Environmental health and occupational medicine

1. Environmental health and occupational medicine Presenters: Dr. Rohit A. Bhat Dr. K. R. Pravinchandra Chairperson:

2. History • The history of occupational medicine can be traced into antiquity. Observations of increased rates of illnesses and mortality among miners date back to Greek and Roman times.

4. UllrichEllenbog- Poisonous, wicked fumes of smokes of metals. • Agricoli[1494-1555] working conditions • Paracelsus[1493-1541] of mining laborers. • Charles Turner[1795-1833]- statistically linked industrial disease with life expectancy. • James Lind- Treatise on scurvy

5. BernadinoRamazzani • 1633-1714 A.D • Father of occupational medicine. • Italy • Investigated miners disease, crafts, trades. • Miscarriages in women.

6. De MorbisArtificumDiatraba • Diseases of artificer • 1700 A.D • 42 chapters initially • 20 editions [addition of 12 chapters]

7. Legislations • 1833- appointment of factory inspectors. • 1844 factory act- certifying surgeons. • 1846 factory act- ventilation for industrial premises. • 1851 census- occupation taken into account. • 1891 factory act- foundation for modern occupational medicine. • 1897 Worksmen compensation legislation. • 1906- permanent commission for OH.

8. -Lead -Phosphorous -Anthrax • Main occupational health hazard • Thomas Arlige- Hygiene, diseases and mortality of occupations[1892] • Sir Thomas Legge[1898]- Industrial Maladies • Thomas Oliver- Dangerous Trades[1902]

11. Occupational Health • Joint ILO/WHO committee in 1950 said occupational health should aim at promotion and maintenance of highest degree of physical, mental and social well being of workers in all occupations

12. the prevention among workers of departures from health caused by their working conditions. • The protection of workers in their employment from risks resulting from factors adverse to health • The placing and maintenance of worker in an occupational environment adopted to his physiological and psychological equipment • The adaptation of work to man and of each man to his job

13. Environmental Medicine • ‘medical specialty involving prevention, diagnosis, treatment and study of diseases, injuries due to external influences but unrelated to patients workplace’ • Non occupational environment rivals or exceeds occupational environment as a source of health concern among public at large.

14. Comparison of Occupational health and Environmental health Occupational health Environmental health • Hazards in work place environment • Hazards largely in air • Hazards are physical chemical, biological and psychosocial • Routes of exposure: inhalational and dermal • Exposure period:8h/day • Exposed population: adults, usually healthy • Hazards in community environment • Hazards in air, soil, water ,food • Hazards are physical chemical, biological and psychosocial • Routes of exposure: ingestion, inhalation and dermal • Exposure period: lifelong • Exposed population: children, adults, elderly and sick population

15. Occupational And Environmental Medicine[OEM] • The occupational and environmental medicine physician assists employers in: • Identifying hazards • Detecting exposures • Protecting the workforce • Educating people regarding workplace hazards

16. Principles of OEM • The clinical and pathological expression of most environmentally caused diseases are indistinguishable from those of non-environmental origin. • Many diseases of occupational and environmental origin are multi factorial, with non-environmental factors playing a contributory role. • The effects of occupational and environmental exposures occur after a biologically predictable latent interval following exposure. • The dose of an exposure to a noxious agent is the strongest predictor of the likelihood and type of effect. • People differ substantially in their responses to noxious exposures.

17. Principles of OEM • The clinical and pathological expression of most environmentally caused diseases are indistinguishable from those of non-environmental origin. • Many diseases of occupational and environmental origin are multi factorial, with non-environmental factors playing a contributory role. • The effects of occupational and environmental exposures occur after a biologically predictable latent interval following exposure. • The dose of an exposure to a noxious agent is the strongest predictor of the likelihood and type of effect. • People differ substantially in their responses to noxious exposures.

18. Principles of OEM • The clinical and pathological expression of most environmentally caused diseases are indistinguishable from those of non-environmental origin. • Many diseases of occupational and environmental origin are multi factorial, with non-environmental factors playing a contributory role. • The effects of occupational and environmental exposures occur after a biologically predictable latent interval following exposure. • The dose of an exposure to a noxious agent is the strongest predictor of the likelihood and type of effect. • People differ substantially in their responses to noxious exposures.

19. Principles of OEM • The clinical and pathological expression of most environmentally caused diseases are indistinguishable from those of non-environmental origin. • Many diseases of occupational and environmental origin are multi factorial, with non-environmental factors playing a contributory role. • The effects of occupational and environmental exposures occur after a biologically predictable latent interval following exposure. • The dose of an exposure to a noxious agent is the strongest predictor of the likelihood and type of effect. • People differ substantially in their responses to noxious exposures.

20. Principles of OEM • The clinical and pathological expression of most environmentally caused diseases are indistinguishable from those of non-environmental origin. • Many diseases of occupational and environmental origin are multi factorial, with non-environmental factors playing a contributory role. • The effects of occupational and environmental exposures occur after a biologically predictable latent interval following exposure. • The dose of an exposure to a noxious agent is the strongest predictor of the likelihood and type of effect. • People differ substantially in their responses to noxious exposures.

21. Principles of OEM • The clinical and pathological expression of most environmentally caused diseases are indistinguishable from those of non-environmental origin. • Many diseases of occupational and environmental origin are multi factorial, with non-environmental factors playing a contributory role. • The effects of occupational and environmental exposures occur after a biologically predictable latent interval following exposure. • The dose of an exposure to a noxious agent is the strongest predictor of the likelihood and type of effect. • People differ substantially in their responses to noxious exposures.

22. Ergonomics • ‘applied, multi disciplinary scientific field concerned with design of jobs, products, systems, and environments to be compatible with human needs, abilities and limitations’ • Objective: to attain best mutual adjustment of man and his work, for the improvement of human efficiency and well being.

23. The OEM Team Industry • Safety Professional • Industrial Hygienist • Worker Representative • Management • Health Physicist • Ergonomist • Environmental Engineer Medicine • Nurse • Physician Assistant • Private Physician • Physical Therapist • Epidemiologist • Clinic • Hospital

24. The Team Approach • Enhanced health and safety in the workplace • A match between the worker and the task • Rapid and appropriate medical management of illness/injury • Effective communication for all • Cost effectiveness/efficiency

25. Components of OEM • Primary medical care • Secondary medical care • Preventive component • Business support and regulatory component • Administrative • Medical management

26. References: • Textbook of clinical occupational and environmental medicine, 2nd edition – Linda Rosenstock, Mark R Cullen, Carl A Brooke, Carrie A Redlich. • Hunter’s diseases of occupation, 10th edition. • International occupational and environmental medicine – Herzstein, Bunn, Fleming, Harrington, Jeyratnam, Gardner. • Oxford textbook of public health, 5th edition.

27. Harrison’s principles of internal medicine, 18th edition. • Park’s textbook of preventive and social medicine, 21st edition – K Park. • Textbook of public health and community medicine, 2009. • Community medicine with recent advances, 2nd edition – AH Suryakantha

28. Thank you

29. Occupational injuries and work place violence • ‘any damage to the body by energy transfer during work with a short duration between exposure and the health event[usually <48hrs].’ • 3,00,000 deaths worldwide per year • 3.5years healthy life lost per 1,00,000 per year due to injuries at work. • ‘Physical assault or verbal assaults or incivility or actions that makes someone uncomfortable in the work place.’

30. Prevention of occupational injury

31. Haddon’s Matrix

32. Hierarchy of Controls

33. Hierarchy of Controls

34. Workplace violence • Physical assault or verbal assaults or incivility or actions that makes someone uncomfortable in the work place.

35. Typology of workplace violence

36. Typology of workplace violence

38. Ex: Multi factorial causation of occupational injury

39. Occupational injuries and work place violence • ‘any damage to the body by energy transfer during work with a short duration between exposure and the health event[usually <48hrs].’ • Acute exposure in workplace to physical agents like mechanical energy, electricity, chemicals, ionizing radiations or lack of essential agents like oxygen or heat. • 3,00,000 deaths worldwide per year • 3.5years healthy life lost per 1,00,000 per year due to injuries at work.