1996 YANT AWARD LECTURE[1]
“THE HARMONIZED DEVELOPMENT OF
OCCUPATIONAL[2]
HYGIENE
- A NEED IN DEVELOPING
COUNTRIES”
Office
of Occupational Health
World
Health Organization
INTRODUCTION
First of all, I
would like to say how honoured I am to receive the 1996 William P. Yant
Award.
On this occasion I
must express my gratitude to all those who have inspired and helped me
throughout my career, from my graduate schools days at the University of Michigan,
under the guidance of the unforgettable Warren A. Cook, and later, at the
University of Pittsburgh, where Morton Corn shared with me years of knowledge
and experience - to my practice in Brazil, where support from Brazilian
occupational health pioneers, and also from NIOSH was invaluable. I still remember when a vertical elutriator
for our first byssinosis study in
I would like to
acknowledge the work of European colleagues who have given such an impulse to
our profession in this part of the world, as well as that of occupational
hygienists in developing countries, working usually under very difficult
conditions in a profession most often unknown.
I would also like to mention those occupational hygienists who believed
in international occupational hygiene and promoted the creation of the
International Occupational Hygiene Association.
I cannot name all the people who have influenced my work but I certainly
must thank them all because their enthusiasm and perseverance have helped me
throughout the years to keep my own enthusiasm and perseverance, as well as the
hope to see our profession universally recognized one day.
I would like to say
that the 1996 Yant Award also honours the World Health Organization, where I
have been working for the last 21 years, bringing the contribution of our
profession to the realization of one of the constitutional principles that led
to its creation:
“the enjoyment of the highest attainable
standard of health is one of the fundamental rights of every human being
without distinction of race, religion, political belief, economic or social
condition”.
OVERVIEW OF
OCCUPATIONAL HEALTH AND HYGIENE IN DEVELOPING COUNTRIES
In view of my
experience, I shall refer mainly to developing countries. However, in practically any country there are
regions of underdevelopment in occupational health and hygiene where hazards
that have been known for centuries still continue to cause new cases of preventable
diseases, one sad example being silicosis.
The Need for
Occupational Hygiene
Work is one of the
most powerful and rewarding forces in human life, indispensable for the
individual, for the community and for the development of nations. Unfortunately it can also be the source of
much suffering. As Pierre Hamp[3]
wrote: “We live on the suffering of
others. ... How many people earn their living pleasantly
? Many do so in unpleasant and often
intolerable conditions”.
As a matter of
social justice, human suffering related to work is unacceptable. I would like to quote what Ramazzini said,
about 300 years ago: “It is but a sad
profit which is achieved at the cost of the health of workers...”
Another aspect is
that harmful workplace agents and factors often result in appreciable financial
loss due to the burden on health and social security systems, to the negative
impact on production and to the associated environmental costs. People should not have to endure, and
countries cannot afford, such damaging effects.
According to the
World Bank “a burden of 36 million disability adjusted life years (DALY’s), or
3 percent of the global burden of disease is caused each year by preventable
injuries and deaths in high-risk occupations and by chronic illness stemming
from exposure to toxic chemicals, noise, stress, and physically debilitating
work patterns” (World Bank, 1993). In a
sample of industrialized countries, the International Labour Organization
estimated economic costs of occupational injuries and associated production
losses to be of the order of 1 to 4 % of the GNP; in developing countries this cost should be
much higher.
Many countries are
becoming industrialized and are undergoing rapid economic growth, often
disregarding, or not having the means to deal with, the steady increase in the
associated health and environmental problems.
It is important to
attain not only economic, but also social development. Workers should not pay with their health and
life for development, and neither should the environment be destroyed; it should be possible to ensure that the
present world population meets its needs for food, water, energy and shelter
without causing adverse effects on health and on the environment, and, without
depleting or damaging the global resource base, hence “without compromising the
ability of future generations to meet their own needs” (WCED, 1987). Unless measures are taken now, the situation
may become uncontrollable in the years to come.
Workers have a
right to a healthy and safe work environment, which is a realistic goal in view
of the knowledge and technology available today for the prevention and control
of hazardous agents in the workplace.
Occupational
hygiene is instrumental in ensuring this right;
furthermore, it also protects surrounding communities and the
environment, and contributes to safeguarding natural resources and improving
production, thus linking work, health, environment and development
aspects. It is therefore a key public
health profession, needed wherever there is a workplace.
Present Working
Conditions and Occupational Diseases in Developing Countries
In spite of all the
progress made, appalling working conditions, which were observed since ancient
times and impressed people like Plinius the Elder, Agricola, Ramazzini, and
later, Alice Hamilton at the turn of this century, are still shocking those of
us who have the opportunity to visit certain workplaces, on the eve of the
twenty-first century !
Although hazardous
exposure occurs everywhere, the situation is particularly serious in most of
the developing countries, where many people, including children, often work
under precarious conditions. Current
statistics do not reflect the global occurrence of occupational diseases and
impairment; however, there are studies
which demonstrate that they are appreciable problems.
In many developing
countries, the most prevalent diseases and impairments resulting from
occupational exposure include:
· pesticide
intoxications;
· lead poisoning;
· acute and chronic
solvent intoxications;
· silicosis and other
pneumoconiosis;
· hearing loss;
· diseases caused by
biological agents;
· diseases caused by
heat stress;
· musculoskeletal
disorders.
Studies correlating
sound exposure data with the associated health impairment are scarce,
particularly in developing countries.
However, the prevalence of health impairment among persons working under
very poor conditions is a good indicator of the situation; a few examples from published data are
provided here.
Uncontrolled
exposure to agricultural chemicals constitutes an appreciable occupational
health problem in developing countries, where a large proportion of the
economically active population is in agriculture, sometimes 80%, as in some African
countries.
In developing
countries, cases of pesticide poisoning demonstrated through clinical
investigations and biological monitoring, although often numerous, constitute
but a sample of the actual prevalence among exposed agricultural workers. Studies on pesticide poisoning and
cholinesterase inhibition, carried out among agricultural workers in
In Costa Rica, an
epidemiological study carried out between 1980 and 1986 showed that 3300
persons were hospitalized and 429 died (60 % of the deaths were due to
Paraquat); high risk groups for
occupational poisonings included agricultural workers in the age group 15-29
years, female workers and banana plantation workers (Wesselings et al., 1993).
Public health
workers engaged in vector control are another target group for pesticide
poisoning; for example, a very large
study carried out in Pakistan, involving 7500 field workers who sprayed a
Malathion[4]
formulation for malaria control, disclosed about 2800 cases of poisoning
(including 5 fatalities), which started
to occur soon after the beginning of the spraying programme (Baker, 1978).
Studies in
In the last 10
years, among 778 workers who had some respiratory complaint and were examined
in the outpatient clinic of the National Foundation for Occupational Health,
São Paulo, Brazil, 50.6% had a confirmed diagnosis of occupational lung
disease, asthma being the most frequent (about 31 %), followed by silicosis
(more than 10%) (Mendonça et al. 1994).
Concerning lead
exposure, a study on storage battery manufacturing, in India, reported air
concentrations around 37.5 mg/m3 and a 67% prevalence of lead poisoning (with
clinical symptoms) among the exposed workers (Durvasula, 1990).
A survey in
A study in a steel
mill in
In
Studies in
In developing
countries, overexposure to vegetable dusts and the resulting health impairment
are much more frequent than it seems, because this occurs among working
populations with little or no access to expert medical diagnosis. For example, a previously unknown disease -
the “rice millers’ syndrome” - was identified in
Biological agents
have not received sufficient attention from occupational hygienists because,
besides being more easily labelled as non-occupational, they are usually
considered of interest only among workers in rural areas and hospitals. It is true that such agents constitute a
serious problem in rural areas of developing countries; for example, a study in 38 districts in Ghana
demonstrated a strong correlation between schistosomiasis infection and
agricultural dams, since, in the worst affected areas, the prevalence in the
surrounding population, which was below 30% before the dams were built, jumped
to more than 70% (Hunter et al., 1993).
Yet, biological agents have a broader impact than sometimes believed as
they range from parasites affecting agricultural workers in developing
countries to spores and bacteria contaminating indoor air in sophisticated
offices.
Although ergonomic
factors usually draw more attention in industrialized countries, they also take
their toll in the developing world, with consequences such as musculoskeletal
disorders, particularly low back pain and impairment resulting from repetitive
motion, stress and fatigue. This is due
mainly to lack of adequate design and selection of equipment, indiscriminate
importation and use of ergonomically unsuitable machinery, and, lack of
adherence to the required work practices and schedules. For example, in
With
industrialization, adverse psychosocial factors and stress are also taking on
increasing importance as the social environment changes, and people suffer from
displacement from rural to urban industrialized areas, introduction to
unfamiliar machinery and equipment, separation from extended families,
crowding, city violence - all of which may become part of a worker’s daily life
influencing health and well being.
Isolated studies with small cohorts give
only a glimpse of what must be actually occurring among the global working
population, estimated by the ILO as 2.4 billion !
Occupational
diseases, which contribute significantly to increased morbidity and mortality,
particularly in developing countries, are very often under-diagnosed and
under-reported, or are diagnosed as non-occupational, thus constituting what is
often referred to as “the silent epidemic”.
In
Two published
examples from
As occupational
health and safety programmes are developed and reporting is improved, the
prevalence of occupational diseases usually shows an increase, although in
reality they must be decreasing due to some preventive action. For example, in Moroccan mines, for the
period from 1975-1990, there was a 100% increase in notified occupational
diseases (95 % being cases of silicosis), while there was a 70% decrease in
occupational accidents (which are rarely hidden as occupational diseases so often
are).
Particularly among
workers in rural areas, small industries and the informal sector, health
impairment is seldom linked to work.
Even when such workers have access to health care services, these are
rarely competent in occupational medicine, and, even if and when they are and
the link is established, very seldom is there adequate reporting of the findings to governments and, even less
frequently do they appear in the international literature.
Such occurrences
are only disclosed when a study is carried out with the purpose of
investigating the health status of a certain group of workers, or when a
certain type of recurring health impairment attracts particular attention. This was, for example, the case with 50
deaths from leukaemia and destruction of bone marrow, disclosed by the
haematology programme in Istanbul, Turkey, among workers who had been working
in the manufacture of shoes and hand bags, using a cheap glue with benzene as
its primary solvent, in small poorly ventilated shops and who had thus been
greatly overexposed to benzene (WHO, 1992a).
PROBLEMS WITH THE
PRACTICE OF OCCUPATIONAL HYGIENE IN DEVELOPING COUNTRIES
Countries have
reached varying stages of occupational health and occupational hygiene
development and practice, with different problems and different perceptions, so
that many scenarios can be observed at the same time on the international
scene.
Perception of
workers’ health problems
Decision makers and
even workers involved, often do not perceive clearly or accept the existing
occupational health problems and the importance of preventing hazardous
occupational exposure. Sometimes what is
lacking is the political will and motivation to apply or fight for the
application of available solutions.
The reasons are many; it is not only a question of awareness and
knowledge, but also of socio-economic and cultural aspects, which vary from
country to country.
One reason is that
the consequences of uncontrolled workplace hazards are seriously
under-estimated. Besides, other public
health problems may influence the perception of the importance of workers’
health within a framework of national priorities. Poor working conditions with no
controls; air, water and soil
pollution; hazardous waste disposal,
and, far away stratospheric ozone depletion, may easily fade into the
background when seen against pressing needs for water, food and shelter,
control of communicable diseases, and reduction of high infant mortality.
The worst scenario
though is when there is awareness of the problems but immediate economic gain
is placed higher than workers' health and environmental protection.
Perception of the
need for occupational hygiene
Yet another matter
is the perception of the need for action on the work environment to protect
workers’ health, that is, the essential role of occupational hygiene.
There are
situations when the concern for workers' health exists but is limited to
medical interventions. There are
occupational health services, which do not include occupational hygiene, and
where “prevention” relies solely on medical surveillance - including biological
monitoring, early detection, or diagnosis of occupational diseases. These may be indispensable adjuncts to
primary prevention, but can never replace it since they can only confirm
exposure or disease. “Early” is already
too late for the detection of such irreversible impairment as occupational
hearing loss, silicosis, and occupational cancer.
In the history of
occupational health, the shift from a purely medical approach to the
understanding that prevention should start at the workplace, in order to
eliminate or control hazards before health impairment occurs, marked the
beginning of occupational hygiene - that is, the change of focus from the “sick
worker” to the “sick environment”. This
shift, however, has not yet taken place in many parts of the world.
Furthermore, lack
of understanding of the professional ethics and commitment involved in the
practice of occupational hygiene, has generated suspicion, among workers, that
occupational hygienists may be biased towards the employers, and vice
versa.
Varying degrees of
resistance to occupational hygiene, on the part of other occupational health
and safety professional groups that feel threatened by a new profession, make
the situation even more difficult.
Another problem is
the belief, by some, that occupational hygienists are “people who measure”,
with the implication that what is done with the results is outside their scope
of action, that the interpretation of the obtained data should be left to the
biomedical personnel, and the control measures, to the safety and ventilation
engineers.
In some countries the only officially recognized occupational health
professions are occupational medicine and safety engineering. This has often been reflected in limited or
inadequate attention to the field of primary health hazard prevention in the
workplace. I once visited a large foundry
where considerable investment had been made in an exhaust ventilation system; when I asked about the frequency of routine
checks and maintenance (it looked as if it really needed it !), the plant physician told me “this is an engineering
problem so ask the safety engineer” and, when I did so, the safety engineer
replied that “airborne contaminants pose health hazards, so ask the
physician”. An outside engineering firm
had designed and installed the ventilation system, apparently with no concern
for its routine checking and maintenance, and never provided any follow-up. The distressing conclusion was that no one
felt really responsible; the company had
made an appreciable investment and the workers were given a sense of “clean
air” that might not be true !
Approaches to
occupational hygiene practice
Again,
it may happen that occupational hygiene services are established in a
governmental department or an institution, and are well equipped with excellent
instrumentation, but are unable to present, or orient towards effective
solutions to workplace problems, because the comprehensive approach to
occupational hygiene is lacking.
It is not unusual
to see more attention given to exposure assessment and monitoring than to
hazard prevention and control. The
fascination exerted by sophisticated equipment and by numbers is, for some
reason, greater than the interest in designing pragmatic solutions to prevent
exposure.
Even when hazard
prevention and control are on the programme of occupational hygiene services,
either at a governmental or workplace level, setbacks are often encountered,
for example:
·
control relying mostly on industrial ventilation and
personal protection (not always efficient), without due consideration to other
applicable measures, such as alternative technology, substitution of materials,
modification of processes, and good work practices;
·
preventive measures taken in an ad hoc manner,
rather than integrated into effective, carefully planned, well managed and
periodically evaluated programmes, and,
·
lack of anticipated preventive action, as well as of
coordination with environmental protection.
The comprehensive
approach to occupational hygiene, covering “anticipation, recognition,
evaluation and control”, must be promoted all over the world.
Even when all the
above aspects are understood and accepted, there may be a lack or shortage of
financial resources; the fact that I do
not go into this aspect does not mean that I underestimate its importance. I am focusing on those shortcomings which may
be overcome by knowledge, experience and collaboration among occupational
hygienists everywhere.
CONSIDERATION
OF SOLUTIONS IN PRESENT CONDITIONS
If the need for
occupational hygiene practice is to be met, there must be developments in
legislation, human resources and services, following appropriate and realistic
approaches.
Legislation
There is no doubt
that a legal framework is needed to ensure the protection of workers’
health. However, occupational health
legislation is a starting point; it has
no effect unless enforcement and control are ensured, through adequate
resources, staffing, programmes and services.
In many developing countries, legislation coverage constitutes another
problem as it does not always include agricultural workers, small enterprises,
and the informal sector.
Enforcement has
been a problem from the start; the first bill aiming at some control of working
conditions, in England - the “Health and Morals of Apprentices Act” of
1802, implied state intervention in private enterprise, but it did not alarm
employers “because the Act was totally ineffective as no proper system of
inspection or enforcement was provided.” (Luxon, 1984). The same statement could be made today in
many situations.
Even well meant
occupational health legislation may fail in ensuring effective protection of
workers’ health. One mistake that has
drawn my attention is the adoption of occupational exposure limit values as the
only instrument to enforce legislation to protect workers’ health, in
situations where there is no infra-structure of services to carry out the required
quantitative evaluations.
Whenever facilities
for sampling, analyzing, measuring, calibrating, are scarce or inexistent,
legislation which requires monitoring to prove compliance or non-compliance
with adopted occupational exposure limit values, may actually have a negative
rather than a positive effect on workers' health protection. It has happened that legislation allowed
employers to get away with not controlling hazardous exposure because enforcing
officers were materially unable to prove it quantitatively.
Lengthy and
expensive environmental or biological monitoring procedures may just not be
feasible in certain situations, and if feasible, may not be affordable,
particularly in developing countries.
Even when feasible
and affordable, monitoring capabilities may be better used in checking the
efficiency of control measures after their implementation (which is often
overlooked) rather than in confirming the obvious. There are laws in certain European countries
requiring that uncontrolled hazardous operations, such as electroplating and
sandblasting, be evaluated only after the required controls are installed, not
before; this should set an example
particularly for nations where the field of occupational hygiene is just
emerging.
“Recognition-evaluation-control”
may need to be changed to “recognition-control-evaluation”, when dealing with
obvious and serious hazards, and even to “recognition-control” if, in addition,
evaluation is not feasible.
In order to be
effective, legislation must take into account the circumstances in which it is
applied. Legislation in terms of “control
interventions” may often be more practical and cost-effective than legislation
relying solely on limit values. In fact,
controlling to the lowest feasible level is the safest principle.
The American
Conference of Governmental Occupational Hygienists (ACGIH), a world leader in
the establishment of acceptable exposure levels, has repeatedly stated that
their threshold limit values cannot be used to establish “fine lines between
safe and dangerous” (ACGIH, 1995).
Moreover:
·
values established for one country do not necessarily
protect workers in other countries where a number of aspects may differ
significantly, for example, socio-economic factors, duration of working week
and work schedules;
·
workplace exposure is usually combined; this is particularly relevant when there is
synergism or potentiation of effects, which are not yet fully accounted for,
among other limitations.
Nevertheless, a
simplistic approach of focusing solely on compliance or non-compliance with
these values has repeatedly been adopted in many developing countries, through
what I consider a “misuse” of the TLV’s.
Furthermore, there
are many uncertainties in the establishment and interpretation of occupational
exposure limits. There are also
uncertainties in the assessment of the exposures which actually occur in the
workplace.
The correct
appreciation of these uncertainties, the full understanding of their meaning,
and professional judgement in deciding on actions to be taken, are essential to
ensure that “the practice of industrial hygiene will be a science and an art
and not a mindless application of numbers and techniques”, as Morton Corn put
it so well in his Cummings Award Lecture ten years ago (Corn, 1986). This fundamental difference between a “person
who measures” and an occupational hygienist has not yet been fully understood
everywhere in the world.
The problem in many
developing countries is that, in the absence of competent persons able to pass
sound professional judgement, a solution is often sought by just “importing”
existing occupational exposure limit values, and considering that occupational
hygiene practice limits itself to measuring concentrations, or intensities, and
comparing the results with adopted tables.
In fact, it is difficult to define the borderline between problems
related to legislation and problems related to human resources. It is during the training of occupational
hygienists that more emphasis should be placed on “problem-solving” than on
“rule-following’.
Human resources
This is a key
issue. Unfortunately, the knowledge,
experience and professionalism required to practice occupational hygiene are
not yet universally available. In many
parts of the world, there is an acute shortage of competent professional
occupational hygienists and all efforts should be made to overcome this serious
shortcoming.
Some countries have
regulations requiring that the principles of occupational hygiene be applied to
the work environment, even if not officially recognizing the profession. These have been very adequately called, by
Burdorf, “occupational hygiene in disguise regulations”. If there are competent persons, the situation
may be kept under control; however, when
there are not, the result may be that the required tasks are performed by
persons who are not fully qualified, leading to voluntary or involuntary
“malpractice”. This may easily go
undetected, with disastrous results: no
effective protection of workers' health, lives endangered, and/or, unnecessary
expenditures of precious time and resources.
Legal instruments
for preventive interventions in the workplace must necessarily be accompanied
by the development of adequate professional competence. It is paradoxical to require by law the
performance of tasks which fall within occupational hygiene competence, while
ignoring the need for this profession.
Everyone knows what
a physician, an engineer, or a lawyer is.
Their training and practice may not be quite the same in different parts
of the world, but there is a fundamental understanding of these professions and
this, in addition to definite responsibilities, gives “recognition, influence
and opportunity[5]”
to all who practice them. This is not
yet true for occupational hygiene everywhere in the world.
In fact,
misconception still exists in relation to a well established profession as
occupational medicine. Many people think
that a doctor whose patients include workers is “an occupational physician”. Some years ago WHO sent to many countries a
questionnaire including a question on the number of available occupational
physicians; the official reply from one
developing country was 630, whereas an occupational physician working in that
same country replied 2 ! It is not
surprising that many are baffled as to what occupational hygiene really is
when, even in many developed countries, our profession is not yet fully
established and officially recognized.
Many of us are
fighting for international harmonization of concepts and requirements for
occupational hygiene training and practice;
why is this important ?
Regardless of
differing circumstances, it is indispensable to arrive at a universal
understanding of what occupational hygiene is and what the profile of an
occupational hygienist should be.
Besides, in
addition to knowledge, experience and a code of ethics, a profession requires
competence and quality assurance in the performance of its defined tasks and
responsibilities.
Quality means
credibility and it can only be universally assured for occupational hygiene, if
and when well defined and harmonized requirements are laid down and followed,
worldwide, for its training, including areas of knowledge, curricula and
training approaches, as well as for its practice, including the recognition of
competence. Accreditation of courses
and certification of professionals, even where not immediately feasible, should
be aimed at as a goal.
Only when such
requirements are met, we can expect to see occupational hygiene officially
recognized as a high level profession everywhere.
This does not mean
that occupational hygiene should be practiced in the same manner, in any
situation, regardless of local conditions - in fact, the “art” of adapting and
applying sound scientific and technical knowledge to each specific case is an
essential requirement of our profession.
Programmes and
services
The World Bank
(World Bank, 1993) estimates that “feasible interventions” in the work
environment could avert 36 million DALY’s per year ! (and this is based on reported
impairment). This is proof, if proof
were needed, that proper occupational hygiene programmes or services, both at
the national and workplace level are essential.
Many developing
countries lack services altogether, or approaches used in existing services are
inappropriate, or the utilization of resources is inefficient. However, if we share the wide experience
already available, both in successes and in failures, we can prevent repeated
errors. Shortage of funds is not the only problem; the proper use of even limited resources may
result in much better and more efficient services.
Multidisciplinary
approach and team work
The protection of
workers’ health and of the environment requires a multidisciplinary approach
involving occupational health, safety and environmental professionals; this includes occupational hygienists,
occupational physicians and nurses, ergonomists, work psychologists, safety and
environmental engineers. The harmonious balance
of a multidisciplinary approach, though difficult to achieve, should be
promoted worldwide.
Intersectoral
cooperation, interdisciplinary understanding, team-work and close collaboration
among all concerned professionals, are indispensable.
Although
occupational hygienists usually have to focus on specific technical issues,
they should not lose the perspective of global health and its
determinants. An integrated approach is
required to solve workers’ health problems, with due appreciation of public
health, socio-economic and other factors beyond the workplace.
On the other hand,
occupational health services should include or have access to occupational
hygiene expertise when envisaging preventive action, otherwise they may fail to
protect workers’ health, placing too much emphasis on the medical aspect and
overlooking indispensable primary prevention.
Alternative
approaches
In certain
developing countries, classical and comprehensive occupational health and
hygiene services cannot be provided everywhere and at all levels.
Occupational
hygiene in particular is often assumed to be “too sophisticated” a field,
applicable only if considerable material means, such as modern equipment and
laboratories, are available. However,
this is not necessarily so. Rather than
leaving large sectors of the working population completely without the benefits
of occupational hygiene, means should be sought to optimize resources and
broaden the scope of action of the often very few existing occupational
hygienists.
The “primary health
care[6]”
approach, adopted by WHO and many of its Members States facing a multiplicity
of health problems with limited resources, may be used as a source of
inspiration.
If properly planned
and applied, under the supervision of experienced occupational hygienists, a
“primary health care” approach to occupational hygiene might help countless
workers all over the world. It would
involve appropriate simple methodology and training of those who form the
“first line contact” with working conditions (e.g., the workers themselves,
supervisors, community health workers, people in health care centres) to:
·
recognize obvious hazards and dangerous work
practices;
·
identify and localize conspicuous hazard sources;
·
recommend simple control measures;
·
recognize conditions which offer immediate danger, or
are somehow suspicious and seem to require further study, and report on them to
the next level of competence, for example, in a governmental department.
This would require
simple but very well designed check-lists.
When working conditions are very bad, lives may even be saved by people
having elementary knowledge, such as:
which chemicals can penetrate through the skin; which conditions may lead to the accidental
formation of toxic agents, or, which work practices are particularly
dangerous. Nevertheless, efficient lines
of communication with fully qualified occupational hygienists are essential.
Common mistakes in
the establishment of programmes
The acknowledgement
of a problem is the first step towards its solution, therefore in order to
improve existing occupational hygiene programmes and services, and to avoid
mistakes when establishing new ones, it is important to look at some of the
shortcomings which are often encountered, particularly in developing countries:
·
planning
Lack of planning
has jeopardized many a programme. In
order to ensure that objectives are adequately established and efficiently
achieved, making the best use of the available resources, elements such as the
nature and magnitude of prevailing hazards, characteristics of the working
populations to be served, legal requirements, existing infrastructure and
support services, should be the object of preliminary analysis.
Planning should
also include the definition of an organizational structure, profile of the
required human resources and plans for their development (if needed), assignment of responsibilities,
provisions for facilities, equipment, operational requirements, communications
and information, as well as for periodical and critical evaluation aiming at
continuous improvement.