Handouts from presentation given to the International Occuaptioanl Medicine Society Collaborative on Saturday, 28 June, 2014 by John Harrison, MD, FRCP, FRCP (Edin), FFOM.

1. International Occupational Medicine Society Collaborative:
“The Future of Occupational and Environmental Medicine”
John Harrison, MD, FRCP, FRCP (Edin), FFOM
Saturday, 28 June, 2014
1
The Future of Occupational and
Environmental Medicine
International Occupational Medicine
Collaborative
Bloomsbury, London UK 2014.
Have we got the terminology right?
Medicine or Health?
Occupational
Health ?
What are we talking about?
WHO – Occupational Health
• Global Plan of Action on Workers’ Health*
– devising and implementing policy instruments on
workers' health;
– protecting and promoting health at the
workplace;
– improving the performance of and access to
occupational health services;
– providing and communicating evidence for action
and practice; and
– incorporating workers' health into other policies.
* 2008 ‐ 2017
WHO – Occupational Health
3 Key Areas:
1. Healthy Workplaces
2. Occupational and work‐related diseases
3. Essential interventions for workers’ health
* 2008 ‐ 2017

2. International Occupational Medicine Society Collaborative:
“The Future of Occupational and Environmental Medicine”
John Harrison, MD, FRCP, FRCP (Edin), FFOM
Saturday, 28 June, 2014
2
Healthy workplaces: a WHO global
model for action
 Work‐related physical and psychosocial risks;
 Promotion and support of healthy behaviours;
 Broader social and environmental determinants.
“WHO considers workplace health programmes as one of the best‐buy options
for prevention and control of non‐communicable diseases and for mental
health. Such programmes can help achieving the WHO objective of reducing the
avoidable deaths of NCDs and the burden of mental ill health and to protect
and promote health at the workplace as stipulated in the Global Plan of Action
on Workers’ health 2008‐2017. “
WHO – Occupational Health
3 Key Areas:
1. Healthy Workplaces
2. Occupational and work‐related diseases
3. Essential interventions for workers’ health
* 2008 ‐ 2017
WHO – Occupational and Work‐related
Diseases
• Carrying our estimates of the global burden of disease
from major occupational risks, such as injuries,
airborne exposures, carcinogens, ergonomic stressors,
noise and other specific risks.
• Incorporating occupational diseases and their causes in
the 11th revision of the International Statistical
Classification of Diseases and Related Health Problems.
• Working with ILO to develop diagnostic and exposure
criteria for occupational diseases and to enable
primary and secondary health care providers to detect
and report such diseases.
WHO – Occupational Health
3 Key Areas:
1. Healthy Workplaces
2. Occupational and work‐related diseases
3. Essential interventions for workers’ health
* 2008 ‐ 2017
WHO – Interventions for workers’
health
“Currently only 15% of workers worldwide have access to specialized
occupational health services carrying out prevention of occupational risks,
health surveillance, training in safe working methods, first aid and advising
employers in occupational health and safety.
WHO’s work on extending access to the most essential health interventions and
services for workers’ health includes:
• Enabling primary care centres to deliver preventive, curative and rehabilitation
people‐centred care according to the specific health needs of working people,
particularly those who do not have access to occupational health services.
• Strengthening the specialized occupational health services – multidisciplinary and
basic and improving their link to primary care centres and the rest of the health
systems.
• Stimulating international efforts to build human resource capacities for workers’
health, both in primary care and occupational health specialists.”

3. International Occupational Medicine Society Collaborative:
“The Future of Occupational and Environmental Medicine”
John Harrison, MD, FRCP, FRCP (Edin), FFOM
Saturday, 28 June, 2014
3
Stage I
Starting level
Stage II
Basic Service
Stage III
International
Standard Service
Stage IV
Comprehensive
Service
Field nurse
Safety agent
Physician and nurse
with short special
training
Multidisciplinary
team with special
training
Multidisciplinary
specialists' team
• Advice in OH
• Accidents and ODs
• Acute ill-health
• PHC
• PHC Infrastructure
• Basic OHS content
• Toolboxes
• OHS Infrastructure
• ILO No. 161, 155
• Multidisciplinary content
• Prevention plus
curative services
• In-company or external
special OHS units
• Comprehensive content:
prevention, curative and
promotion & develop-
ment services
Objective for all!
SMEs,SSEs,SEs,IFS SMEs,SSEs,SEs,IFS
Starting point for Big
industries and well
organised SMEs
Big industries and
Big OHS Centres
B.O.H.S.
The BOHS cycle
Surveillance of WE
WE Risk Assessment
Initiatives
Accident prevention
Prevention of
OH hazards
Emergency
preparedness
Evaluation
Record keeping Surveillance of
worker's health
Assessment of
individual's
health risk
Health education
and health
information
Dg of ODs
and WRDs
First aid
General
health service
Workers health
Worker
Information
Education
Individual
health record
Work environment Work Organization
Orientation
and planning
Grand challenges of work life in the 21st century
• Globalization: MNCs 70 % of world economies
• New enterprise structures: Fragmentation
• New technologies: Nanomaterials
• New work organizations: Ameba organizations
• New forms of work: Employee entrepreneurship
• Ageing: Work life expectancy
• New morbidity: Work-related diseases
• Mobility of workers: Migrant workers
• New working times: Flexibility, 24/7
• New competence requirements: Multi-skills
• New management systems: Autonomous units
• New working contracts: Precariocity
THE PARADIGM SHIFT
OCCUPATIONAL HEALTH
Health, Wellbeing & Productivity
• Health and Productivity Management.
Simply defined, Health and Productivity Management,
or HPM, is a concept that directs corporate investment
into interventions that improve employee health and
business performance. It can also be described as the
integrated management of health risks, chronic illness,
and disability to reduce employees' total health‐related
costs, including direct medical expenditures,
unnecessary absence from work, and lost performance
at work ‐ also known as "presenteeism."
ACOEM http://hpm.acoem.org/abouthpm.html

4. International Occupational Medicine Society Collaborative:
“The Future of Occupational and Environmental Medicine”
John Harrison, MD, FRCP, FRCP (Edin), FFOM
Saturday, 28 June, 2014
4
OH Workforce
How can OH ensure it will be
relevant to the health needs
of the UK working population
in 2015 and 2030?
Where are we now?
Where are we going?
How do we get there?
Philosophy
Good work is good for health, good for business and good for national prosperity
Vision
Universal access to multidisciplinary OH resources delivers good health and good business in the working
age population
Principles
1. OH arrangements include people and other resource ‐ they address non‐medical and medical
barriers to remain in or return to work.
2. Effective leadership is essential to ensure the appropriate positioning, marketing and delivery of
Occupational Health.
3. The multidisciplinary OH workforce are trained in unified core competencies including leadership ‐
they are accredited to a standard that reassures the public
4. The need for an Occupational Health resource is such that there is a demand for it by a public who
understand it, value it, and know how to access it.
5. OH resources are affordable and sustainable
6. An Occupational professional input on functional capability is an integral part of health decision‐
making in people of working age
7. Decisions on the design of work systems and workplaces take account of current occupational
health knowledge and standards.
The public includes……. People of working age, their employers and advisers (medical and non‐
medical) who we work in partnership with to achieve this philosophy.
Implications of the Strategic Analysis
Carrying on as normal will not be an option
Opportunity
• prevention and management of chronic conditions,
• incorporate preventative wellbeing strategies into its arsenal.
• Workplace health and safety and health risk management is part of a holistic
approach to workplace health and wellbeing.
Review the knowledge and skills required of the multidisciplinary workforce including
behavioural psychologists, therapists, physiotherapists, etc. to embrace care rather
than treatment.
• The dominant model for healthcare is becoming the integrated care pathway.
Implications of the Strategic Analysis
Positioning within Public Health to promote wellbeing and tackle long term
conditions, such as obesity, and other lifestyle issues.
Support for healthcare:
• 7 day working’ for GPs and hospitals
• Demand from employers for 24/7 support.
Precision medicine:
• Investment in education and training in genomics.
Support employment of people with cancer.
Implications of the Strategic Analysis
Make best use of this emerging technology:
• Tele/video conferencing will become ubiquitous
• Smart phones, tablets and other communication devices.
Embrace Informatics and health informatics.
• Websites such as PatientsLikeMe are pioneering patient‐driven data.
• Develop strategies to collect and use data to meet the demands of stakeholders
and improve service delivery.
Build capability for multi‐disciplinary services
• Adapt to technological and demographic changes and function
• Mitigate and prevent illness caused or made worse by work.
• Abandon silo working and become a fully fledged and integrated specialty

5. International Occupational Medicine Society Collaborative:
“The Future of Occupational and Environmental Medicine”
John Harrison, MD, FRCP, FRCP (Edin), FFOM
Saturday, 28 June, 2014
5
Case Study 1 Case Study 1
The Evidence
Case Study 1
The Solution
Case Study 10
Case Study 10
The Evidence
Case Study 10
The Solution

6. International Occupational Medicine Society Collaborative:
“The Future of Occupational and Environmental Medicine”
John Harrison, MD, FRCP, FRCP (Edin), FFOM
Saturday, 28 June, 2014
6
Academic OH
• Essential for future of OH
• Research agenda must support (lead?) the
paradigm shift
• Funding agencies need to fully understand OH
and the research priorities
• Need for high quality training of multi‐
professional workforce.
AND FINALLY.......
Occupational health needs to move beyond the prevention of
work‐related disease and health surveillance but develop a
broader remit, which encompasses the needs of all working‐age
people, and the aim should be of contributing to maximizing the
functional capacity of each individual.
In doing so, it can be argued that occupational health
professionals have the potential to make a greater contribution
to improving population health than any other group of health
professionals.
Occupational Health Services Now and in the Future: The Need
for a Paradigm Shift
Macdonald, Ewan B.; Sanati, Kaveh A.
Journal of Occupational & Environmental Medicine. 52(12):1273‐
1277, December 2010.