Overview
Emerging occupational and environmental health issues can broadly be categorized as either due to environmental changes, to the changing nature of work, or to the composition of the workforce. They provide new challenges to occupational health professionals.
Environmental: Climate change–exposure of outdoor workers to heat stress, emergency workers to flooding, or exposure of agricultural workers to different infectious disease due to changes in distribution (e.g. West Nile fever and dengue fever)
Work-related: New technologies, changing patterns of work, psychosocial hazards.
Worker-related: Migrant workers, ageing workforce, chronic diseases and work
A rapidly changing physical and social environment has a profound impact on health and healthcare, and provides new challenges in the practice of occupational and environmental medicine. Technological advances and social and organizational change lead to the emergence of new risks, and the impact of pre-existing issues may be altered. For example, new technologies may be implemented in industry before potential health risks are adequately understood, and at times of organizational change and economic crisis psychological stress may become more prevalent. Global and country-level economic changes can also lead to an increase in the number of migrant and informal sector workers; and both groups often experience hazardous working conditions. Work arrangements that are gaining in popularity such as self-employment, outsourcing and time-limited contracts give rise to new occupational health (OH) concerns, and rapid globalization has also resulted in a number of new challenges for OH practitioners to consider. With easy access to a wealth of information on the internet, not to mention the increasingly popular social networking sites, workers are now more connected and informed than ever before. This has led to workers having higher expectations of their employers and also their OH practitioners, and has possibly resulted in greater litigiousness.
Forces that Drive Emerging Issues
Technological and Scientific Advances
When technology advances, job processes change and new materials are introduced. This changes the profile of the work as well as the resultant risks to health and to the environment. OH professionals are faced with the challenge of workers who present with conditions that could have resulted from new and poorly understood workplace risks.
With improved scientific understanding and increasing recognition, a better appreciation of certain occupational and environmental risks can occur: the effects of shift work on health, for example. Changing perceptions of the importance of certain risk factors may also influence which of them comes to prominence. An example is the effect of psychosocial factors on work-related stress (ILO 2010).
One important step is to recognize the work-relatedness of many health issues. For example, high work stress may manifest with vague symptoms such as headaches or dizziness. These may easily be misclassified as malingering or non-compliance with medication if work-relatedness is not considered (Figure 20.1).
Figure 20.1 For women, juggling work with caring for their families can put them at higher risk of work-related stress which may present with vague, non-specific symptoms.
An example of a work-related disease that was initially ill defined, but subsequently officially recognized is ‘karoshi’ (Box 20.1).
Karoshi
- First reported in Japan in 1969, legally recognized in the 1980s, now recognized in Japan, Korea, Taiwan
- Sudden death of any employee who works an average of 65 hours per week for more than 4 weeks or an average of 60 hours a week for more than 8 weeks may be karoshi
- Major medical causes are acute myocardial infarction and cerebrovascular accidents
- Likely to gain prominence as more people worldwide are working longer hours
- Higher risk if long working hours are combined with high job demand, low control and poor social support
- Karojisatsu, the term given to suicide due to overwork, is an issue in the Far East
- Over the past decade there has been an increase in karojisatsu in Europe
Changing Demographic and Employment Patterns
With an ageing workforce and an increasing prevalence of lifestyle-related illnesses, there is a growing need for health promotion and preventive services in the workplace. This century will see the world’s population ageing at an unprecedented rate, with profound effects on many facets of life, including work (www.un.org/esa/population/publications/worldageing19502050/) (see Chapter 18)
The global financial meltdown in 2008 led to record unemployment levels and a global crisis of ‘discouraged jobseekers, involuntary temporary and part-time workers, informal employment, pay cuts and benefit reductions’ (ILO 2010). Although some types of work can be hazardous to health, lack of work (or worklessness) is also known to be associated with increased adverse health effects (Box 20.2) (Chapter 2). This in itself should be considered to be a type of work-related health hazard. (Dorling 2009)
- cardiovascular disease
- cerebrovascular disease
- lung cancer
- depression
- suicide and parasuicide
*Covered in greater detail in Chapter 2.
Development and Globalization
Newly industrializing countries (NICs) are less developed nations that experience rapid economic growth. The potential effects of such rapid growth are the amplification of pre-existing risks and the introduction of new risks. As such, many of these countries grapple with a ‘triple burden’ of occupational and work-related diseases. Box 20.3 presents some examples for each category.
Traditional occupational diseases:
- Pneumoconiosis, e.g. silicosis
- Pesticide poisoning
- Heavy metal poisoning
Work-related disorders:
- Musculoskeletal pain from workplace ergonomic issues
- Stress-related conditions, e.g. hypertension
- Chronic non-specific respiratory disorders
Emerging occupational risks:
- Infections, e.g. SARS (severe acute respiratory syndrome)
- New materials/processes, e.g. nanotechnology
- Psychosocial hazards, e.g. karoshi
Over the past few decades, regional economies, societies and cultures have become increasingly integrated and acculturated. To some degree, the same integration occurs in the workplace and has resulted in practices such as outsourcing and supply chaining. This has given rise to some new and emerging issues in occupational and environmental health such as working non-standard hours, home working, increasing measurement of work rate and quality, competitiveness within workforces, presenteeism and the uncertainty of continuous employment
Emerging Work Issues
New Technologies
The application of new technological discoveries in industry has often run ahead of adequate health and safety research. One example is nanotechnology, defined by The Royal Society and The Royal Academy of Engineering as the‘design, characterization, production and application of structures, devices and systems by controlling shape and size at the nanometre scale’. Given the diversity of nanomaterials and nanotechnology research, the potential applications for nanomaterials in industry are boundless. Consumer products containing nanomaterials began to appear at the turn of the 21st century, and by 2011 there were over a thousand such products on the market (Box 20.4). However, the potential health and environmental risks are still poorly understood and cannot be ignored, as nano-sized (Figures 20.1 and 20.2) materials exhibit properties that are different from those of bulk materials. (Table 20.1).
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