ENVIRONMENTAL &

OCCUPATIONAL HEALTH
MSCPH
MARY MBOOWA, mmboowa@ihsu.ac.ug ; 0701846989
 COURSE OBJECTIVES
1. Understand the principles and concepts of environment health and occupational
health
2. Describe the difference categories of both environmental health and occupational
health and safety hazards, their sources and effects on human health
3. Understand the basic relationship between environmental factors and health and the
interrelationship between economic development and health
4. Appreciate the importance of occupational health and safety
5. Acquire adequate knowledge of diseases related to the general environment and
the working environment
6. Define and understand risk assessment methodologies and management
7. Describe the national regulatory programs, guidelines and statutory bodies that are
responsible for controlling environmental health and occupational health
programmes
8. Responding and management of environment health threats and emergencies
 COURSE OUT LINE
1. Introduction to Environmental health; concepts, definitions

2. Over view of environmental health hazards

3. Introduction to occupational health and safety

4. Vectors and Vector born diseases

5. Waste management

6. Air pollution

7. Water and sanitation

8. Food and safety

9. Chemical safety

10. Industrial Pollution

11. The urban environment and health

12. Energy use and sustainable development

13. Policies and laws relevant to environmental health and OSH

14. Environmental impact assessment

15. Disasters

16. Global climate change and human health

17. HIV/AIDS and the workplace

18. Child labour

19. Accident prevention and investigations

20. Women and the work place

21. Health Promotion at work

22. Work place Inspection

23. Occupational Health surveillance

24. Protective and preventive measures at work

25. People with disabilities and work

26. Occupational Health in specific economic/ service sectors

 MODE OF DELIVERY

1. Lectures

2. Group discussions

3. Presentation of students

4. Interactive class presentations

5. Field visit (If funds are available)

6. Self directed reading

 SUGGESTED READING
The reading list shall include but will not be limited to;
• Principles of Environmental Health and safety management by West
Gordon(1995)
• A community guide to Environmental health by Jeff Conant & Pam Fadem
• Uganda Ministry of Health; National Environmental health policy, July 2005
• Hand book of Environmental Health and safety; Principles and practices, second
edition, volume 1 by Herm Koren (1991)
• Nadavukaren Anne(2006), Our Global Environment: A health perspective, 6th edition
• Nadavukaren Anne(2006), Study guide to accompany our Global Environment: A
health perspective, 6th edition
• Basic Environmental Health(UNEPI 2001) by Annalee Yassi, Tord Kjellstrom, Theo de Kok,
Tee L.Guidotti
• Environment, Health and sustainable Development (2006), Megan Landon

• Fundamental Principles of occupational Health and safety, Benjamin O. Alli

(International Labour organisation)

• Uganda National Occupation Health and safety Act,(2006)

• Uganda National Child Labour Policy

• Uganda National Environment Management statute, 1995

• The ILO code of practice on HIV/AIDS

 BASIC CONCEPTS IN
OCCUPATIONAL HEALTH

Occupational Health Unit

 AIMS & OBJECTIVES

Aim:
To be able to apply the basic principles of occupational Health to your professional practice
as PHW
Objectives:
1. Know what questions to ask in order to take an appropriate and relevant occupational
history
2. Identify factors or patterns in a patient’s history that may indicate a work related contribution
to ill health
3. Consider a work related health dilemma and reach a conclusion with reasons
4. List 3 causative agents and related work activities for occupational asthma, allergic contact
dermatitis and cancer.
5. Specify what information is necessary to make a fully informed assessment of an individual’s
medical fitness for work
 OCCUPATIONAL HEALTH
• Work Health
(occupational disease/work related ill health)

• Health Work
(medical fitness for work)
 OCCUPATIONAL HEALTH/THERAPY

Occupational Health Occupational Therapy

a branch of medicine concerned assessment & treatment to enable

with the interaction between health maximum independent function in
and work (“occupation”) daily living, using purposeful activity
(“occupation”)
 CASE 1: THE HAZARDS OF WORK
You are an occupational specialist.

A 31-year-old laboratory technician is referred to your clinic by her manager, because of alleged
lateness and poor performance at work. You are asked to assess whether there is an underlying medical
cause for this.

She tells you that she has not been sleeping well lately, possibly due to nocturnal coughing. She says the
lab is cold and drafty, and that by the end of the working day her right arm is aching. She says that
when she told her manager, he was unsympathetic; telling her she should leave if she doesn’t like the
job.

1. What are the presenting medical problems?

2. What are the possible work-related causes of her symptoms?
3. What are the potential hazards in her workplace and how might you classify them?
4. How will you respond to the manager’s questions?
 CLASSIFICATION OF WORK
HAZARDS
• Physical
• Mechanical
• Chemical
• Biological
• Psychosocial
 HAZARD AND RISK

• Hazard: potentially harmful

• Risk: probability of harm

(quantifiable as risk assessment)
 PRINCIPLES OF CONTROL OF
WORKPLACE HAZARDS
• Identify

• Evaluate

• Control
• Eliminate

• Substitute

• Enclose/separate

• PPE/vaccinate
 CASE 2: IS IT WORK-RELATED?
• A 58-year-old hospital porter has been off sick for almost a year, with low back pain. He says he
injured his back at work. His back pain has not improved with physiotherapy and analgesia. He has
difficulty walking up and down stairs and is breathless on exertion. His occupational history is as
follows:

• Left school at 15
• Had numerous labouring jobs in the construction industry for 20 years or so
• Worked on a tunnelling project for 18 months
• Worked as a lorry driver for a brewery for 8 years
• Worked as a hospital domestic assistant for 2 years
• Has been employed as a hospital porter for 11 years

1
1. What occupational hazards might account for his breathlessness?

2. How would you assess whether his symptoms are work related or not?

3. What are the possible causes of his back pain?

4. What advice would you give him?

5. Is he likely to be return to work?

6. What work might he be able to do?

 PRESENTATION OF OCCUPATIONAL
DISEASE
• Pathology

• Timing of symptoms

• Possible causes

• Elicit relevant history

 THE OCCUPATIONAL HISTORY
1. What is your job? What do you do for a living?
2. What do you do at work? What do you work with?
What is a typical working day?
3. How long? What else?
4. Any known hazards? Anyone else with similar
symptoms?
5. Hobbies? (DIY, pets, gardening, chemicals)
 OCCUPATIONAL ASTHMA
Occupational Asthma
• Asthma induced by specific substances encountered in the
work place. It may occur in individuals who would otherwise
not have developed asthma

Work-related Asthma
• Asthma which relates to substances in the work place (resp
irritants) that exacerbate asthma in people with pre-existing
asthma
 CAUSES OF OCCUPATIONAL ASTHMA

• Isocyanates • Grain / Flour (barley, oats,

wheat, maize)
• Platinum salts
• Caster bean dust
• Proteolytic enzymes
• Laboratory animals
• Wood dusts
• Antibiotics
• Glutaraldehyde
• Latex
• Soya bean
• Soldering flux (colophony)
• Per sulphates or henna
• Ispaghula
• Crustaceans or fish products
• Tea dust
 DOSE RESPONSE RELATIONSHIP
risk

exposure

KOH 2006
UK detergent factory: incidence of occupational asthma vs enzyme use

% all cohort
10

0
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

incidence
UK detergent factory: incidence of occupational asthma vs enzyme use

% all cohort ktonnes enzyme

10 80

75
8
70

6 65

60
4 55

50
2
45

0 40
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

enzyme incidence
UK detergent factory: incidence and new employees

% all cohort new employees

10 200

8
150

6
100
4

50
2

0 0
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

new employees incidence

UK detergent factory: incidence among new employees vs enzyme use

ktonnes
% new employees enzyme
40 80

35 75

30 70

25 65

20 60

15 55

10 50

5 45

0 40
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

enzyme (ktonnes) incidence (new)

 INVESTIGATION OF A CASE OF SUSPECTED
OCCUPATIONAL ASTHMA
History
• Symptoms
• Associated symptoms
• Duration
• Work history
• Is patient aware of exposure to any respiratory sensitizers at work?
• Timing of symptoms (immediate /delayed)
• Improvement away from work
• Adult onset
• Smoking history
• History of atopy
 INVESTIGATION OF A CASE OF
SUSPECTED OCCUPATIONAL ASTHMA
Clinical investigations

• 2hrly PEFR

• Skin prick test

• RAST / ELISA

• Spirometry

• Bronchial challenge
 MANAGEMENT
1. Drug treatment
• as for non-occupational asthma
2. Non-drug treatment
• Remove from exposure
• Review work place
• Is prevention possible?
• Are control measures adequate?
• Compliance with (COSHH) regulations?

3. Health surveillance
 UK Supermarket bakeries

What happens when a supermarket opens?

X X X
surveillance no surveillance

No cases of
Increased incidence of
occupational asthma
occupational asthma
 OCCUPATIONAL DERMATITIS
• Endogenous (constitutional)

• Exogenous (contact)
• Irritant (acute/chronic)

• Allergic (immediate/delayed)
 OCCUPATIONAL DERMATITIS

Allergic Irritant

• Latency • usually involves the hands

• Lag period • Scaling and redness

• Eye lid swelling • Papules and vesicles are unusual

• Papules and vesicles • Exposure to a known irritant

• Exposure to a known sensitizer

 CAUSES OF OCCUPATIONAL
DERMATITIS
Irritant Allergic

• Latex
• “Wet work”
• Biocides/preservatives (e.g.
• Soap
formaldehyde)
• detergents • Chrome salts
• vegetable juices/fruit • Plant allergens (e.g. onion, garlic, spices)

• fish/meat • Epoxy resin monomers

• dough • Hairdressing chemicals

 HISTORY

• Duration

• Site

• Work history

• Exposure to known allergens/irritants

• Improvement away from work

• Treatment
 MANAGEMENT

• Avoid exposure

• Allergen/irritant replacement

• Skin protection

• Change job

• Drug treatment
 OCCUPATIONAL CANCER

Target Organ Carcinogen

• Asbestos, As, Be, Cd, Cr(VI), Ni, Fe,
• Lung BCME
• Nasal sinuses • Ni

• Urothelial tract • Rubber, Dyes, Al, Tar/pitch

• VCM
• Liver(angiosarcoma)
 INDUSTRIAL INJURIES DISABLEMENT
BENEFIT

• Prescribed diseases (IIAC)

• relevant disease

• relevant occupation

• Administered by DWP
 CASE 3: ASSESSING FITNESS FOR WORK
You are an occupational specialist.

A 29-year old HIV positive doctor has been offered a post on an

anaesthesia rotation.

1. Is it relevant to know how HIV was acquired?

2. How will you assess whether s/he is medically fit for the job?

3. What information will you need, to make a fully informed

assessment?
 FITNESS FOR WORK

•Job

•Relevant medical history

•Risks (self, colleagues, employer, public)

A MODEL FRAMEWORK FOR ASSESSMENT OF MEDICAL
FITNESS FOR WORK

Person
Relevant medical history
Functional capacity
(physical/psychological)

Fitness for
Risks
Employee
Work
Job
Employer
Demands/requirements
Colleagues
Safety critical work
3rd parties
Hours, travel etc
(customers/service
users/public)