Re: Occupational morbidity and the state of occupational health in Greece

Abstract

Dr Kourouklis [1] has presented data on disability from occupational diseases in Greece (Social Security Institution; IKA). Allergic contact dermatitis was the most prevalentdiagnosis,whileallrespiratorydiseaseaccountedfor39% of the recognized occupational morbidity. These figures in part corroborate our results published inOccupational Medicine in2005[2].DrKourouklisdeclared thatoccupational diseases in Greece are underreported due to the absence of a unified recording and notification system covering all insurance schemesand we agree that all schemes in the country should have a common notification system. The problem is that even if other schemes replicated the figures provided by IKA, the annual incidence rate of 0.39 recognized occupational diseases/100 000employeeswouldnot change. Thus, the establishment of a common notification system for is only a part of the problem. DrKourouklishasmentionedthat therenewalof theprescribed list could be a first step towards improvement of the reporting and notification of occupational diseases. We agree with him, but again the renewal of the prescribed list per sedoes not solve the problem of underreporting and the undiagnosed burden of occupational morbidity in Greece. An illustrative example is pleural mesothelioma that was not included in the prescribed list until 2005 and only one case of pleural mesothelioma was recognized in 2001 [2] despite the country’s major asbestos industry in the past. This is also is the case for lung cancer and a Greek case–control study revealed that exposure to occupational carcinogens including asbestos was associated with an attributable risk of lung cancer 9.9–16.6% [3]. The question is why do these figures suggest underregistration of occupational disease in Greece? As well as the low number of specialized occupational physicians, problems with the notification system and renewal of the prescribed list, there are more fundamental reasons for this situation. The system of insurance coverage for occupational risk has a variety of limitations and often the main target of employers is simply to demonstrate compliance with health and safety legislation. There are no reference centres for the diagnosis and management of occupational diseases as there are for instance in the UK and occupational health and safety has received low priority in the Greek political and public agenda [4]. We feel that the current model of occupational health in Greece has exhausted all its potential for development and the under registration of occupational morbidity reflects the state of occupational health in our country.