Dr. Tawfik A. M. Khoja MBBS, DPHC, FRCGP, FFPH (UK) Director General – GCC

1. OCCUPATIONAL HEALTH RISK ASSESSMENT Dr. Tawfik A. M. Khoja MBBS, DPHC, FRCGP, FFPH (UK) Director General – GCC Health Ministers’ Council TO BE PRESENTED IN THE OCCUPATIONAL HEALTH AND SAFETY CONFERENCE Muscat Sultanate of Oman 20-22 Dhul-Qada 1427 H / 11-13 December 2006

3. IN THE NAME OF ALLAH, THE MOST GRACIOUS, THE MOST MERCIFUL

4. Introduction Chemicals can be either beneficial or harmful, depending on a number of factors, such as the amounts to which we are exposed. are used to determine if a particular chemical poses a significant risk or problemto human health and, if so, under what circumstances. Health risk assessments

5. How much of the chemical would someone have to be exposed to before it would be dangerous? How serious could the health risks be? What activities might put people at increased risk? ( The total removal of harmful pollutants from environment is often infeasible or impossible, and many naturally occurring substances also pose health risks ).

6. Risk assessment helps scientists and regulators identify serious health hazards and determine realistic goals for reducing exposure to toxics and threat to the public . Estimating the hazards posed by toxic chemicals in the environment involves the compilation and evaluation of complex sets of data . These perform or assist by specialists include scientists in toxicology and epidemiology as well as physicians, biologists, chemists, and engineers .

7. As broadly defined,RISK ASSESSMENTcan be used to predict the likelihood of many unwanted events : including industrial explosions, workplace injuries, failures of machine parts, natural catastrophes, injury or death from an array of voluntary activities, diseases, natural causes, life-style or others.

8. HEALTH RISK ASSESSMENT : is a separate and distinct discipline which uses toxicology data collected from animal studies and human epidemiology, combined with information about the degree of exposure, to quantitatively predict the likelihood that a particular adverse response will be seen in a specific human population. The risk-assessment process has been used by agencies for almost 40 years, most notably within the U.S. Food and Drug Administration (FDA).

9. With the emergence of quantitative methods, risk-assessment models can better estimate the probability that a specific adverse effect will occur over a wide range of doses. Since 1980, many environmental regulations and some occupational health standards have been based on the results of low-dose extrapolation models and exposure assessments. Cont.

10. For example, risk-assessment methodologies have been used to set standards for pesticide residues, food additives, pharmaceutical agents, drinking water, soil and ambient air.

11. RISK ASSESSMENT, by its very nature, is a process whereby the magnitude of a specific risk is characterized so that decision makers can conclude whether the potential hazard is sufficiently great that it needs to be managed or regulated. Before deciding to conduct such analyses, one must concede that some level of risk can be deemed acceptable; that is, a risk-benefit balance can be found.

12. Some nations , have traditionally regulated chemicals to reduce emissions and exposure to the lowest level achievable using engineering controls or to impose a ban. Reducing health risks to levels that are "as low as reasonably achievable" (ALARA) or requiring the use of the "best available technology" (BAT) can produce significant reductions in the degree of exposure . Cont.

13. First, adopting an ALARA or BAT approach can be costly and may not result in an appreciable overall benefit (reduction of risk) to society. Second, a reliance on banning may not ensure that a significant or even measurable level of risk reduction will occur.

14. Risk characterization This is the most important part of an assessment, it summarizes and interprets the information collected from previous activities and identifies the limitations and the uncertainties in risk estimates. Cont.

15. A risk is the probability (chance) , high or low, that somebody could be harmed hazards, together with an indication of how serious the harm could be. The risk can either be expressed mathematically, (0.5 = a 50/50 chance) "high/medium/low". The outcome would be a musculoskeletal disorders (MSDs)

16. What is a hazard ? A hazard is something that has the potential to cause harm. This harm can effect people,propertyand processes as follows: * People – injury, illness, death, psychological trauma; * Property – Damage, contamination, theft chemical, electricity and wastage; * Process – Work disruption working from ladders and interruption to production.

17. HAZARD IDENTIFICATION is the first and most easily recognized step in risk assessment. It is the process of determining whether exposure to an agent could (at any dose) cause an increase in the incidence of adverse health effects in humans or wildlife.

18. Dose-response evaluations define the relationship between the dose of an agent and the probability of a specific adverse effect in laboratory animals. Exposure assessment quantifies the uptake of xenobiotics from the environment by any combination of oral, inhalation and dermal routes of exposure.

19. What is occupational risk assessment ? Modern occupational safety and health legislation usually demands that a risk assessment be carried out prior to making an intervention. • Biological agents • Chemical agents • Physical agents, including • noise • vibration • ionizing radiation Cont.

20. Physical hazards • Slips and trips • Falls from height • Workplace transport • Dangerous machinery • Electricity • Work related stress causal factors Various models for conducting occupational health risk assessment provide step-by-step guidance for the identification and assessment of significant occupational health hazards.

21. Occupational risk assessment helps you to make sure that you can weigh up whether you have taken enough precautions or should do more to prevent harm. Accidents and ill health can ruin lives and affect your business too if output is lost, machinery is damaged, insurance costs increase or you have to go to court. The aim is to make sure that no one gets hurt or becomes ill. Cont.

22. You are legally required to assess the risks in your workplace so that you put in place a plan to control the risks. The importance things you need to decide are: whether a hazards is significant , and whether you have than a careful examination of what, in your work, could it covered by satisfactory precautions so that the risk is small.

23. How to assess the risks in the workplace Step 1 : Look for the hazards Step 2 :Decide who might be harmed and how Step 3 : Evaluate the risks and decide on precautions Step 4 : Record your findings and implement them Step 5 : Review your assessment and update if necessary

24. HRAVsEpidemiological Studies The term “health risk assessment” is often misinterpreted. People sometimes think that a risk assessment will tell them whether a current health problem or symptom was caused by exposure to a chemical. This is not the case. HRA and epidemiologic studies have different objectives. Most epidemiologic studies evaluate whether pastchemical exposures may be responsible for documented health problems in a specific group of people. Cont.

25. In contrast, health risk assessments are used to estimate whether current or futurechemical exposures will pose health risks to a broad population, such as a city or a community. Scientific methods used in health risk assessment cannot be used to link individual illnesses to past chemical exposures assessments.

26. The Four-Step Process of Risk Assessment

27. RISK ASSESSMENT PARADIGM Risk assessment has (by convention) been separated into four sub-disciplines: 1) hazard identification, 2) dose-response assessment, 3) exposure assessment. and 4) risk characterization. This has been called the “Risk Assessment Paradigm."

28. Step 1 Hazard Identification Scientists determine the types of health problems a chemical could cause by reviewing studies of its effects in humans and laboratory animals. Depending on the chemical, these health effects may include: • Short-term ailments, such as headaches; nausea; and eye, nose, and throat irritation; • Or chronic diseases, such as cancer.

29. Effects on sensitive populations, such as pregnant women and their developing fetuses, children, the elderly, or those with health problems (including those with weakened immune systems those with pre-existing medical conditions), must also be considered. Responses to toxic chemicals will vary depending on the amount and length of exposure.

30. The effects of the vast majority of chemicals often rely on animal studies to evaluate a chemical’s health effects. • Comparison of human and animal metabolism may be useful in selecting the animal species that should be studied, if similar effects were found in more than one species, the results would strengthen the evidence that humans may also be at risk.

31. Step 2 Exposure Assessment Scientists attempt to determine : • How long people were exposed to a chemical; • How much of the chemical they were exposed to; • Whether the exposure was continuous or intermittent; • And how people were exposed—through eating, drinking water and other liquids, breathing, or skin contact.

32. To estimate exposure levels, scientists rely on air, water, and soil monitoring; human blood and urine samples; or computer modeling. Although monitoring of a pollutant provides excellent data, it is time consuming, costly, and typically limited to only a few locations.

33. So Scientists often rely on computer modeling, which is relatively inexpensive and less time consuming, also uses mathematical equations to describe and assess how a chemical is released ( industrial facilities ) and to estimate the speed and direction of its movement through the surrounding environment.

34. Step 3 Dose-Response Assessment Scientists evaluate the information obtained during the hazard identification step to estimate the amount of a chemical that is likely to result in a particular health effect in humans. An established principle in toxicology is that “the dose makes the poison.” For example, a commonplace chemical like table salt is harmless in small quantities, but it can cause illness in large doses.

35. Scientists perform a dose-response assessment to estimate how different levels of exposure to a chemical can impact the likelihood and severity of health effects. The dose-response relationship is often different for many chemicals that cause cancer than it is for those that cause other kinds of health problems.

36. Cancer Effects For chemicals that cause cancer, the general assumption in risk assessment has been that there are no exposures that have “zero risk” unless there is clear evidence otherwise. Very low exposures to carcinogens might increase the risk of cancer, if only by a very small amount. Several factors make it difficult to estimate the risk of cancer. Cont.

37. Cancer appears to be a progressive disease because a series of cellular transformations is thought to occur before cancer develops. Cancer in humans often develops many years after exposure to a chemical. Collective data from new studies can be used to improve estimates of cancer risks.

38. Non-cancer Effects Non-cancer health effects (such as asthma, nervous system disorders, birth defects, and developmental problems in children) typically become more severe as exposure to a chemical increases. One goal of dose-response assessment is to estimate levels of exposure that pose only a low or negligible risk for non-cancer health effects.

39. Step 4 Risk Characterization The last step in risk assessment brings together the information developed and dose response assessments to describe the resulting health risks that are expected to occur in the exposed population. Scientists analyze the information developed during the exposure is presented in different ways for cancer and non-cancer health effects, as explained as follow: Cont.

40. Cancer Risk Cancer risk is often expressed as the maximum number of new cases of cancer projected to occur in a population of one million people due to exposure to the cancer-causing substance over a 70-year lifetime. For example, a cancer risk of one in one million means that in a population of one million people, not more than one additional person would be expected to develop cancer as the result of the exposure to the substance causing that risk.

41. An individual’s actual risk of contracting cancer from exposure to a chemical is often less than the theoretical risk to the entire population calculated in the risk assessment. For example, the risk estimate for a drinking-water contaminant may be based on the health-protective assumption.

42. Moreover, an individual’s risk not only depends on the individual’s exposure to a specific chemical but also on his or her genetic background (i.e., a family history of certain types of cancer); health; diet; and lifestyle choices, such as smoking or alcohol consumption.

43. How Health Risk Assessment Is Used

44. Risk managers rely on risk assessments when making regulatory decisions, such as setting drinking water standards, or developing plans to clean up hazardous waste sites. Risk managers are responsible for protecting human health, but they must also consider public acceptance, as well as technological, economic, social, and political factors, when arriving at their decisions.

45. For example, they may need to consider how much it would cost to remove a contaminant from drinking water supplies or how seriously the loss of jobs would affect a community if a factory were to close due to the challenge of meeting regulatory requirements that are set at the most stringent level. Health risk assessments can help risk managers weigh the benefits and costs of various alternatives for reducing exposure to chemicals.

46. One of the most difficult questions of risk management is: How much risk is acceptable? ! While it would be ideal to completely eliminate all exposure to hazardous chemicals, it is usually not possible or feasible to remove all traces of a chemical once it has been released into the environment.

47. The goal of most regulators is to reduce the health risks associated with exposure to hazardous pollutants to a negligibly low level.

48. Risk Assessment of Work Related Stress Definition work related stress as "the adverse reaction people have to the excessive pressures or other types of demand placed on them".

49. Principles Stressors need to be assessed by the same methodology as other work related hazards. Heads of departments of the organization are required to appoint one or more persons (who are senioremployees, qualified, and trainaed members) in their department to carry out the necessary risk assessments, judgments and to recommend appropriate actions.

50. FACTORS TO BE CONSIDERED BY ASSESSORS ARE: Demands - such as workload, fear of exposure to physical hazards etc; Control - the degree of control an employee in their role/job has in the work that they do; Relationships - in particular harassment or bullying in the department; Change - the way organizational change is managed and communicated in the department; Cont.