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Dr Obadiah T Lulu Elekima , MBBS, MPH, M.Sc (Tox.), M.Sc

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Dr Obadiah T Lulu Elekima , MBBS, MPH, M.Sc (Tox.), M.Sc

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  1. Understanding Occupational & Environmental Health AND the Occupational & Environmental Medicine (OEM) Subspecialty : Specialty Training, Legislations and applications at work: A UK Perspective.Understanding Occupational & Environmental Medicine (OEM) & OEM Subspecialty: Specialty Training, Legislations & applications at work: A UK Perspective Dr Obadiah T Lulu Elekima, MBBS, MPH, M.Sc(Tox.), M.Sc M.Sc(Occ Med), MBA, Ph.D AFOM, FRSPH, FWACP, FFOM Consultant Occupational & Public Health Physician,

  2. Content (1) • What is Occupational Medicine (OEM)? • Work-related Ill –health (WRI)/Occupational Diseases-Burden & Mortality-Overview • Training in OEM • What are Occupational Health Services (OHS)? • Who is an Occupational Health Physician (OHP)? • Problems with Occupational Health Practise in Nigeria • OH Legislations in the UK

  3. Content (2) • Recommendations • Federal, State & Local Governments • Medical & Dental Council of Nigeria (MDCN) • Organisations (Public & Private) & Individuals • Conclusions

  4. Occupational Health…. What is it? “..the promotion and maintenance of the highest degree of physical, mental and social well being of workers in all occupations.” (ILO/WHO 1950)

  5. Oc Principal role of Occupational MedicinecupationalHealth…. What is it? ……. is the provision of health advice to organisations and individuals to ensure that the highest standards of Health and Safety at Work can be achieved and maintained (Fac of Occup Med, UK).

  6. Work-Related Disease/occupational disease Burden & Morality-Overview (1)cupational • When prevention and control measures at work fail, occupational diseases (OD) can occur. • OD cause huge suffering and losses to workers, businesses, social security funds and societies at large. • Diseases caused by work kill six times more workers than work-related accidents (ILO, 2014).

  7. Work-Related Disease/occupational disease Burden & Morality-Overview (2)cupational • estimated that there are globally about 2.02 million deaths annually caused by disease due to work13, • annual global number of cases of non-fatal work-related disease is estimated to be 160 million. • OD cause immeasurable human suffering to victims and their families, & entail major economic losses for enterprises and societies as a whole

  8. Work-Related Disease/occupational disease Burden & Morality-Overview (3)cupational • OD also results in lost productivity and reduced work capacity. • Globally, ILO estimates that around 4 per cent of the world’s gross domestic product (GDP), or about US$2.8 trillion, is lost owing to work-related accidents and diseases in direct and indirect costs.

  9. Work-Related Disease/occupational disease Burden & Morality-Overview (4)cupational • Identification and reporting of OD or work-related ill-health (WRI)- posed a huge challenge in most countries. • OD can be invisible in public policy discussion, since in most countries, especially developing countries, there is very limited reporting of such diseases. • Identification & reporting made worse by lack of OH legislations.

  10. Training in Occupational & Enironmental Medicine (OEM)? (1) • A clinical specialty -just as surgery, general/internal medicine, paediatrics, obstetrics & gynaecology, Community Health etc • A Faculty of Occupational Medicine (UK), American College of Occupational & Environmental Medicine (USA) and other equivalents. • Need broad clinical knowledge of the different specialties of medicine to qualify and be able to train in OEM • In the UK, needs a Minimum of 4 years of postgrad training after Senior House Officer (SHO) or at least 3 years post graduation. Similarly in Australia and some EU countries.

  11. Training in OEM (2) OEM Residency training in UK-exclusively for Doctors No nurses or any other groups involved Faculty of Occupational Medicine (FOM) only admits doctors Residency Examination in 3 parts: Part 1 (Diploma Examination)=Equivalent to membership WACP. Taken end of 2nd year of training

  12. Training in OEM (3) • Part 2 examinations-written & Clinicals (2 long cases, 6 short cases & Photographic & hygiene stations)=Equivalent to part FWACP Part II. Taken at the end of 4th or 5th Year of training. • Successful candidates get MFOM (membership of Faculty of Occupational Medicine)

  13. Training in OEM (4) • Part 3-Successful Completion of a dissertation-marked by 2 examiners. Done after successful part II exams (MFOM) • In addition, Trainee/Resident needs to complete the competencies contained in the OEM training curriculum • On completion of competencies, Trainee issued with “Certification of Completion of Training (CCT) by FOM. Only issued after successful MFOM+ Dissertation + completion of competencies.

  14. Training in OEM (4) • MFOM is the final exit exam for OEM training. • MFOM + CCT-individual gets registered on the Specialist Register with General Medical Council (GMC), UK =equivalent of “Additional qualification section A on MDCN Register)

  15. Training in OEM (5) • MFOM+CCT on Specialist Register-qualifies to take up a post as a Consultant • MFOM+CCT is equivalent to FWACP • Post MFOM, at least 5 years, having made a valuable contribution to the development of OEM, such individual awarded FFOM (Fellowship of the Faculty of Occupational Medicine

  16. Training in Occupational Medicine (OM)? (6) • Satisfactorily completion of competencies, pass the prescribed Board or Faculty of the Appropriate College Examinations (2 parts-I & II), Complete a Dissertation, awarded MFOM (equivalent to Fellowship awarded in different specialties in Nigeria following the exit exams) & put on the Specialist Register. • Slight Variation in the USA but still requires regulated period of training and board certification

  17. What OH Services involve? (1) A. Clinical Occupational health activities • Pre-employment assessments-to consider reasonable adjustments. E.g. mental health, surgeon with Parkinson’s or HIV/Hep C/Hep B • Periodic medical examinations • Post sickness absence review or management of sickness absence e.g. back injury, MS, Myaesthenia gravis, Epilepsy

  18. What OH Services involve? (2) Immunisations including Travel Advice Ill health retirement advice & completion of relevant applications Psychological therapy (Counselling, CBT, EMDR, talking therapies etc) physiotherapy Health & Wellbeing Provide advice to Employers, managers, client

  19. What OH Services involve? (3) • Health Surveillance-HAVS, Asbestos, IRR, Drug & Alcohol monitoring • Management of needlestick or sharps/BFE injuries • Development of Policies, processes & procedures e.g. BBV Policy, BFE Policy, measles, pandemic Flu, EBOLA • Workplace assessment e.g. DSE, manual handling • Environmental impact assessment • Aviation medicine • Diving medicine

  20. What OH Services involve? (4) • Annual immunisation FLU campaign • Immunisations for all staff-Hep B, measles, varicella, Tb, • Contact tracing in Tb, meningitis • Oil & Gas medicals • Expert Court Witness in Employment Tribunal cases • Running clinics

  21. What OH Services involve (3) C. General advice and support • Advice on compensation e.g. Industrial injuries benefit (IIDB), prescribed diseases • Disaster planning including advice on managing chemical incidents e.g EBOLA, Pandemic FLU • Food hygiene (Food industry) • Advice on environmental issues

  22. What OH Services involve (4) D. Other activities • Audit, quality assurance e.g. SEQOHS • Worker protection and business protection • Risk assessment e.g. BFE • Clinical Risk management • Stress risk assessment • Various Committees • Teaching, training of residents, nurses

  23. Some Areas covered Toxicology, Epidemiology, occupational Hygiene, environmental health, psychology, ergonomics, Health & Safety, Occupational Health, physiotherapy, work station/work place Assessments, clinical case management, legislations & regulations, infectious diseases, public health, research, Audit & Quality Assurance, public health, Food Hygiene, Health Surveillance, statistics, mental health

  24. List of Relevant Professionals (1) Physicians, Nurses occupational hygienists sociologists/social care workers psychiatrists Toxicologists Statisticians

  25. List of Relevant Professionals (2) health physicists microbiologists, virologists, Epidemiologists ergonomists Human Resources managers Health & Safety psychologists,

  26. Values of OEM Increases productivity, savings Reduces sickness absences & loss of earnings Avoids/minimises litigations & Compensation claims Ensures healthy workforce & Improved Efficiency Early identification & prevention of work-related stress & other work factors & resolution Ensures safe, quality practices Planning & managing outbreaks of infectious dis Audit, Quality Assurance

  27. Who is an Occupational Physician (OHP) /Occupational Health Practitioners (OHP)? Doctor-Specialises in Occupational Medicine after a regulated period of training by a recognised professional body, acquired competences, passed the prescribed examinations, and on the Specialist Register e.g. MFOM, FFOM (UK), FACOEM (USA).= Consultant/Specialist Occupational Physician Doctors in the USA-generally, start training in Public Health but specialise in Occupational Medicine (Board Certified) Doctors- in active OH practise + AFOM or AFOM-recognised as Specialist in Occupational Medicine Doctors whose primary employment is in an occupational setting and have acquired at least 10 years of experience should be described as OHP with or without the Diploma in OH/M.Sc in Occupational Medicine*

  28. Problems with OH Practise in Nigeria? (1) • Lack of the folowing: • regulated OH practice-open to Abuse • Appropriate regulations to govern/guide OH Practice • Appropriate Professional Body to standardise the registration and regulation of OH practitioners doctors, Nurses and other HCWs • Enforcement • Appropriate Health & Safety regulatory body independent of the Ministry of Labour/Ministry of Health e.g. HSE (UK) , OSHA (USA) • Understanding the of OEM Specialty • understanding of the requirement for OH practice • understanding of the Occupational Medicine Specialty by the MDCN (Medical and Dental Council of Nigeria) & other regulatory bodies in region.

  29. Problems with OH Practise in Nigeria? (2) Lack of the folowing: • recognition of the Faculty of Occupational Medicine as a Specialty and or as a Subspecialty by the Medical and Dental Council of Nigeria. • clarity in the understanding of the differences between the practises of Occupational Medicine/Health specialists and Health & Safety officers or Environmental Officers • respect and ignorance on the part of our medical colleagues in other specialties about Occupational Health/Medicine and its practises. • understanding of the relationship between health and work i.e. the impact of Health on Work and the Impact of Work on Health.

  30. Problems with OH Practise in Nigeria? (3) Lack of the folowing: • Of recognition that workers need to be Healthy to work efficiently & effectively. To work safely such that your work does not make you become unwell. • Non-existence of an Employment Tribunal or equivalent courts -dealing specifically with employment laws & Work-related issues • Lack of appropriate regulations/legislations for OH practise • No equivalent of the Disability Act (Equality Act ) • Misunderstanding that OEM is only for multinational companies, industries, big corporations etc. • OEM IS FOR ALL OCCUPATIONS STARTING FROM THE CIVIL SERVICE

  31. Encouragement I understand: • the Faculty of Public Health of the Nigeria Medical Postgraduate College- approved subspecialty training in Occup & Environmental medicine but still early days. • the Faculty of Community Health of the West African College of Physicians (WACP) is also considering training in Occup & Environmental medicine as a Subspecialty. Already has Draft document for Approval by College

  32. Occupational Health Legislations (1) • OH or Work-related legislations in Nigeria are still very rudimentary and limited to what had existed since the Factory Act. Even when claims are made that the Acts or Regulations have been updated, they are either NOT enforced, Ambiguous, Not Clear or Not Effective. • It would be difficult to effectively practise OH without clear, unambiguous and Effective legislations. • Difficult to practise OH without enforcing the regulations • However, we can borrow a leaf from the UK or USA or other countries with more advanced OH legislations. Typical Example of some of the Regulations in the UK that we may be able to adapt are as follows:

  33. Occupational Health Legislations (2) • Major Sources of Law in the UK: • Statute- Acts of Parliament compromising primary legislation • Common law- the principles of law accumulated from the decisions of judges in cases presented to them in courts over the years; • European Directives & Regulations

  34. Occupational Health Legislations (3) • Types of OH related laws • Criminal law: • Primarily deters & punishes offenders through prosecutions by the State and its Public Officials-Crown Courts or criminal courts (Magistrates Courts). • Successful convictions requires ‘beyond reasonable doubt’ & results in a penalty for the offender e.g. fines or prison sentences. • Breaches of health & Safety legislation, HSE & local authorities (local governments) bring about criminal prosecutions.

  35. Occupational Health Legislations (4) • Civil law: • Primarily compensates for injury or loss proved to be resulting from a failure to carry out a duty of care owed to the wronged party. • Successful claim requires a proof on ‘balance of probabilities’ and results in awarding of damages or compensation to the plaintiff (Complainant). • Health & Safety cases in civil courts arise mainly from either breach of statutory duty or negligence, where the claimant must prove that he was owed a duty of care by the defendant and that his injuries or losses were a foreseeable consequence of failure by the defendant to take reasonable care.

  36. Occupational Health Legislations (5) • What are Regulations? • Regulations are laws made by Parliament and usually made under the Health & Safety at Work Act (legally binding as the parent Act). • Approved Codes of Practice (ACoP)-provide guidance on how to apply the law and have a special legal status. Following them is not compulsory. However, in practice not following an ACoP could be difficult to defend and could lead to successful prosecution. • 1974-The Health & Safety (H & S) at work Act (HASWA) enacted: Underpins occupational H & S practice in the UK. Enables all other H & S legislations. Imposes statutory duties on employers in the UK to take reasonable care of their employee’s health and safety

  37. Occupational Health Legislations (6) • The Health & Safety (H & S) at work Act (HASWA), 1974 states: • employers’ statutory duties • employees’ statutory duties to comply with all health and safety at matters at work • successful prosecution could lead to fine or prison terms • Act covers everyone at work, including independent contractors and their employees, the self-employed, visitors, but excludes domestic servants in private households. • Act is the parent of many other statutory regulations, e.g. Management of Health & safety at Work Regulations 1999,

  38. Occupational Health Legislations (7) The Health & Safety (H & S) at work Act (HASWA), 1974 states: • Manual Handling Regulations, & Control of Substances Hazardous to Health Regulations 2002. • Employers’ Statutory Duties Include: • to ensure so far as reasonably practicable that: • There is a safe system of work • There is a safe place of work • Staff are given information, instruction and training on matters of health and safety and are adequately supervised

  39. Occupational Health Legislations (8) The Health & Safety (H & S) at work Act (HASWA), 1974 states: • There is a safe system for the handling, storage & transport of substances & materials • There is a safe working environment-may include pre-employment medical exam & Equality Act, 2010 or Disability Discrimination Act (DDA), 2005. Although, these were NOT specified under the act.

  40. Occupational Health Legislations (9) The Health & Safety (H & S) at work Act (HASWA), 1974 states: • Employees’ Statutory Duties: • Do nothing to endanger their health • Duty to inform the employer truthfully when requested for information on matters concerning medical history. • Failing to disclose , when requested, material information about previous or current medical conditions may result in fair dismissal.

  41. Occupational Health Legislations (10) Regulations from the Health & Safety at Work Act, 1974 • 1992-Display Screen Equipment (DSE) Regulations • 1999-Management of Health at work Regulations • COSHH 2004 • Control of Asbestos at work regulations-2012 • Control of lead at work regualtions-2004 • Equality Act, 2010 (replaced Disability Discrimination Act (DDA), 2005) (UK)

  42. Occupational Health Legislations (11) Institutions that Enforce the Act and Regulations • The Health & Safety Commission (HSC) –responsible for Policy • The Health & Safety Executive (HSE) responsible for enforcing the Act for all public services, agriculture, construction & manufacturing industries. • The Employment Medical Advisory Service (EMAS)- a division of the HSE- issues notices to companies or Individuals for breaches of health & safety law. • Environmental Health Officers employed by the local authorities (local govt) –enforce the act in relation to shops, restaurants, hotels, offices

  43. Occupational Health Legislations (12) The ‘Six pack’ -came into force in 1993 under HASWA: include • Management of Health & safety at Work Regulations 1999 • Workplace (Health, Safety & Welfare) Regulations 1992; • Provision and Use of Work Equipment Regulations (PUWER) 1998; • Personal Protective Equipment Regulations (PPEs) 192; • Manual Handling Regulations 1992; • Display Screen Equipment (DSE) Regulations 1992

  44. Occupational Health Legislations (13) Management of Health & safety at Work Regulations 1999-Employer’s duties: • ‘Suitable & sufficient’ assessment of the health & Safety risks of employees & others in the workplace • Implement measures identified by the risk assessment • Training must be provided to all employees • Appropriate Health Surveillance • Further risk assessment for women of childbearing age • Record findings • Emergency procedures set up

  45. Occupational Health Legislations (14) Workplace (Health, Safety & Welfare) Regulations 1992-covers The work environment-ventilation, cleanliness, waste, lighting, temperature, room dimensions & space, workstations and seating, floors, surfaces, lavatories, facilities for washing, rest & eating.

  46. Occupational Health Legislations (15) • Provision and Use of Work Equipment Regulations (PUWER) 1998: • Ensures equipment for work is suitable, complies with standards, safe, maintained safely, regularly inspected, safety measures in place e.g. warning signs. • Risk assessment of equipment • Risks controlled as far as reasonably practicable • Provide information, training, instructions to all employees

  47. Occupational Health Legislations (16) • Personal Protective Equipment Regulations (PPEs) 1992 • (amended 2002) • Suitable PPEs e.g. masks, gloves, apron, goggles, overall • Provide information, training, instructions to all employees • Maintained, regularly inspected, safety measures in place

  48. Occupational Health Legislations (17) • Manual Handling Regulations 1992 • Applied in Transporting or supporting of a load (include: lifting, putting down, pulling, pushing, carrying or moving) • Eliminate risk, where possible • If not, carry out Manual handling risk assessment • Implement measures to reduce risks • Employees under duty to use safe systems e.g. use of hoist, • attend manual handling training, • follow instructions

  49. Occupational Health Legislations (18) • Display Screen Equipment (DSE) Regulations 1992 : • Covers computers, laptops, CCTVs, or any other equipment used for the display of text or graphics used ‘habitually’ (about 30-50% of time at work) at work • Regular breaks • DSE workplace assessment • Workstations-has appropriate lighting, noise, temperature, avoid glare, enough legroom, adjustable chairs (back and height), appropriate software • Provide regular eye tests

  50. Occupational Health Legislations (19) • Control of substances Hazardous to Health (COSHH) Regulations 2002 (Amended 2004) • Risk assessment of exposure to hazardous substances at work • Prevent exposure if reasonably practicable • If not, exposure adequately controlled • Not exceeding any applicable Workplace Exposure Limits (WEL) • Health Surveillance • Provide instructions, training & supervision of employees • Control measures to follow hierarchy of control measures: elimination, substitution, isolation/enclosures, engineering controls, PPEs

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