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Occupational and environmental health 

Occupational and environmental health

Occupational and environmental health

J. M. Harrington

and Raymond M. Agius

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date: 30 March 2017

Occupational health is concerned with managing the health of working people. Occupational health physicians deal with the effects of work on health, and the influence of health on work. Other professional groups, including nurses, hygienists, toxicologists, psychologists, and safety engineers, also have important roles to play in keeping people healthy and at work.

Diseases associated with occupation have been with us since the dawn of history, but it was the vicissitudes of the Industrial Revolution of the 18th and 19th centuries that brought real progress in controlling these diseases through legislation, compensation, and health care.

Occupational health services are not universal, nor are they necessarily comprehensive. National governments in the developed world have approached the question of preventing ill health at work in different ways, with the European Union’s directives increasingly dominating the scene in Europe. In general terms prevention involves (1) the recognition of a health problem; (2) an assessment of the workplace risks; and (3) the implementation of control measures in the working environment to eliminate or minimize the risks to human health.

Particular occupational diseases

The most prevalent occupational diseases in developed countries today are musculoskeletal disorders and stress-related conditions, but occupationally related malignancies have the most serious outcomes.

Malignancies—the most significant occupational cancers and relevant exposures are (1) lung—asbestos, ionizing radiation, polynuclear aromatic hydrocarbons, and the compounds of certain metals such as arsenic, chromium, and nickel; (2) bladder—exposure to organic compounds such as aromatic amines; and (3) skin—coal gasification and coke production. Also of note is benzene, widely used in petrochemical industries and the cause of nonlymphocytic leukaemia and aplastic anaemia.

Musculoskeletal disorders caused by the workplace are primarily upper-limb disorders such as tenosynovitis or epicondylitis, mainly due to repetitive movement, bad posture, poorly designed tools, and mechanical stresses in the workplace. Low-back pain and osteoarthritis of the hips and knees are also associated with certain occupations, workplace postures, and weight-bearing activities.

Stress-related conditions—reports of occupational stress have increased dramatically in recent years. Effective management involves both (1) primary prevention, such as ensuring a good match between job demands, job control, and job rewards; and (2) helping those affected to cope with the stresses. Rehabilitation with counselling and behavioural therapies may be required in the last resort.

Skin—most occupational disorders are irritant contact dermatitides, with about one-third due to allergens. Skin care and protection are vitally important components of a preventive health programme to protect workers from the chemicals and dusts to which they may be exposed.

Other systems—the haemopoietic, digestive, nervous, genitourinary, reproductive, and cardiovascular systems can also be damaged by occupational exposures. The effects are extremely variable in type and pathogenesis, ranging from direct toxic damage from heavy metals, such as lead and cadmium, to the bone marrow or kidney, to secondary effects of organic solvents on hepatorenal function. The significant and extensive effects of workplace airborne particulates on the respiratory system are dealt with in Chapter 18.13.

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