Ebook Current occupational and environmental medicine (5/E): Part 1

(BQ) Part 1 book “Current occupational and environmental medicine” has contents: The practice of occupational medicine, international occupational and environmental health, migration and occupational health, the occupational & environmental medical history, electronic health records,…. And other contents.

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Authors

Preface

Section I Occupational Health

1 The Practice of Occupational Medicine

Karen B Mulloy, DO, MSCH

5 Electronic Health Records

Sachin Kapoor, DO, MBA, MPH

6 Workers’ Compensation

Joseph LaDou, MS, MD

James Craner, MD, MPH

7 Disability Management & Prevention

Jordan Rinker, MD, MPH

Robert Eric Dinenberg, MD, MPH Mauro Zappaterra, MD, PhD

Glenn Pransky, MD, MOH

Section II Occupational Injuries

Peter D Lichty, MD, MOH

15 Ergonomics & the Prevention of Occupational Injuries

David M Rempel, MD, MPH

Ira L Janowitz, MPS, PT, CPE

Section III Occupational Illnesses

Mahbub M.U Chowdhury, MBChB, FRCP

22 Upper Respiratory Tract Disorders

Section V Program Management

35 Occupational Mental Health & Workplace Violence

Marisa Huston, MA, MFT

Robert C Larsen, MD, MPH

36 Substance Use Disorders

Marisa Huston, MA, MFT

Stephen Heidel, MD, MBA

37 CBRNE Preparedness

Marek T Greer, MD, MPH

Richard Lewis, MD, MPH

38 Occupational Safety

Peter B Rice, CSP, CIH, REHS

39 Industrial (Occupational) Hygiene

Peter B Rice, CIH, CSP, REHS

Section VI Environmental Health

43 Principles of Environmental Health

49 Multiple Chemical Sensitivity

Mohana Amirtharajah, MD

Assistant Professor

Hand and Upper Extremity Surgery

Department of Orthopedic Surgery

University of California, San Francisco

amirtharajahm@orthosurg.ucsf.edu

Chapter 9

John R Balmes, MD

Professor of Medicine

University of California, San Francisco

Professor of Environmental Health Sciences

School of Public Health

Director, Northern California Center for Occupational and EnvironmentalHealth

University of California, Berkeley

Mahbub M.U Chowdhury, MBChB, FRCP (UK)

Consultant in Occupational Dermatology

Department of Dermatology

University of Hospital of Wales

Cardiff, Wales, United Kingdom

Assistant Clinical Professor

Division of Occupational and Environmental Medicine

University of California, San Francisco

jcraner@drcraner.com

Chapters 6 & 41

Rupali Das, MD, MPH

Assistant Clinical Professor

University of California, San Francisco

Executive Medical Director

California Division of Workers’ Compensation

Department of Industrial Relations

Sacramento, California

rdas@dir.ca.gov

Chapters 42 & 45

Alexis Descatha, MD, PhD

Associate Professor, Occupational Health

INSERM, Centre for Research in Epidemiology and Population Healthalexis.descatha@inserm.fr

Chapter 9

Michael J Dibartolomeis, PhD

Chief, Exposure Assessment Section

California Department of Public Health

Richmond, California

michael.dibartolomeis@cdph.ca.gov

Chapter 50

Robert Eric Dinenberg, MD, MPH

Chief Medical Officer, Viridian Health Management

Executive Director, Viridian Institute for Applied Health Improvementwww.viahi.org

Timur S Durrani, MD, MPH, MBA

Clinical Instructor of Medicine

University of California, San Francisco

Associate Medical Director

Battelle Memorial Institute

Columbus, Ohio

marektgreer@sbcglobal.net

Chapter 37

Robert J Harrison, MD, MPH

Clinical Professor of Medicine

Division of Occupational and Environmental MedicineUniversity of California, San Francisco

robert.harrison@ucsf.edu

Chapters 1 , 20 , 25 , 31 , 32 , & 49

Stephen Heidel, MD, MBA

Clinical Professor of Psychiatry

School of Medicine

University of California, San Diego

stephen.heidel@sbcglobal.net

Chapter 36

German T Hernandez, MD, FASN

Assistant Professor of Medicine

Department of Internal Medicine

Marisa Huston, MA, MFT

Mental Health Coordination Services

Dean of Students Office

University of California, Santa Barbara

marisa.huston@sa.ucsb.edu

Chapters 35 & 36

Ira L Janowitz, MPS, PT, CPE

Senior Ergonomics Consultant

Berkeley Ergonomics Program

University of California, San Francisco

janowitz@comcast.net

Chapter 15

Sarah Janssen, MD, PhD, MPH

Assistant Clinical Professor

University of California, San Francisco

sarah.janssen@ucsf.edu

Chapters 28 & 29

Sachin Kapoor, DO, MBA, MPH

Medical Director Employee Health

The Permanente Medical Group

Walnut Creek, California

Adjunct Associate Professor

Colorado School of Public Health

Associate Professor of Medicine

Division of Pulmonary and Critical Care MedicineStanford University School of Medicine

Stanford, California

kuschner@stanford.edu

Chapter 33

Joseph LaDou, MS, MD

Clinical Professor Emeritus

Division of Occupational and Environmental Medicine

University of California, San Francisco

Peter D Lichty, MD, MOH

Health Services Department

Lawrence Berkeley National Laboratory

University of California, San Francisco

Assistant Deputy Director for Scientific Affairs

Office of Environmental Health Hazard AssessmentSacramento, California

melanie.marty@oehha.ca.gov

Chapter 45

Wolf Mehling, MD

Associate Professor of Medicine

University of California, San Francisco

Chapter 16

Michael A O’Malley, MD, MPH

Medical Director

Occupational Health Service

University of California, Davis

maomalley@ucdavis.edu

Chapter 34

Glenn Pransky, MD, MOH

Associate Professor

Tufts University School of Medicine

Director, Center for Disability Research

Peter B Rice, CIH, CSP, REHS

Manager of Safety, Health, and Environmental ProgramsAhtna Netiye’, Inc

Sacramento, California

price@ahtna.net

Chapter 38 & 39

Jordan Rinker, MD, MPH

Associate Clinical Professor

Division of Occupational and Environmental MedicineSan Francisco, California

Assistant Clinical Professor

Division of Occupational and Environmental MedicineUniversity of California, San Francisco

rachel.roisman@cdph.ca.gov

rroisman@gmail.com

Chapter 32

Hope S Rugo, MD

Clinical Professor of Medicine

Director, Breast Oncology Clinical Trials ProgramUCSF Comprehensive Cancer Center

University of California, San Francisco

hrugo@medicine.ucsf.edu

Chapters 18 & 19

Kazeem B Salako, MBBS, MRCP

Welsh Institute of Dermatology

University Hospital of Wales

Cardiff, Wales, United Kingdom

kazeem.salako@wales.nhs.uk

Chapter 21

Marc B Schenker, MD, MPH

Professor and Director

Center for Occupational and Environmental Health

Co-director, UC Global Health Institute, Center of Expertise on Migrationand Health

Department of Public Health Sciences

University of California, Davis

mbschenker@ucdavis.edu

Chapter 3 & Appendix A

Megan R Schwarzman, MD, MPH

Environmental Health Scientist

Center for Occupational and Environmental Health

Associate Director, Berkeley Center for Green Chemistry

University of California, Berkeley

mschwarzman@berkeley.edu

Chapter 44

Dennis J Shusterman, MD, MPH

Clinical Professor of Medicine

Division of Occupational and Environmental Medicine

University of California, San Francisco

dennis.shusterman@cdph.ca.gov

Chapter 22

Yuen T So, MD, PhD

Professor, Neurology and Neurological Sciences

Department of Neurology and Neurosciences

Stanford University Medical Center

Stanford, California

yuen.so@stanford.edu

Chapter 27

Gina M Solomon, MD, MPH

Deputy Secretary for Science and Health

Office of the Secretary

California Environmental Protection Agency

Sacramento, California

gsolomon@calepa.ca.gov

Chapter 43

Craig Steinmaus, MD, MPH

Public Health Medical Officer III

Pesticide and Environmental Toxicology BranchOffice of Environmental Health Hazard AssessmentSacramento, California

craig.steinmaus@oehha.ca.gov

Chapter 48

Eileen Storey, MD, MPH

Chief, Surveillance Branch

Division of Respiratory Disease Studies

National Institute for Occupational Safety and HealthMorgantown, West Virginia

estorey@cdc.gov

Chapter 40

Marilyn C Underwood, PhD

Director of Environmental Health

Contra Costa County

Martinez, California

marilyn.underwood@hsd.cccounty.us

Chapter 45

Michael P Wilson, PhD, MPH

Director, Labor Occupational Health ProgramCenter for Occupational and Environmental HealthSchool of Public Health

Physical Medicine and Rehabilitation

Los Angeles, California

maurozappaterra@gmail.com

Chapter 7

The Fifth Edition of Current Occupational & Environmental Medicine

continues to serve as a concise yet comprehensive resource for health careprofessionals in all specialties who diagnose and treat occupational andenvironmental injuries and illnesses

COVERAGE & APPROACH TO THE SUBJECT

The book provides a complete guide to common occupational andenvironmental injuries and illnesses, their diagnosis and treatment, andpreventive measures in the workplace and community Our aim is to helphealth care professionals understand the complexities of occupational andenvironmental health issues and provide useful clinical information oncommon illnesses and injuries The book contains many new chapters,expanding the coverage of occupational and environmental medicine wellbeyond that of the earlier editions To enhance the book’s usefulness as aclinical resource, it is published in the Lange® Current series The seriesconsists of practical, concise, and timely books in core specialties and keysubspecialties that focus on essential diagnostic and treatment information

SPECIAL AREAS OF EMPHASIS

• Detailed coverage on the diagnosis and treatment of a broad spectrum ofoccupational and environmental injuries and illnesses

• Chapters on how to conduct an occupational and environmental history,perform a physical examination, and prevent further injury

• The important role that health care providers can play in preventing

disability

• Practical information on the toxic properties and clinical manifestations ofcommon industrial materials.

• Techniques to prevent workplace-related injuries and illnesses through theapplication of ergonomic principle

ORGANIZATION & HIGHLIGHTS OF EACH SECTION

Section I (Chapters 1 through 7) define the practice of occupational andenvironmental medicine and introduce the health care provider to thediagnosis of occupational injuries and illnesses These chapters offerguidance for identifying workplace and community exposures to toxicmaterials—putting this information to immediate clinical use and applying ittoward better health and safety practices in the workplace This sectionpresents a comprehensive discussion of disability prevention andmanagement, and considers the important issues in the international practice

of occupational and environmental medicine

Section II (Chapters 8 through 15) concisely discusses commonoccupational injuries and their treatments Noise-induced hearing loss and theimpact of other physical hazards, such as heat, cold, and radiation areexamined This section also discusses how ergonomic principles can beinstituted in the workplace to prevent further work loss associated with injuryand illness The chapter on management of chronic pain is an important newaddition to the book

Section III (Chapters 16 through 29) is a comprehensive discussion ofclinical toxicology arranged by organ system, with special emphasis on theenvironmental as well as workplace origins of toxic exposure It thoroughlyreviews commonly recognized environmental and occupational illnesses andhighlights many clinical problems not often thought to be work related

Section IV (Chapters 30 through 34) presents the most common toxicmaterials encountered in the workplace and community with diagnostic andtreatment recommendations This section is designed to serve as animmediate reference source and clinical guide for the practicing health careprofessional The discussion on pesticides, in particular, emphasizes theenvironmental as well as occupational exposures that may lead to illness

Section V (Chapters 35 through 42) presents the roles and responsibilities

of the industrial hygienist and the safety professional Chapters onoccupational mental health and workplace violence, and substance usedisorders present programs for controlling and treating these problems

Section VI (Chapters 43 through 50) provides a comprehensive discussion

of environmental medicine and some of the complex societal issues thataccompany industrialization and technologic advances throughout the world.Emphasis is placed on recognizing that some common “occupational”exposures are found also in homes and public locations and require the samehigh index of suspicion that is assumed when encountered in the workplace

The Appendix concisely introduces biostatistics and epidemiology These

topics are important not only in research but also in clinical practice.Ultimately, all occupational and environmental physicians serve as clinicalepidemiologists

This book brings together UCSF faculty with a combined experience of 40years of teaching occupational and environmental medicine, and manygraduates of the program now working in public health agencies and othercampuses I also welcome the new co-editor, Robert J Harrison, MD, MPH,whose considerable contributions to the former editions of the book uniquelyqualify him to take on this role

Joseph LaDou, MS, MDSan Francisco, California

May 2014

Section I Occupational Health

The Practice of Occupational Medicine

Joseph LaDou, MS, MD Robert J Harrison, MD, MPH

The Occupational Safety and Health Act of 1970 (OSHAct) ensures “everyworking man and woman in the United States safe and healthful workingconditions.” This act created the Occupational Safety and HealthAdministration (OSHA) and the National Institute for Occupational Safetyand Health (NIOSH) At the time the OSHAct was passed, occupationalmedicine was one of the country’s smallest medical specialties, with only afew residency-trained specialists in academic positions, consulting practices,

or employed by major corporations Private practitioners provided care foroccupational injuries, sometimes in industrial settings, but mostly as a part ofother services provided in a private office or hospital setting

As a result of passage of the OSHAct and formation of OSHA andNIOSH, occupational medicine became the center of considerable attention

by medical schools, hospitals, clinics, and physicians from many differentspecialties The opportunities for public health practice, union-based clinicalcare, and independent consulting created new career opportunities formedical students Medical schools received financial support for trainingfrom NIOSH, and OSHA gave occupational physicians a voice in theincreasingly regulated industrial setting

Moreover, the IOM reports a severe shortage of frontline primary carephysicians who are willing and able to care for patients with occupational andenvironmental illnesses The IOM concludes that data from the Bureau ofLabor Statistics (BLS) are significant underestimates of occupationaldiseases, which emphasizes the need for more and better diagnoses ofoccupational diseases by primary care practitioners The IOM recommendsthat “all primary care physicians be able to identify possible occupationally

or environmentally induced conditions and make appropriate referrals forfollow-up.”

Since passage of the OSHAct, US employment has more than doubled,from 56 million workers at 3.5 million work sites to 130 million workers atnearly 8 million work sites Most of the labor force expansion during thisperiod was in service sector companies with fewer than 500 employees.Although these companies are not likely to employ occupational physicians,they do add to the demand for injury and illness care as well as for health andsafety consulting Employers expect to hire almost 500 occupationalphysicians over the next 5 years and are looking for residency-trainedspecialists Skills in evidence-based clinical evaluation and treatment,determining fitness for work, and worker and management communicationsare the most important technical skills needed by employers The estimatednumber of occupational physicians that employers expect to hire over thenext 5 years is substantially higher than the number estimated to be producedfrom current training programs Opportunities in occupational medicine, and

in the increasingly important specialty of environmental medicine, vary byregion There are many industrial areas with an established medicalcommunity serving their needs, yet in other areas there are growing industrialcorridors very much in need of occupational physicians

Occupational Medical Practice

Occupational injuries and illnesses are among the five leading causes ofmorbidity and mortality in the United States and in most other countries.Injuries at work comprise a substantial part of the country’s injury burden,accounting for nearly half of all injuries in some age groups Occupationalinjuries are significantly underreported, yet 3.8 million recognized disablinginjuries still occur per year One-third of all injury cases result in loss ofwork There are over 4500 traumatic occupational fatalities each year,

ranking the workplace as the eighth leading cause of death Since the early1970s, more than 113,000 worker deaths have been attributed topneumoconioses This number represents only a small portion of the totaldeaths attributable to occupational lung disease The number of deaths fromasbestos-related mesothelioma has been increasing steadily in the same timeperiod, as are deaths with hypersensitivity pneumonitis as an underlying orcontributing cause Asthma is now the most common occupationalrespiratory disease Population-based estimates suggest that approximately15% of new-onset asthma in adults is work-related.

The human costs associated with occupational injuries and illnesses arestaggering Financial costs of occupational injuries and illnesses exceed $250billion per year The medical and indirect costs of occupational injuries andillnesses are at least as large as the cost of cancer

Workers’ compensation law places the occupational physician in acritically important role The physician must determine that an injury orillness is caused by work, diagnose the condition, prescribe care, and assessthe extent of impairment and the ability of the worker to resume work Insome instances, determinations that injuries or illnesses are the result of workmay be contentious and require the physician to determine causation andprovide an opinion in the legal setting

Occupational physicians play an important role in prevention, recognition,and treatment of injuries and illnesses In some regions, occupationalphysicians customarily are employed by corporations More recently, it hasbecome the practice of corporations to contract with occupational physicians

to act as their consultants These consultants increasingly become involved inissues of environmental as well as occupational health Most workplaceinjuries and illnesses, however, are attended by private practitioners in clinicand hospital settings This is a function of the framework of the workers’compensation systems within each state

When a compensation case results in litigation, occupational healthprofessionals become important experts in resolving disputes The physicianasked to evaluate the worker in most states is designated an independentmedical examiner (IME) The evaluation by IME is often the highest level ofevaluation the worker will encounter Most requests for IME opinions comefrom insurers, but on occasion, plaintiffs’ attorneys, judges, and others mayinitiate an IME evaluation Many occupational physicians find a full-time

practice in this highly specialized area of workers’ compensation.

Recognition of Occupational Injury & Illness

It is a disconcerting fact that workers’ compensation fails to compensate mostoccupational injuries and illnesses, including fatalities Only a small fraction

of occupational diseases is covered by workers’ compensation, and only asmall fraction of people suffering from occupational illnesses ever receivesworkers’ compensation benefits Either by law or by practice, compensation

in many states is particularly limited for occupational diseases A recent studysuggests that workers’ compensation insurance absorbs only 21% of the truecosts of occupational injuries and illnesses

Many workers’ compensation laws now prevent or discourage therecognition of occupational diseases The efforts of many industries and theirinsurers to deny claims lead to the failure to compensate workers who haveoccupational diseases Another important contributing cause is the limitedinformation available to physicians Of the tens of thousands of chemicals incommon commercial use in the United States each year (3000 of them inquantities of > 1 million pounds per year), only 7% have been screened fortoxicity, and fewer than half of those have been studied thoroughly Althoughinterest in occupational medicine is increasing across the country, the failure

to diagnose occupational diseases and the lack of proper compensation ofworkers continue to be major social policy failures

More than half a million chemicals are found in work settings, and manymillions of workers are exposed to these substances Yet only 10,000workers’ compensation claims for illnesses caused by chemical exposure arefiled each year Workplace exposure to carcinogens accounts for about 5–10% of all cancer cases, yet fewer than 0.1% of cancer patients ever receiveany settlement from employers For example, NIOSH estimates that 16–17%

of lung cancer cases in men and 2% of cases in women are work-related

As many as 15,000 of the 100,000 commonly used industrial chemicalsare carcinogenic to humans Although occupational cancers are totallypreventable, workers continue to be exposed to carcinogens possibly becausefew cases are reported, are awarded benefits, or are successful in litigation.With the exception of cancers caused by exposure to asbestos, occupationalcancer cases ever receive workers’ compensation benefits

Teaching Occupational Medicine

The majority of physicians who practice occupational medicine in the privatepractice setting do so with the knowledge gained by self-study, attendance atshort courses, and practice experience A lack of training in occupationalmedicine may account for some of the failure to diagnose occupationaldiseases and eventually to compensate workers Traditional public healthapproaches are infrequent in many such practices Moreover, the long latencyperiods of many occupational diseases present a causation dilemma both forphysicians and for insurers Time constraints and knowledge may hamper theability to recognize common work-related conditions such as work-relatedasthma, and concerns regarding the effect of the diagnosis on the patient’s joband income may discourage reporting

Occupational medicine in recent years is receiving an increasing emphasis

in medical schools Faculty that had limited opportunity for research andteaching in occupational medicine at most medical schools now find anumber of new positions through the avenue of environmental health Thisdynamic advancement is largely the result of academic achievements in theUnited States where fundamental research in both fields appears to beexpanding In a survey of European medical schools, on the other hand, amean number of 25.5 hours was given to formal instruction in occupationalmedicine to medical undergraduates Occupational diseases and principles ofprevention are covered in most schools, while disability and return to workare very poorly represented among the topics that were taught to students.The teaching of occupational medicine to undergraduates in the UnitedKingdom has declined, with fewer schools now providing lectures, projectwork, or ward-based tuition in this subject However, the success of addingenvironmental medicine to occupational is now beginning to be recognizedthroughout the world in both teaching and research venues

Residency and Other Training

NIOSH, in addition to its roles in supporting occupational health research andrecommending occupational standards to OSHA, funds most trainingprograms in occupational health and safety NIOSH extramural funds support

a network of 18 regional education and research centers located atuniversities in 17 states and approximately 30 individual training projectgrants in 20 states In 2010–2011, 329 professionals graduated from the ERC

training programs with specialized training in disciplines that includeoccupational medicine, occupational health nursing, industrial hygiene,occupational safety, and other closely related occupational safety and healthfields of study.

Most training programs in occupational medicine are associated withuniversities that have schools of public health, but some programs are foundwithin specific departments (eg, preventive medicine, community medicine,internal medicine, or family practice) within a medical school There are 25approved residency programs in the United States The annual number ofgraduates from each residency program averages only slightly greater thantwo This small number does not answer the requirement for academicallytrained occupational physicians, nor does it fill the vacancies in public healthdepartments in many areas of the country

Board Certification

Board-certified physicians generally have more diverse practice activities andskills, with greater involvement in management, public health–orientedactivities, and toxicology The American Board of Preventive Medicine(ABPM) began board certification of specialists in occupational medicine in

1955 ABPM has certified a total of 4047 occupational physicians through

2013 Fewer than half of these board-certified occupational physicians arecurrently in practice Although occupational medicine is the most popular ofthe ABPM certifications, it remains one of medicine’s smallest specialties.Applicants for board certification peaked at 331 in 1996 Fewer than half thatnumber applied for board certification in 2013 The number of occupationalphysicians certified by ABPM is not replacing the losses to retirement orretreats from the field In 2012, 86 of 119 physicians (a pass rate of 72%)passed the board certification examination This small supply of new board-certified specialists is far below that which would be required merely toreplace the loss by retirement of older board-certified physicians

The ABPM approved a complementary pathway in 2010 to accommodatephysicians who want to make a mid-career shift into the practice ofpreventive medicine and to achieve certification by the ABPM in one of threespecialty areas—aerospace medicine, occupational medicine, or public healthand general preventive medicine A variety of distance learning opportunitiesare increasingly available for maintenance of certification for physicians with

ABPM certification after 1998.

For details on certification, contact

American Board of Preventive Medicine

111 West Jackson Boulevard, Suite 1110

Harber P: Career paths in occupational medicine J Occup Environ Med2012;54:1324 [PMID: 23047658]

Harber P: Occupational medicine practice: activities and skills of a nationalsample J Occup Environ Med 2010;52:1147 [PMID: 21124250]

Harber P: Value of occupational medicine board certification J Occup

Environ Med 2013;55:532 [PMID: 23618887]

Leigh JP: Economic burden of occupational injury and illness in the UnitedStates Milbank Q 2011;89:728 [PMID: 22188353]

Leigh JP: Workers’ compensation benefits and shifting costs for

occupational injury and illness J Occup Environ Med 2012;54:445

[PMID: 22446573]

National Assessment of the Occupational Safety and Health Workforce,2011

http://www.cdc.gov/niosh/oshworkforce/pdfs/NASHW_Final_Report.pdf.Parhar A: Barriers to the recognition and reporting of occupational asthma

by Canadian pulmonologists Can Respir J 2011;18:90 [PMID:

21499594]

SELF-ASSESSMENT QUESTIONS

Select the one correct answer to each question

Question 1: Occupational injuries and illnesses

a are defined by workers’ compensation law

b require an occupational physician to provide medical care

c are among the five leading causes of morbidity and mortality in theUnited States and in most other countries

d are declining in number as insurance settles claims

Question 2: Occupational physicians

a are primarily employed by public health agencies

b play an important role in prevention, recognition, and treatment ofinjuries and illnesses

c are prevented by law for acting as consultants to employers

d should endeavor not to become involved in issues of environmentaland occupational health

Question 3: Independent medical examiners

a are required when a compensation case results in litigation

b are hired by workers to resolve disputes

c often provide the highest level of evaluation the worker will

encounter

d are in most jurisdictions hired by plaintiff’s attorneys

Question 4: Board-certified physicians

a generally have more diverse practice activities and skills, withgreater involvement in management, public health-oriented

activities, and toxicology

b make up the large majority of occupational physicians in privatepractice

c more than replace the losses to retirement or retreats from the field

d are unable to appear as expert witnesses in court cases

International Occupational &

Environmental Health

Joseph LaDou, MS, MD

GLOBAL WORKING CONDITIONS

The world’s workforce sustains more than 250 million injuries every year.Included in this number are 2 million people killed by their work each year.Occupational illnesses attributed to hazardous exposures or workloads may

be as numerous as occupational injuries The lack of adequate surveillance ofoccupational disease prevents accurate assessment of the problem The globalepidemic of occupational injury and disease is not new It is inherent in thenature of industrial development that poorer countries adopt hazardousproduction The resultant epidemic of injuries and illnesses is compounded

by the rapid transfer by developed countries of hazardous industries no longercompatible with host country government regulation While internationalstandards attempt to obligate employers to pay for occupational injury anddisease, inadequate prevention, detection, and compensation make a mockery

of these standards

Occupational injuries and diseases have a profound effect on the health ofthe world’s population Occupational injuries and diseases play an even moreimportant role in developing countries where 70% of the working population

of the world lives Occupational injuries and diseases have a serious impact

on the economy of all countries Occupational accidents cause permanentdisabilities and economic losses amounting to 4–6% of national incomes.These preventable injuries and diseases also have profound impacts on thework productivity, income, and social well-being of workers and theirfamilies Often ignored is the reality that a single occupational injury or

illness can tip an entire family into poverty.

Developing countries seldom have enforceable occupational andenvironmental regulations Occupational health should have high priority onthe international agenda, but occupational safety and health (OSH) lawscover only about 10% of workers in developing countries These laws omitmany major hazardous industries and occupations Progress in bringingoccupational health to the industrializing countries is painfully slow In thepoorest countries, there has been no progress at all

Many other health issues compete with occupational and environmentalhealth for scarce funding Developing countries are concerned withoverwhelming problems of unemployment, malnutrition, and infectiousdiseases About 450 million people live in extreme poverty and malnutrition,while another 880 million live in what can only be described as absolutepoverty Nearly every fifth worker in the world has to survive on less than $1

a day for each family member Sixteen million people die each year fromeasily preventable diseases, and occupational diseases are not included in thatdefinition

Working conditions in much of Latin America, Africa, Central andEastern Europe, China, India, and Southeast Asia are unacceptable The laborforce in developing countries totals around 1.8 billion, but it will rise to morethan 3.1 billion in 2025—implying a need for 38–40 million new jobs everyyear This being the case, demands by workers and governments forimproved occupational safety and health are not likely to be heeded

Developing countries are far behind industrialized countries in thedevelopment of workers’ compensation programs In many countries of Asia,Latin America, and Africa, only a small fraction of the workforce is covered

by workers’ compensation programs In countries as large as Egypt, India,Pakistan, and Bangladesh, fewer than 10% of workers are covered byworkers’ compensation In China, fewer than 15% of workers are covered,and in Venezuela and Colombia, fewer than 20% In many developingcountries, workers’ compensation is little more than a paper program wherethe government works in concert with industry to minimize the provision andthe costs of benefits

GLOBALIZATION