SCOPE OF  the goal and axioms of

OCCUPATIONAL occupational health

 the subdisciplines of occupational
LEARNING OUTCOMES health
HEALTH  disease categories related to
occupations
Preventive medicine and public health  criteria of occupational diseases
As a result of this lecture  main groups of occupational
Occupational health module diseases and difficulties of their
students should learn: identification
Dr. Balázs Ádám
associate professor  disease burden of work-related ill-
adam.balazs@sph.unideb.hu health
 categories of workplace hazards
Dr. Balázs Ádám  hierarchy of workplace preventive
module leader
measures
adam.balazs@sph.unideb.hu
 characteristics of occupational
Dr. János Sándor health activities, monitoring and
head of institute surveillance
sandor.janos@sph.unideb.hu

HISTORY OF OCCUPATIONAL HEALTH HISTORY OF OCCUPATIONAL HEALTH II

Villanovanus (1225 – 1311), Agricola (1494 – 1555)
„When thou buildest a new house, then thou shalt make a certain diseases associated with some occupations
battlement for thy roof, that thou bring not blood upon thy
Bernardino Ramazzini (1633 – 1714)
house, if any man fall from thence.” documentation of occupational diseases
Holy Bible, The Fifth Book of Moses, 22:8 description of pneumoconioses
observation of corrosive chemicals, dusts and metals
Hippocrates (460 – 377 B.C.) Edwin Chadwick
nutritional, environmental and ”The sanitary condition of the Labouring population in
occupational causes of diseases Great Britain”, 1842
Thomas Morison Legge
First Medical Inspector of Factories and Workshops in
the UK, 1898
Bernardino Ramazzini
“De morbis artificum diatriba”
” unearth in the shops of craftsmen, for these shops are schools
1700
… the arts that men practice are various and diverse and from
them may arise various diseases. Accordingly, I have tried to
whence one can depart with more precise knowledge ,
whatever may appeal to the taste of investigators, and, which is
the main thing, to suggest medical precautions for the
prevention and treatment of such diseases as usually affect the
workers.

… a doctor … should … question … carefully, … What occupation

does he follow?

– Ramazzini

EXAMPLES OF OCCUPATIONAL DISEASES

• cancer of the scrotum specific

to chimney sweepers
• mercury poisoning in hat makers
• byssinosis in cotton mill workers
• mesothelioma in asbestos workers

• spinal disorders in typists

• medial neuritis in computer workers
 OCCUPATIONAL HEALTH AND SAFETY OCCUPATIONAL HEALTH AND SAFETY
• ‘The promotion and maintenance of the highest degree of A broad, multidisciplinary subject dealing with the
physical, mental and social wellbeing of workers in all relation of work and health:
WORK

occupations;
- effect of work on health PREVENTION
ill-health
of ASSESSMENT of
workability
• the prevention amongst workers of departures from health
- effects of health on work
caused by their working conditions; HEALTH HEALTH
promotion

• the protection of workers in their employment from risks - vast majority of health problems are not caused by work
resulting from factors adverse to health; - most health problems can influence an individual’s ability
• the placing and maintenance of the worker in an to work, or their performance at work
occupational environment adapted to his physiological and
psychological capabilities; and Principles of occupational health:
• to summarise, the adaptation of work to the workers and of • prevent ill-health due to work
each worker to his or her job’. • prevent pre-existing medical conditions from
Joint ILO/WHO Committee on Occupational Health, First Session (1950) being aggravated by work
revised by 12th Session (1995)

OCCUPATIONAL HEALTH AND SAFETY CONDITIONS RELATED TO OCCUPATIONS

Occupational health and safety Increased exposure: physiologic state with increased strain.

Occupational health
Occupational medicine
Clinical specialty which deals with the
diagnosis, management and
prevention of ill-health due to
workplace factors and the assessment
of effects of illness on work.
Occupational safety
Occupational hygiene
Applied science concerned with the
identification, measurement and
appraisal of risk, and with control to
acceptable standards of physical,
chemical and biological factors arising
from the workplace which may affect
the health or well-being of those at
work or in the community.
Occupational disease: disease having a specific or a strong
relation to occupation, generally with only one causal agent, and
recognised as such.
Work-related disease: disease with multiple causal agents,
where factors in the work environment may play a role, together
with other risk factors, in the development of such disease,
which has a complex aetiology.
Disease affecting working populations: disease without
causal relationship with work, but which may be aggravated by
occupational hazards to health.
CRITERIA FOR DIAGNOSING OCCUPATIONAL CRITERIA FOR DIAGNOSING OCCUPATIONAL
DISEASES DISEASES
• minimum intensity of exposure
1. Effect - fit to the description of the disease • minimum duration of exposure
2. Exposure - documented by: • maximum latency period
• occupational history (chronology) exposure
• minimum induction period
• examination (marks of exposure)
• investigation (environmental, biological 4
and biological effect monitoring)
2
3. Time sequence - cause → effect
0 time
4. Competing causes - balance
Exposure Preclinical phase Clinical phase

THE “ICEBERG” OF OCCUPATIONAL DISEASES DISEASE BURDEN OF WORK-RELATED ILL-HEALTH

Changes in the leading risk factors of disease burden,
DALY, 1990-2015
Recognized
as being
related to work

Medical attention received, but

relationship of illness to
occupation not recognized

Symptoms but no medical attention sought

Affected but no symptoms

Institute for Health Metrics and Evaluation. Global Burden of Diseases, Injuries, and Risk Factors Study 2015
 Leading risk factors of disease burden, Top 25 risk factors of disease burden
DALY, 2015 1990-2010

Institute for Health Metrics and Evaluation. Global Burden of Diseases, Injuries, and Risk Factors Study 2015 Global Burden of Diseases, Injuries, and Risk Factors Study 2010

WORK-RELATED MORTALITY, 2014-15 NIOSH LIST OF 10 LEADING WORK-RELATED

DISEASES AND INJURIES IN THE UNITED STATES*
(USA, NIOSH, 1983)
• 2.4 million caused by various types of
illness 1. Occupational lung diseases: asbestosis, byssinosis,
14% silicosis, coal workers’ pneumoconiosis, lung cancer,
occupational asthma
2. Musculoskeletal injuries: disorders of the back, trunk,
upper extremity, neck, lower extremity; traumatically
86%
induced, Raynaud’s phenomenon
3. Occupational cancers (other than lung): leukemia,
mesothelioma, cancers of the bladder, nose, and liver
Hämäläinen et al. Global Estimates of 4. Severe occupational traumatic injuries: amputations,
Occupational Accidents and Work-
Fatal Occupational Accidents Fatal Work-Related Diseases related Illnesses 2017, WSH Institute, fractures, eye loss, lacerations, and traumatic deaths
Ministry of Social Affairs and Health,

• 380,000 by accidents Finland, 2017

5. Cardiovascular diseases: hypertension, coronary artery
disease, acute myocardial infarction
cont. Estimated new cases of self-reported work-related
6. Disorders of reproduction: infertility, spontaneous illness amongst people who worked in the last 12
abortion, teratogenesis months, United Kigdom, 2001-2015
7. Neurotoxic disorders: peripheral neuropathy, toxic
encephalitis, psychoses, extreme personality changes
(exposure-related)
8. Noise-induced loss of hearing
9. Dermatological conditions: dermatosis, burns
(scaldings), chemical burns, contusions (abrasions)
10.Psychological disorders: neurosis, personality disorders,
alcoholism, drug dependency
* Three criteria were used to develop the list: frequency of occurrence
of the disease or injury, its severity in the individual case, and its
amenability to prevention. The conditions listed under each category are to
be viewed as selected examples, not comprehensive definitions of the category
From MMWR 32(2):24, 1983 Health and Safety Executive. Health and Safety Statistics, 2014/15

Proportions of new cases of ill health, comparison ETIOLOGY OF OCCUPATIONAL DISEASES

between THOR-GP* and Labour Force Survey, (WORKPLACE HAZARDS)
United Kingdom 1. Physical: noise, vibration, radiation, light,
heat & cold, pressure, electricity

2. Chemical: metals, solvents, gases, plastics,

pesticides, particles (dust and fibres)

3. Biological: bacteria, viruses, fungi, insects

4. Mechanical: ergonomics (manual handling, repetitive

movements, somatography) and safety
*THOR-GP: The Health and Occupation Research Network in General Practice, University of Manchester

Health and Safety Executive. Health and Safety Statistics, 2014/15

5. Psychosocial: pressure/stress, morale/motivation
 PREVENTION OF OCCUPATIONAL DISEASES
• Elimination
• Substitution
• Engineering control
• Control at design
• Change of process
• Maintenance, housekeeping
• Administrative measures (work schedule)
• Training, education
• Personal protective equipment

TRADITIONAL PUBLIC- AND OCCUPATIONAL COMPONENTS OF SURVEILLANCE FOR

HEALTH ACTIVITIES
• Environmental (exposure) monitoring: Air
concentration measurements of chemicals to which workers
are exposed.
• Biological (-effect) monitoring: Sampling of body tissue
for toxic agents, their metabolites, or other physiological
indicators of exposure.
• Medical screening: Testing to diagnose disease in
individuals at an early and, hopefully, reversible stage.
• Health surveillance: Routine measurement of health
indices, with analysis and interpretation of data.
OCCUPATIONAL DISEASE AND INJURY
I. Detection and enumeration of occupationally
related morbidity and mortality
II. Data evaluation and interpretation to characterise
trends and identify new patterns or clusters of
disease and injury
III. Intervention to decrease the incidence or severity
of occupational disease and injury identified in
data collection and analysis
 ACTIVITIES RELATED OCCUPATIONAL HEALTH GLOBAL STRATEGY FOR OCCUPATIONAL HEALTH
SURVEILLENCE FOR ALL (WHO)
• Comprehensive evaluation of workplaces where 10 priority objectives
• strengthening of national policies for health at work and
health effects have been detected development of policy tool
• Medical screening of co-workers of affected • development of healthy work environment
individuals • development of healthy work practices and promotion of
health at work
• Development of educational programs and • strengthening of Occupational Health Services (OHS)
consultative services for primary care physicians • establishment of support services for occupational health
who need assistance in identifying and managing • development of occupational health standards based on
occupational diseases scientific risk assessment
• development of human resources for occupational health
• Recommendations and educational outreach for • establishment of information systems
workers, unions, and management • strengthening of research
• Contributing to drafting new regulations • development of collaboration in occupational health and
with other activities

HEALTHY PEOPLE 2020 No OBJECTIVE

OCCUPATIONAL SAFETY AND HEALTH OSH-3 Reduce the rate of injury and illness cases involving days away from
SUMMARY OF OBJECTIVES work due to overexertion or repetitive motion to 26.64 per 10,000
workers
Goal: Promote the health and safety of people at OSH-4 Reduce pneumoconiosis deaths to 2,187
work through prevention and early intervention. OSH-5 Reduce deaths from work-related homicides to 565
No OBJECTIVE OSH-6 Reduce work-related assaults to 7.6 per 10,000 full-time workers
OSH-1 Reduce deaths from work-related injuries
OSH-7 Reduce the proportion of persons who have elevated blood lead
OSH-1.1 All industry to 3.6 per 100,000 full-time workers concentrations from work exposures to 20.2 per 100,000 employed
OSH-1.2 Mining to 19.3 per 100,000 full-time workers adults
OSH-1.3 Construction to 9.7 per 100,000 full-time workers
OSH-8 Reduce occupational skin diseases or disorders among full-time
OSH-1.4 Transportation and warehousing to 14.8 per 100,000 full-time w.
workers to 4 per 10,000 full-time workers
OSH-1.5 Agriculture, forestry, fishing, and hunting to 24.3 per 100,000 f-t w.
OSH-2 Reduce nonfatal work-related injuries resulting in medical treatment, OSH-9 Increase the proportion of employees who have access to workplace
lost work time, or restricted work activity, as reported by employers programs that prevent or reduce employee stress
OSH-2.1 Injuries in private sector industries to 3.8 per 100 full-time workers OSH-10 Reduce new cases of work-related, noise-induced hearing loss to 2.0
per 10,000 workers
OSH-2.2 Injuries treated in emergency departments to 2.2 per 100 full-time w.
Adolescent workers aged 15 to 19 years to 4.9 per 100 full-time w. Baseline data are from 2003-2009
OSH-2.3
Obligatory reading:
• Learning materials presented on the website of the Faculty of
Public Health, lecture notes

Recommended literature:
• Aw TC, Gardiner K, Harrington JM. Occupational Health:
Pocket Consultant (5th ed.), Blackwell, Oxford, 2007. Thank you for your attention.
• Levy BS, Wegman DH. Occupational Health. 3rd ed, Boston:
Little, Brown and Company, 1995.
• International Labour Organization. Encyclopaedia of
Occupational Health and Safety. Online edition, ILO, 2012,
available at: http://www.iloencyclopaedia.org