Health Surveillance Programs In Industry

Abstract

Abstract There is no universal agreement on what is included or what should be included in the term health surveillance in industry . Some apply a narrow interpretation, for example, making it synonymous with “health effects monitoring” or “the periodic medical– physiological examinations of exposed workers with the objective of protecting health and preventing occupationally related disease. The detection of established diseases is outside the scope of the definition”. It was defined as distinct from biological monitoring , “the measurement and assessment of workplace agents or their metabolites either in tissues, secreta, excreta, expired air or any combinations of these to evaluate exposure and health risk compared to an appropriate measure.”. This discussion, however, is not limited to such a narrow definition of health surveillance; the maintenance and protection of worker health must include evaluations of exposure as well as evidence of biologic effects, if any. Any discussion of health surveillance in industry must take into account the reasons for such surveillance. First and foremost in the rationale for such a program should be concern with health maintenance and health protection of those in the work force. This should not exclude mental health, an area of concern which has rarely been addressed when looking at health surveillance in industry. Any discussion of health surveillance in industry must, however, take into account the important influence of government regulations. These regulations will differ greatly around the globe. This discussion will be directed primarily toward the American experience and regulations. These include mandates by the Occupational Safety and Health Administration (OSHA), the Mine Safety and Health Administration (MSHA), the Environmental Protection Agency (EPA), the Equal Employment Opportunities Commission (EEOC), and others. There are also influential guidelines by nonregulatory agencies, such as the National Institute for Occupational Safety and Health (NIOSH). The specific requirements embedded in regulations promulgated by these agencies, and some of the fallacies therein, will be addressed after a more general review of current medical and scientific concepts regarding the role of such surveillance in worker health protection. Although the emphasis in this chapter will be on hazard‐oriented health surveillance aimed at protection of workers, it is still important to regard this as part of a broader program of health maintenance. The effective incorporation of special elements into a more general health program is the preferred approach. For this reason it is not feasible to discuss hazard‐oriented examinations out of the context of examinations to detect preexisting conditions or the development of abnormalities unrelated to the work environment.