The contribution of occupational health to primary health care (prof Carel Hulshof)

MAETIS ARBO. WERKEN IS GEZOND

The contribution of occupational

health to primary health care

Prof dr Carel Hulshof

• Coronel Institute of Occupational Health,

AMC

• Netherlands Society of Occupational

Medicine (NVAB) • Chair ICOH Scientific Committee on Health Services

Research and Evaluation in Occupational Health


The relation between Work and Health

• Work Health

– Prevention of occupational and work-

related diseases

• Health Work (ability)

– Maintaining the work ability: management

of sickness absence and disability

– Health promotion

• Together sustained workability


Is Work Good for your Health and Wellbeing? (Waddell & Burton, 2006, Schuring 2007)

YES:

• Strong evidence: Work is generally good for physical and

mental health and wellbeing and can help recovery

• Reverses the adverse health effects of unemployment

• Beneficial effects depend on the nature and quality of work and

its social context: jobs should be safe and accommodating

• Workplace is a setting for health promotion

• Moving off benefits without entry in to work associated with

deterioration in health and wellbeing


What is work?


What is work?

Work is of two kinds: first, altering the position of matter at or

near the earth's surface relatively to other such matter; second,

telling other people to do so. The first kind is unpleasant and ill

paid; the second is pleasant and highly paid.

Bertrand Russell. In Praise of Idleness, 1932


Predicted 12-month change in mental health scores (and SEs) for

transitions from unemployment, by subsequent employment

circumstances

Butterworth P et al. Occup Environ Med 2011;68:806-12


Paradigm shift! (GPA 2007)

Occupational Health

Employees with labour contract

Employer's responsibility

Only at the workplace

Only work-related health issues

Negotiation between workers

and employers

Workers’ Health

All workers

Responsibility of everybody

Beyond the workplace

All health determinants

Wider social dialogue with

stakeholders: insurance, health

and environment authorities

Health protection not subject to

collective negotiation

The Labour Approach The Public Health Approach


What determines workers’ health?

• Working environment

– mechanical

– physical

– chemical

– biological

– ergonomic

– psycho-social risks

• Social factors

– occupational status, employment

conditions

– income

– inequities in gender, race, age, etc.

• Work-related health practices

– individual risk-taking behaviour

– physical exercise, sedentary work

– diet and nutrition

– unhealthy habits – smoking,

alcohol

• (Access to) health services

– preventive occupational health

services

– specialized curative care and

rehabilitation

– health and accident insurance


Occupational Health Interventions

Risk factor at work

Worker’s Health

Behaviour

Disease, Disability

Exposure Change Behaviour change Disease Change

Worksite visits

Employer consultation

Exposure elimination

Health promotion

Training

Health surveillance

Treatment

Rehabilitation

Verbeek J et al., Scand J WEH 2004

environmental behavioural clinical


Workers covered by OHS in Europe (Source: Hämäläinen et al 2001, Rantanen 2002)

50

28

50

34

80

70

95

80

90

50 50

15

60 60

39

86

4

48

0

10

20

30

40

50

60

70

80

90

100

PT GR DK GB BE SE NL FR FI IT NOR EST BULG HUNG POL SLOV SL TURK

%

More than 80% of the workers in the world do not have access

to OHS. The proportion of workers and workplaces with access

to occupational health services is diminishing. In developing

countries, where production often occurs in small and medium

sized enterprises and frequently at home, traditional tools like

inspection are not feasible. So, many workers in the world are

underserved in terms of OHS


basic occupational health care/services

• Bring occupational health ‘as

close as possible to where

people live and work’

• Including elements of

occupational health in Primary

Health Care

• Integration of OHC and PHC


What?

• prevention of occupational health hazards

• diagnosis, treatment and rehabilitation of occupational or work-

related diseases

• surveillance of work environments and workers’ health

• health education and promotion

• risk assessment

• maintenance of work ability


How?

• Consultation of OH professionals in PHC

• Training of PHC personnel in OH activities

• Organizing support services, e.g. (inter)national/regional OH institutes (OH clinics, laboratory, technical support)

• OH care can support local or regional health systems in prevention and therapy of life threatening diseases such as malaria, HIV AIDS and tuberculosis.

• Including work (outcomes) in clinical practice guidelines


Example 1



Inleiding (3)

ArboAntwoord.com


Incorporating work outcomes into clinical

practice guidelines

Don’t you work a

little too hard?


Integration of work-related aspects in practice

guidelines in primary and secondary health care

• Many chronic diseases in PHC have an impact on work

opportunity for work-related interventions

• Guidance Document of NVAB and CBO based on answering

three questions:

are work-related disorders or disability related to the subject of this

guideline? (“doctor, is my work causing this?; can I work with this?”)

are work-related interventions possible and effective?

what is the role of occupational health care?


Health Condition

Function Activity Participation

Personal factors External factors

Clinical

interventions

Behavorial

interventions

Environmental

interventions

ICF model* and intervention options Adapted by PBA Smits and JHAM Verbeek s. EMUTOM project, August 2011

* ICF model, International Classification of Functioning, disability and health. ICF © World Health Organization 2001


Involvement ‘work and health’ in many

multidisciplinary guidelines in NL

• Carpal tunnel syndrome

• COPD

• Alcohol abuse

• Inflammatory bowel diseases

• Whiplash

• Obesity

• Cystic fibrosis

• Early interventions after disasters

• Obstructive sleep apnoea syndrome

• Atopic dermatitis

• Herniated lumbar disk

• Somatoform disorders

• Problematic use of drugs

• Multiple sclerosis

• Ankle injury

• Oncologic rehabilitation

• Urine incontinence

• Needle stick injuries

• Lyme’s disease

• Low back pain

• Anxiety disorder

• Depressive disorder

• Chronic fatigue syndrome

• Cardiovascular risk management

• Heart failure

• Adjustment disorder/burnout

• Complex regional pain syndrome

• Chronic rhino sinusitis

• Sub fertility

• Rheumatic arthritis

• Domestic violence

• Treatment smoking addiction

• Complaints of arm, neck, shoulder

• Lower extremity amputation



Sometimes evidence on a more aggregated

or general level


Collaboration between professional

associations: ICOH - Wonca

• ICOH SC on Rural Health: Agriculture, Pesticides and

Organic Dusts and Wonca already had a history of

collaboration

• In Milan 1996, presidents of ICOH and Wonca met and a joint

working group was established

• The aim of the group was: bringing together and discussing

experiences from GPs and OPs in several European

countries with providing sufficient coordinated care to working

people with health problems


OHC PHC

Health & Medicine

The contribution of occupational health to primary health care (prof Carel Hulshof)