ENVIRONMENTAL HEALTH
AND OCCUPATIONAL
MEDICINE
Presenters:
Chairperson:
Dr. Rohit A. Bhat
Dr. K. R. Pravinchandra
History

The
history
of
occupational
medicine
can be traced into
antiquity. Observations of
increased rates of illnesses
and mortality among
miners date back to Greek
and Roman times.
Ancient
classical
• Slave labor
• Mining and metallurgy
• Agriculture and crafts
7-17
century
• Armaments, soldering
• Metallurgy
• Scurvy
• Renaissance technologies
• Coal fuel power
1650-1900 • Industrial revolution





Ullrich Ellenbog- Poisonous, wicked fumes of smokes of
metals.
Agricoli[1494-1555]
Paracelsus[1493-1541]
working conditions
of mining laborers.
Charles Turner[1795-1833]- statistically linked
industrial disease with life expectancy.
James Lind- Treatise on scurvy
Bernadino Ramazzani





1633-1714 A.D
Father of occupational
medicine.
Italy
Investigated miners
disease, crafts, trades.
Miscarriages in women.
De Morbis Artificum Diatraba

Diseases of artificer

1700 A.D

42 chapters initially

20 editions [addition
of 12 chapters]
Legislations







1833- appointment of factory inspectors.
1844 factory act- certifying surgeons.
1846 factory act- ventilation for industrial premises.
1851 census- occupation taken into account.
1891 factory act- foundation for modern
occupational medicine.
1897 Worksmen compensation legislation.
1906- permanent commission for OH.


Main occupational health hazard
-Lead
-Phosphorous
-Anthrax
Thomas Arlige- Hygiene, diseases and mortality of
occupations[1892]

Sir Thomas Legge[1898]- Industrial Maladies

Thomas Oliver- Dangerous Trades[1902]
• New public health
• I and II WW
1900-1950 • Air pollution emergencies
• Nuclear threats
•
Petrochemical
industry
1950-1970
Occupational Health

Joint ILO/WHO committee in 1950 said
occupational health should aim at promotion and
maintenance of 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 worker in an
occupational environment adopted to his
physiological and psychological equipment
The adaptation of work to man and of each man to
his job
Environmental Medicine


‘medical specialty involving prevention, diagnosis,
treatment and study of diseases, injuries due to
external influences but unrelated to patients
workplace’
Non occupational environment rivals or exceeds
occupational environment as a source of health
concern among public at large.
Comparison of Occupational health
and Environmental health
Occupational health






Hazards in work place
environment
Hazards largely in air
Hazards are physical
chemical, biological and
psychosocial
Routes of exposure:
inhalational and dermal
Exposure period:8h/day
Exposed population: adults,
usually healthy
Environmental health






Hazards
in
community
environment
Hazards in air, soil, water ,food
Hazards are physical chemical,
biological and psychosocial
Routes of exposure: ingestion,
inhalation and dermal
Exposure period: lifelong
Exposed population: children,
adults, elderly and sick
population
Occupational And Environmental
Medicine[OEM]

The occupational and environmental medicine
physician assists employers in:

Identifying hazards

Detecting exposures

Protecting the workforce

Educating people regarding workplace hazards
Principles of OEM
1)
2)
3)
4)
5)
The clinical
and pathological expression of most
environmentally caused diseases are indistinguishable from
those of non-environmental origin.
Many diseases of occupational and environmental origin
are multi factorial, with non-environmental factors playing
a contributory role.
The effects of occupational and environmental exposures
occur after a biologically predictable latent interval
following exposure.
The dose of an exposure to a noxious agent is the
strongest predictor of the likelihood and type of effect.
People differ substantially in their responses to noxious
exposures.
Principles of OEM
1)
2)
3)
4)
5)
The clinical and pathological expression of
most environmentally caused diseases are
indistinguishable from those of nonenvironmental origin.
Many diseases of occupational and environmental origin are multi
factorial, with non-environmental factors playing a contributory role.
The effects of occupational and environmental exposures occur after a
biologically predictable latent interval following exposure.
The dose of an exposure to a noxious agent is the strongest predictor of
the likelihood and type of effect.
People differ substantially in their responses to noxious exposures.
Principles of OEM
1)
2)
3)
4)
5)
The clinical and pathological expression of most environmentally
caused diseases are indistinguishable from those of nonenvironmental origin.
Many diseases of occupational and
environmental origin are multi
factorial,
with
non-environmental
factors playing a contributory role.
The effects of occupational and environmental exposures occur
after a biologically predictable latent interval following exposure.
The dose of an exposure to a noxious agent is the strongest
predictor of the likelihood and type of effect.
People differ substantially in their responses to noxious exposures.
Principles of OEM
1)
2)
3)
4)
5)
The clinical and pathological expression of most environmentally caused diseases
are indistinguishable from those of non-environmental origin.
Many diseases of occupational and environmental origin are multi factorial, with
non-environmental factors playing a contributory role.
The effects of occupational and environmental
exposures occur after a biologically
predictable latent interval following exposure.
The dose of an exposure to a noxious agent is the strongest predictor of the
likelihood and type of effect.
People differ substantially in their responses to noxious exposures.
Principles of OEM
1)
2)
3)
4)
5)
The clinical and pathological expression of most environmentally caused
diseases are indistinguishable from those of non-environmental origin.
Many diseases of occupational and environmental origin are multi
factorial, with non-environmental factors playing a contributory role.
The effects of occupational and environmental exposures occur after a
biologically predictable latent interval following exposure.
The dose of an exposure to a noxious
agent is the strongest predictor of the
likelihood and type of effect.
People differ substantially in their responses to noxious exposures.
Principles of OEM
1)
2)
3)
4)
5)
The clinical and pathological expression of most environmentally caused
diseases are indistinguishable from those of non-environmental origin.
Many diseases of occupational and environmental origin are multi
factorial, with non-environmental factors playing a contributory role.
The effects of occupational and environmental exposures occur after a
biologically predictable latent interval following exposure.
The dose of an exposure to a noxious agent is the strongest predictor of
the likelihood and type of effect.
People differ substantially in their
responses to noxious exposures.
Ergonomics


‘applied, multi disciplinary scientific field concerned
with design of jobs, products, systems, and
environments to be compatible with human needs,
abilities and limitations’
Objective: to attain best mutual adjustment of man
and his work, for the improvement of human
efficiency and well being.
The OEM Team
Industry
 Safety Professional
 Industrial Hygienist
 Worker
Representative
 Management
 Health Physicist
 Ergonomist
 Environmental
Engineer
Medicine
 Nurse
 Physician Assistant
 Private Physician
 Physical Therapist
 Epidemiologist
 Clinic
 Hospital
The Team Approach
•
Enhanced health and safety in the workplace
•
A match between the worker and the task
•
Rapid and appropriate medical management
of illness/injury
•
Effective communication for all
•
Cost effectiveness/efficiency
Components of OEM






Primary medical care
Secondary medical care
Preventive component
Business support and regulatory component
Administrative
Medical management
References:




Textbook of clinical occupational and environmental
medicine, 2nd edition – Linda Rosenstock, Mark R
Cullen, Carl A Brooke, Carrie A Redlich.
Hunter’s diseases of occupation, 10th edition.
International occupational
and
environmental
medicine – Herzstein, Bunn, Fleming, Harrington,
Jeyratnam, Gardner.
Oxford textbook of public health, 5th edition.
Harrison’s principles of internal medicine, 18th
edition.
 Park’s textbook of preventive and social
medicine, 21st edition – K Park.
 Textbook of public health and community
medicine, 2009.
 Community medicine with recent advances, 2nd
edition – AH Suryakantha

Thank you
Occupational injuries and work place
violence




‘any damage to the body by energy transfer during
work with a short duration between exposure and the
health event[usually <48hrs].’
3,00,000 deaths worldwide per year
3.5years healthy life lost per 1,00,000 per year
due to injuries at work.
‘Physical assault or verbal assaults or incivility or
actions that makes someone uncomfortable in the
work place.’
Prevention of occupational injury
Haddon
Matrix
Hierarchy
of Controls
• Haddon[1968]
• Chain of multi factorial events,
provides opportunities for
intervention.
• Barnett and Brickman[1986]
• Prioritized set of prevention
strategies.
Haddon’s Matrix
PERSON
[HOST]
VECTOR
[VEHICLE]
PHYSICAL
SOCIAO
ENVIRONMENT ECONOMIC
ENVIRONMENT
PRE EVENT
Is host
predisposed or
overexposed to
risk?
Is vector
hazardous?
Is environment
hazardous?
Does it have
hazard reduction
features?
EVENT
Is host able to
tolerate force or
energy transfer?
Does vector
provide
protection?
POST
EVENT
How severe is the Does vector
trauma or harm? contribute to
trauma?
Does
environment
contribute to
injury during
event?
Does
environment add
to the trauma
after the event?
Does
environment
encourage or
discourage risk
taking and
hazard?
Does
environment
contribute to
injury during
event?
Does
environment
contribute to
recovery?
Hierarchy of Controls
Eliminating hazards through designs
Using safeguards that eliminate/minimize
worker exposure to hazards
Providing warning signs or devices to
identify hazards
Training workers in safe work practices
and procedures
Using PPE to prevent or minimize worker
exposure to hazards or to reduce injury
severity if it occurs
Hierarchy of Controls
Workplace violence

Physical assault or verbal assaults or incivility or
actions that makes someone uncomfortable in the
work place.
Typology of workplace violence
TYPE
DESCRIPTION
I Criminal intent
The perpetrator has no legitimate relationship
to the business or its employees, and is usually
committing a crime in conjunction with the
violence
II Customer/client
The perpetrator has a legitimate relationship
with the business and becomes violent while
being served by the business
The perpetrator is an employee or past
employee of the business who attacks or
threatens another employee or past employee
in the workplace
III Worker on worker
IV Personal relationship
The perpetrator does not have a relationship
with the business but has a personal
relationship with the intended victim
Typology of workplace violence
TYPE
DESCRIPTION
I Criminal intent
The perpetrator has no legitimate relationship to the business
or its employees, and is usually committing a crime in
conjunction with the violence
II Customer/client
The perpetrator has a
legitimate relationship with the
business and becomes violent
while being served by the
business
III Worker on worker
The perpetrator is an employee or past employee of the
business who attacks or threatens another employee or past
employee in the workplace
IV Personal relationship
The perpetrator does not have a relationship with the business
but has a personal relationship with the intended victim
Ex: Multi factorial causation of
occupational injury
Occupational injuries and work place
violence




‘any damage to the body by energy transfer during
work with a short duration between exposure and
the health event[usually <48hrs].’
Acute exposure in workplace to physical agents like
mechanical energy, electricity, chemicals, ionizing
radiations or lack of essential agents like oxygen or
heat.
3,00,000 deaths worldwide per year
3.5years healthy life lost per 1,00,000 per year
due to injuries at work.