1. Introducing occupational health Grant McMillan Hon 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

2. Learning Points Scope of occupational health Scope of occupational health Interactions between work and health Interactions between work and health Extent of work-related ill health and deaths in GB Extent of work-related ill health and deaths in GB Basic tasks of an occupational health service Basic tasks of an occupational health service Concept of hazard and risk Concept of hazard and risk Hazards of some specific occupations Hazards of some specific occupations Matching people to jobs & jobs to people Assisting return to work of sick and injured Keeping patients at work during treatment Keeping patients at work during treatment Promoting health at work Promoting health at work Additional handouts on taking and using an occupational history

3. 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

4. Why 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

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

6. Interactions between work and health Work can improve health Work can harm health Health can adversely effect work.

7. Interactions between work and health Work can improve health Work can harm health Health can adversely effect work. “Is your patient fit for work?”

8. Extent 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

9. Descending order of new cases of work-related illnesses seen by specialist doctors Musculoskeletal disorders Mental ill health Skin diseases Respiratory diseases incl asthma Infections

10. Extent and effects of work-related ill-health 39 million working days lost Cost of £10 billion Plus deaths

11. Work-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 work related to work Latency of effects – as in mesotheliomaLatency of effects – as in mesothelioma

12. Latency of work-related diseases Asbestos exposure causally linked to mesothelioma

13. Latency of work-related diseases Occupational exposure to asbestos started to cease in late 1960s ub UKOccupational exposure to asbestos started to cease in late 1960s ub UK UK Mesothelioma deaths still rising because of latency of effect. 1968 = 153 2002 = 1862UK Mesothelioma deaths still rising because of latency of effect. 1968 = 153 2002 = 1862 Mesothelioma death rates in males under 45 now steadily decreasing. Why?Mesothelioma death rates in males under 45 now steadily decreasing. Why?

14. Basic tasks of an Occupational Health Service of 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

15. Risk assessment and management Identify hazards Assess risks to health in the circumstances Consider workers and general population Control risks to an acceptable level

16. Hazard Any exposure that might cause harm

17. Risk The chance of that harm occurring in given circumstances

18. Classes of hazards   Chemical  Physical  Mechanical and ergonomic  Biological  Psycho-social/organisational

19. Where can exposure to a hazard occur?   Confined within workplace  Vented from workplace  Carried from workplace  Domestic  Leisure

20. Chemical exposures at work   Hairdressers  Farmers  Cleaners  Builders  Healthcare workers

21. Physical exposures at work   Heat welders, soldiers, ex-pats  Cold fishermen, storemen  Noise airport workers, road repairs  Vibration construction workers  Radiation radiographers, welders  Lifting nurses

22. What hazards a medical student might meet at work ?  Sources of hazards patients, investigations, therapeutic agents environment  Most important include infectious agents anaesthetic agents antineoplastic drugs ionising radiation violence

23. Matching jobs and people People: health, fitness/disability, susceptibilities People: health, fitness/disability, susceptibilities : use evidence-based fitness standards : use evidence-based fitness standards Jobs: Ergonomics + minimising risks Jobs: Ergonomics + minimising risks Psychosocial: work organisation Psychosocial: work organisation : work-life balance : work-life balance Common sense Common sense

24. Should you be assisting your patient to stay at or return to work? Are there patient factors which might impede remaining or returning? Are there patient factors which might impede remaining or returning? Do you have a meaningful measurement of performance? Do you have a meaningful measurement 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? What work does the patient do? What work does the patient do?

25. Help 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

26. Learning Points Check Scope of occupational health Scope of occupational health Interactions between work and health Interactions between work and health Extent of work-related ill health and deaths in GB Extent of work-related ill health and deaths in GB Basic tasks of an occupational health service Basic tasks of an occupational health service Concept of hazard and risk Concept of hazard and risk Hazards of some specific occupations Hazards of some specific occupations Matching people to jobs & jobs to people Assisting return to work of sick and injured Keeping patients at work during treatment Keeping patients at work during treatment Promoting health at work Promoting health at work Additional handouts on taking and using an occupational history