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DR ISHTA RAMPERSAD

OCCUPATIONAL HEALTH PHYSICIAN

NWRHA

OCCUPATIONAL HEALTH SERVICES

National Occupational Safety & Health Week 2013

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SETTING UP AN OH PROGRAMME FOR YOUR ORGANIZATION• Why

• How

• Who

• Measuring performance

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WHY?OCCUPATIONAL HEALTH SERVICES

BACKGROUND

www. ilo.org 4

• An estimated 2.34 million people die each year from work-related accidents and diseases.

• Of these, the vast majority—an estimated 2.02 million—die from a wide range of work-related diseases.

• This means that 5,500 of the estimated 6,300 work-related deaths that occur every day are caused by various types of work-related diseases.

• The ILO also estimates that a further 160 million cases of nonfatal work-related diseases occur annually.

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• Over the last two decades, societies have undergone significant changes and developments, with important repercussions for issues of health at work,

• Both private and public sectors of economic life operate under pressure for development, and often in highly competitive markets

• The increasing speed and volume of work, pressures for flexibility in organizations and people, and the slimming of organizations, lead to strains and stresses on the staff of enterprises and organizations.

• Physical workplace hazards are increasingly controlled and managed, but are progressively being replaced by psychological strain at work, and health disorders related to mental stress

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• These changes have health effects on the individual employee level, organization level and society level.

• Individual - suffering and loss of quality of life; economic loss and insecurity in employment; loss of control with regard to individual and family life.

• Organization - loss in production capacity; constant needs to recruit new staff

• Society - increasing social security costs for sickness benefits and pensions; payments of compensation for occupational disease

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• Enterprises in the 21st century are under pressure to develop into learning organizations. The workplace constitutes a major setting where available knowledge may be used to develop OH services to:

• Protect health

• Promote health through appropriate work culture and work organization

• Promote wellbeing and mental health and, on the individual level, healthy life style

• Sustain the health and maintain the work ability of all staff

• Reduce health care and national insurance costs of injuries, diseases, illnesses and premature retirement, caused by a combination of occupational, environmental, life style and social health determinants

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HOW?OCCUPATIONAL HEALTH SERVICES

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OCCUPATIONAL HEALTH SERVICES• The ILO Occupational Health Services Convention (No. 161; 1985) defines “occupational

health services” as services entrusted with essentially preventive functions and responsible for advising the employer, the workers and their representatives on the requirements for establishing and maintaining a safe and healthy working environment which will facilitate optimal physical and mental health in relation to work and the adaptation of work to the capabilities of workers (in the light of their state of physical and mental health)”.

• Ratified by 33 countries thus far; only one Caribbean (Antigua and Barbuda)

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• Provision of occupational health services means carrying out activities in the workplace with the aim of:

• protecting and promoting workers’ safety, health and well-being

• improving working conditions and the working environment

• These services are provided by occupational health professionals functioning individually or as part of multi-disciplinary units of the enterprise or of external (contracted) services.

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• In order to establish an Occupational Health action plan tailored to company need, it is necessary to agree upon the base-line situation of the organization, to set common goals, plan procedures and intervention strategies, and to decide on how and when to evaluate the results.

• What should we look at when developing an action plan?

• Regulations

• Results of workplace surveys and risk assessments

• Health surveillance records

• Sickness and accident statistcs

• The expectations from the OHS

• The concerns and needs of the employees

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KEY DELIVERABLES OF AN OH SERVICE• Health risk assessment of the workplace

• Advice on planning and organization of work, including the design of workplaces

• Advice on occupational health, safety and hygiene and on ergonomics

• Surveillance of workers' health in relation to work

• Contribution to measures of vocational rehabilitation

• Collaboration in providing information, training and education in the field of occupational health

• Organizing of first aid and emergency treatment

• Participation in analysis of occupational accidents and occupational diseases.

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OH SERVICES: GENERAL PRINCIPLES• In health and safety law, the ultimate responsibility for protecting the health and welfare of

employees and the public lies with the employer

• Employers may choose whether to take and how to implement OH advice

• The OH professional seeks to advise and influence key decision makers

• Best achieved by getting “buy in” from the top down

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WHO?OCCUPATIONAL HEALTH SERVICES

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OH PHYSICIAN• Specialized in Occupational Medicine

• Part-time or full-time

• May be the service manager, with overall responsibility for occupational health and (sometimes) safety

• Dual responsibility of OH professionals to provide advice for both employers and employees

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OCCUPATIONAL HEALTH PHYSICIAN

• Advise on occupational health, safety and hygiene responsibilities

• Fitness for specific jobs, ill health retirement and health surveillance programmes

• Rehabilitation

• Ensure that workplace health and safety standards are maintained

• Workplace visits

• Advise on risk management

• Input on health policy, planning, research

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OH NURSE• Registered nurse with occupational health nursing training

• May provide services in industry with or without supervision by a OHP

• Health screening, health surveillance (audiometry, spirometry, drug testing, skin surveillance), immunizations

• Advisory role in risk management, health promotion, counseling, first aid training

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OCCUPATIONAL HYGIENIST• Specialists in assessing and monitoring workplace exposures

• Fundamental role in identification, evaluation and Mx of work-related hazards

• Mostly uneconomical to employ full time for SME

• BOHS definition: ‘the applied science concerned with the identification, measurement, appraisal of risk and control to acceptable standards of physical, chemical and biological factors arising in or from the workplace, which may affect the health or well-being of those at

work, or in the community’

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ERGONOMIST• Specialized in fitting the task to the human, and may be involved in assessing and

advising on tasks, processes, products and work systems

• Their advice should be sought at the process or plant design stage in an effort to design out potential problems

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FACTORS INFLUENCING MODELS OF OH SERVICES• Legal – in some countries the model is prescribed ( Germany, Italy, Austria)

• Most countries have laws governing the provision of occupational health services, but the structure of the legislation, its content and the workers covered by it vary widely (Rantanen 1990; WHO 1989c)

• Locally, instead of stipulating what might be regarded as programmes, the legislation stipulates the responsibility of employers to provide risk assessments, health examinations of workers and other individual activities related to workers’ health and safety

• Type of industry & risks involved – the services that are needed by an office population in large city will require a different skill mix to those in a steel foundry or shipyard

• Priorities of the employer - health promotion may be only considered in large profitable organizations

• Human resources – trained OH personnel may not be available; few OHPs

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Model Advantages Disadvantages

Single OHP or OHN Autonomy Difficult to maintain clinical competence and establish clinical governance; Auxillary staff may be needed

OHP and OHN TeamworkAppropriate use of resources

Same as above

In-house service Understanding of the organization’s needsKnowledge of other members of the extended OH team

Can become institutionalized and inward looking; loss of independence (actual or perceived)

Group OH service; providing services to a number of enterprises

Adequate resources and experience of different sectors;More likely to have QA processes

May experience shareholder pressure for profit maximization; may result in distorted advice to organizations; may not be multi-disciplinary

Multi-disciplinary service Potentially best service Uneconomical for SMEs

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MEASURING PERFORMANCEOCCUPATIONAL HEALTH SERVICES

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QUALITY & AUDIT IN OH PRACTICE• OH professionals must be able to show benefit, constantly seek to justify and improve

what they do, and demonstrate the use of evidence-based best practice guidelines

• Standards can be derived from a number of sources:

• The purchaser of services (contract specifications)

• The professional body ( e.g. good OH practice guidelines

• The statutory enforcing authority (e.g. standards for legal compliance)

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AUDIT• Essential part of professional practice

• Informs need for change in either the practice or the standard

Set standard

Observe practice

Compare with

standard

Implement change

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DATA COLLECTION IN OHOutcome Source

Morbidity Sickness absence by location, occupation, function

Mortality In service; pensioners

Occupational disease Sickness absence by cause

Accidents and incidents Reported A&I statistics

Health Health survey data

Stress Employee Assistance Programme, surveys etc.

Litigation Analysis of compensation claims

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QUALITY & AUDIT• An effective OHS will be able to demonstrate positive change in some or all of the

following:

• Attitudes, knowledge or behaviour

• Health status or self-rated health

• Morbidity

• Mortality

• Occupational health process and practice

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• Good data provide a basis for designing an effective prevention strategy

• Data on occupational accidents and diseases are mainly obtained through three channels:

• reporting by employers to labour ministries

• claims accepted by employment injury compensation schemes

• information from medical practitioners

• Globally, more than half of countries do not provide statistics for occupational diseases

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CHALLENGES IN DATA COLLECTION

• Lack of adequately trained OH professionals

• Weak or absent National OSH programmes

• Workers in SMEs and the informal economy tend to be outside national OSH monitoring systems

• Migration, ageing of the workforce, increasing contract workers

• Difficulty with diagnosis of Occupational Diseases

TRINIDAD OH&S STATISTICS

PAHO/WHO Country Cooperation Strategy Report 2006-2009 30

• “Laboratory and testing equipment needed to support occupational health presently do not exist”

• “There has been a steady increase in the number of claims paid by the National Insurance Board (NIB) for injury and disablement benefits due to workplace incidents”

• “Deaths due to workplace accidents are consistently high”

OCCUPATIONAL INJURIES/DEATH STATISTICS (T&T) – 1999 TO 2005

PAHO/WHO Country Cooperation Strategy Report 2006-2009 31

Year Work Injuries Disablement Death Total

1999 1924 161 21 2106

2000 2733 369 45 3147

2001 2494 415 43 2952

2002 2467 361 29 2857

2003 2383 297 43 2723

2004 2343 413 22 2778

2005 (Oct 13) 1855 212 36 2103

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• No of persons employed 2005: 574,000 - Central Statistical Office T&T

• No of deaths in 2005: 36

• No of deaths per 100,000 workers: 6.3

• No of deaths per 100,000 workers (UK): 0.8 – Health and Safety Executive UK

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WHAT IS THE MINISTRY OF HEALTH DOING?• Occupational disease reporting systems and data are weak

• The MOH recently engaged a committee to develop an occupational disease reporting form for physicians to complete for notification of an occupational disease

• The Ministry of Health as a responsible employer and in complying with the TT OSH Act has :

• Developed an umbrella Health and Safety Management Policy for the MOH and RHAs

• Mandated the set up of OH units at SWRHA, NCRHA and NWRHA

• These OH units have been staffed with OH physicians who are developing OH services for the > 10000 collective employees they serve at the RHAs

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CONCLUSIONOCCUPATIONAL HEALTH SERVICES

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• Occupational health services are available to only 10%–15% of workers worldwide.

• In industrialized countries, the coverage varies between 15% and 90% and in developing countries between a few percent and 20%

• The needs of occupational health services grow continuously

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• Occupational health care activities, therefore, should not be regarded as unrelated actions, but rather as integral parts of an ongoing process, that:

• start with the assessment of the company-specific need for OHS

• continue with the planning and follow-up of applicable services and

• end with documenting and assessing the achieved results including evaluation of programme efficiency, quality management and further continuous improvement

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• The fight against occupational diseases is at a critical point

• Prevention is the key, since it is more effective and less costly than treatment and rehabilitation; and it involves protecting the lives and livelihoods of workers and their families and contributes to ensuring economic and social development.

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QUESTIONS?