OCCUPATIONAL HEALTH

JAIME A. BARRON, M.D.,M.P.H.,M.H.A.

ASSOCIATE PROFESSOR VII University of Perpetual Help System, Laguna

DOCTORS
ARE MEN WHO PRESCRIBE MEDICINES OF WHICH THEY KNOW LITTLE, TO CURE DISEASES OF WHICH THEY KNOW LESS, FOR HUMAN BEINGS OF WHICH THEY KNOW NOTHING!!

Definitions: 1. Industrial Hygiene: science and art of preserving health through the recognition, evaluation, and control of environmental causes and sources of illness in industry. 2. Industrial Health: specialized form of medical and public health practice, combining elements of med., eng., chem., toxicology, psychology, sociology, statistics, and the principle of disease and health promotion, to the end result that the physical and mental efficiency of the worker is increased and production bettered in QUAL and QUAN and permanence.

3. Industrial Medicine: broad field which is concerned with all of the health problems of employed persons; and ind, health as the objective of ind. Medicine. In other words, ind. Health is the END and the practice of ind. Med. Is the MEANS 4. Occupational Medicine: deals with the restoration and conservation of health in relation to work, the working environment and maximum efficiency. 5. OCCUPATIONAL HEALTH: sum total of all efforts to improve the health of workers.

Objectives of O.H.
1. Prevent the occurrence of occupational diseases and injuries. 2. To minimize the progression of any disease or injury. 3. To utilize maximally residual capacities. 4. To promote the optimum health and well being of the worker

Aims of Occupational Health

1. Promotion and maintenance of the highest degree of physical, mental and social well being of workers in all occupations.

2. Prevention among workers of departures from health caused by their working conditions.
3. Protection of Workers in their employment from risks resulting from factors adverse to health. 4. Placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological make-up 5. Adaptation of work to man and of each man to his job.

Aims of Occupational Health

1. Inadequate controlled occupational hazards 2. Illnesses: a. parasitic b. zoonotic c. respiratory d. GIT e. Others 3. Malnutrition 4. Poisoning 5. Occupational Injuries/Accidents 6. Poor law enforcement 7. Poor Legislation 8. Health Care 9. Psychosocial 10. Few labor Inspectors 11. Occupational Health Manpower

12. Child Labor

13. Underemployment

OCCUPATIONAL HEALTH FUNCTION

Some of the major activities included in the occupational health function are:
(A) Ability to recognize occupational disease signs symptoms; (B) Collection of morbidity statistics for workers; (C) Visits to plants; (D) Immunization of workers;

(E) Recommendation of environmental control measure;

(F) Industrial hygiene assessment; (G) Pre employment and periodic medical examinations of workers exposed to know, e.g. lead, silica, dust etc.; (H) Evaluation of physical fitness for work; (I) Respiratory function test and chest x-ray workers; (J) Treatment of occupational injuries.

1) Meaning:

OCCUPATIONAL HEALTH PROGRAM

Program provided by management to deal constructively with the health of employees in relation to their works.

2) Objectives:
a) To facilitate the placement and insure the suitability of individuals according to their physical capacities, mental abilities, and emotional make-up in work which they can perform with an acceptable degree of efficiency and without endangering their own health and safety and that of their co-workers. b) To protect employees against health hazards in their work environment. c) To ensure adequate medical care and rehabilitation of the occupationally ill and injured; d) To encourage personal health maintenance, e.g. physical fitness activities. e) Provisions for first aid, emergency services and treatment depending on the nature of the industry. f) Provide guidance, information and service for family planning programs.

3) Activities:

a) Maintenance of healthful work environment

FUNCTION OF AN OCCUPATIONAL HEALTH SERVICE

1) Placing people in suitable work.
2) Maintaining people in suitable work 3) Provision of treatment 4) Controlling recognize hazards 5) Identifying unrecognized hazard 6) Avoiding potential risks 7) Screening for early evidence of non-occupational disease 8) Supervision of vulnerable groups 9) Counseling

10) Surveillance of sanitary, catering and welfare amenities

11) Environmental control outside the work place

OBJECTIVE OF OCCUPATIONAL PHYSICIAN; (WHO)

1) Promotion and maintenance of highest degree of physical, mental and social well being of workers in all occupations. 2) Prevention among workers of workers of departures from health caused by their working conditions.

3) Protection of workers in their employment from risk resulting from factors adverse to health.
4) Placing and maintenance of workers in an occupational environment adapted to their physiological equipment.

DUTIES OF PHYSICIANS:
The Physician whether part-time or full-time shall be responsible of promoting and maintaining the physical and mental well-being of the workers. It shall be the duty and function of the physicians to: 1) Organize and administer a health service program integrating there in occupational safety program. 2) Conduct studies on occupational health 3) Prevent disease or injury in the workplace by establishing proper medical supervision over substances used, process, work environment; 4) Converse the health of the workers through physical examinations, proper advice for placement and health education; 5) Providing medical and surgical care to restore health and earning capacity of injured worker; 6) Maintain and analyze records of all medical cases and to prepare and submit the reports required by this standards 7) Continually monitor the work environment for health hazards through periodic inspection of the workplace; 8) Act as adviser to management and labor on all health matters; and 9) Report directly to top management in order to be effective

Undetected/Unchecked Occupational Diseases

Inadequate Industrial Health Service Program

Increased Exposure of Workers to Health Hazards

Inadequate Health Manpower

Inadequate Health Facilities

Increased Health Needs of Workers

Ignorance on Safety Precautionary Measures

Poor Institutional Health Hazards Control Measures

Unstable Employment Status

Lack of Occupational Health & Safety Program Training

Preference for Private Medical Care

Susceptibility to Community Health Problems (pollution, malnutrition etc.)

Low Enforcement of Labor Laws on Working Conditions

Figure I. CAUSATIVE MODEL OF OCCUPATIONAL HEALTH PROBLEM

Physical

Chemical

OCCUPATIONAL HEALTH HAZARDS Biologic Ergonomic

MEDICAL AND DENTAL SERVICES

AS AMENDED BY ADMINISTRATIVE ORDER # III-S, 1991 OF P.D. 856

MEDICAL AND DENTAL SERVICES

AS AMENDED BY ADMINISTRATIVE ORDER # III-S, 1991 OF P.D. 856

HAZARDOUS WORKPLACES
A. Exposure to dangerous environmental elements, contaminants,
i. ii. Radiation Chemicals

iii. Fire
iv. Flammable and Noxious substances

B. Workers
i.
ii.

Construction
Logging

C. Explosives / pyrotechnic D. Exposure to Biological agents

iii. Fire fighting iv. Stevedoring v. Deep sea diving vi. Mechanized working vii. Mining quarrying viii. Blasting

What are Work Hazards? Work hazards are negative factors in the workplace that affect man and the work environment and can cause illnesses, injuries or deaths. What are the most common work hazards and what are their effects on the workers health? There are four major categories of work hazard that can affect the workers health and safety. Below are the examples of these and their possible effects on the workers health.

PHYSICAL HAZARDS
Noise Vibrations Poor Lighting Abnormal Temperature Inadequate Ventilation Radiations

CHEMICAL HAZARDS
Solvents, vapors, gases, dust, particulates, heavy metals, fumes, toxic gases, etc.

Effect on Workers (Risk) Hearing loss Joint Strain Visual problems/accidents Leg cramps, dizziness, Unconsciousness Lung/respiratory problems Skin irritations, visual Disturbance May cause diseases of lungs, skin, liver, heart & blood system. They can also cause poisoning.

BIOLOGICAL HAZARDS
Bacteria, virus, fungi, enzymes, microorganisms, molds, etc. Can cause ailments like TB, Tetanus, Viral Hepatitis HIV/AIDS, etc.

ERGONOMIC HAZARDS
Improperly designed tools or work area, improper lifting, poor visual condition, repeated motions in awkward positions Can lead to low back pain, accident

How can employees help employers in the prevention or removal of work hazard at the workplace?

By assisting in good housekeeping - All sources of harmful or unsafe condition must be eliminated. Work environment must be clean, spotless if possible. - Layout of work areas should be well-planned, with materials properly stored or piled, aisles and passageways should be clear and accessible. - Waste materials should be removed as soon as possible and properly disposed. - Materials should be handled and stored properly. - Signages must be properly placed and must serve as reminders/warnings on the presence of hazards. - Walking surfaces should be free from contaminants like water and oil. - A proper maintenance system is part of good housekeeping. Workplace cleaning should be scheduled and done regularly.

 By being safety conscious - Observe proper posture when performing tasks such as reaching, bending and lifting. - Dont smoke near combustible materials. - Pay attention and be alert at all times. - Dont operate machines when under the influence of drugs or alcohol. - Use the right tool for the job
By observing fire/electrical safety - Use insulated tools - Always replace a fuse with the same kind and rating. Never bridge a fuse (using wire, metal, etc.) - When working with any part of electrical circuit, make sure that there is someone to look after you. - Observe proper maintenance schedules of electrical equipment, loads and wires. - Strictly follow established regulations and rules

 By observing machine safety - Use machine guards and safety devices - Always follow safe lock-out/tag-out procedures - Follow safety procedures keep hands away from moving parts, and keep all guards in place By wearing Personal Protective Equipment (PPE) or equipment used to isolate the worker from the hazardous environment.
- Use of protective mask or face shields in the case of welders. - Use of safety belts or cable harness in the case of workers perched on posts, extended stairs or scaffoldings. - Use of buoyant work vest if there is a danger of falling into water while working. - Use of helmets and safety shoes in the case of construction workers. - Use of electrical safety helmets, rubber gloves, insulation garments, sleeve cover and insulation tube in the case of electricians and fireman

Republic of the Philippines DEPARTMENT OF LABOR AND EMPLOYMENT Employees Compensation Commission

List of Occupational and Compensable Diseases under the Employees Compensation Program

Occupational Diseases The ECC, in consultation with the Philippine Medical Association, the Philippine Hospital Association and specialist on occupational health and safety, has listed ailments which may be deemed work-connected and subject to certain conditions in the work environment, under P.D. 626, as amended, a disability arising from an ailment may be deemed work-connected if the illness is contracted due to the workers nature of employment. This is so if all the following conditions are present. 1) The employees work must involve the risks or conditions described; 2) The disease was contracted as a result of the employees exposure to the described risks; 3) The disease was contracted within a period of exposure and under such other factors necessary to contract it; and 4) There was no notorious negligence on the part of the employee. The employer who has failed to provide adequate protection and safety devices shall be subjected to the penalty imposed by Article 200 of the Labor Code. Where he has provided adequate protective and safety devices, there shall be a determination as to whether or not the employee has been notoriously negligent.

The following diseases are considered as occupational when contracted under working conditions involving the risks described herein:
Occupational Diseases 1. Cancer of the epithelial lining of the bladder. (Papilloma of the bladder) 2. Cancer, epitheliomatous or ulceration of the skin or of the corneal, surface of the eye due to tar, pitch, bitumen, mineral oil or paraffin, or any compound product or residue of these substances. Nature of Employment Work involving exposure to alphanaphthylamine, betanaphthylamin or benzidine or any part of the salts; and auramine or magenta The use or handling of, exposure to tar, pitch, bitumen, mineral oil (including paraffin) soot or any compound product or residue of any of these substances.

3. Cataract produced by exposure to the glare of, or rays from molten glass or molten or red hot metal

Frequent and prolonged exposure to the glare of or rays from molten glass or red hot metal.

Occupational Diseases 4. Deafness

Nature of Employment
Any industrial operation having to the glare of or rays from molten glass or red hot metal.

5. Decompression sickness (a) Caissons disease (b) Aeroembolism 6. Dermatitis due to irritants and sensitizers. 7. Infections (a) Anthrax (b) Brucellosis (c) Glanders (d) Rabies

Any process carried on in compressed or rarefied air. Any process carried on in rarefied air. The use or handling of chemical agents which are skin irritants and sensitizers. Work in connection with animals infected with anthrax, handling of animal carcasses or parts of such carcasses including hides, hoofs and horns. Any occupation involving handling of contaminated food and drink particularly milk, butter and cheese of infected goats and cows. Any occupation involving rabid dogs, or equine animals or carcasses. Any occupation involving rabid dogs.

Occupational Diseases
(e) Tuberculosis

Nature of Employment
Any occupation involving close and frequent contact with source or sources of tuberculosis infection by reason of employment: (a) in the medical treatment or nursing of person or persons suffering from tuberculosis, (b) as a laboratory worker, pathologist or postmortem worker, where occupation involves working with material which is a source of tuberculosis infection Any occupation involving handling of rabbits, ground squirrels, mice or other rodents. Any occupation involving handling of rats, mice, swine and dogs. Any occupation involving handling of horse, cattle and sheep, or their slaughter and meat packing. Any occupation involving handling of flows or pigeons.

(f) Tularemia (g) Weills disease (h) Q. Fever or equine encephalomyelitis (i) Mite dermatitis

Occupational Diseases
8. Ionizing radiation disease, inflammation, ulceration or malignant disease of skin or subcutaneous tissues of the bones or leukemia, or anemia of the aplastic type due to X-rays, ionizing particle, radium or other radioactive substances. (a) Acute radiation syndrome (b) Chronic radiation syndrome (c) Glass blowers cataract

Nature of Employment
Exposure to X-rays, ionizing particles of radium or other radioactive substance or other forms of radiant energy.

Short duration of exposure to large doses of Xrays, gamma rays, alpha rays and beta rays. Chronic over-exposure to X-rays with a long latent period affecting the skin, blood and reproduction organ. These are workers exposed to infrared rays.

Occupational Diseases

Nature of Employment

9. Poisoning and its sequelae caused by: All work involving exposure to the risk concerned. a) Ammonia b) Arsenic or its toxic compound c) Benzene or its toxic homologues; nitro and aminotoxic derivatives of benzene or its homologue compound d) Beryllium or its-toxic compounds e) Brass, zinc or nickel f) Carbon dioxide g) Carbon bisulfide h) Carbon monoxide i) Chlorine j) Chrome of its toxic compounds k) Dinitrophenol or its homologue l) Halogen derivatives of hydrocarbon of the aliphatic series m) Lead or its toxic compounds n) Manganese or its toxic compounds o) Mercury of its toxic compounds p) Nitrous fumes q) Phosgene r) Phosphorous of its toxic compounds s) Sulfur dioxide

Occupational Diseases
10. Pneumoconiosis
a) Coal miners b) Bysinosis c) Bagassosis d) Psittacosis

Nature of Employment
Exposure to coal dust Exposure to cotton dust causing weavers cough or mill fever Exposure to sugar cane dust Any occupation involving handling of parrots, parakeets and other species of birds. Exposure to particles of silica, quartz or slate Exposure to asbestos particles. Any occupation involving exposure to excessive heat or cold.

e) Silicosis f) Asbestosis
11. Diseases caused by abnormalities in temperature and humidity.

a) Heat stroke/cramps/exhaustion Any occupation involving exposure to excessive heat. Any occupation involving exposure to excessive cold. b) Chilblain/frostbite/freezing Any occupation involving exposure to excessive cold. c) Immersion foot/general hypothermia

12. Vascular disturbance in the upper extremities due to continuous vibration from pneumatic tools or power drills, riveting machines or hammers.

Any occupation causing repeated motions, vibrations and pressure of upper extremities.

Occupational Diseases
13. Viral Hepatitis *

Nature of Employment
Among workers in close and frequent contact with (a) human blood products and (b) a source of vital hepatitis by reason of employment in the medical treatment or nursing of a person suffering from viral hepatitis, or in a service ancillary to such treatment or nursing.

14. Poisoning by cadmium * 15. Leukemia and lymphoma * 16. Cancer of stomach and other lymphatic and blood forming vessels; nasal cavity and sinuses *

Among workers in battery factories who are exposed to cadmium fumes.

Among operating room personnel due to exposure to anesthetics Among woodworkers, wood products industry carpenters, loggers and employees in pulp and paper mills and plywood mills.

17. Cancer of the lungs, liver and brain *

Among vinyl chloride workers, plastic workers.

18. CARDIO-VASCULAR DISEAS. ** All of the following conditionsa. If the heart disease was known to have been present during employment, there must be proof that an acute exacerbation was clearly precipitated by the unusual strain by reason of the nature of his work. b. The strain of work that brings about an acute attack must be of sufficient severity and must be followed within 24 hours by the clinical signs of a cardiac insult to constitute causal relationship. c. If a person who was apparently a symptomatic before being subjected to strain at work showed signs and symptoms of cardiac injury during the performance of his work and such symptoms and signs persisted, it is reasonable to claim a causal relationship.

19. CEREBRO-VASCULAR ACCIDENTS. **All of the following conditionsa. There must be a history which should be proved, or trauma at work (to the head specially) due to unusual and extraordinary physical or mental strain or event, or undue exposure to noxious gases in industry.

b. There must be a direct connection between the trauma or execution in the course of the employment and the workers collpase.
c. If the trauma or exertion then and there caused a brain hemorrhage, the injury may be considered as arising from work.

20. MALARIA AND SCHISTOSOMIASIS. ** All of the following conditionsa. Through the knowledge of the respective incubation periods of the different types of the diseases, the physician determining the causal relationship between the employment and the illness or malaria or schistosomiasis should be able to tell whether the disease of the afflicted employee manifested itself while he was so employed. b. Compensability should be based on the principle of greater risk acquiring the disease in the place of work than in the place of usual residence of the afflicted worker. c. The place of work of employment has to be verified as a malarial or schistosomal work area.

21. PNEUMONIA. ** All of the following conditionsa. There must be an honest and definite history of wetting and chilling during the course of employment and also, of injury to the chest wall with or without rib fracture, or inhalation of noxious gases, fumes and other deleterious substances in the place of work. b. There must be direct connection between the offending agent or event and the workers illness. c. The signs of consolidation should appear soon (within a few hours) and the symptoms of initial chilling and fever should at least be 24 hours after the injury or exposure. d. The patient must manifest any of the following symptoms within a few days of the accident: (1) sever chill and fever; (2) headache and pain, agonizing in character, in the side of the body; (3) short, dry painful cough with blood tinged expectorations; and (4) physical signs of consolidation, with fine rales.

22. HERNIA. ** All of the following conditionsa. The hernia should be of recent origin. b. Its appearance was accompanied by pain, discoloration and evidence of a tearing of the tissues. c. The disease was immediately preceded by unique or severe strain arising out of and in the course of employment. d. A protrusion of mass should appear in the area immediately following the alleged strain.

23. BRONCHIAL ASTHMA. ** All of the following conditionsa. There is no evidence of history of asthma before employment. b. The allergen is present in the working conditions.

c. Sensitivity test to allergens in the working environment should yield positive results.
d. A provocative test should show positive results.

24. OSTEOARTHRITIS. *** Any occupations involving a. Joint strain from carrying heavy loads, or unduly heavy physical labor, as among laborers and mechanics. b. Minor or major injuries to the joint. c. Excessive use or constant strenuous usage of a particular joint, as among sportsmen, particularly those who have engaged in the more active sports activities.

d. Extreme temperature changes (humidity, heat and cold exposures), and

e. Faulty work posture or use of vibratory tools.

25. VIRAL ENCEPHALITIS. *** Any occupations involving a. Contact with an infected person, as in areas of poor sanitation, with a high density of schoolchildren, who are the most frequent virus spreaders; b. Rural exposure, primarily in picnics, camping activities, fishing or hunting in, or adjacent to, woods or subtropical vegetation, or as among agricultural or forest workers; and c. Contact with other sources of infection, such as birds and animals, as among veterinarians and abattoir workers. 26. PEPTIC ULCER. *** Any occupation involving prolonged emotional, or physical stress, as among professional people, transport workers and the like.

27. PULMONARY TUBERCULOSIS. *** In addition to working conditions already listed under P.S. 626, as amended, any occupation involving constant exposure to harmful substances in the working environment, in the form of gases, fumes, vapors and dust, as in chemical and textile factories: overwork or fatigue; and exposure to rapid variation in temperature, high degree of humidity and bad weather conditions. 28. VIRAL HEPATITIS. *** In addition to working conditions already listed under P.S. 626, as amended, any occupation involving: exposure to a source of infections through ingestion of water, milk, or other foods contaminated with hepatitis virus; Provided, that, the physician determining the causal relationship between the employment and the illness should be able to indicate whether the disease of the afflicted worker manifested itself while he was so employed, knowing the incubation period thereof. 29. ESSENTIAL HYPERTENSION. **** Hypertension classified or essential is considered compensable if it causes impairment of function of body organs like kidneys, heart, eyes and brain, resulting in permanent disability: Provided, that, the following documents substantiate it: (a) chest x-ray report, (b) ECG report, blood chemistry report, (d) funduscopy report, and (f) C-T scan.

30. ASBESTOSIS. ***** All of the following conditions a. The employee must have been exposed to asbestos dust in the work place, as duly certified to by the employer, or by a medical institution, or competent medical practitioner acceptable to or accredited by the Systems: b. The chest x-ray report of the employee must show findings of asbestos, or asbestos related disease. E.G. pleural plaques, pleural thickening, effusion, neoplasm and interstitial fibrosis; and c. In case the ailment is discovered after the employees retirement/separation from the service, the claim therefore must be filled with the System within three (3) years from discovery.
* ** *** **** ***** Approved under ECC Resolution No. 247-A, dated April 13, 1977 Approved under ECC Resolution No. 432, dated July 20, 1977. Although not considered occupational diseases, they are nevertheless work-related and thus compensable too. Approved under ECC Resolution No. 1676, dated Jan. 29, 1981 Approved under ECC Resolution No. 92-07-0031, dated July 8, 1992. Approved under ECC Resolution No. 96-08-0372, dated Aug. 1, 1996


Agent Wood Leather

COMMON OCCUPATIONAL CARCINOGENS

Organ Affected Nasal cavity and Sinuses Nasal cavity and sinuses, Urinary Bladder Lung, Larynx

Occupation Woodworkers Leather and Shoe workers

Iron Oxide

Iron ore miners, metal grinders and polishers, silver finishers, iron foundry workers Nickel smelters, mixers and roasters, electrolysis workers Miners, smelters, mixers and roasters, electrolysis workers Chromium producers and users, acetylene and aniline workers, bleachers, glass, pottery and linoleum workers, and battery workers

Nickel Arsenic Chromium

Nasal sinuses, Lung Skin, Lung, Liver Nasal cavity and sinuses, lung larynx

Agent Asbestos

Organ Affected Lung (pleural and peritoneal mesothelioma) Nasal avity, larynx, lung, skin, scrotum

Occupation Miners, millers textile, insulation and shipyard workers Contact with lubricating, cooling, paraffin or wax fuel oils or coke rubber filters, textile weaver, diesel jet testers Mustard gas workers Plastic workers Chemical workers

Petroleum, coke, wax, creosol anthracene, paraffin, shale mineral oil Mustard gas Vinyl chloride Bis-chlo romethyl ether, chloromethyl methyl ether Isopropyl oil Coal soot, coal tar, other products of coal combustion

Larynx, Lung, trachea, bronchia Lung, brain Lung

Nasal cavity Lung, larynx, skin, scrotum, urinary bladder

Isopropyl oil producers Gashouse workers, stokers and producers, asphalt, coal, tar, and pitch workers, coke oven workers, miners, steel cleaners

Agent Benzene

Organ Affected Bone marrow

Occupation Explosives and benzene makers, distillers, cement workers, dye users, painters, shoemakers Dye Stuff manufacturers and users. Rubber workers, filter man textile dyers, paint manufacturer

Auramine, Benzidine, Napthalamine, BetaNathalamine, magenta 4-Aminodiphenyl, 4Nitrodiphenyl

Urinary Bladder

Maraming Salamat Po!

i
JAIME A. BARRON, M.D., M.P.H., M.H.A.
Associate Professor VII University of Perpetual Help System, Laguna