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EDITORIAL
Year : 2017  |  Volume : 61  |  Issue : 3  |  Page : 153-154  

Strengthening occupational medicine to address challenges of occupational diseases: A priority


Professor and Head, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Web Publication15-Sep-2017

Correspondence Address:
Pankaja Raghav
Professor and Head, Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_267_17

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How to cite this article:
Raghav P. Strengthening occupational medicine to address challenges of occupational diseases: A priority. Indian J Public Health 2017;61:153-4

How to cite this URL:
Raghav P. Strengthening occupational medicine to address challenges of occupational diseases: A priority. Indian J Public Health [serial online] 2017 [cited 2017 Dec 11];61:153-4. Available from: http://www.ijph.in/text.asp?2017/61/3/153/214818

Worldwide, occupational diseases continue to be the leading cause of work-related deaths. According to International Labour Organization (ILO) estimates, out of 2.34 million occupational fatalities every year, only 321,000 are due to accidents. The remaining 2.02 million deaths are caused by various types of work-related diseases, which correspond to a daily average of more than 5500 deaths.[1] In addition, many millions of workers suffer nonfatal injuries and illnesses. The use of modern technologies has posed the workers with high rate of accidents and occupational diseases. With rapid industrialization, factories with unhealthy environment are built; workers are exposed to dangerous materials without the necessary protective measures leading to increase in overall burden of occupational diseases, especially in developing countries. Occupational diseases carry an enormous cost for workers and their families. ILO estimates that occupational accidents and diseases result in an annual 4% loss in the global gross domestic product, or about US$ 2.8 trillion, in direct and indirect costs of injuries and diseases. However, ultimate cost of the occupational disease is human life. It impoverishes workers and their families and may undermine whole communities when they lose their most productive workers.[2]

Concern for the protection of workers' health is not new to medicine. Physicians in the 1400s raised awareness among colleagues as to the need to prevent the diseases of employment in mines. Paracelsus, a Swiss-born nomadic physician (1453–1541), published some of the earliest works on the relationship between respiratory disease and the mining and smelting industries. These monographs led to increased attention to “hygiene” in the mines.[3] It is now more than 300 years since Bernardino Ramazzani, the father of occupational medicine (OM), advised the doctors to ask, “what your occupation is?” to their patients.[4] However, nowadays, occupational history is just followed as the ritual by the person sitting at the reception.

While accurate figures for occupational issues are still hard to obtain on a global scale, it is much more widely recognized today that occupational accidents and diseases can have a major impact on the productivity, competitiveness, and reputation of individual enterprises, as well as on the livelihoods of individuals and their families. Globally, more than half of all countries do not provide statistics for occupational diseases. This underreporting of occupational accidents and diseases is a major obstacle in raising the awareness of the need to place safe work higher in the political agenda. Most work-related deaths and nonfatal occupational accidents occur in low- and middle-income countries in South-East Asia and the Western Pacific region. These countries possess most of the world's working population, and additionally, the proportion of workers occupied in risky jobs is also higher. According to ILO, the great majority of workplace accidents and diseases are preventable, and prevention is the key to tackle the growing number of work-related diseases.[5] This clearly shows a need for developing OM with an effective occupational disease surveillance program to address various issues related to occupations. According to Block,[6] there is no other field in medicine where the harvest could be as rich as in OM if we used all the information that we have at our disposal for the better understanding of health and disease. It is regrettable that we make very little use of this information.

Steve Levin, Professor of OM at the Mount Sinai School of Medicine, described OM as, “work that combines clinical medicine, research, and advocacy for people who need the assistance of health professionals to obtain some measure of justice and health care for illnesses they suffer as a result of companies pursuing the biggest profits they can make, no matter what the effect on workers or the communities they operate in.”[7]

In OM, the critical point is not clinical diagnosis but instead the etiological diagnosis, which is, utilized for preventive, epidemiological, regulatory, and insurance measures. In addition, informed suspicion is the principal tool for correct diagnosis of occupational disease.[8] As rightly pointed out by Khogali [9] in 1966, “in a developing country like Sudan, coping with problems of occupation will be a part of the work of the public health expert.” Although occupational health (OH) practice can vary among countries, there are core values, knowledge, and skills, characterizing the specialty. The competencies required of occupational medical practitioners have been the subject of peer-reviewed research in different countries around the world.[10],[11] Lalloo et al.[11] developed the list of competencies from the training curricula of a range of OM institutions globally. These curricula identified a high degree of crossover in terms of competency requirements between countries. Tiwari et al.[12] prepared the framework of OH competencies for medical graduates, postgraduates, and master in public health course. According to Slattery,[4] number of medical schools have demonstrated that principles of OM can be introduced into the training program in a number of ways, without much extra demand on the students' time. Elective periods in industry or other areas of OH practice can also be arranged, without much difficulty.

The work carried out on OM demonstrated that OM specialist should be multiprofessional and customer oriented. To further conclude, need for prevention of occupational diseases is both obvious and urgent. It must remain a high priority for all stakeholders who are motivated to sustain efforts to make workplaces safer and healthier around the globe. It is high time that we should initiate OH surveillance and generate correct data. The statistics on occupational diseases generated will attract the attention of different stakeholders and it hopefully will find a place in political agenda.

As suggested by the ILO Director, General Guy Ryder in a statement issued for the World day for safety and health at work on April 28, 2013, “significantly reducing the incidence of occupational disease is not simple, it may not be easy, and it will not happen overnight, but progress is certainly feasible. So, let us, in our respective areas of responsibility, set clear occupational safety and health goals, establish a roadmap and most critically, act and persevere, so that, together, we succeed in turning the tide on the epidemic and make good progress on this dimension of decent work.”[2]

 
   References Top

1.
Available from: http://www.ilo.org/safework/events/meetings/WCMS_204594/lang--en/index.htm. [Last accessed on 2017 Aug 07].  Back to cited text no. 1
    
2.
Available from: http://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_211627/lang--en/index.htm. [Last accessed on 2017 Aug 07].  Back to cited text no. 2
    
3.
Wade R. The evolution of occupational health and the role of government. West J Med 1982;137:577-80.  Back to cited text no. 3
    
4.
Slattery DA. Occupational medicine as a specialty. Postgrad Med J 1989;65:89-93.  Back to cited text no. 4
    
5.
Safety and Health at Work: A Vision for Sustainable Prevention: XX World Congress on Safety and Health at Work 2014: Global Forum for Prevention, 24-27 August, 2014, Frankfurt, Germany/International Labour Office; Geneva: ILO; 2014.  Back to cited text no. 5
    
6.
Block DL. The relation between occupational medicine and the community. Bull N Y Acad Med 1971;47:1213-21.  Back to cited text no. 6
    
7.
Halper K, Levin S. Stephen Levin's Work Continues to Effect Change and Save Lives. The Nation; 14 February, 2012. Available from: https://www.thenation.com/article/remembering-dr-stephen-levin/. [Last accessed on 2017 Aug 01].  Back to cited text no. 7
    
8.
Lee WR, Tar-Ching AW. The occupational history. In: Baxter PJ, editor. Hunter's Diseases of Occupations. 9th ed. UK: The Bath Press; 2000. p. 3-13.  Back to cited text no. 8
    
9.
Khogali M. The future of an occupational health unit in Khartoum University, the Sudan. Br J Ind Med 1966;23:154-8.  Back to cited text no. 9
    
10.
Franco G. Consensus on evidence or evidence of consensus? The evolving role and the new expertise of the occupational physician. Occup Med (Lond) 2003;53:79-81.  Back to cited text no. 10
    
11.
Lalloo D, Demou E, Kiran S, Cloeren M, Mendes R, Macdonald EB. International perspective on common core competencies for occupational physicians: A modified Delphi study. Occup Environ Med 2016;73:452-8.  Back to cited text no. 11
    
12.
Tiwari RR, Sharma A, Zodpey SP. Occupational health training in India: Need for a competency-driven approach. Indian J Occup Environ Med 2016;20:39-43.  Back to cited text no. 12
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