ABC of Work Related Disorders: HAZARDS OF WORK

David Snashall Most readers of this series will consider themselves lucky to have an interesting job. However tedious others may find it, work defines a person--which is one reason why most people who lack the opportunity to work feel disenfranchised. As well as determining our standard of living, work takes up about a third of our waking time, widens our social network, constrains where we can live, and conditions our personalities. " ood" work is life enhancing, but bad working conditions damage your health. Occupational disorders in eneral practice eneral practitioners are likely to see as much work induced illness as doctors who work in occupational medicine, who spend most of their time assessing fitness for work on preventive programmes. !uch illnesses do not necessarily present at work, and, as only a minority of workers have access to an occupational health department, they usually first consult their general practitioner.
How occupational diseases present in general practice Musculoskeletal problems Respiratory problems Psychological problems 48% 10% 10%

"hese days few doctors see classic occupational diseases such as pneumoconiosis, heavy metal poisoning, or the various forms of occupational cancer. However, several conditions commonly seen in general practice may be occupational in origin--such as back pain, dermatitis, deafness, and asthma. Many of the injuries sustained at work will also be seen and dealt with in general practice or in accident and emergency departments. Reportin occupational illnesses# $ccupational diseases are supposed to be reported to the Health and !afety %&ecutive by employers 'usually advised by doctors( under )*++$) ')eporting of *njuries, +iseases, and +angerous $ccurrences )egulations(, but this cannot be relied on--if these official statistics were the only source of information, occupational illness would seem to be very rare.

Sur eys in !inland" where reporting is assiduous" ha e shown rates o# occupational disease to be underestimated $%& times

,hen the -../ 0abour 1orce !urvey asked workers themselves it found that 2.2 million people had had an illness that year which they thought was caused or made worse by their work. *t was estimated that these illnesses led to 34 of all general practice consultations. 1urther cases of occupational disease come to light via the +epartment of !ocial

!ecurity5s compensation scheme for diseases prescribed under the *ndustrial *njuries 6rovisions of the !ocial !ecurity Act -.37.
't has been estimated that 4% o# cancer deaths in the (nited States are directly due to occupational causes) 'ndustrial agents that cause cancer include aromatic amines *rubber and dye industries+" asbestos" ben,ene" ionising radiation" nickel" polyaromatic hydrocarbons" and wood dust

8ewer initiatives have enabled us to gain a much better picture of certain occupational diseases--notably the !,$)+ '!urveillance of ,ork )elated and $ccupational )espiratory +isease in the 9nited :ingdom( and %6*-+%)M reporting systems, which have collected data on respiratory and skin conditions respectively from general practitioners and specialists. "hese have now been supplemented by $6)A '$ccupational 6hysicians )eporting Activity(, which will include other occupational diseases.
If work related illness is diagnosed Prescribed disease%%Proo# that a patient has ac-uired one o# these diseases may lead to substantial compensation) (rge patients" e en i# they are retired"to contact the .epartment o# Social Security Reportable disease%%'# one o# these diseases related to work is diagnosed by a doctor" an employer must by law report this to the Health and Sa#ety /0ecuti e 1oti#iable in#ectious disease *under the Public Health 2cts+ must be reported by doctors to the local authority

*ndustrial injuries are reported more fully than occupational diseases despite the fact that their impact on workers5 health is less. "heir cause is usually obvious and recent, whereas cause and effect in occupational disease can be far from obvious and the e&posure to the ha;ardous material may have occurred many years before.
3otal cost o# work related illness" in4ury" and other accidents was 56bn%517bn *1%7% o# gross domestic product+ in 1880

!s an illness occupational" ,hereas asbestosis and chronic lead poisoning can hardly be described as anything other than occupational diseases 'about 3/ of these are listed by the +epartment of !ocial !ecurity(, this may not be true of conditions such as back pain in a construction worker or an upper limb disorder in a keyboard operator when activities outside work may be contributing. A lifetime working in a dusty atmosphere may not lead to chronic bronchitis and emphysema, but, when it is combined with cigarette smoking, it makes this outcome much more likely. <ommon conditions for which occupational e&posure is an important but not the sole or even the major cause can be more reasonably termed work related disease rather than occupational disease.

<ertain occupations carry a substantial risk of premature death while others are associated with the likelihood of living a long and healthy life. "his is reflected in very different standardised mortality ratios for different jobs, but not all the differences are due to the various ha;ards of different occupations. !election factors are important, and social class has an effect 'although this is defined by occupation(. 8on-occupational causes related to behaviour and lifestyle may also be important.
9ccupations associated with high and low standardised mortality ratios *all causes+ 18:8%8$ Occupation Mortality ratio 3ailors and dressmakers *single women+ 184 Road sur#acers *men+ 16& ;us conductors *men+ 1&0 2ll occupations *men and single women+ 100 Medical practitioners *men+ 66 Physical and geological scientists and mathematicians *men+ (ni ersity academic sta## *single women+

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#resentation of $ork related illnesses +iseases and conditions of occupational origin usually present in an identical form to the same diseases and conditions due to other factors. "hus, bronchial carcinoma has the same histological appearance and follows the same course whether it results from working with asbestos, uranium mining, or cigarette smoking. "he possibility that a condition is work induced may become apparent only when specific =uestions are asked because the occupational origin of a disease is usually discovered 'and it is discovered only if it is suspected( by the presence of an unusual pattern. 1or e&ample, in occupational dermatitis the distribution of the lesions may be characteristic. A particular history may be another clue# asthma of late onset is more commonly occupational in origin than asthma that starts early in life. +aytime drowsiness in a fit young factory worker may not be due to late nights and heavy alcohol consumption, but to unsuspected e&posure to solvents at work. "he occupational connection with a condition may not be immediately obvious because patients may give vague answers when asked what their job is. Answers such as "driver," "fitter," or "model" are not very useful, and the closer a doctor can get to e&tracting a precise job description the better. !ometimes patients will actually have been told 'or should have been told( that there are specific ha;ards associated with their job, or they may know that fellow workers have e&perienced similar symptoms.
2n <engineer< may work directly with machinery and risk damage to limbs" skin"and hearing or may spend all day working at a computer and risk back pain" upper limb disorders" and sedentary stress

"iming of events "he timing of symptoms is important as they may be related to e&posure events during work. Asthma provides a good e&ample of this# many people suffering from occupational asthma develop symptoms only after a delay of some hours, and the condition may present as nocturnal whee;e. *t is essential to ask whether symptoms occur during the performance of a specific task and if they occur solely on work days, improving during weekends and holidays.

,orking conditions 6atients should be asked specifically about their working conditions. <ommon problems are dim lighting, noisy machinery, bad office layout, dusty atmosphere, draconian management, and bad morale. !uch =uestioning not only investigates possibilities but gives the doctor a good idea of the general state of a patient5s working environment and how he or she reacts to it. A visit to a patient5s workplace, if it can be arranged, may be a revelation and just as valuable as a home visit if you want to understand how a patient5s health is conditioned and how it might be improved. :nowing about somebody5s work can help you to place the person in conte&t and to gain insight. 6atients are often happy to talk about the details of their work# this may be less threatening than talking about details of their home life and can promote a better doctor-patient relationship. "he causes of occupational disease can e&tend beyond the workplace to affect local populations by air or soil pollution and other members of workers5 families when overalls soiled with to&ic materials are taken home to be washed. <hanging trends in work related illnesses <hanges in working practices in >ritain are giving rise to work that is more intense and stressful but also less physically demanding. "here are more jobs in service industries, more working from home, more handling of newly developed products, and more women at work. "his is not necessarily so in many developing countries, where headlong industriali;ation has led to sweatshop labour and where occupational accidents and diseases, both acute and chronic, are much more common. As important, of course, are the effects on health of an increasing rate of long term unemployment among the potential workers of the post-industrial world.

Medical Advisory !ervice, which is contactable through local branches of the Health and !afety %&ecutive. "he e&ecutive produc