Ill health and the work environment
The size of the problem
Work is an important determinant of health. It can influence health positively or negatively. This page focuses on the adverse effects of work on health, although the positive effects of appropriate work on health and well-being are no less important.
Every year about 10 million of the 150 million workers in the European Community are affected by incidents, "accidents" or diseases at work. Direct compensation costs are estimated at 20 billion ECU per year.
According to UK official statistics, every year about 2,000 lives are lost through occupational disease or injury, about 20,000 major industrial injuries occur (e.g. skull fracture, loss of sight) and there are about 200,000 injuries resulting in a work disability of 3 days or more. These figures are gross underestimates of the true incidence of occupational ill-health. Thus for example the "true" figure of occupational cancer deaths alone in the U.K. may be to the order of 5,000 per year. While only about 300 workers receive disablement benefit for industrial dermatitis every year, there may be between 15,000 and 60,000 new cases of this condition every year.
Extrapolation from the UK Labour Force Survey suggest that in a year at least one million people believed they had ill health caused by work and a further million believed they had ill health made worse by work.
For further information, see: Occupational ill-health in the modern world (Agius website)
Hazards and risks in the workplace
Hazard is the potential to cause harm. Risk is a measure of the likelihood of a specified harmful effect in specified circumstances. It is important to distinguish between hazard and risk.
Hazards in the workplace include the following:
Physical
- Non-ionising radiation, e.g. microwaves, infra red, visible and ultra-violet light
- Ionising radiation, e.g. X-rays,gamma rays,beta particles, alpha particles from radon daughters
- Noise (usually measured in decibels dB) and vibration
- Temperature, humidity etc
- Ergonomic: posture, movement (e.g. keyboard operation), load bearing (e.g.patient handling)
Chemical
- Inorganic - e.g. lead, arsenic, silica
- Organic - e.g. solvents, resins, glues, fluxes (vapours and gases are usually expressed in concentrations of parts per million or per billion: ppm or ppb)
Biological
- Allergens of biological origin: laboratory animals, insects, mites, wood and other plant material, fungal spores
- Infections: Bacteria: Tuberculosis, Brucella, Leptospira etc
- Viruses: e.g. Hepatitis B from needlestick injuries
Psychological
- Various aspects of work organisation may be stressors
Responsibilities of the employer, and the participation of employees, so as to reduce the risks to health from work
The responsibilities of the employer mainly stem from legislation such as the Health and Safety at Work etc. Act (1974) but other more recent UK and European Union legislation is very important in managing Health and Safety at work. These include the Management of Health and Safety at Work Regulations, Control of Substances Hazardous to Health Regulations,Manual Handling Operations Regulations, Personal Protective Equipment at Work Regulations and various others.
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The image shows a worker, protected from a chemical exposure contained within a reaction vessel, provided with local exhaust ventilation at the orifice of the vessel, designed so as to suck away any gases or vapours as they emanate from the vessel. In addition, he is wearing personal protective equipment consisting of an airhood supplied by piped breathing air, as well as rubber gloves, safety shoes and other skin protection.In his case, there are therefore several lines of defence to protect him from exposure. |
Assessment of health risks created by work
- Identification of hazards
- Assessment of exposure, work practices etc
Prevention or control of risks
- Elimination of hazards
- Substitution of hazards
- Enclosure/segregation so as to reduce exposure
- Local exhaust ventilation if appropriate
- Personal protection e.g. gloves, goggles, masks, footwear
- Appropriate work organisation and practice
Monitoring and evaluation
- Checking of control measures
- Environmental monitoring: personal and background
- Appropriate health surveillance
Consultation, information, instruction and training
Sadly, not all information or instruction is useful and appropriate.
 Electronic caries detector |
Information alone is not a substitute for reasonable risk reduction strategies. Consider this image, for example.
Would you consider that advising workers not to inhale blue asbestos is a reasonable way of protecting their health, and preventing ill-health? |
Incidentally - this sign was attached to the boilerhouse of a National Health Service hospital in Britain and the photo was taken in the early 1980's. With attitudes such as those illustrated by the photo, it is no surprise that hundreds of workers are sadly still dying every year from mesothelioma caused by occupational exposure to asbestos several years previously, and the number is set to continue rising before it eventually falls.
Record keeping and reporting
These are requirements of several regulations and are essential means of assessing the adequacy of risk reduction measures and of identifying previously unrecognised hazards.
Occupational diseases and other work-related ill-health
The effect that occupation may have on a worker's health is dependent on the exposure (expressed quantitatively) to relevant agents, and on host factors. Taking a history is often very important in identifying relevant exposures and linking them to ill-health. The concept of "cumulative exposure" i.e. a quantitative measure of the intensity of exposure and the duration of exposure is important, since generally it is the main determinant of risk. Health may be harmed by occupational exposures in many different ways, and practically any organ system can be affected.
Some examples follow - (starting with the lungs and skin, the organs of first contact for most chemical occupational exposures):
Skin
- Eczema/ dermatitis - This can be irritant e.g. caused by detergents, or allergic e.g. as caused by certain rubber chemicals.
- Cancer e.g. from skin exposure to pitch/tar, or to excessive sunlight
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Lungs
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Musculoskeletal
- Tenosynovitis and similar conditions
- Back pain from manual handling
Nervous and mental
- Peripheral neuropathy, e.g. caused by lead or n-hexane
- Nerve deafness induced by noise
- Mental ill-health, e.g. caused by stress or by chemical exposures such as mercury
Blood/marrow
- Anaemia, e.g. caused by lead, which may impair the synthesis of normal haemoglobin
- Aplastic anaemia may be caused by high exposures to benzene
- Leukaemia (a cancer of certain white blood cells) caused by benzene
Genitourinary and endocrine
- Kidney damage caused by some solvent exposures or by cadmium
- Bladder cancer, e.g. caused by beta naphthylamine, or compounds of similarstructure (generally aromatic amines, with an aromatic group in the 'para' position to the amine)
- Infertility caused by some chemical exposures, e.g. male infertility caused by DBCP (dibromochloropropane). A range of chemicals have been implicated in the potential for endocrine disruption and/or effects on reproduction such as phthalates, glycol ethers, and organophosphates
Liver
- Hepatitis, e.g. toxic from some chemicals or viral e.g. in health care workers
- Cancer, e.g. Vinyl chloride monomer causing angiosarcoma
Note:
- In the Great Britain the Employment Medical Advisory Service of the Health and Safety Executive employs medical doctors who should be available to advise workers or their general practitioners
For further details, see: Health and Safety Executive website
- Some National Health Service Trusts also offer this facility to patients referred by their general practitioners:
For further details, see: Control of risks to health from work
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