OSH HISTORY AND

INTRODUCTION TO
OCCUPATIONAL HEALTH

Prof Dr Krishna Gopal Rampal

 OCCUPATIONAL HEALTH

Health ------------------------- Work

Work --------------------------- Health
Safety, health and welfare of workers and other
persons at place of work.
Work has both positive and negative effects
Occupational injuries
Occupational diseases
Work related diseases
Occupational health is the application of biology,
medicine, epidemiology, engineering, economics,
education, politics, the law and other disciplines to
protect workers form diseases of the workplace.
Anthony Robbins
Former Director, NIOSH USA
 Disciplines under occupational safety and health

Occupational medicine
Safety engineering
Industrial hygiene
Ergonomics
Toxicology
Occupational epidemiology
Occupational health nursing
 HISTORICAL PERSPECTIVE OF OH
Agricola (1494-1555) – physcian – Joachimsthal –
mining – De Re Metallica
Paracelsus (1493-1541) – disease of metallurgists
– mercurialism
Ramazinni (1633-1714) – Professor in Padua 1700-
De Morbis Artificum – Father of OM- What is your
occupation
Sir Thomas Legge (1863-1932) – First Medical
Inspector of Factories – England – Lead poisoning
Alice Hamilton (1869-1970)– Professor at Harvard
Stone age
Hunter gatherer
Agricultural age
Industrial Revolution
Information technology and K-economy
 OCCUPATIONAL HEALTH ORGANIZATIONS

International Labour Organization 1919

League of Nations
Tripartite – government, employers, workers
Conventions and Recommendations
ILO Encyclopedia
ILO Classification of Pneumoconiosis
World Health Organization
Occupational health unit (Workers Health)
Healthy settings (workplaces) approach
International Agency for Research in Cancer (IARC)
IARC Classification of Carcinogens
American Conference of Governmental Industrial
Hygienists (ACGIH)
Threshold Limit Values
 United Kingdom

Factories Act 1833

Inspectorate system
Medical Inspector of Factories
Medical surveillance – 1895 – lead,
phosphorus
Health and Safety at Work Act 1974 – Robens
Commission – safety and health responsibility of
those who create risks and those who work with
risks
COSHH – 1986 – Risk Assessment
European directives – six pack regulations - 1992
 United States of America

1914 – USPHS –Office of Industrial Hygiene and

Sanitation – NIOSH
1916 – American Association of Industrial Physicians
and Surgeons – ACOEM
1939 – American Industrial Hygiene Association
1946 – American Academy of Occupational Medicine
1955 American Board of Preventive Medicine (OM)
 Malaysia
Occupational Safety and Health Legislation

Boiler Enactments 1890s

FMS Mining Enactment 1926
Rump Labour Code 1833
Workmen’s Compensation Act 1952
Factories and Machiner Act 1967
Employees Social Security Act 1969
Pesticides Act 1974
Occupational Safety and Health Act 1994
 HISTORICAL PERSPECTIVE OF OSHMS
 ISO 9000 (Quality)
 ISO 14000 (Environment)
 BS 8800 – (OHSMS)
 OHSAS 18001 – (OSH)
 ILO-OSH 2001 (OSH)
 Malaysian Standard MS1722
 Exxon Mobil - Operations Integrity Management
System (OIMS)
 Shell - Health, Safety, Security and Environment
(HSSE) Management System
 OCCUPATIONAL HEALTH
• Interface between work and health
• Occupational health is aimed at establishing and
maintaining a safe and healthy work environment and to
facilitate optimal physical, mental and social well being
among workers.
• Hazards in workplace affect health of individuals. Health of
individuals affect ability to get work, perform work,
tolerate work and gain satisfaction from work.
• Medical practitioners taking care of workers health must
know what work patients do, understand work process,
know nature of the work environment, able to identify
workplace hazards and know their effects on health.
 Types of Occupational Medicine Practice

Occupational medicine in general practice (primary care

practice)

In-plant clinic

Estate clinics/hospitals and visiting medical officer (VMOs)

Industrial medicine clinics

Individual or partnership consultation practice in OM

Hospital based OM clinic

 Competency requirements for
occupational physicians

Legislation
Hazards
Fitness
Communication
Exposures
Research
Promotion
Management
 Occupational history

An occupational history is a chronological list

of all the patient's employment, with dates,
from leaving school – or even earlier. It may
be expanded as necessary to detail any
evidence of occupational exposure to
potentially hazardous agents and resulting
effects on health.
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Why take an occupational
history?

 To determine if there is evidence that:

 Work is a cause of ill health
 Work has aggravated existing ill health.
 Health or ill health has an effect on the
capacity for work.

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An occupational history is the most
effective instrument for the proper
diagnosis of occupational disease if it
provides evidence which generates
informed suspicion of risk of harm which
is acted upon correctly.

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An occupational history may also be an
effective instrument for assisting return
to work after injury or disease if it helps
to identify required standards in health or
fitness and how the individual measures
up to these.

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The occupational history or exposure history seeks to define
possible exposure to hazards to health and links with actual ill-
health outcomes.
Current job only
or full occupational history?
• Work-related illnesses often present
with common signs and symptoms.
• Where you suspect an occupational
aetiology, start with the current job.
• In acute cases, only the current job and
exposures in last 24 hours are likely to
be relevant.

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 Procedures for taking an
occupational history
• Oral questioning about current job. Patient probably has
good recall. Usually a quick process.
• Oral questioning about previous jobs. Expect gaps initially
and limited or poor recall on dates. This can be a slow
process which takes much doctor time.

• There is advantage in leaving the patient with a pro forma

about previous jobs to complete in his/her own time then
returning to question. Experience shows that this reduces
gaps and inaccuracy which would be present without such
an aid. It also reduces the time the doctor must be present.
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 OCCUPATIONAL HAZARD

An agent, process or activity, which has

the potential to cause harm or adversely
affect safety and health.
 Safety and Health Hazards
Physical
– Noise, heat, cold, vibration (hand-arm and whole body),
ionizing and non-ionizing radiation, electricity, mechanical
Chemical
– Irritants, allergens, carcinogens, mutagens, teratogens –
Heavy metals, solvents, pesticides
Biological
– Viruses (H1N1, SARS, HIV, Hepatitis B), Bacteria - T.B.
Psychological
– Stress, burnout, violence, sexual harassment
Ergonomic problem
– Shift work, night work, manual handling, poor posture
 OCCUPATIONAL DISEASES
e.g.
Occupational lung diseases e.g. asthma
Occupational cancers
Occupational musculoskeletal disorders
Occupational hearing loss and HAVS
Occupational eye disorders
Occupational skin disorders
Occupational neurological/neurobehavioral disorders
Occupational reproductive disorders

Occupational diseases are a long term cause of

disability and death.
 The global burden of selected occupational
diseases and injury risks (Nelson DI et al 2005)
Global burden of disease and injury due to selected
occupational hazards. WHO Comparative Risk
Assessment methodology.

In 2000 occupation was responsible worldwide for:

• 37% of back pain
• 16% of hearing loss
• 13% of chronic obstructive pulmonary disease (COPD)
• 11% of asthma, 9% of lung cancer
• 8% of injuries
• 2% of leukemia
Risks at work caused 850,000 deaths worldwide and
loss of about 24 million years of healthy life.
Hierarchy of control
Hierarchy of Controls

 Elimination
 Substitution
 Isolation
 Engineering controls
 Safe work practices (administrative)
 Personal protective equipment (PPE)
 Elimination
Elimination

 Removal from further use

 Best way of hazard control
 Applies to materials, processes and
technologies
 using clips/clamps instead of an adhesive

 purchasing supplies of a material in a

ready-cut sized rather than carrying out

dust producing cutting process on site
 Substitution

 Hazardous substance/process substituted to

non hazardous/less hazardous substance
 Consideration base on the toxicity of
reactants, intermediates, products, wastes
and contaminants
 benzene-----toluene (paint manufacture)

 Asbestos---synthetic mineral fibre

(insulation)
 Isolation
Isolation

 Physical separation of hazardous

material/process to prevent emissions of that
material into local environment

 Installation a physical barrier

 Enclosing operators in a clean environment

 Storage of flammable liquids inside an

enclosed boundary
 Engineering Controls

 Hazards control usually of a mechanical

nature, specifically designed for plant and
equipment/process
 Control hazard at the source by preventing
exposures from reaching workers
 Ventilation- local exhaust ventilation
 Using pumps for hazardous substances rather than
manual transfer
 Wet cutting process (stone, brick) that reduce
dust
LOCAL EXHAUST VENTILATION
 Safe work practices
Safe Work Practices
 Planned practices and processes which lead
to workers being adequately informed,
trained and supervised
 Rely on human behaviour
 Reducing number of employee exposed
 Reducing period of exposure for employees
 Providing information on hazards
 Safety culture
 Job rotation
 Personal Protective
Equipment
Personal protective equipment
 Barrier between the hazard and the wearer
 Offers protection only to the wearer
 Should be the last resort of control
 Short term measure and specific use during
part of the process
 General (overalls, clothing)
 Skin protection (aprons, gloves)
 Eye protection (chemical glasses, face shield)
 Respiratory protective equipment
 Hearing protection (ear plug, ear muff)