Managing Occupational Disease - The Journey Toward Prevention

Abstract

Management The International Labor Organization estimates that globally, 2.78 million people die each year from causes attributed to work. Fatal accidents accounted for 13.7% of these deaths but surprisingly, the vast majority of these deaths, 2.4 million or 86.3%, were due to work-related diseases. Circulatory conditions, work-related cancers, and respiratory diseases were the top three diagnostic categories. Understandably, many have asked how experts determine that a condition is work-related since occupational diseases often have a long latency period and may not be clinically or pathologically different than non-work-related diseases. While the work relatedness of some occupational diseases is well known (e.g., mesothelioma or silicosis), linking other diseases to the workplace often requires a more in-depth analysis. From a population perspective, experts use epidemiological methods to determine the proportion of occupational disease related to a specific risk factor. By extension, with certain caveats, this attributable fraction can also be used to estimate the fraction of disease that would not occur if exposure to the risk factor was not present. These kinds of studies are instrumental in prompting further research into the mechanism of disease causation and development of effective treatment regimens. When attempting to diagnose an occupational disease in an individual, clinicians need to follow a stepwise approach that begins with taking a full clinical history, which should include relevant information regarding the patient’s occupation. The association with the workplace must then be evaluated in the context of the following: Is there a known linkage between the condition and risk factors in the workplace? Is there an identifiable dose-response relationship? Does the temporal relationship add further support for work relatedness? Are there other more likely causes for the condition in question, such as underlying conditions, lifestyle (e.g., smoking), family history, etc.? The health and wellbeing of employees is truly a valuable asset and occupational disease exacts an unmeasurable emotional and financial toll on all involved—employers, workers, and their families. Leaders in occupational medicine have a duty to not only treat these diseases but should work with employers to prevent them from occurring—especially across various global work locations where protective regulations may not exist. Below are suggestions to help you design workplace programs that will put you on a journey toward prevention and actively demonstrate your commitment to worker safety and health. Know Your Workplace The occupational medicine professional should be familiar with the chemical, physical, biologic, and other hazards present in their workplace. Examples of these are listed below. Chemical hazards such as gases, liquids, dust/fibers (silica, asbestos, manmade fibers, etc.), welding fumes, and selected pharmaceutical agents Physical hazards such as ionizing and non-ionizing radiation, electromagnetic fields, noise, temperature extremes, and emerging risks such as sedentary work Biologic hazards such as selected viruses (hepatitis B, C) and pharmaceutical agents