What is "Occupational Health Services"
An important part of the work in Occupational Health is to visit workplaces and evaluate the worker’s risk of developing injuries or diseases. Here, an occupational hygienist visits a worker at a sisal plant. ©University of Bergen
On the web pages of the International Labour Organization we recently read that one of their news was about National occupational health and safety policies in the world. The text also told us: ”The long term development goal of Tanzania is to reduce the poverty of her people and improve the working conditions of the entire workforce, at all workplaces, through the provision of quality occupational health and safety services.” In June 2015 a statement was signed by the 31th International Congress on Occupational Health in Seoul as an agreement on “The Development of Occupational Health Services for all”. ILO has provided a definiton of occupational health services:
The ILO Convention on Occupational Health Services (No. 161) and the ILO Recommendations on Occupational Health Services (No. 171) were adopted in 1985. In the ILO convention the following definition was given:
“The term ‘occupational health services’ means services entrusted with essentially preventive functions and responsible for advising the employer, the workers and their representatives in the undertaking, on
i) the requirements for establishing and maintaining a safe and healthy working environment which will facilitate optimal physical and mental health in relation to work
ii) the adaptation of work to the capabilities of workers in the light of their state of physical and mental health”.
Tasks of Occupational Health Services
The main tasks are mentioned in the definition of OHS in the ILO Convention. But what does this mean in practical life? What does this type of health personnel do? This may differ from country to country. It can also differ because some countries have only physicians employed in OHS units, while others have multidisciplinary teams. There is no doubt that multidisiplinarity is needed in an OHS, where for instance competence in health is needed as well as insight in technical solutions for improving the work environment.
The most common types of professions who work in an OHS are physicians, nurses, physiotherapists, occupational hygienists and safety engineers. In addition they have office staff and some places an OHS can have a psychologist employed or even a priest.
Occupational health personnel, such as a safety engineer and a physician can have different skills and tools, but work well together. © G. Tjalvin
There are different requirement to become a competent company doctor. Some countries have a specialty in occupational medicine. The company doctor is an advisor for the business in the health and medical issues and has the medical responsibility in the OHS unit. In many OHS units the physician is the administrative leader for the OHS. The company doctor can participate in health examinations, rehabilitation, supervision and counselling and information work, as well as surveillance of the work places.
A corporate nurse is a nurse who is employed in an OHS- Some countries have specific courses and special education for these nurses, others not. A corporate nurse work with primary and secondary preventive measures. The nurse can have tasks related to health examinations of workers, counselling and information work, as well as surveillance of the work places.
An occupational nurse often perform audiometries and check the hearing of the workers, and do other health examinations. © G. Tjalvin
In some countries you can be educated as an occupational hygienist if you have a background as a physiologist, chemistry or biology for instance. Occupational hygienists are involved in surveillance and supervision related to chemical, biological or physical factors at the work places.
Occupational hygienists can have different backgrounds. © G. Tjalvin
Occupational physiotherapists develop their competence by different courses, and few countries have a specialty for this profession related to the work places. They work on preventive issues related to musculoskeletal diseases, but do often participate in general surveillance and supervision in the work environment. The seldom treat individual persons, their main task is to work with prevention of musculoskeletal diseases.
Some OHS units have their own engineers specialized to work on safety issues at the work places. In some countries the safety engineer and the occupational hygienists have a close co-operation.
General tasks in an OHS
It is difficult to tell exactly what each person should do in an OHS. This will depend on the type of personnel which is employed in the unit, as well as the competence among the personnel. The most common tasks that an OHS unit should deal with are in some countries described in the local/national legislation. Otherwise, ILO suggests the following tasks:
a) Surveillance of the working environment
The quality of the working environment through compliance with safety and health standards has to be ensured by surveillance at the workplace. According to ILO Convention No. 161, surveillance of the working environment is one of the main tasks of the occupational health services. This can be performed by a walk-through survey of the workplace as well as interviews with managers, foremen and workers. When needed, special safety, hygiene, ergonomic or psychological checks and monitoring can be performed.
b) Informing employer, enterprise management and workers about occupational health hazards
As information about potential workplace health hazards is obtained, it should be communicated to those responsible for implementing preventive and control measures as well as to the workers exposed to these hazards. The information should be as precise and quantitative as possible, describing the preventive measures being taken and explaining what the workers should do to ensure their effectiveness.
c) Assessment of health risks
To assess occupational health risks, information from surveillance of the work environment is combined with information from other sources, such as epidemiological research on particular occupations and exposures, reference values like occupational exposure limits and available statistics. Qualitative (e.g., whether the substance is carcinogenic) and, where possible, quantitative (e.g., what is the degree of exposure) data may demonstrate that workers face health hazards and indicate a need for preventive and control measures.
Lung x-rays of a group of workers can be taken, if we suspect development of lung diseases due to a dusty work place. © G. Tjalvin
d) Surveillance of workers’ health
Due to limitations of a technological and economic nature, it is often not possible to eliminate all health hazards in the workplace. Under such circumstances, surveillance of workers’ health plays a major role. It comprises many forms of medical evaluation of health effects developed as a result of workers’ exposure to occupational health hazards. For instance, if a work place has high noise levels, the hearing ability of the workers can be examined. The purpose is to be able to tell if any of the workers develop reduced hearing. If they do so, they need specific protection and care to avoid further development of the hearing loss, and the work place must work harder on preventive issues to avoid other workers from developing the same problem.
Pre-employment health examinations
Preemployment health assessment is carried out before the job placement of workers or their assignment to specific tasks which may involve a danger to their health or that of others. The purpose of this health assessment is to determine whether a person is physically and psychologically fit to perform a particular job and to ensure that his or her placement in this job will not represent a danger to his or her health or to the health of other workers. This work is not always a task for an OHS unit. Pre-employment examinations might put the occupational physician into a difficult position. These examinations require that an evaluation is made; to find out if the worker fits in or not. This is another role than the one a physician in an OHS normally has; being a support for the worker. The physician who performs pre-employment examinations must think this through and know what kind of role he/she enters.
e) Advisory role
Occupational health services have an important task to perform by providing advice to the enterprise management, the employers, the workers, and health and safety committees in their collective as well as individual capacities. This needs to be recognized and used in the decision-making processes as it often happens that occupational health professionals are not directly involved in the decision-making.
f) Occupational health care and curative health services
Occupational health services may be involved in the diagnosis, treatment and rehabilitation of occupational injuries and diseases. The knowledge of occupational diseases and injuries combined with the knowledge of the job, the working environment and occupational exposures present in the workplace enable the occupational health professionals to play a key role in the management of work-related health problems. General curative health services are not normally recommended as a part of the OHS activity, as this work may steal time from the preventive issues. However, in low income countries the situation might be different. In low income countries, health services in general might be lacking, and the company will need these services. To be able to treat a worker with malaria in an OHS might be extremely useful if the alternative is no treatment at all! However, when curative work and ordinary OHS work is mixed, the OHS personnel should be very aware of the difference in tasks and not end up with only curative activities. The prevention is after all the main aim of an OHS.
The participation of occupational health services is particularly crucial in guiding workers’ rehabilitation and their return to work. This is becoming more and more important owing to a large number of occupational accidents in developing countries and the ageing of the working populations in industrialized societies. The occupational health service may play an important role in seeing that workers recovering from injury or disease are referred to them promptly. It is greatly preferable, when practicable, for a worker to return to his or her original place of employment, and it is an important function of the occupational health service to maintain contact during the period of incapacity with those responsible for treatment during the acute stages in order to identify the time when a return to work can be envisaged.
h) Health promotion activities
Many occupational health services participate in “stop smoking” campaigns. © Colourbox
There is some tendency, particularly in North America and Europe, to incorporate wellness promotion activities in the form of occupational health programmes. These programmes are, however, essentially general health promotion programmes that may include such elements as health education, stress management and assessment of health risks. They usually aim at changing personal health practices such as alcohol and drug abuse, smoking, diet and physical exercise, with a view to improving overall health status and reducing absenteeism. These programmes, designed as health promotion programmes, though valuable as such are not usually considered as occupational health programmes, but as public health services delivered in the workplace, because they focus attention and resources on personal health habits rather than on protection of workers against occupational hazards.
© University of Bergen/Author: B.E. Moen