, risk assessment Counsellor Trainer Source of knowledge – disseminating relevant information Skill development resource 9

10. Identify the problems Treat or fix the problems Assess the effectiveness of the programs and interventions or in other words, to evaluate the programs 10

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12. Identification and assessment of the risks from health hazards Health risk assessment – carry out assessment on hazards that may arise from operation, e.g. machinery Advise for control methods Diagnosing ill-health related to environment or occupation Assessment by multidisciplinary team 12

13. Physical Hazards– are in the form of energy or force Chemical Hazards – Chemical hazards can appear as gasses, vapours, liquids, solids, dust, fumes, or mists which can be flammable, toxic, corrosive, reactive or explosive Biological Hazards – can cause disease and are found in living organisms Ergonomic Hazards – results from poorly designed equipment, work processes or work stations Psychosocial Hazards – affect the psychological well-being 13

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15. Pre-employment and pre-placement examination – medical check-up to obtain base line health data Periodical medical monitoring – auditory status, blood lead level, lung function Examination after illness or injury – to determine whether worker is able to work Termination examination – start work disease free, should stop work disease free 15

16. Advising of occupational health Assessing control systems designed to eliminate or reduce exposure and ensure it is working Selecting appropriate personal protective equipment – but this is the last resort 16

17. Why walk-through survey is important? To enable the visualisation of the possibility for injury to occur To enable OH professionals to observe workers in order to give effective advice 17

18. Advising on the planning and organisation of work/project Providing safe operating procedures to be used by workers for existing work system Provide information, instruction guidance and training Advising on introduction of new working systems/technique Including human factors in the process design 18

19. Participating in formulating safety, health and environment policies Policies based on ethical principles – identify who formulate the policy? Sometimes the policy formulated by management is not in line with the occupational health aspiration Public/workers fully informed of the policy and their right 19

20. Collaborating in providing information and training Dissemination of information and skill development Participating in relevant committees – MIHA, DOSH, NIOSH Evaluation of work-related diseases – lung cancer 20

21. Contributing to scientific knowledge regarding hazards to health Recognising and investigate ill-health determinants Analysing routinely collected data – statistical analysis to identify pertinent risk factors Conducting scientific investigation – collaborate with research organisations 21

22. Advising and supporting the implementation of relevant legislation Application and implementation of relevant laws and regulations – e.g. certificate of fitness is obtained for specific machinery before it is used Formulating a Health policy in the workplace Advising workers and management of their legal obligation 22

23. Participation in health promotion programs Needs analysis – based on the evidences obtained Cost-benefit analysis Seeking participation from various relevant groups Evaluating and auditing health promotion programs 23

24. Management of health and safety - ISO Policy Organising Planning and implementation Evaluation Action for improvement 24

25. Working as part of a multidisciplinary services Promoting multidisciplinary scientific work on exposure data gathering – e.g University of Manchester developed THOR (The Health and Occupation Network) and SWORD (Surveillance of Work-Related and Occupational Respiratory Disease) Planning the efficient use of multidisciplinary resources Coordinating health surveillance, environmental surveillance and other risk assessment 25

26. Medical sciences – diagnosis, treatment, risk assessment/analysis Laboratory sciences – monitoring Relevant legislation and policies Health promotion Education, training and communication skills Scientific research – epidemiology and biostatistics Genetics 26

27. Surveillance – disease, exposure and behaviour Toxicology – study of agents that produce adverse responses in the biological system with which they interact Public health ethics – human right, confidentiality, equity Risk communication – exchange of information of health risks Management – planning, effective evaluation, cost benefit analysis, capacity building 27

28. Need for focused national and international leadership Lack of disease exposure tracking, training of relevant professionals, developing strategic partnership and financial support Focus on health promotion, trained professionals, developing national performance standards and best practice and providing technical assistance Emerging threats Rapid industrialisation, globalisation, natural disasters, terrorist attacks, epidemics, under reporting of diseases Preventive approach, coordination of multidiscipline agencies 28

29. Photo: View at lower ground floor which was covered with blood 29 What improvements would you suggest as an Occupational Health professional?

30. The incident involved a machine that has been fabricated and installed in a furniture store. It has the characteristic of a hoisting machine which had resulted in a worker being crushed to death by a drum motor which had fallen down. The victim body was discovered at the lower ground of the building and covered with blood with his head smashed. From the initial investigation, it was found that the incident was due to hook installation on the cross beam structure at the top level which is used to hang the drum motor. The hook cannot withstand the load, which was being lifted. The victim was believed to have started work after the holiday. He is likely to have not received any safety training on use of the machinery, which was newly fitted in that furniture store, and it is not yet completely installed and tested properly. 30

31. What would you suggest as an Occupational Health professional What improvements would you suggest as an Occupational Health professional? 31

32. Around 8.45 am on February 24, 2012 a fatal accident occurred at Port Klang, Selangor involving a Bangladeshi employee who worked with the cleaning contractor During the accident, the victim was collecting mill scale that has spilled on the pier floor under the path of the wharf crane (capacity 20 tons), which, at the time was unloading the mill scale from vessels into the hopper on the pier (Figure 1). While the grab bucket used to transport the mill scale passing through the area where the victim was working, grab bucket had opened suddenly and cause the load carried to fall and buried the victim below (Figure 2). Victim died on the way to the hospital. 32

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