Occupational health and occupational hazards by Dr. Sonam Aggarwal

• "Occupational health should aim at the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations;
• the prevention among workers of departures from health caused by their working conditions;
• the protection of workers in their employment from risks resulting from factors adverse to health;
• the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological equipment, and,
• to summarize, the adaptation of work to man and of each man to his job.”
The Joint ILO/WHO Committee on Occupational Health,1995

1. OCCUPATIONAL HEALTH Dr . Sonam Aggarwal MD Community Medicine Occupational Health 1

2. Contents: Definition Aim and Objectives of Occupational Health Ergonomics Occupational Hazards Occupational Diseases Sickness Absenteeism Accidents Health Problem due to Industrialization Measures for Health Promotion of Workers Prevention of Occupational Disease Bibliography Occupational Health 2

3. Definition of Occupational Health • "Occupational health should aim at the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; • the prevention among workers of departures from health caused by their working conditions; • the protection of workers in their employment from risks resulting from factors adverse to health; Occupational Health 3

4. • the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological equipment, and, • to summarize, the adaptation of work to man and of each man to his job .” The Joint ILO/WHO Committee on Occupational Health,1995 Occupational Health 4

5. Aim of Occupational Health To provide a safe occupational environment in order to safe guard the health of the workers and step up industrial production . Occupational Health 5

6. Objectives • To maintain and promote the worker’s health and working capacity. To improve the working environment and work . To develop the work organizations in a direction which supports health and safety at work. Occupational Health 6

7. Ergonomics It is derived from Greek words, ‘Ergon’ means work and ‘Nomos’ means law. It means ‘fitting the job to the worker”. According to the International Ergonomics Association, ergonomics is ‘ concerned with the understanding of interactions among humans and other elements of a system, and is the profession that applies theory, principles, data and methods to design in order to optimize human well being and overall system performance’. Occupational Health 7

8. Occupational disease: According to ILO, an occupational disease is “ any disease contracted as a result of an exposure to risk factors arising from work activity”. Occupational injury: Occupational injury can be defined as any personal injury, disease or death resulting from occupational accident. It is different from occupational diseases, which are diseases contracted due to long term exposure of particular risk factors existing in occupational environment. Occupational hazard: it is a substance, agent, or physical situation with a potential for harm in terms of ill health, damage to the environment, or a combination of these. Occupational Health 8

9. Occupational Safety and Health : Occupational Safety and Health (OSH) is an important for the health and well being of the workers to ensure the hazard free workplace, reduces absenteeism and enhancing the productivity by properly addressing the safety and health issues of the employees . Occupational Environment: the sum of external conditions and influences which prevail at the place of work and which have a bearing on the health of the working population. Occupational Health 9

10. Occupational Hazards Occupational Health 10

11. Physical hazards Heat And Cold: burns, heat exhaustion, heat stroke and cramps, Chilblains, Erythrocyanosis , Immersion foot, Frostbite, general hypothermia, decreased efficiency, increased fatigue and enhanced accident rates. Light: eye strain, headache, eye pain, lachrymation , congestion around the cornea and eye fatigue. Noise: Auditory hearing loss, interference with communication by speech, decreased efficiency and annoyance. Occupational Health 11

12. Vibration: affects the hands and arms, injuries of the joints of the hands elbows and shoulders Ultraviolet Radiation: Radiation mainly affects the eyes, causing inter conjunctivitis and keratitis (welder's flash). Symptoms are redness of the eyes and pain. Ionizing Radiation: e.g ,X-rays causes Cancer leukaemia , ulceration, sterility and in extreme case death Occupational Health 12

13. Chemical hazards 1)Local Action : Dermatitis, Eczema, Ulcers, Cancer by primary irritant action 2 ) Inhalation : Dusts, Gases, Metals and their compounds 3) Ingestion: Occupational diseases may also result from ingestion of chemical substances such as lead, mercury , arsenic, zinc, chromium, cadmium, phosphorus etc . Occupational Health 13

14. Dusts Dusts are finely divided solid particles with size ranging from 0.1 to 150 microns Dust particles larger than 10 microns settle down from the air rapidly, Indefinitely particles smaller than 5 microns are directly inhaled into the lungs and are retained there and is mainly responsible for pneumoconiosis. Occupational Health 14

15. Gases • Simple gases (e.g., oxygen, hydrogen), • Asphyxiating gases (e.g. carbon monoxide, cyanide gas, sulphur dioxide , chlorine) • Anaesthetic gases (e.g., chloroform, ether, trichlorethylene ). Metals and their compounds Lead, antimony, arsenic, beryllium, cadmium, cobalt , manganese, mercury, phosphorus, chromium , zinc and others Occupational Health 15

16. Biological hazards Biological hazards are due to various parasites, zoonotic diseases, fungal infection , bacterial infection. Brucellosis • Leptospirosis • Anthrax • Hydatidosis • Tetanus • Encephalitis • Schistosomiasis Occupational Health 16

17. Mechanical hazards Mechanical hazards refers to unprotected machines ,the protruding moving parts, lack of safety measures. These may causes accidents and disabilities. Occupational Health 17

18. Psychosocial hazards Psychological hazards arise when the worker does not fit into job due to incapacity, frustration, lack of job satisfaction &poor human relation with fellow workers and administration. The health effects can be classified in two: (a) Psychological and behavioral changes (b) Psychosomatic ill health Occupational Health 18

19. Occupational Diseases Problem statement: 1.9 million cases(17 %) of the global cases are contributed by India. The adverse occupational factors cost 2%–14% of the gross national product (GNP). Heavy burden and poor concern for OH disease is reflected in high attack rates for eg : Silicosis, 4.1%–54.6% among miners and Byssinosis, 28%–47% in textile workers Physical Agents causing the disease • Heat • Cold • Light • Pressure • Noise • Radiation • Mechanical factors • Electricity Occupational Health 19

20. Chemical Agent causing the disease • Gases • Dusts (pneumoconiosis) Inorganic dust: coal dust; silica; asbestos; iron Organic(vegetable dust): cane fiber; cotton dust; tobacco; hay or grain dust • Metals and their compounds: lead ,mercury, cadmium, manganese, beryllium , arsenic , chromium . • Chemicals: acids, alkalies , pesticides • Solvents: carbon bisulphide , chloroform , benzene Occupational Health 20

21. Disease due t o Biological Agent • Brucellosis, leptospirosis, anthrax, tetanus, encephalitis, fungal infection. Occupational Cancer • Cancer of the skin, lungs, bladder Occupational Dermatosis • Dermatitis, eczema Disease of Psychological Origin • Industrial neurosis , hypertension, peptic ulcer . Occupational Health 21

22. Pneumoconiosis Dusts within the range of 0.5 micron to 3 micron is a health hazard producing, after a variable period of exposure, a lung disease known as pneumoconiosis, which may gradually cripple a man by reducing his work capacity due to lung fibrosis and other complications. Silicosis • Anthracosis • Byssinosis • Bagassosis • Asbestosis • Farmers lungs Occupational Health 22

23. Silicosis • It is the most common type of pneumoconiosis. In I ndia, silicosis is more prevalent in Jharkhand, Chhattisgarh, West Bengal, and Odisha. Caused by inhalation of dust containing free silica or silicon dioxide • Snow storm appearance in chest X ray Occupational Health 23

24. Anthracosis Also known as coal workers’ pneumoconiosis. It is caused by inhalation of coal dust over a long period of time. The disease occurs in two phases: • First phase is called simple pneumoconiosis which is associated with little ventilatory impairment . • Second phase is characterized by Progressive massive fibrosis. X ray chest shows multiple, nodular densities. Occupational Health 24

25. Byssinosis • Inhalation of cotton fibre dust over long periods of time. This is commonly found in workers of textile industry. The symptoms are: • Chronic cough • Progressive dyspnoea, • Chronic bronchitis Emphysema If early diagnosis is made then, symptoms may reverse. Occupational Health 25

26. Bagassosis • Caused by inhalation of bagasse or sugar-cane dust . • Bagassosis has been shown to be due to a thermophilic actinomycetes The symptoms are: Breathlessness , Cough, haemoptysis, slight fever. X ray chest shows ‘mottling appearance’ in lung fields. P reventive measures: Dust control, Personal protection, Medical control, Bagasse control Occupational Health 26

27. Asbestosis • In India, Asbestosis is more prevalent in Jharkhand, Andhra Pradesh, Rajasthan. Asbestos is of two types- serpentine or chrysolite variety and amphibole type. • Clinically the disease is characterized by dyspnoea . • Clubbing of fingers, • Cardiac distress and cyanosis. • The sputum shows "asbestos bodies" • An X-ray of the chest shows a ground-glass appearance in the lower two thirds of the lung fields Occupational Health 27

28. Preventive Measures: • Use of safer types of asbestos ( chrysolite and amosite) • Substitution of other insulants: glass fibre , mineral wool, calcium silicate, plastic foams, etc. • Rigorous dust control • Periodic examination of workers; biological monitoring (clinical , X-ray, lung function), and continuing research. Occupational Health 28

29. Farmer's lung Farmer's lung is due to the inhalation of mouldy hay or grain dust . This is a chronic disease of lungs X ray chest shows ‘ fine nodular density’. Occupational Health 29

30. Prevention of control of Pneumoconiosis: Health promotion B y following measures: Preplacement examination Health Education Provision of healthy physical environment Control of dust Specific protection Early diagnosis and treatment Disability limitation Rehabilitation Occupational Health 30

31. Lead Poisoning It is the most common metal poisoning occurring in the industries. Sources of lead: Occupational & non occupational Mode of Absorption (1) Inhalation. (2) Ingestion. (3) Skin Occupational Health 31

32. Clinical Picture The toxic effects of inorganic exposure: • abdominal colic • Constipation • loss of appetite • blue-line on the gums • stippling of red cells • Anaemia • wrist drop • foot drop . The toxic effects of organic lead compounds are mostly on the central nervous system • Insomnia • Headache • Mental confusion • Delirium. Occupational Health 32

33. Diagnosis (1) History (2) Clinical Features (3) Laboratory Tests: • Coproporphyrin in Urine (CPU) • Amino Levulinic Acid in Urine (ALAU) • Lead in Blood and Urine: • Basophilic Stippling of RBC Preventive Measures • Substitution • Isolation • Local exhaust ventilation • Personal protection. • Good house-keeping • Working atmosphere • Periodic examination of workers • Personal hygiene. • Health education Occupational Health 33

34. Occupational Cancer • Skin cancer: gas workers, oil refiners, tar distillers , oven workers. • Lung cancer: gas industry, nickle and chromium work, mining of radio active substance Bladder cancer: dye stuff, dyeing industries, rubber, gas and electrical cable industry. Leukemia : benzol , roengenten rays and radioactive substance Occupational Health 34

35. The control measures: • Elimination or control of industrial carcinogens. • Medical examinations • Inspection of factories, • Notification, • Licensing of establishments, • Personal hygiene measures, • Education of workers and management, research . Occupational Health 35

36. Occupational Dermatitis Causes • Physical • Chemical • Biological • Plant products Prevention ( 1) Pre-selection (2) Protection (3) Personal hygiene (4) Periodic inspection Occupational Health 36

37. Radiation Hazards Prevention: Shielding of workers • Monitoring the employees • Protective clothing • Adequate ventilation • Replacement and periodic examination • Avoidance of pregnant women to work Occupational Health 37

38. Sickness Absenteeism It means remaining absent from the work by the industrial worker due to certified sickness or injury, but not due to pregnancy or confinement. Causes: • Economic • Social • Medical • Non occupational causes Occupational Health 38

39. Prevention: • Good factory management and practices • Adequate preplacement examination • Good human relations • Application of ergonomics Occupational Health 39

40. Accidents Causes: • Human factors • Physical • Physiological • Psychological • Environmental factors Occupational Health 40

41. Prevention: • Adequate preplacement examination • Adequate job training • Continuing education • Ensure safe working conditions • Establishing safety department in the organization under a competent safety engineer. • Periodic surveys for finding out hazards • Careful reporting Occupational Health 41

42. Health Problem d ue to Industrialization • Environmental sanitation problems • Communicable disease • Food sanitation • Mental health • Accidents and social problems Morbidity and mortality Occupational Health 42

43. Measures f or Health Promotion of Workers Nutrition • Communicable disease control • Environmental sanitation • Mental health • Measures for women and children • Health education • Family planning Occupational Health 43

44. Nutrition • Under Indian factory act, One canteen when number of employees exceeds 250. • Education of workers on the value of balanced diet . Communicable disease control Adequate immunization against communicable diseases Occupational Health 44

45. Environmental sanitation • Water supply, Installation of drinking water fountains Food Sanitary preparation, storage & handling of food Education of food handlers Toilet- one sanitary convenience for 25 employees for the first 100 employees and thereafter on for 50 General plant cleanliness Sufficient space- the recommended standard is of minimum of 500 cubic feet. Housing Occupational Health 45

46. Lighting Standards for illumination High precision work 50-75 foot candles Regular work- 6 to 12 foot candles Corridors and passages- 0.5 foot candles Occupational Health 46

47. Mental health • To promote the health and happiness of the workers . • To detect signs of emotional stress and strain and to secure relief of stress and strain where possible • The treatment of employees suffering from mental illness and the rehabilitation of those w ho become ill. Occupational Health 47

48. Measures for Women and Children ( 1) Expectant mothers are given maternity leave for 26 weeks , (2) Provision of free antenatal, natal and postnatal services. (3) The Factories Act (Section 66) prohibits night work between 7 p.m. and 6 a.m.; (4) The Indian Mines Act (1923) prohibits work underground . (5) The Factories Act, 1976 provides for creches in factories where more than 30 women workers are employed . Occupational Health 48

49. Prevention of Occupational Disease Medical Measures Pre-placement examination Periodical examination Medical and health care services Notification Supervision of working environment Maintenance and analysis of records Health education and counselling Occupational Health 49

50. Engineering Measures Design of building Good housekeeping General ventilation Mechanization Substitution Dust-enclosure and isolation Local exhaust ventilation Protection device Environmental monitoring Statistical monitoring and research Occupational Health 50

51. Legislation The Factory Act-1948 The Employees state insurance act-1948 Occupational Health 51

52. The Factories Act,1948 For purposes of the act, a factory means an establishment, • In which 10 or more workers have been employed during the preceding 12 months in a manufacturing process, operated on power Or • In which 20 or more workers have been employed during the preceding 12 months in manufacturing process without power . Occupational Health 52

53. Provisions for Industrial workers • Employment provisions • Welfare provisions • Safety provisions • Sanitary provisions Occupational Health 53

54. The Employee State Insurance Act,1948 • The ESI Act of 1948 covered all power-using factories other than seasonal factories where in 20 or more persons were employed ( excluding mines , railways and defense establishments ). The provisions of the ESI (Amendment) Act of 1975 were extended to the following new classes of establishments: a) Small power-using factories employing 10 to 19 persons, and non-power-using factories employing 20 or more persons b) Shops; c) Hotels and restaurants; d) Cinemas and theatres; e) Road-motor transport establishments; and f) Newspaper establishments Occupational Health 54

55. Administration • ESI Corporation • Chairman – The Union Ministry of labour • Vice Chairman- Secretary to Govt. of India Chief executive officer- Director general Assisted by four principal officers Insurance commissioners Medical commissioners Finance commissioners Actuary Occupational Health 55

56. Benefits to employees (1) Medical benefit (2) Sickness benefit (3) Maternity benefit ( 4) Disablement benefit (5) Dependent’s benefit (6) Funeral expenses (7 ) Rehabilitation allowance Occupational Health 56

57. Medical benefit The services comprises (1) out-patient care (2) supply of drugs and dressings (3) specialist services in all branches of medicine (4) pathological and radiological investigations (5) domiciliary services (6) antenatal, natal and postnatal services (7) immunization services (8) family planning services (9) emergency services (10) ambulance services (11) health education and (12) in-patient treatment Occupational Health 57

58. Sickness benefit • The benefit is payable for a maximum period of 91 days, in any continuous period of 365 days, the daily rate being about 50% of the average daily wages • 34 diseases for which Extended Sickness Benefit where the insured person has been in continuous employment for 2 years Maternity benefit For confinement, the duration of benefit is 26 weeks, for miscarriage 6 weeks and for sickness arising out of confinement etc. 30 days. Occupational Health 58

59. Disablement benefit • The rate of temporary disablement benefit is about 70 per cent of the wages as long as the temporary disablement lasts. • In case of total permanent disablement, the insured person is given life pension on the basis of loss of earning capacity determined by a medical board Occupational Health 59

60. Dependent’s benefit • Pension at the rate of 70 per cent of wages is payable, on monthly basis. Funeral expenses • The amount not exceeding Rs . 15000 . Rehabilitation • On monthly payment of Rs 10 Occupational Health 60

61. Bibliography : Park K. Preventive and Social Medicine. 25 th Edition. India: M/s Banarsidas Bhanot Publishers ; 2019 . Suryakantha AH. Community Medicine with Recent Advances. 3 rd Edition. India: Jaypee Brothers Medical Publishers Ltd; 2014. Kadri AM. IAPSM’s Textbook of Community Medicine. 1 st Edition. India : Jaypee Brothers Medical Publishers Ltd; 2019. Detels R. Oxford Textbook of Public Health. 5 th Edition. Oxford University Press; 2009. The Factories Act- 1948. A vailable from https://www.ilo.org/dyn/travail/docs/663/ . Employees’ State Insurance Corporation, Ministry of Labour & Employement , Government of India. Information – Benefits . Available from: https://www.esic.nic.in/ . Occupational Health 61

62. Thank you Occupational Health 62