This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
• OD also results in lost productivity and reduced work capacity.
• Globally, ILO estimates that around 4 per cent of the world’s gross
domestic product (GDP), or about US$2.8 trillion, is lost owing to
work-related accidents and diseases in direct and indirect costs .
• Identification and reporting of OD or work-related ill-health (WRI)- posed a huge challenge in most countries.
• OD can be invisible in public policy discussion, since in most countries, especially developing countries, there is very limited reporting of such diseases.
• Identification & reporting made worse by lack of OH legislations.
Training in Occupational Medicine (OM)? (1)
A clinical specialty -just as surgery, general/internal medicine, paediatrics, obstetrics & gynaecology etc
A faculty of the royal college of physicians (UK), American College of Occupational & Environmental Medicine (USA) and other equivalents.
Need broad clinical knowledge of the different specialties of medicine to be able to train and qualify in OM
In the UK, needs a Minimum of 4 years of postgrad training after Senior House Officer (SHO) or at least 3 years post graduation. Similarly in Australia and some EU countries.
Satisfactorily completion of competencies, pass the prescribed Board or Faculty of the Appropriate College Examinations (2 parts-I & II), Complete a Dissertation, awarded MFOM (equivalent to Fellowship awarded in different specialties in Nigeria following the exit exams) & put on the Specialist Register.
Slight Variation in the USA but still requires regulated period of training and board certification
Training in Occupational Medicine (OM)? (2)
What OH Services involve? (1)
A. Clinical Occupational health activities
• Pre-employment assessments-Health screening
• Periodic medical examinations (including health
surveillance)
• Post sickness absence review
• Immunisations including Travel Advice
• Health Promotion, education and counselling
(Health Promotion)-Good Health is Good Business
• Treatment• Rehabilitation of employees back into the
workplace
B. Workplace assessments= Evaluation of workplace to reduce or eliminate exposure• Recognition• Evaluation• Control
What OH Services involve (2)
C. General advice and support
• Advice on compensation
• Disaster planning including advice on managing
chemical incidents
• Food hygiene (Food industry)
• Advice on environmental issues
What OH Services involve (3)
D. Other activities
• Audit, quality assurance and evaluation
• Worker protection and business protection
What OH Services involve (4)
What is not Occupational Medicine? (1)
• All other medical Specialties other than OM i.e. Family Medicine (FM)/ General Practitioner (GP), surgery, Obstetrics & Gynaecology (O&G), Paediatrics, General Public Health.
• A medical doctor who does Appendicectomy or herniorraphy- Not surgeon
• Performing Caesarian Section (C/S) or “TOP” –does not make the doctor an Obstetrician or Gynaecologist.
• In a similar way, having retainerships or just working in an industry or company without training in OM does not make the doctor a Specialist Occupational Physician.
Who is an Occupational Physician (OHP) /Occupational Health Practitioners (OHP)?
Doctor-Specialises in Occupational Medicine after a regulated period of training by a recognised professional body, acquired competences, passed the prescribed examinations, and on the Specialist Register e.g. MFOM, FFOM (UK), FACOEM (USA).= Consultant/Specialist Occupational Physician
Doctors in the USA-generally, start training in Public Health but specialised in Occupational Medicine (Board Certified)
Doctors- in active OH practise + AFOM or AFOM-recognised as Specialist in Occupational Medicine
Doctors whose primary employment is in an occupational setting and have acquired at least 10 years of experience should be described as OHP with or without the Diploma in OH/M.Sc in Occupational Medicine*
Who is not an Occupational Health Specialist?
• Any doctors who do not fall under the definitions above & Not trained in OH including *(General Public Health Physicians), Professionals-Surgeons, Paediatricians, Internists, Obstetricians & Gynaecologists, Medical Officers, Family Physicians (FP)/General Practitioners (GPs)
• Other Nurses other than trained Occupational Health Specialist Nurses
• Allied Health Professionals-Environmental Health Officers, Physiotherapists,
• Just doing a dissertation in work-related topic or among workers or in a work-environment DOES NOT MAKE YOU AN OH PHYSICIAN/Specialist. E.g. some of our colleagues in General Public Health.
Who is an Occupational Health Specialist Nurse (SOHN)?
• Nurse -Specialises in Occupational Health Nursing after a regulated period of training by a recognised professional body, acquired competences, passed the prescribed examinations, and on the Specialist Register e.g. on Occupational Health/Public Health section of the Specialist Register of Royal College of Nursing (RCN, UK)) or the American College of Nursing
Who is NOT an Occupational Health Specialist Nurse (SOHN)?
Any nurse or midwife or general public health nurse who does not meet the above criteria.
Problems with OH Practise in Nigeria? (1)
Lack of the folowing:
regulated OH practice-open to AbuseAppropriate regulations to govern/guide OH PracticeAppropriate Professional Body to standardise the registration and regulation of OH practitioners doctors, Nurses and other HCWs EnforcementAppropriate Health & Safety regulatory body independent of the Ministry of Labour/Ministry of Health e.g. HSE (UK) , OSHA (USA)Understanding the of OM Specialtyunderstanding of the requirement for OH practiceunderstanding of the Occupational Medicine Specialty by the MDCN (Medical and Dental Council of Nigeria)
Problems with OH Practise in Nigeria? (2)
Lack of the folowing:
recognition of the Faculty of Occupational Medicine as a Specialty and or as a Subspecialty by the Medical and Dental Council of Nigeria.
clarity in the understanding of the differences between the practises of Occupational Medicine/Health specialists and Health & Safety officers or Environmental Officers
respect and ignorance on the part of our medical colleagues in other specialties about Occupational Health/Medicine and its practises.
understanding of the relationship between health and work i.e. the impact of Health on Work and the Impact of Work on Health. Need to be Healthy to work efficiently & effectively. To work safely such that your work does not make you become unwell.
Non-existence of an Employment Tribunal-look specifically at employment laws & Work-related issues
Problems with OH Practise in Nigeria? (3)
Of recognition that workers need to be Healthy to work efficiently & effectively. To work safely such that your work does not make you become unwell.
Non-existence of an Employment Tribunal or equivalent courts -dealing specifically with employment laws & Work-related issues
Lack of the folowing:
Encouragement
• the Faculty of Public Health of the Nigeria Medical Postgraduate College- recently approved subspecialty training in Occup & Environmental medicine but still early days.
• the Faculty of Community Medicine of the West African College of Physicians (WACP) is also considering training in Occup & Environmental medicine as a Subspecialty. Already has Draft document for Approval by College (Delayed by EBOLA CRISIS!!!)
I understand:
Occupational Health Legislations (1)
• OH or Work-related legislations in Nigeria are still very rudimentary and limited to what had existed since the Factory Act. Even when claims are made that the Acts or Regulations have been updated, they are either NOT enforced, Ambiguous, Not Clear or Not Effective.
• It would be difficult to effectively practise OH without clear, unambiguous and Effective legislations.
• Difficult to practise OH without enforcing the regulations
• However, we can borrow a leaf from the UK or USA or other countries with more advanced OH legislations. Typical Example of some of the Regulations in the UK that we may be able to adapt are as follows:
Occupational Health Legislations (2)
Major Sources of Law in the UK:
•Statute- Acts of Parliament compromising primary legislation
•Common law- the principles of law accumulated from the decisions of judges in cases presented to them in courts over the years;
•European Directives & Regulations
Occupational Health Legislations (3)
Types of OH related laws
•Criminal law:
• Primarily deters & punishes offenders through prosecutions by the State and its Public Officials-Crown Courts or criminal courts (Magistrates Courts).
• Successful convictions requires ‘beyond reasonable doubt’ & results in a penalty for the offender e.g. fines or prison sentences.
• Breaches of health & Safety legislation, HSE & local authorities (local governments) bring about criminal prosecutions.
Occupational Health Legislations (4)
• Civil law:
• Primarily compensates for injury or loss proved to be resulting from a failure to carry out a duty of care owed to the wronged party.
• Successful claim requires a proof on ‘balance of probabilities’ and results in awarding of damages or compensation to the plaintiff (Complainant).
• Health & Safety cases in civil courts arise mainly from either breach of statutory duty or negligence, where the claimant must prove that he was owed a duty of care by the defendant and that his injuries or losses were a foreseeable consequence of failure by the defendant to take reasonable care.
Occupational Health Legislations (5)
What are Regulations?
•Regulations are laws made by Parliament and usually made under the Health & Safety at Work Act (legally binding as the parent Act).
•Approved Codes of Practice (ACoP)-provide guidance on how to apply the law and have a special legal status. Following them is not compulsory. However, in practice not following an ACoP could be difficult to defend and could lead to successful prosecution.
1974-The Health & Safety (H & S) at work Act (HASWA) enacted: Underpins occupational H & S practice in the UK. Enables all other H & S legislations. Imposes statutory duties on employers in the UK to take reasonable care of their employee’s health and safety
Occupational Health Legislations (6)
The Health & Safety (H & S) at work Act (HASWA), 1974 states:
employers’ statutory duties
employees’ statutory duties to comply with all health and safety at matters at work
successful prosecution could lead to fine or prison terms
Act covers everyone at work, including independent contractors and their employees, the self-employed, visitors, but excludes domestic servants in private households.
Act is the parent of many other statutory regulations, e.g. Management of Health & safety at Work Regulations 1999,
Occupational Health Legislations (7)
The Health & Safety (H & S) at work Act (HASWA), 1974 states:
Manual Handling Regulations, & Control of Substances Hazardous to Health Regulations 2002.
Employers’ Statutory Duties Include:
• to ensure so far as reasonably practicable that:
• There is a safe system of work
• There is a safe place of work
• Staff are given information, instruction and training on matters of health and safety and are adequately supervised
Occupational Health Legislations (8)
The Health & Safety (H & S) at work Act (HASWA), 1974 states:
There is a safe system for the handling, storage & transport of substances & materials
There is a safe working environment-may include pre-employment medical exam & Equality Act, 2010 or Disability Discrimination Act (DDA), 2005. Although, these were NOT specified under the act.
Occupational Health Legislations (9)
Employees’ Statutory Duties:
Do nothing to endanger their health
Duty to inform the employer truthfully when requested for information on matters concerning medical history.
Failing to disclose , when requested, material information about previous or current medical conditions may result in fair dismissal.
The Health & Safety (H & S) at work Act (HASWA), 1974 states:
Regulations from the Health & Safety at Work Act, 1974
Institutions that Enforce the Act and Regulations
The Health & Safety Commission (HSC) –responsible for Policy The Health & Safety Executive (HSE) responsible for enforcing the Act for
all public services, agriculture, construction & manufacturing industries. The Employment Medical Advisory Service (EMAS)- a division of the HSE-
issues notices to companies or Individuals for breaches of health & safety law.
Environmental Health Officers employed by the local authorities (local govt) –enforce the act in relation to shops, restaurants, hotels, offices
Occupational Health Legislations (11)
Occupational Health Legislations (12)
The ‘Six pack’ -came into force in 1993 under HASWA: include
Management of Health & safety at Work Regulations 1999 Workplace (Health, Safety & Welfare) Regulations 1992; Provision and Use of Work Equipment Regulations (PUWER) 1998; Personal Protective Equipment Regulations (PPEs) 192; Manual Handling Regulations 1992; Display Screen Equipment (DSE) Regulations 1992
Occupational Health Legislations (13)
Management of Health & safety at Work Regulations 1999-Employer’s duties:
‘Suitable & sufficient’ assessment of the health & Safety risks of employees & others in the workplace
Implement measures identified by the risk assessment Training must be provided to all employees Appropriate Health Surveillance Further risk assessment for women of childbearing age Record findings Emergency procedures set up
The work environment-ventilation, cleanliness, waste, lighting, temperature, room dimensions & space, workstations and seating, floors, surfaces, lavatories, facilities for washing, rest & eating.
Occupational Health Legislations (15)
Provision and Use of Work Equipment Regulations (PUWER) 1998:
Ensures equipment for work is suitable, complies with standards, safe, maintained safely, regularly inspected, safety measures in place e.g. warning signs.Risk assessment of equipmentRisks controlled as far as reasonably practicableProvide information, training, instructions to all employees
Occupational Health Legislations (16)
Personal Protective Equipment Regulations (PPEs) 1992
(amended 2002)
Suitable PPEs e.g. masks, gloves, apron, goggles, overallProvide information, training, instructions to all employeesMaintained, regularly inspected, safety measures in place
Occupational Health Legislations (17)
Manual Handling Regulations 1992
Applied in Transporting or supporting of a load (include: lifting, putting down, pulling, pushing, carrying or moving)
Eliminate risk, where possibleIf not, carry out Manual handling risk assessmentImplement measures to reduce risksEmployees under duty to use safe systems e.g. use of hoist, attend manual handling training, follow instructions
Occupational Health Legislations (18)
Display Screen Equipment (DSE) Regulations 1992 :
Covers computers, laptops, CCTVs, or any other equipment used for the display of text or graphics used ‘habitually’ (about 30-50% of time at work) at work
Control of substances Hazardous to Health (COSHH) Regulations 2002 (Amended 2004)
Risk assessment of exposure to hazardous substances at workPrevent exposure if reasonably practicableIf not, exposure adequately controlled
Not exceeding any applicable Workplace Exposure Limits (WEL) Health Surveillance Provide instructions, training & supervision of employees Control measures to follow hierarchy of control measures: elimination,
The Control of Vibration at Work Regulations 2005-employers’ duties:
Risk assessment of exposure to vibration (individuals using vibrating tools: drills, hammer drills, sanders, breakers, hedge cutters, strimmers) Dentists, Dental Technicians, construction workers, carpenters, farmers, oil workers, workers in most industries, mechanics , miners etc)Health surveillanceControl measuresProvide instructions, training & supervision of employeesProvisions appropriate PPEs-anti-vibration gloves, water-resistant clothing, warm clothingExposure Action Value-2.5m/s2
Daily Exposure Limit value (ELV) 5.0ms/s2
Occupational Health Legislations (21)
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995:
Employer must report to HSE or local authority via the incident contact centre, any of the following arising out of, or in connection with work:
Death or major injuries from accidentMinor injuries causing the individual to be off work or unable to perform the full range of their normal duties for over 3 daysReportable industrial diseases when confirmed in writing by a doctorDangerous occurrences, including needlestick injuries
Occupational Health Legislations (22)
The Control of Noise at Work Regulations 2005
Risk assessment of exposure to noise (Workers affected: Dentists, Dental Technicians, construction workers, carpenters, farmers, oil workers, workers in most industries, mechanics , miners etc)Health surveillanceControl measuresProvide instructions, training & supervision of employeesProvisions appropriate PPEs-hearing protectionAt or above 80dB(A) hearing protection must be worn. Hearing checks regularlyAt or above 85dB(A) a programme control measures must be implemented to reduce the risk of exposure to a minimum
•Employers: to make reasonable adjustments to be able to accommodate employees with disability.
Disability: Physical or Mental impairment with substantial adverse effect, long-term (likely to last or lasted 12 months or more), requires regular treatment, tendency to relapse e.g. mental health anxiety & depression, bipolar disorders, cancers, HIV, multiple sclerosis, diabetes, hypertension, NOT Disabled: personality disorders, Alcohol, drug or nicotine addiction unless complications of their addictions i.e. liver failure, mental illness
Occupational Health Legislations (24)
Medical Assessment of Oil & Gas UK (OGUK) & UK offshore operations association (UKOOA)
Regulates Oil & Gas Workers in the UK
Pre-employment/pre-placement medicalMinimum age for employment: 18 yrs
Periodic medical- 3 yearly up to age 39 yrs, 2 yrly between 40 and 50 yrs, & annually.
more frequent medical after significant absence due to injury or illness. measurements-height, weight, body mass index (BMI), visual acuity, colour
Investigations: urinalysis, pulmonary function, audiometric testing Certification of dental fitness; routine dental surveillance Catering staff to have at least one stool sample cultured for pathogens
HIV does NOT debar from employment BUT symptoms and signs of AIDS related Complex debars
Malignancy (unfit) but decided case by case basis Alcohol & substance abuse-positive test=exclusion But companies ready
to assist Medications: cytotoxics, anticoagulants, immunosuppressants, insulin,
anticonvulsants, oral steroids, routine use of psychotropic agents, tranquillizers, narcotics, hypnotics are unfit to work offshore
Occupational Health Legislations (26)
Chronic ear disease or vertigo, significant symptomatic nasal airway obstruction, recurrent or chronic sinus infection
Hearing loss in better ear greater than 35dBA for lower frequencies or 60dBA for higher frequencies
Neurological disorders e.g. epilepsy, cerebral disorders-unacceptable Peripheral vascular disease.eg. varicose veins with ulceration, varicose
eczema or active deep vein thrombosis-unacceptable
Medical conditions Unfit/unacceptable for Offshore work:
Federal Government, State & Local Governments Actions
Enact Laws/Legislations- regulations to govern/guide OH PracticeAppoint appropriate body/Committee consisting of Occupational Professionals to assist with drafting the legislations and advising the government.Establishment of Health & Safety regulatory body similar to HSE (UK) & OSHA (USA) independent of the Ministry of Labour/Ministry of Health –Headed by Occupational Physician but with membership from other health professional groupsEstablishment of Employment Tribunals to address specifically employment cases & employment laws
Recommendations (2)
Federal Government, State & Local Governments Actions
Monitoring & Regulatory systemBetter understanding of the relationship between health and work i.e. the impact of Health on Work and the Impact of Work on Health. To raise the profile of Occupational MedicineTo make Occupational services mandatory for all organisations-small, medium and large organisations, both private and public-through legislations.
Equality Act or Disability Discrimination Act Law MUST be Established: Avoid wrongful dismissals, rejection for employment, retired too early, discrimination against disabled people e.g. air crew with HIV
Recommendations (3)
Mandatory for organisations to employ OH physician with the right OH qualifications-ensure appropriate advice & correct OH Practise.
Environmental laws to stop pollution especially work-related by companies, individuals or organisations.
Medical & Dental Council of Nigeria
Better understanding of the OH SpecialtyEstablishment of the Faculty of Occupational MedicineRegistration of Accredited Specialist qualifications acquired from Reputable medical bodies e.g. American Board Certification, MFOM & other equivalents under category A of the Specialist Register- as there are currently OH specific training programmes in Nigeria.
Recommendations (4)
Recognition of medical Doctors with over 10 yrs experience practising OM full time as their primary assignment as Specialist in some capacity. Establishment -appropriate pathways with various bodies such as the WACP, the Nat. Postgrad. Med. College of Nigeria, the American College of Occupational & Environmental Medicine, The Faculty of Occupational Medicine of the Royal College of Physicians, UK and others for the recognition of Medical Doctors without OH qualifications but with at least 10 years of continuous OH practice as Specialist in Category B of the Specialist Register for the first 2 yrs of registering the Specialty.Set up regulations for Occupational Health Practice
Medical & Dental Council of Nigeria
Recommendations (5)
Medical & Dental Council of Nigeria
to standardise the registration and regulation of OH practise by doctors and other HCWs
Enforcement of professional registrations & Restriction of OH Practices to qualified OH Specialists only
Postgraduate Medical Colleges
Time both the Nigeria Medical Postgraduate College & the West African College of Physicians (WACP) gave recognition to Specialist OH Physicians trained outside from reputable accredited bodies & support their registrations under Category A of the Additional Registration.
Time both Faculties of Public Health & Community Medicine of the Nigeria Postgrad. Med. College & WACP considered the benefits to the colleges & the Nation of having trained OH consultants & award Fellowships of the colleges to OM Specialists/consultants who trained outside Nigeria from reputable accredited bodies to boost training & development of future specialists in OM.
Recommendations (6)
Recommendations (7)
Postgraduate Medical Colleges
Establish genuine pathways for recognising Medical Doctors without formal training but practising OM full time as their primary assignment for at least 10 yrs as Specialists in some capacity during the first 2yrs of establishment of OM Specialty/Subspecialty.
To stand shoulder to shoulder to clarity the friction between Occupational Medicine/Health specialists and Health & Safety officers or Environmental Officers.
Faculties of Public Health of the 2 colleges to build better relationships with external faculties of Occupational Medicine, FOM (UK) or ACOEM (USA)-effective & Robust dev. OM in Nigeria.
Recommendations (8)
Postgraduate Medical Colleges
• Work towards closer integration & Reciprocal Recognition with external faculties of Occupational Medicine i.e. FOM (UK) & ACOEM) (USA) & others.
Both Colleges to offer appropriate advice to both the MDCN & Fed Govt to ensure the growth & development of OM in Nigeria.
Both Colleges to stop the dirty Politics & Cold War and work together for the growth of OM, the medical profession and the greater benefit of Nigeria & Nigerians.
Recommendations (9)
Organisations –Public & Private & Individuals
To recognise the distinct role of OH Physicians & Nurses and the value they add to the organisation
To re-configure services such that OH services will be made distinct and separate from Family Medicine/GP practices, Paed., O & G, Surgery and other clinical services.
To stop confusing other clinical services especially family medicine/GP practices as OH services. The diagnosis, investigations & treatment of various medical conditions except work-related are not part of OH role.
Families and dependents of employees should be seeing Family Physicians or other clinicians for their medical problems and not OH.
Recommendations (10)
• OH services are purely for workers, - it is about adjustments that could be made to make individuals work safely.
Organisations –Public & Private & Individuals
OH services are about ensuring that the work environment & the systems of work are safe
Ensure recruit individuals with specialist OH qualifications and not confuse it with fellowships/memberships from other clinical specialities-as you will give you better value for money.
By employing a well trained OH physician (Not Imitations) & appropriate OH legislations, you will get the following benefits:Reduction in work-related Disease burden, injuries & mortality Less Litigations & payment for compensationsIncreased Productivity as sicknesses absences will be brought to a minimum Appropriate advice and adjustments to work will cut down the duration of sickness absences.A Healthier workforce will by far be more productiveCut down a lot of unnecessary overheads
Recommendations (11)
Organisations –Public & Private & Individuals
Conclusions
Establishment of OH laws that are enforceable with appropriate support structures is paramount to the future development of OH in Nigeria.