Prevention and Management of

Occupational Diseases
in Hong Kong

Dr Mandy Ho
Specialist in Occupational and Environmental Medicine

17 August 2018

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Outline
 Definition of OD
 Local legislation
 Statistics of OD in Hong Kong
 Prevention of OD
 Management of OD
 Conclusion
 Work Health
 Work adverse impact on health
beneficial to health and well-being
 Health status of workers
Healthy  more productive
Impaired health  danger to self,
other workers,
and community
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Relationship between work and diseases

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Occupational Disease (OD)

 International Labour Organisation

(ILO) definition
 Disease having a specific or a
strong relation to occupation,
generally with only one causal
agent (i.e. causative factor at
work), and recognised as such
Work-related disease

 ILO definition
 Disease with multiple causal agents, where
factors in the work environment may play a
role, together with other risk factors, in the
development of such diseases, which have a
complex aetiology
 E.g. the majority of musculoskeletal disorders,
hypertension, ischaemic heart disease, chronic
non-specific respiratory disease, behavioural and
psychosomatic illness
Criteria for Prescribing Occupational
Diseases in HK
 Reference to the ILO’s criteria-
 the disease poses a significant and recognised
risk to workers engaged in a certain
occupation in Hong Kong; and
 the causal relationship between the disease
and the occupation can be reasonably
presumed or established in individual cases.
Statutory OD in HK
 Occupational Safety and Health
Ordinance (Cap. 509)
 Schedule 2:
 51 notifiable ODs
 HK e-legislation
 http://www.elegislation.gov.hk
Occupational Safety and Health
Ordinance (OSHO), Cap. 509
 Section 15 stipulates that a medical practitioner
must notify the Commissioner for Labour if
he/she :
 finds or suspects that a worker suffers from any
occupational disease specified in Schedule 2 of the
Ordinance; and
 believes that the disease was or may have been
attributable to an occupation specified opposite to
that disease in that Schedule.
 Failure to comply: liable on conviction to a
maximum fine of $10,000
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Publications of Occupational Health Service
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Notices Remark: The Labour Department has issued a revised Guidance Notes on the Selection,
Use and Maintenance of Safety Helmets (“GN”) in June 2018 and will continue to update
the relevant contents of other occupational safety and health publications issued. The GN
Public Services prevails regarding the specifications and use of the safety helmets.

o Employment • Occupational Health

Services
• Pressure Equipment
o
• Employees' Compensation
Notification of OD to Labour Department by medical practitioner

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Sources of OD Notification
 Occupational Health Clinics
 Doctors in public and private sectors
 Employers / employees report to Labour
Department

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 OD Notification
 Follow up actions of Occupational Health Service,
Labour Department
 Investigation of notified case
 Advice on compensation issues
 Finding of other affected workers
 Occupational safety and health (OSH) assessment
of the workplace and law enforcement
 Recommendations of specific preventive measures
 Monitoring of occupational disease trend and
pattern
 Formulation of governmental OSH strategies
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Compensation of IOD and POD
 Individual employers’ liability
 Employees’ Compensation Ordinance, Cap. 282
 Compulsory insurance cover
 No fault compensation scheme
 Allow both statutory and common law claims
 Collective employers’ liability
 Diseases with long latency
 Collection of levy on employers to establish funds
 Pneumoconiosis and Mesothelioma (Compensation)
Ordinance and Occupational Deafness Compensation
Ordinance
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Employees’ Compensation
Ordinance (ECO), Cap.282
 9 diseases caused by physical agents
 12 diseases caused by biological agents
 22 diseases caused by chemical agents
 5 diseases caused by miscellaneous agents
 Total 48 diseases

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Employees’ Compensation
Ordinance (ECO)
 Under section 34, if an employee
 suffers incapacity or dies as a result of any occupational disease
specified in the 2nd column of the 2nd Schedule of the
Ordinance; and
 was within the period specified opposite to that disease in the 4th
column of the Schedule immediately preceding such incapacity
or death employed in any work specified opposite to that disease
in the 3rd column of the Schedule;
the disease is presumed, until the contrary is proved, to
be arising from work and the employee can recover
compensation from the employer under section 32 of the
Ordinance.
Employees’ Compensation
Ordinance (ECO)
 Compensation claims processed by the
Employees’ Compensation Division,
Labour Department
Employees’ Compensation Ordinance

Temporary incapacity

Permanent total or partial incapacity

Medical expenses

Others: Prostheses and surgical appliances, cost of constant

attention

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Employees’ Compensation Ordinance
 Processing of non-fatal EC cases
 Notification of Accidents or PODs - 7 days (fatal);
14 days (non-fatal)
 Medical clearance
1. vet and record S/L chits
2. update rehabilitation progress
3. arrange medical assessment
 Medical assessment
− conducted at 16 HA hospitals
− different specialties are involved

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Employees’ Compensation Ordinance
 When to arrange assessment?
 The employee reaching maximal medical
improvement (MMI)
 Medical advice confirming “fit/ suitable/ stable for
assessment” and/ or conducing to assessment
 The employee is considered to have suffered
permanent incapacity if sick leave reaches 24 months
or more
 The employee seeks to review OAB’s assessment

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Employees’ Compensation Ordinance
 What to assess?
 the period of absence from duty necessary
 the percentage of loss of earning capacity
permanently caused by the injury in

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Pneumoconiosis and Mesothelioma
(Compensation) Ordinance
 Compensation payable to:
 to any person suffering from pneumoconiosis or
mesothelioma, in respect of any incapacity resulting
from the above disease or diseases and any pain,
suffering and loss of amenities arising from the
above disease or diseases ; and-
 who was a resident in Hong Kong for 5 years or more
at the date of the notification of the claim, or resident
in Hong Kong for less than 5 years at such date if he
contracted pneumoconiosis or mesothelioma in Hong
Kong
 Pneumoconiosis refers to silicosis or asbestosis
Pneumoconiosis and Mesothelioma
(Compensation) Ordinance
 Patient found to have pneumoconiosis
 Application for compensation submitted to LD's
Pneumoconiosis Compensation Office
 Referral to Pneumoconiosis Medical Board for medical
and incapacity assessment
 Calculation and granting of compensation to patient
Occupational Deafness
(Compensation) Ordinance (ODCO)
 Compensation for sensorineural hearing loss amounting to
not less than 40 dB in each ear, where such loss is due in
the case of at least one ear to noise and being the average
of hearing losses measured by audiometry over the 1, 2
and 3 kHz frequencies
 Extended to employees with noise-induced monaural
hearing loss in February 2010.
 Occupational requirement
 At least 5 or 10 years of employment in noisy occupations as
specified in Schedule 3 of the Ordinance
 Have been employed under a continuous contract of
employment in a specified noisy occupation within 12 months
prior to making the application for compensation
Occupational Deafness
(Compensation) Ordinance (ODCO)
 Applicant submit application and relevant employment
information to Occupational Deafness Compensation
Board (ODCB)
 ODCB confirms occupational requirement
 Referral of applicant to undergo medical examination and
audiometric test at designated centres for hearing loss
assessment
 Referral to Occupational Deafness Medical Committee for
medical and incapacity assessment
 Calculation and granting of compensation
OD confirmed in HK from 2013 – 2017
Occupational Disease 2013 2014 2015 2016 2017
Occupational deafness 98 102 133 184 177
Silicosis 51 68 56 43 54
Tenosynovitis of hand or forearm 38 64 31 63 39
Mesothelioma 17 14 13 7 16
Tuberculosis 7 7 9 6 9
Occupational Dermatitis 2 1 3 11 3
Asbestosis 2 7 0 4 2
Gas poisoning 5 6 7 14 1
Compressed air illnesses 4 2 2 0 1
Others 7 1 2 2 2
Total: 231 267 256 334 304
Common OD in Hong Kong
 In 2017, total 304 confirmed OD cases
 Occupational deafness – 177
 Silicosis – 54
 Tenosynovitis of hand or forearm – 39
 Services and sales workers (cooks, waiters,
salespersons, personal care workers), clerks,
elementary occupations (cleaners)

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 Development of OD

Health hazards
Occupationa
at work
Physical
Disease
Chemical
Biological
Disease
development
Exposure Individual
level susceptibility
 Prevention of OD

Health hazards
at work Occupational
Physical Disease
Chemical
Biological Disease
Exposure Individual development
level susceptibility

Decrease exposure, Education & training

Control at source, e.g. engineering and Proper work practice Periodic
e.g. substitution administrative control, Personal hygiene medical examinationEarly treatment
personal protection, Healthy lifestyle Early treatment
avoidance environmental monitoring Pre-placement
medical examination
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Prevention of ODs
 Primary prevention
 Reduce the occurrence of disease by
eliminating the cause or to prevent it
from causing damage, e.g. elimination
of noise or the use of ear protectors to
prevent occupational deafness
 Control the hazards at source – most
effective
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Hierarchy of Control Measures

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Prevention of ODs
 Secondary prevention
 Detection of and taking corrective
action in situations of early effects of a
disease before they manifest as clinical
symptoms and signs, e.g. regular
monitoring of blood lead levels among
lead workers

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Prevention of ODs
 Tertiary prevention
 Minimise the consequences in persons
who have already contracted the disease
 Treatment and rehabilitation

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 Prevention of OD
 Employers
 Employees and their family members
 Multi-disciplinary professionals: Safety
and Health, Engineering, Ergonomics,
Chemistry, Physics, Medical, …
 Government
 Management of OD
 Make the diagnosis (Clinical)
 History of present illness
 Occupational history – job related to the onset of illness,
job description/nature of job, hours of work/shift work,
work process/posture, materials used, hazards exposed, time
relationship between work and symptoms, use of protective
devices, past occupations, other jobs, domestic exposures,
hobbies, similar complaints among other workers
 Past medical history, Family history, Social history
 Physical examination
 Investigation (Urine, blood, imaging, ECG, lung fx, etc.)
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 Management of OD
 Workplace investigation
 Identify occupational risk factors related to OD
 Work-through and interview (management and workers):
 Identification– name, address, telephone no.
 Contact – management, supervisor, OSH personnel

 Background – nature of business, site plan, no. of

workers, working hours, working days, meal/rest break
 Work – materials, equipment, work process, work
posture, environment, identify hazards, control
measures against risk factors including training,
personal protective equipment
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 Management of OD
 Patients –
 physical, psychological, social
 treatment (western medicine, traditional Chinese
medicine, alternative medicines)
 rehabilitation (physiotherapy, occupational therapy)
 sick leave
 work practice, posture
 Workplace: environment, materials, work processes
 Gradual return to work (duration, modified work)
 Work capacity evaluation
 Manage expectation (motivation, confidence, psycho. prepared)
 Compensation issues 38
Return to Work
 Gradual
 A differential of the worker's work capacity
with the job requirement
 Rehabilitation therapy
 RTW safely before recovered fully
 modified or alternative work on a
temporary basis before full duty
 Role of case managers
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Management of OD
 Ethical issues
 OM physician – interface between employer /
management and employee / trade union
 Primary concern – protect workers from ill-
health as a consequence of work
 Must not take sides, especially paid by
management
 Confidentiality – medical information, public
interest, safety of worker and others,
commercial secrecy
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Tenosynovitis of Hand or Forearm
 Inflammation of the tendons or associated
tendon sheaths in the hand or forearm, e.g.
 de Quervain's disease
 Extensor pollicis brevis and abductor
pollicis longus
Tenosynovitis of Hand or Forearm
 Includes also:
 Tennis elbow
 Common origin of
wrist extensors at
lateral epicondyle
 Golfer’s elbow
 Origin of wrist
flexors at medial
epicondyle
Tenosynovitis of Hand or Forearm

 Risk factors:
 Prolonged working with
 Highly repetitive movements

 Forceful exertion

 Awkward postures
Tenosynovitis of Hand or Forearm

 Occupations at risk
 Chinese restaurant
cook, waiter
 Cleansing and
housekeeping worker
 Factory worker, e.g.
packaging
 Manual labourer
 Computer operator
Tenosynovitis of Hand or Forearm
 Treatment
 Health advice
 Rest
 NSAIDs, steroid
injection
 Physiotherapy and
occupational therapy
 Surgery
 Job modification
 Local Cases
 OD investigation - An outbreak of refrigerant-
induced acute hepatitis in Hong Kong

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Return to work
 a clerk with right DeQuervain’s disease and
right wrist injury on duty
 a wheelchair policeman after gun shot

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 Scope of Work in OM
 Clinical – Occupational Health Clinics
 Out-patient consultation: diagnosis, return-to-work
 Medical examination: assess fitness for work by pre-
employment examination, periodic medical
examination
 Workplace investigation
 Occupational Health Promotion
 Compensation related issues
 Underwater Medicine – Diver, compressed air work
 Aviation Medicine – assess pilots’ medical fitness
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Hong Kong College of
Community Medicine
3 subspecialties
 Public Health Medicine
 Administrative Medicine
 Occupational and Environmental Medicine
 new name to replace Occupational
Medicine since 1995
 24 OEM Fellows
 13 OEM specialists in the specialist register
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OEM Training Pathway
Status Timeline Pathway

Basic Training
Basic • Work in one training site -
Specialist Labour Department, HA OM Care Service,
3 years CUHK
Trainee in • at least 18 months in a clinical training unit
OEM recognized by HKAM

Part I Examination (Written)

Higher Higher Training

Specialist • Work in one training site -
3 years Labour Department, HA OM Care Service,
Trainee in CUHK
OEM • Follows prevailing training guidelines

Part II (Written & Clinical Exam) + Part III Exit Exam

Specialist
OEM Fellow
in OEM 53
 Relevance of OM and You
 You as a worker – hazards at work, workstation,
work posture
 You as a medical professional
 Manage patients – listen, ask “What’s your job?”, work
posture, exposure to hazards
 Treat – medical and non-medical
 Sick leave
 Refer, notify OD
 As a member in compensation assessment board
 You as an employer – ensure the occupational
safety and health of employees 54
Key of Managing Patients
有心
 Happiness (開心)
 Awareness (留心)
 Care (關心)

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Thank You

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