What is occupational health?

The field of Occupational Health covers a wide area. It should be

included in public health programmes in all countries. Industry is
increasing in developing countries, and knowledge about occupational
health is necessary to reduce health problems related to this activity.

When you work with Occupational health, your task is to avoid and reduce
the effect of factors in the work places which may cause any adverse health
effects among the workers. To have a work place and earn your salary, is of
course a very important issue, but nevertheless, factors at work can
sometimes have unwanted side effects. In occupational health we try to
reduce these side effects. We aim to obtain good health among the workers.
As one industrial leader once said to me: We should produce goods, not
patients! In occupational health this is the main task: To avoid workers
becoming patients. Some examples of work situations where risk factors for
health appear will be described for you. Hopefully, the examples will give
you a better understanding of what occupational health is. Along with the
examples themselves, the difference between acute and chronic health effects
will be explained to you.

a) Acute health effects

Example 1

The first example is regarding work in a saw mill.

A saw mill. Colourbox

Here the workers cut timber to get materials ready for building purposes.
However, there are dangerous tools such as saws present in this working
environment.
 A saw can be very dangerous. G. Tjalvin

The workers cut the timber, but can also cut other things, for example, the
hands of the worker. Our yours and mine - awareness is now increased
regarding possible risk factors for adverse health effects when working in
saw mills by looking at these photos. However, we can do several things to
avoid such injuries from happening. That is what occupational health is
about.

Enclosed saw blade. G. Tjalvin

On the photos you can see that we can enclose the moving part of the saw so
the worker does not come in contact with the saw blade easily. We can also
have security systems, so the saw blade is not turning if the saw is not well
enclosed, and the saw can be in a special place or special room where no one
other than the saw technician is located.

Enclosed saw blade and worker with gloves. Colourbox

We can also protect the worker, for instance by giving them strong,
protective gloves, but for this particular case, strong gloves are not at all as
good as the technical installations and enclosure I described. Anyway, I think
you might get the point: We can prevent these accidents.

Example 2
There are many other potential risk factors at different work places. Another
example is that health personnel may develop infectious diseases during
contact with patients with such diseases. An example we recently have
experienced occurred during the Ebola outbreak. Ebola is a deadly disease
where we have little treatment to offer our patients. During the Ebola
outbreaks, the World Health Organization (WHO) reported a large number of
deaths among health personnel. This is summarised in a report about the
impact of the Ebola epidemic on the health workforce of Guinea, Liberia and
Sierra Leone, covering the period from 1th January 2014 to 3th March 2015.

815 health personnel died due to confirmed/probable Ebola disease in

the period from January 2014 to March 2015.

Personal protective equipment for health personnel involved in the care of a

Ebola patient: Powered air purifying respirator and full body suit Oslo University
Hospital, Anders Bayer

However, such infections among health personnel can be prevented. This

photo shows the protective equipment for health personnel working with an
Ebola patient, and organizing her bed. They are using whole body suit with
integrated helmet, each suit equipped with a powered air purifying unit
creating positive air pressure within the suit. This equipment protects the
health personnel from being exposed to the virus. Correct use of protective
equipment will reduce the Ebola risk among the health personnel. Here we
show the optimal protective equipment for such situations.
Example 3

Rose farm with large numbers of green houses.

B.E. Moen

The third example is from East Africa. There are an increasing number of
flower farms here, especially farms growing roses. Roses are very popular in
the Western world, and large numbers of roses are exported from several
countries in East Africa, such as Tanzania, Ethiopia and Uganda. These
flower farms are huge, like you see in the photo, with many greenhouses. The
farms employ thousands of people.

Roses stored after cutting in a green house. K. Segadal

The roses from the farms are transported to other countries. They are sent
from the farms first by trucks and then by airplane every day, so the roses are
fresh when they arrive.

Last year, a truck filled with roses at a flower farm was ready to travel to the
airport with the roses at the end of the day. One leader at the flower farm
passed by, observing that some space was not filled up in this truck. He asked
two women working there, to cut more roses from the green house, to fill in
this space. There was not much time before the plane should leave, and
things had to be done quickly. The women protested, because the green
houses where the roses were growing had just been sprayed with pesticides,
and no one should enter.
Cutting roses in a green house. K. Segadal

Normal practice is that the pesticide sprayers close up green houses some
hours after spraying, to avoid human exposure to these toxic substances. In
this case, the female workers were not listened to, but told to be quick, to go
into the green house and cut more roses. They did so. Immediately
afterwards, they felt very sick, with nausea, headache and vomiting. One of
the women died the same day; she had serious pesticide intoxication and her
kidneys stopped working.

This is a tragic example of an avoidable situation. The workers should not

have entered the green house just after spraying. There are strict rules about
waiting a certain amount of time after spraying before re-entering the area, to
avoid workers running the risk of inhaling these substances. Or if the
workers need to enter, they should be equipped with personal respiratory
protective equipment so they do not inhale or get in contact with the toxic
pesticides.

b) Chronic diseases at work

The types of risk factors described in the examples so far cause acute health
effects, meaning they develop at the time of exposure at work or soon after.
In working life, however, workers may also be exposed to factors that cause
adverse health effects over longer periods of time. In occupational health we
call these chronic diseases. One such factor is dust. Dust can be inhaled and
reach the lungs and cause respiratory problems. Sometimes, these types of
lung diseases do not develop until after years of exposure. This is the
situation for coal miners for instance, like the ones you see in the photo.
Inhaling coal dust over years may cause coal miners pneumoconiosis, a
disease which at first will cause cough during work in this dust. At first this
symptom may be considered as an acute health effect; the dust irritates the air
ways. However, after some time, the cough may worsen and in addition
serious problems in breathing may develop. This is a typical start of the
pneumoconiosis; a chronic disease that we cannot cure. Workers with this
disease may become invalided and unable to perform any further work.
However, this is a disease we can prevent. If you are skilled in occupational
health, you will know, for instance, that using water during drilling will
reduce the dust in the air, and also that respiratory protective equipment
exists, which can reduce the amount of dust exposure for the worker.

Definition of occupational health and the

size of the problem

Handling hot iron sticks can be very dangerous. G. Tjalvin

a) Prevention is very important

Some serious examples of what may happen in certain work places if the
working conditions are not optimal have been shown to you now. Many
other, different examples from different work places will be illustrated for
you later in this course. The existence of the problems may seem depressing.
However, one exciting thing is that these types of injuries and diseases can be
prevented! We have a mission to do so in occupational health; to reduce the
problems resulting from injuries, diseases and deaths that are work place-
related.

b) Definition

Actually, occupational health as a discipline includes even more; it is not

only the issue of avoiding and reducing serious injuries and diseases, but also
to work to campaign for improving the general well-being of workers in a
work place. There are several definitions of occupational health, but the one
most commonly used is this one, from WHO and the International Labour
Organization (ILO):
A definiton of occupational health is: The promotion and maintenance
of the highest degree of physical mental and social well-being of
workers in all occupations.

This definition gives us a very high aim to work for, but this is the standard
we should have; we should work for the highest degree of physical, mental
and social well-being of workers in all occupations. You will learn more
about different aspects of occupational health in this course, and how to work
on these issues. We can improve the world of working life.

c) The size of the problem

Workers represent half the worlds population in the age group 16-67 years,
and are the major contributors to economic and social development.
However, around the world, millions of men and women are paid to work
under poor and hazardous conditions. Despite the availability of effective
interventions to prevent many occupational hazards and to protect and
promote health at the workplace, large gaps exist between and within
countries concerning the health status of workers and their exposure to
occupational risks. More information is given in the report Workers health:
Global plan of action 2008-2017 by World Health Organization.

We also have some figures from the International Labour Organization, ILO.

More than 2 million people die from work-related diseases every year

321 million accidents occur due to workplace hazards annually

Every 15 seconds, a worker dies from a work-related accident or disease

Every 15 seconds, 153 workers have a work-related accident

Worldwide, occupational injuries and diseases continue to be the leading

cause of work-related deaths. The situation is unacceptable.
The inadequate prevention of occupational diseases has profound negative
effects not only on workers and their families but also on society at large due
to the tremendous costs that it generates; particularly, in terms of loss of
productivity and burdening of social security systems.

In many developing countries, death rates among workers are higher than
in industrialized countries, and work-related injuries and diseases are largely
un-documented. Global competition, an expanding labour market and rapid
changes in all aspects of work creates an increasing need for labor protection,
especially in developing countries. While globally much is known about
occupational health, implementation measures are lacking in many poor
countries, probably due to lack of competence and political will.

Coal miners from Tanzania. S.H.D. Mamuya

Legislation and actors in occupational

health
a) Legislation
Most countries have a specific law, A Working Environment Act, to ensure
that a working environment does not harm the employees. The Working
Environment Act itself and its interpretation can vary in different countries.
The Norwegian Working Environment Act, for instance, formulates its
function like this:
The purpose of the Act is:
a) to secure a working environment that provides a basis for a healthy and meaningful working situation, that affords full safety
from harmful physical and mental influences and that has a standard of welfare at all times consistent with the level of
technological and social development of society,
b) to ensure sound conditions of employment and equality of treatment at work,
c) to facilitate adaptations of the individual employees working situation in relation to his or her capabilities and circumstances
of life,
d) to provide a basis whereby the employer and the employees of undertakings may themselves safeguard and develop their
working environment in cooperation with the employers and employees organisations and with the requisite guidance and
supervision of the public authorities,
e) to foster inclusive working conditions.

This formulation can be quite different in another country. Some countries

may also have specific regulations related to certain types of work, such as
mining or manufacturing industry; others have not. It is, however, very
important to know about the regulations and guidelines when you work with
occupational health. It carries more weight when you tell an employer that
this does not adhere to the existing law, than to just say that in your opinion
the work place should improve. It is important to understand that these laws
are designed to protect workers and should be used accordingly.

There are also major differences between countries in how the adherence to
the law is controlled. Many countries have some kind of labour inspection
office that performs this task, like OSHA which was described earlier in this
session. However, the labour inspection can, in reality; have few resources in
some developing countries. This is unfortunate for the workers. It is very
important to have a functioning labour inspection authority. Without
inspections, it can be difficult to improve standards regarding work and
health. Also, we see very different approaches in the different labour
inspectorates. Some countries are strict and give hard penalties to companies
that do not adhere to the laws, others do not. It is difficult to say how this
should be performed to achieve the best results, but it is important that there
will be some kind of consequence if the situation at the work place is not
optimal.

b) Who works with occupational health issues?

Who works in occupational health, you may ask apart from employees in
the labour inspection. Maybe you have never seen or heard about anyone
doing this kind of job. Occupational health should be integrated in many
different settings. It is an area with far too few resources and focus in many
countries. Here are five examples of groups of people who can and should
work with occupational health:
1. All
All persons who are involved in work where there are employees or who
employ others should have some knowledge about occupational health. All of
us need to know the rules and the consequences of not keeping them.

2. Health personnel
It is important that health personnel in general have some knowledge about
occupational health. For example, an x-ray photo of the lungs of a person
with severe pneumoconiosis can look very much the same as severe
tuberculosis. We want the physician to find the correct diagnosis. With
training in and knowledge of occupational health, this is possible. You should
not treat workers for tuberculosis when they instead should be helped by an
improvement of the dust levels at the work place.

3. Occupational health personnel

Specific professionals receive more training in occupational health than
others. Many countries have special occupational health services attached to
companies, to ensure that the health of the workers is not harmed in any way.
It is important to have competent personnel who can perform risk
assessments of the work places and suggest preventive measures. This way,
health hazards at work can be reduced. Occupational health personnel are
multidisiplinary groups, including for instance occupational physicians,
nurses, physiotherapists, occupational hygienists and safety engineers. You
will learn more about such units later in this course. In addition, many
countries have specific out-patient clinics for occupational diseases in their
hospitals. This facilitates the process of patients receiving the correct
diagnoses.

4. Labour inspectorates
Occupational Health is a main issue for employees in the Labour
Inspectorates. The personnel in Labour Inspectorates work to improve the
work environment at the work places.

5. Stakeholders
Stakeholders and policy makers, such as politicians need to have some
knowledge of occupational health. They are important players in the process
of improving working life. They work to initiate and develop legislation,
policies and other official actions that affect conditions in the work place.
Also, trade unions can be mentioned here. They have been important for
developing good working conditions and legislation in many countries, both
historically and today.

Occupational injuries
317 million occupational accidents occur annually; many of these resulting in
long absences from work. Even if the data are not very accurate on the
national level, it is clear that in many countries the problem requires more
decisive action from the public authorities.

Definitions
According to ILO; occupational injuries are defined as any personal injury,
disease or death resulting from an occupational accident. An occupational
injury is therefore distinct from an occupational disease, which is a disease
contracted as a result of an exposure over a period of time to risk factors
arising from work activity.

An occupational accident is an unexpected and unplanned occurrence,

including acts of violence, arising out of or in connection with work.
Occupational accidents also include travel, transport or road traffic accidents
in which workers are injured and which arise out of or in the course of work,
i.e. while engaged in an economic activity, or at work, or carrying on the
business of the employer.

The cost of occupational injuries

Worldwide, hazardous conditions in the workplace were responsible for a
minimum of 312,000 fatal unintentional occupational injuries. Together, fatal
and non-fatal occupational injuries resulted in about 10.5 million Disability-
Adjusted Life Years (DALYs); that is, about 3.5 years of healthy life are lost
per 1,000 workers every year globally. Occupational risk factors are
responsible for 8.8% of the global burden of mortality due to unintentional
injuries and 8.1% of DALYs due to this outcome. (The Global Burden Due to
Occupational Injury; Concha-Barrientos et.al., Am J Ind Med 48:470481,
2005).

Economic costs of work-related injury and illness vary between 1.8 and 6.0%
of GDP in country estimates, the average being 4% according to the
ILO. (Global Estimates of the Burden of Injury and Illness at Work in 2012,
Takala et.al., J Occup Envir Hyg, 11: 326337, 2014).

The direct and indirect costs of work-related accidents and ill-health have
been extensively researched and documented in recent years. This has clearly
demonstrated the great economic burden that such accidents and ill-health
place on individuals, enterprises, families and on society in general (Figure 1
in the link below).

Takala et.al., Journal of Occupational and Environmental Hygiene, 11: 326

337, 2014

Occupational accidents not only cause great pain, suffering and death to
victims, but also to their dependants. Occupational accidents also result in:

loss of skilled and unskilled but experienced labour

material loss, i.e. damage to machinery and equipment as well as
spoiled products
costs of medical care, payment of compensation and repairing or
replacing damaged machinery and equipment.

Preventive measures
Recognition, prevention and treatment of both occupational diseases and
accidents, as well as the improvement of recording and notification
systems are high priorities for improving the health of both individuals
and the societies they live in. This can only be achieved by improving
national safety and health management system competency.

Managers and workers need to think about how to eliminate, reduce and
control risks.

Four Key Steps to Reduce Risk:

1. Eliminate or minimize risks at source
(Example: Window cleaning at height; window open inside/out, no leaning
out for cleaning.)
2. Reduce risks through engineering controls or other physical
safeguards. (Use specially coated self-cleaning glass, use movable
lift/platform)

3. Provide safe working procedures (Carry out a Safe Job Analysis, and
describe safe work procedures)

4. Provide, wear and maintain personal protective equipment (Harness,

helmet)

Data on work-related accidents and diseases is essential for improving

prevention. Having assessed the economic consequences and the types of
accidents that most frequently occur at its workplace, a company can identify
high-risk occupations or processes and devise better accident prevention
strategies to minimize or eliminate future accidents at work.

Since most hazardous conditions at work are, in principle, preventable,

efforts should be concentrated on prevention at the workplace, as this offers
the most cost-effective strategy for their elimination and control.

WHO concludes that mechanical factors, unshielded machinery, unsafe

structures at the work-place and dangerous tools are of the most prevalent
environmental hazards in both industrialized and developing countries and
these affect the health of a high proportion of the workforce. There is a
growing body of data showing that most accidents are preventable and that
relatively simple measures in the work environment, working practices,
safety systems and in behavioral and management practices are able to reduce
accident rates even in high-risk industries by 50% or more in a relatively
short period of time. Accident prevention programmes are an important and
technically feasible part of occupational health services; they are shown to
have high cost-effectiveness and yield rapid results.

The British Safety Council suggested the following main contributing factors
to occupational accidents;

Organisation lacks health and safety policy, structure, work

involvement and management system
Poor safety culture
Lack of knowledge and lack of awareness of information sources
Lack of, or poor, government policies, legislation, enforcement and
advisory system
 Lack of incentive-based compensation system
Lack of, or poor, occupational health services
Lack of research and proper statistics for priority-setting
Lack of effective training and education

Occupational Health Services

ILO has provided a definition of occupational health services:

The term occupational health services means services entrusted with

essentially preventive functions and responsible for advising the employer,
the workers and their representatives in the undertaking, on

i) the requirements for establishing and maintaining a safe and healthy

working environment which will facilitate optimal physical and mental health
in relation to work

ii) the adaptation of work to the capabilities of workers in the light of their
state of physical and mental health.

The ILO Convention on Occupational Health Services (No. 161) and the ILO
Recommendations on Occupational Health Services (No. 171) were adopted
in 1985. The main tasks for occupational health services are mentioned in
these documents. But what does this mean in practical life? What does this
type of health personnel do? In practice this may differ from country to
country. It can also differ because some countries have only physicians
employed in OHS units, while others have multidisciplinary teams. There is
no doubt that multidisciplinarity is needed in OHS, where competence in
health is needed as well as insights into technical solutions for improving the
work environment.

Organizational models for occupational

health services
Occupational health services for all workers, irrespective of age, sex,
nationality, type of employment, size or location of workplace, has been a
long-term objective of the World Health Organization. Few countries, if
any, have lived up to this challenge completely. The development of
occupational health services differs from country to country. Some
countries have hardly any occupational health services at all; others
provide highly developed services.

Occupational health services are organized in various ways in different

countries. An important issue is that the OHS must be free and independent.
The OHS must be neutral and not take side with any of the two parts of the
working life, either the employer or the employee. The challenge is to
determine how can this best be accomplished.

Two models
Two main types of occupational health services exist: One is called internal
occupational health service. In internal OHS, personnel are employed by the
individual companies. The second type is called external occupational health
service, and involves personnel working in an external unit serving several
companies.

Internal OHS

Internal OHS - An occupational health services

can be organized inside a factory, as an internal OHS. University of Bergen

In internal occupational health services, the occupational health personnel

usually are located on the company premises, and the personnel are employed
by the company. This is a solution often chosen by large companies who can
afford to employ their own personnel. This model of OHS makes it possible
for OHS personnel to be close to the workers and their problems, and gives
great opportunities for understanding the work processes as well as the
company culture. However, the closeness to the company might make it
difficult for OHS personnel to ask for changes; for instance, for improvement
of the work environment. It is important that OHS units are able to to keep
their integrity.
External OHS

External OHS - An occupational health

service can be external, serving many companies. University of Bergen

Personnel in the external model are most often based in units outside the
companies. There are different ways to organize such units. An external
occupational health services can be owned by a number of companies that co-
operate. These types of OHS can also be established as separate companies,
owned by an outside owner, a hospital or privately (a joint-stock-company).
They can also be owned by the health personnel themselves. An external type
of OHS usually serves many companies, and is a good solution for smaller
companies who cannot employ their own OHS staff. In this model of OHS, it
is harder for the OHS personnel to be close to the workers and their
problems, and a thorough understanding the work processes in the company
might also be challenging. The external OHS unis often describe themselves
as particularly independent, as they do not depend on the company they serve
directly. However, such units have to find customers. The customers are the
companies. Discussions on the price of the service and how to attract clients
are common among personnel in the external occupational health services,
and competition between the units can be fierce in some countries. External
OHS units can sometimes be large, giving opportunities for a good scientific
environment, but can also be organized as a chain of smaller units where the
personnel work much alone.

Who pays?
In some countries, the OHS is paid by the companies themselves, with no
public support. In other countries, the OHS is partly paid by public sources.
Some countries have integrated the OHS in other activities such as
community health units, while other countries have OHS as separate units,
with no specific association with other parts of the health system. It is
difficult to say what is the best solution. What seems to be important is that
the countries have legislation which requires OHS to be in place, one way or
the other. Without any legislation, establishment of OHS is hard to achieve.
The legislation can, for instance, ask for OHS to be established within certain
industries or activities where the risk of work related diseases and injuries are
high.
Professions and tasks of OHS
According to ILO Recommendations on Occupational Health Services
(No. 171) OHS should be made up of multidisciplinary teams whose
composition should be determined by the nature of the duties to be
performed. The most common types of professions who work in an OHS
are physicians, nurses, physiotherapists, occupational hygienists and
safety engineers. In addition they have office staff and some places an
OHS can have a psychologist employed or even a priest.

In the literature there is no clear consensus concerning the use of terminology

occupational physician / company doctor etc. In this chapter we will use the
designation occupational health worker (doctor, nurse, hygienist etc.) to
indicate that the health worker in question has completed specialized
occupational health training.

Occupational physician
The occupational physician, who sometimes is referred to as a company
doctor, advises the business on health related and medical issues, and also has
the medical responsibility in the OHS unit. In many OHS units the physician
is the administrative leader for the OHS. The doctor can participate in health
examinations, rehabilitation, supervision and counselling and information
work, as well as surveillance of the work places. There are different
requirements in different countries to become a competent company
doctor/occupational physician, and some countries have a medical specialty
in occupational medicine.

Occupational nurse
An occupational, or corporate, nurse works with primary and secondary
preventive measures. The nurse can have tasks related to health examinations
of workers, counselling and information work, as well as surveillance of the
work places. Some countries have specific courses and special education for
these nurses.
 An occupational nurse often perform audiometries
checking the hearing of the workers. G. Tjalvin

Occupational hygienist
Occupational hygienists are involved in surveillance and supervision related
to chemical, biological or physical factors at the work places. Occupational
hygienists can have different backgrounds, such as chemistry or biology, and
some countries have specialized courses to certify occupational hygienists.

Occupational hygienists can plan and perform

specialized measurements, such as dust measurements, in the work place. G.
Tjalvin

Occupational physiotherapist
Occupational physiotherapists work on preventive issues related to
musculoskeletal diseases, and often participate in general surveillance and
supervision in the work environment. Their main task is to work with
prevention of musculoskeletal diseases, but they seldom treat individual
persons. Occupational physiotherapists develop their competence by
attending different courses, and a few countries have a specialty for this
profession related to the work places.

Safety engineer
Some OHS units have their own engineers specialized to work on safety
issues at the work places. In some countries the safety engineer and the
occupational hygienists have a close co-operation.
General tasks in an OHS
The role of occupational health services should be essentially preventive, and
their activity should take into account the particular occupational hazards in
the working environment as well as the problems specific to the branches
they serve.

The most common tasks that an OHS unit should deal with are in some
countries described in the local/national legislation. Otherwise, ILO suggests
the following tasks:

a) Surveillance of the working environment

The quality of the working environment through compliance with safety and
health standards has to be ensured by surveillance at the workplace.
According to The ILO Convention on Occupational Health Services (No.
161), surveillance of the working environment is one of the main tasks of the
occupational health services. This can be performed by a walk-through
survey of the workplace as well as interviews with managers, foremen and
workers. When needed, special safety, hygiene, ergonomic or psychological
checks and monitoring can be performed.

b) Informing employer, enterprise management and workers about occupational

health hazards
As information about potential workplace health hazards is obtained, it
should be communicated to those responsible for implementing preventive
and control measures as well as to the workers exposed to these hazards. The
information should be as precise and quantitative as possible, describing the
preventive measures being taken and explaining what the workers should do
to ensure their effectiveness.

c) Assessment of health risks

To assess occupational health risks, information from surveillance of the
work environment is combined with information from other sources, such as
epidemiological research on particular occupations and exposures, reference
values including occupational exposure limits and available statistics.
Qualitative (e.g., whether the substance is carcinogenic) and, where possible,
quantitative (e.g., what is the degree of exposure) data may demonstrate that
workers face health hazards and indicate a need for preventive and control
measures.
 Lung x-rays of a group of workers can be taken, if
we suspect development of lung diseases due to a dusty work place. G. Tjalvin

d) Surveillance of workers health

Due to limitations of a technological and economic nature, it is often not
possible to eliminate all health hazards in the workplace. Under such
circumstances, surveillance of workers health plays a major role. It
comprises many forms of medical evaluation of health effects developed as a
result of workers exposure to occupational health hazards. For instance, if a
work place has high noise levels, the hearing ability of the workers can be
examined. The purpose is to be able to tell if any of the workers develop
reduced hearing. If they do so, they need specific protection and care to avoid
further development of the hearing loss, and the work place must work harder
on preventive issues to avoid other workers from developing the same
problem.

Pre-employment health examinations

Pre-employment health assessment is carried out before the job placement of
workers or their assignment to specific tasks which may involve a danger to
their own health or that of others. The purpose of this health assessment is to
determine whether a person is physically and psychologically fit to perform a
particular job and to ensure that his or her placement in this job will not
represent a danger to his or her health or to the health of other workers. This
work is not always a task for an OHS unit. Pre-employment examinations
might put the occupational physician into a difficult position. These
examinations require that an evaluation is made; to find out if the worker fits
in or not. This is another role than the one a physician in an OHS normally
has; being a support for the worker. The physician who performs pre-
employment examinations must think this through and know what kind of
role he/she is assuming.

e) Advisory role in decision-making processes

An important task for occupational health services is to provide advice to the
enterprise management, the employers, the workers, and health and safety
committees in their collective as well as individual capacities. Such advice
needs to be taken into account in any company decision-making processes,
especially if the occupational health professionals are not directly involved in
the decision-making.

f) Occupational health care and curative health services

Occupational health services may be involved in the diagnosis, treatment and
rehabilitation of occupational injuries and diseases. The knowledge of
occupational diseases and injuries combined with the knowledge of the job,
the working environment and occupational exposures present in the
workplace enable the occupational health professionals to play a key role in
the management of work-related health problems. General curative health
services are not normally recommended as a part of the OHS activity, as this
work may steal time from the preventive issues. However, in low income
countries the situation might be different. In low income countries, health
services in general might be lacking, and employees will need these services.
For an OHS to be able to treat a worker with malaria might be extremely
useful if the alternative is no treatment at all. However, when curative work
and ordinary OHS work is mixed, the OHS personnel should be very aware
of the difference in tasks and not end up only undertaking curative activities.
The prevention is after all the main aim of an OHS.

g) Rehabilitation
The participation of occupational health services is particularly crucial in
guiding workers rehabilitation and their return to work. This is becoming
more and more important as there are a large number of occupational
accidents in developing countries and in terms of the ageing of the working
populations in industrialized societies. OHS may play an important role in
seeing that workers recovering from injury or disease are referred to them
promptly. It has been shown to be preferable, when practicable, for a worker
to return to his or her original place of employment. It is an important
function of OHS to maintain contact during the period of incapacity with
those responsible for treatment during the acute stages in order to identify the
time when a return to work can be envisaged.
h) Health promotion activities

Many occupational health services participate in stop smoking

campaigns. G. Tjalvin

There is some tendency, particularly in North America and Europe, to

incorporate wellness promotion activities in the form of occupational health
programs. These programs are, however, essentially general health promotion
programs that may include such elements as health education, stress
management and assessment of health risks. They usually aim at changing
personal health practices such as alcohol and drug abuse, smoking, diet and
physical exercise, with a view to improving overall health status and reducing
absenteeism. These programs, designed as health promotion programs,
though valuable as such, are not usually considered as occupational health
programs, but as public health services delivered in the workplace, because
they focus attention and resources on personal health habits rather than on
protection of workers against occupational hazards.