About a hundred years ago occupational health became an Increasingly urgent topic in the West. Today’s perceptions for the prevention and treatment of occupational health problems are mainly historical products of the classical industrial era (1).
These are some views and comments from published literature on the future of the filed of occupational medicine.
The rise and fall of occupational medicine in the United States (2)
(By J LaDou )
Thirty years ago, occupational medicine was one of the smallest of all the medical specialties, ignored by most physicians and medical schools. Occupational physicians were more likely to have entered the field through career transition than by residency training. In 1970, governmental agencies sought to transform occupational medicine into a major clinical specialty. Influential groups projected a need for large numbers of physicians in the field. Residency training was expanded, as were other teaching programs. However, industry and its workers’ compensation insurance partners were not widely included in these plans. For that reason, among others, many physicians entering the field met with disappointment. About half the corporate positions for occupational physicians have disappeared in the last decade. Private practice opportunities turned out to be much more limited than planners had anticipated. Attempts to bring occupational medicine into the curriculum of the medical schools failed. Many of the residency programs that had been created are now closing. The proposal that occupational medicine create a joint specialty with environmental medicine is not widely accepted by the rest of medicine. Because so few physicians obtain board certification, it appears that the specialty of occupational medicine is returning to its former obscurity.
Full article:
http://www.ajpmonline.org/article/S0749-3797(02)00414-2/abstract
Occupational medicine is in demise(3)
(By Anne Raynal)
The British Health and Safety Executive is failing in its statutory duty to protect workers from occupational disease.
More than 13 000 deaths a year in Britain are directly attributable to occupational exposures, the Health and Safety Executive (HSE) says.1 These are mainly from cancers (predominantly related to asbestos) and respiratory diseases (caused by dusts and chemicals). Fewer than 15% of all working British people are likely to have access to occupational health services.2
Britain is the only major European country that does not have a legal requirement for the provision of occupational health services, by the state or employers. The Health and Safety at Work etc Act 1974 implies a duty on the employer based on risk,3 but this is minimally enforced.
In other major European countries occupational health services are either incorporated into national health and social services for all working people or are statutorily required through risk based insurance levies on employers, who are obliged to purchase comprehensive occupational health, rehabilitation, and compensation services from independent providers.3
Statutory reporting of occupational disease in Britain started in 1895. In 1973 the government brought all doctors who were part of the Factory Inspectorate into the Employment Medical Advisory Service (EMAS).4 EMAS was tasked with overseeing high risk industries (box) and was envisaged to have 100 full time.
Full article: http://www.bmj.com/content/351/bmj.h5905
Is occupational health fit?
(Reply by: Gerald T Freshwater)
It is difficult to imagine that occupational health is fit and well, but its demise may not be imminent. I believe the future of occupational medicine rests with GPs. They know the patients and, more than any other doctors, are aware of their lives as well as their health. OH physicians understand about the patients’ work in a similar way, but rarely know about their family and home lives, which generally are interconnected. When a person becomes unable to work due to illness or injury, their first contact is almost invariably with their GP. “Fit notes” are issued by the GP – not always on the basis of good understanding of capacity for their job – before any suggestion of specialist advice being sought. Most health related absence from work is dealt with entirely by GPs.
OH is an interesting specialty, and it is particularly suited to doctors wanting flexible, part time, or ‘office hours’ work patterns. Generally it is well paid. Why do we not attract more applicants? Perhaps because we keep such a low profile within the profession as a whole, and because the more academic aspects of practice dominate what is still a very practical branch of medicine. Furthermore, current medical post–graduate training militates against broader practice, and makes career change almost impossible. Twenty years ago, one could move from general practice to OH specialist over several years, without having to move house, but this could not be repeated today. However, OH benefits from wider clinical experience, and, as the majority of its practice in the past has shown, it is easily and usefully incorporated into general practice. There is a need for an introduction to OH, which should be part of every GP trainee’s portfolio. Since we are unlikely to meet the working population’s needs with specialist practitioners, should we not disseminate knowledge and understanding to those who already carry much of that burden? Occupational Health needs to go to General Practice, since the other direction is, for most, effectively blocked.
Teaching of occupational medicine to undergraduates in UK schools of medicine(4)
(BY: Wynn PA,)
Over the past 30 years, national and international
governmental bodies and medical authorities have
reiterated the importance of medical input into
occupational health issues and the desirability of
training in the discipline at medical undergraduate
level.1–3 This has recently been repeated by the UK
Department of Health as part of its ‘Our Healthier
Nation’ initiative.4 The Health and Safety Executive
(HSE) strategy to improve access to occupational
health support recommends that ‘more time should be
given at an appropriate stage in undergraduate medical
training to promote awareness of occupational health
issues and the control of work-related ill-health’.5
These reports recognize that most people will spend a
third of their adult lives at work and that the workplace
represents both a potential hazard to health and a
forum for health promotion initiatives. The economic
importance of both absence due to sickness and early
retirement due to ill-health, and the need for
appropriate rehabilitation strategies, contribute to the
current political agenda.6
Waldron7 and Harrington et al.8 published reports on
the levels of undergraduate teaching in occupational
medicine in UK medical schools. In 1989, Harrington
found the number of schools undertaking formal
instruction in occupational medicine had increased to
92% from the 60% found in 1974. However the
Harrington study reported a wide variation in hours
of teaching, from nil to 10 hours, with the majority of
medical schools without an academic department of
occupational medicine teaching five or fewer hours.
This contrasted with the higher levels of tuition
undertaken in many overseas medical schools,1,9
The numbers of doctors trained in occupational
medicine remains small, with an average of 50 awards
of Associateship and 20–30 awards of Membership
(accredited specialist) of the Faculty of Occupational
Medicine (FOM) per year. While employees of small
businesses (<51 employees) account for 45% of non
public sector employment,5 employees of organizations
with fewer than 500 staff usually have no access to any
occupational health advice. The teaching of occupational
medicine to undergraduates is therefore vital as
most work-related health problems will be managed
by general practitioners or hospital doctors such as
respiratory or dermatology specialists. An understanding
of the range of hazardous exposures commonly
experienced by their working patients, health and safety
legislation and organizational structures will allow
doctors to dispense appropriate advice to patients and
employers about disability, workplace adjustment and
rehabilitation back to the workplace.
In recent years the introduction of new legislation
enabling health care staff to have a significant impact
on the management of health issues in the workplace
has further reinforced the case for more teaching of
occupational medicine.10–13 In addition, government
initiatives such as ‘Our Healthier Nation’4 and the
HSE’s ‘Good Health is Good Business’14 have
emphasized the importance of the workplace in the
primary prevention of the major causes of morbidity
and mortality in the UK as well as reducing the burden
of work-related ill-health. The National Health Service
(NHS) in particular has been identified as a site for the
development of ‘best practice’ in such activities.4
This study aims to assess any change in commitment
to the teaching of occupational medicine in the undergraduate
medical curricula since the earlier studies in
light of the importance of occupational medicine to
govern- ment strategies and initiatives.
Full article: http://occmed.oxfordjournals.org/content/53/6/349.full.pdf
The erosion of occupational medicine teaching
(Reply by: P.Wynn)
Time pressures from other specialities, an increase in
undergraduate numbers and the introduction of short
(4-year) undergraduate programmes in UK medical
schools appear to have contributed to the erosion of
occupational medicine teaching. On current evidence, it
would be difficult to envisage how the workplace visit
could be resurrected within UK universities given the
limited academic resources within the speciality and
the difficulties of organizing such activities with large
numbers of undergraduates. This is a particular concern
since, if as Newson-Smith and Nicol suggest, such
activities are a significant factor in increasing the profile
and interest of medical undergraduates in occupational
medicine as a career, then the loss of this teaching
opportunity may exacerbate the shortage of occupational
medicine-trained physicians within the UK.This shortage
will prove increasingly problematic with the possible
transfer of sick certification to occupational health
departments for a large portion of the UK working
population arising out of recent changes to the general
practitioner’s contract.
We agree that, in order to renew the status of
occupational medicine in UK medical schools, new
approaches will be required for delivering training.
Worldwide-web-based learning resources, such as those
already developed by the University of Manchester, and a
curriculum common to a number of universities could
help achieve this. The trend towards using a comprehensive
approach within the curriculum, instead of dividing it
into specific subject areas, may offer an opportunity for
occupational medicine teaching to be integrated with that
of other disciplines such as clinicians, pathologists, public
health specialists, etc. We would agree with Newson-
Smith and Nicol that a ‘hands-on’ workplace visit would
still be preferred. Whilst the practicalities of ‘industrial’
worksite visits are prohibitive, the use of medical students’
own working environment, i.e. the wards, laboratories,
operating theatres and offices of teaching hospitals,
should provide a good insight into basic workplace risk
assessment and health and safety legislation.
We congratulate the United Emirates University for
their success in this area of teaching occupational and
environmental medicine.
Industry Influence on Occupational and Environmental Public Health(5)
By: JAMES HUFF, PHD
Traditional covert influence of industry on occupational
and environmental health (OEH) policies has
turned brazenly overt in the last several years. More
than ever before the OEH community is witnessing the
perverse influence and increasing control by industry
interests. Government has failed to support independent,
public health-oriented practitioners and their
organizations, instead joining many corporate endeavors
to discourage efforts to protect the health of workers
and the community. Scientists and clinicians must
unite scientifically, politically, and practically for the
betterment of public health and common good. Working
together is the only way public health professionals
can withstand the power and pressure of industry. Until
public health is removed from politics and the influence
of corporate money, real progress will be difficult
to achieve and past achievements will be lost.
References
1- Nelson M, Occupational Health and Public Health, Lessons from the Past – Challenges for the Future National Institute for Working Life, S-113 91 Stockholm, Sweden, ISB N 13: 978-91–7045–810–1
2- Ladou J. The rise and fall of occupational medicine in the United States. Am J Prev Med 2002;22:285–295.
3- Raynal A, Occupational medicine is in demise
BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h5905 (Published 11 November 2015) Cite this as: BMJ 2015;351:h5905
4- Wynn PA, Aw T-C, Williams NR, Harrington M. Teaching of occupational medicine to undergraduates in UK schools
of medicine. Occup Med (Lond) 2003;53:349–353.
5- James H, Industry Influence on Occupational and
Environmental Public Health, INT J OCCUP ENVIRON HEALTH 2007;13:107–117
