Challenges implementing LEV in Developing Countries

Workplace Health Without Borders (WHWB) is an international organisation of occupational hygienists and other occupational health professionals dedicated to providing technical assistance,  training and skills development to workers in developing economies to help them to develop the capacity and local infrastructure to manage and improve health conditions in their workplaces. I’ve been involved with the organisation for a couple of years and last year helped to set up a branch in the UK.

Last week, I gave a presentation on the work WHWB is doing on LEV to a joint conference organised by the British Occupational Hygiene Society (BOHS) and the Occupational Hygiene Society of Ireland (OHSI) in Liverpool on Exposure Control and Containment. The presentation was based on my own experience helping a company in Tanzania (a consultancy project) and some advice I provided to a project in Uganda on behalf of WHWB, but mainly focused on the LEV aspects of the Agate worker project using some excellent material provided by Paul Bozek of Toronto University.

The presentation slides (with annotation) are available on Slideshare

 

Occupational lung disease in the UK – a continuing challenge

Last week I was up in Glasgow for the annual BOHS Conference. As usual, there were lots of good interesting Keynotes, workshops and technical sessions. And there were plenty of opportunities for networking – and some fun too.

One of the highlights for me was the very first session, the Warner lecture, which this year was given by Professor Sir Anthony Newman Taylor, the renowned and respected expert in respiratory disease. Sir Anthony is the President’s Envoy for Health at Imperial College London and also chairs the new Workplace Health Expert Committee recently set up by the Health and Safety Executive. The theme of his lecture was The continuing challenge of UK Lung disease.

The Health and Safety Executive estimate that there are about 13,000 deaths every year in Great Britain due to respiratory disease caused by exposures to hazardous substances at work. The main agent of concern is asbestos, followed by respirable crystaline silica. Due to the long latency period associated with these diseases (i.e. the time taken for the disease to develop) most of these deaths have ben caused by historical exposures. So some people might argue that the numbers will reduce in the future as the substances causing the disease have either been banned (i.e. asbestos) or are becoming better controlled, and that these diseases are a problem of the past. However, for Sir Anthony this is not the case.

He pointed out that although silicosis is sometimes considered to be a disease of the 19th and 20th Centuries, there are still a significant number of cases in the UK, particularly in the construction industry where at least 50% of workers are exposed to silica. Internationally, examples of where silica exposure occurs include sandbalsting of oil platforms in Mexico and the use of sand to produce faded denim jeans. In both these cases the serious risk of silicosis and cancer can be prevented by substituting alternative processes or materials.

Although the use of asbestos has been prohibited in the UK, it is still present in many buildings, and there is still a risk of exposure for maintenance workers, electricians, plumbers etc. and also for building occupants where the material degrades. Even low exposures to asbestos, particularly the amphiboles (which include “blue” and “brown” asbestos) can lead to the development of mesothelioma, a serious cancer of the tissue surrounding the lungs. So it is likely that workers will continue to develop asbestos related disease for many years to come.

Other respiratory diseases also continue to be a problem, including asthma in bakers, paint sprayers and other workers and hypersensitivity pneumonitis associated with exposure to metalworking fluids.

New technology also presents risks to health, including respiratory disease. One example Sir Anthony highlighted was carbon nanotubes, which potentially have many uses. These very fine, fibre like particles have many similarities with asbestos in that they are small enough to reach the deep lung and are resiliant, so aren't easily absorbed by the body. Given these properties, perhaps it isn't surprising that there is evidence that they may present the same health hazards as asbestos, particularly mesothelioma.

There have been major changes in employment in the UK, with many of the “traditional” heavy industries exported overseas to the “developing” economies in Eastern Europe and the Far East where labour is cheap. Measures to control exposure in these countries are often less stringent and effective meaning that the historical industrial diseases are likely to re-emerge. Some might argue that the othe side of this coin is that these diseases will decline and even disappear in the UK. However, this is too simplistic an analysis. Sir Anthony demonstrated that there are still exposures occuring which are likely to mean that these diseases will continue to be a problem for many years to come. Yet most of the problems Sir Anthony highlighted could be prevented or, at least, reduce by applying good occupational hygiene practice. Unfortunately, many employers don't recognise this. So there is still much work for BOHS to raise awareness of the problems and the solutions and continue to argue for more emphasis to be placed on controlling health risks in the workplace.

Stress

 

One issue occupational hygienists don’t usually get involved with is mental health, yet this is a major cause of ill health associated with work. The best estimate from the Health and Safety Executive is that In Great Britain there were at least 5,750 new cases of work-related mental health problems in 2007, although this is likely to be a significant underestimate of the true incidence. A survey of the British workforce suggested that in 2007/08 an estimated 442 000 individuals in Britain, believed that they were experiencing work-related stress at a level that was making them ill. These figures are comparable to the numbers affected by more traditional types of occupational ill health.

The nature of work in Western Europe is changing. Traditional industry is shutting up shop and moving to cheap labour economies. The number of people exposed to chemical and physical stressors in Western Europe and the USA has reduced and will probably continue to do so for the foreseeable future. In the developing economies occupational hygienists will continue to face the same types of problems that hygienists have been dealing with for many years. But elsewhere, the nature of work related illness is changing and will continue to do so with mental stress probably becoming even more important. This is a challenge that will need to be addressed. There are other professions that view mental health as “their” territory – particularly medical professionals. But they are focused on treatment rather than prevention.

Preventing stress at work is largely about work organisation and the social, rather than physical, environment. These issues often fall into the remit of ergonomists but most occupational hygienists don’t get too involved in them. However, the principles of control are the same, whatever the stressor and I believe that most hygienists have to skills to apply the principles of good control practice to the prevention and control of mental stress. Where we are likely to have difficulties is in the recognition and evaluation of the problem and if we are to begin to become involved in tackling the issue this is where we are likely to have to develop new knowledge and skills and learn how to apply our existing skills to a new problem. HSE have some interesting material on their website including tools that can be used for the identification and assessment of work related stress.

Occupational hygiene is about preventing ill health and if the causes and nature of work related illness changes perhaps we need to change our focus and adapt our skills to the new challenges posed in the recognition, evaluation and control of stress at work. This wouldn’t be easy, but perhaps its something we ought to be thinking about.