Presentation at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012

1. Occupational Health
and
Primary Health Care
NOTICES FOR ROUND TABLE 2: PEOPLE-CENTRED CARE
Assoc. Prof. Milan Tuček, M.D., Ph.D.
Czech Society of Occupational Medicine
Charles University, First Faculty of Medicine,
Institute of Hygiene and Epidemiology
Prague, Czech Republic
e-mail: milan.tucek@lf1.cuni.cz
www.pracovni.lekarstvi-cz
WHO Global Conference on Occupational Health and Primary Health Care,
The Hague, Nov.29 – Dec.1, 2011

2. Occupational health services definition (1)
Occupational medicine is a speciality of physicians.
Occupational health covers a broader spectrum of
different health protective and promotional services.
Modern occupational health is a multidisciplinary expert
area, which consists of several knowledge domains
including
occupational medicine (clinical medicine focusing on occupational diseases,
their diagnostics, treatment and prevention),
occupational health services (protection of workers against hazards at work,
protection of their health and promotion of health and work ability),
occupational psychology (identification, assessment and prevention of
psychological and psycho-social factors at work and their prevention
and control),
occupational hygiene (measurement of physical, chemical, biological and other
hazardous agents at the workplace, risk assessment and advice in
preventive actions),
ergonomics (identification, assessment and prevention of unphysiological
working conditions, such as repetitive movements, their prevention
and control),
occupational safety including accident prevention and development of safe
work environments and working practices

3. Occupational health services definition (2)
Occupational medicine is one of the major disciplines of
occupational health.
Complex of
- preventive medical examinations,
- workplace inspections/visits,
- consultations and recommendations
provided in the Czech Republic mainly
by medical staff, i.e. by physicians and nurses.

4. LEGISLATIVE FRAMEWORK (1)
ILO Convention
Former Czechoslovakia ratified the ILO Convention no
161 in 1988 and no 155 in 1989.
Transformation of medical services
Primary occupational medical/health services are a part
of special health services (valid Special Health Services
Act, effective since April 1,2012)

5. LEGISLATIVE FRAMEWORK (2)
Authorized physicians
General practitioners
without special postgraduate training/education in
occupational medicine!!!!
Occupational physicians
2009: Certified postgraduate course in OM (2 years)
after internal medicine, paediatric medicine, general
medicine and hygiene and epidemiology !!!!

6. DISTRIBUTION AND COVERAGE (1)
It is very difficult to estimate the coverage of OHSs in the
Czech Republic (no precise statistics are at hand):
Controls in enterprises were performed (2010), checking
existence of a signed contract between an employer and an OHS provider, and
provision of OHS services in the full scope as prescribed by the legislature.
2% of employers did not provide OHSs at all
33 % of employers did not provide OHS in the scope
prescribed by the legislature
Especially the workers in SMEs are rarely covered by OHSs
because of the costs of services ensuing for the employers,
the lack of providers of these services or an unfavorable
geographic location of the enterprise.

7. DISTRIBUTION AND COVERAGE (2)
Concerning the quality assurance system, the
development of guidelines and standards in occupational
medicine is of primary importance. The standards for
preventive examinations define the minimum range and
frequency of medical examinations performed by
authorized occupational physicians and the kind of
consultations which have to be performed in workers at a
particular workplace. Instructions or Guidelines are
published by the Society of Occupational Medicine.
Currently, there is no specific system for quality
assurance for OHS. The Czech Society of Occupational
Medicine has submitted a project aimed at preparation of
such a system in the field of OHS.

9. MAIN ORIENTATION OF OH (1)
Categorization of Work Operations
Public Health Protection Act No. 258/2000 Dig. and the
Labor Code No. 155/2000 Dig. stipulate the obligation of
employers to perform risk assessment, i.e.
to identify all health hazards present at the workplace,
and
to estimate the level of risk (exposure assessment).
According to the level of risk, all working activities are
classified into four categories (category 1 is the safest) .
Based on the categorization of work operations in a
particular enterprise, appropriate measures for risk
management have to be adopted including frequency and
content of different health examinations.

10. Categorization of working operations 2010
(workplace health risk assessment)
Number of persons (Source : Czech Ministry of Health)
The working population in the Czech Republic : about 5 million employees.
Of them, about 8 % are working at high risk of various risk factors of
work or working environment.

11. Financing structure(s) (1)
At present, OHS is funded partly by Health Insurance,
partly by employers and some other subjects.
The funding is based on the Act on general health insurance No. 48/1997
Dig., and other associated Acts, such as No. 242/1997 Dig.
The OHSs paid from the general health insurance include
activities within the frame of first aid, periodical
preventive examinations of workers at risk,
extraordinary examinations performed for medical
reasons (§11, 12, 13, 14 of the Directive of the Ministry of Health No
49/1967 Dig), follow-up examinations of workers with
notified occupational diseases and check-ups of
workers exposed to hazard factors with long-term or
delayed effects.
The pre-employment examinations, some periodical
examinations (e.g. in drivers and firefighters), and
extraordinary examinations performed for non-medical
reasons are paid by employers/employees.

12. Problems of OHSs in the Czech Republic (1)
The main problems in OHSs in the Czech Republic are
At the national level (1):
Absence of the effective cooperation between stakeholders
in the field of occupational health.
Incomplete legislation (full implementation of EU Directive
89/391/EEC in the part relating to preventive and
protective services is lagging).
Ineffective control of employers
There are two independent bodies in the field of occupational
health and safety state inspection:
(1) occupational health inspection (which belongs to the
Ministry of Health)
and
(2) labor inspection (which belongs to the Ministry of Labor
and Social Affairs).

13. Problems of OHSs in the Czech Republic (2)
The main problems in OHSs in the Czech Republic are
At the national level (2):
Lack of well-educated professionals in occupational health,
industrial hygiene, safety engineering, occupational health
nurses, etc.
Several important enactements have not yet passed,
especially Act on Accident Inssurance and Occupational
Health Services Act.
Lack of unified concepts and practical usage of risk
assessment methodology.
Limited collaboration and mutual exchange of information
between occupational health care providers and general
practitioners or other health care specialists.
Gaps in the coverage of OHSs, fragmentation of the OHSs
system, and the real danger of turning OHSs into a plain
commercial business (medical chain services).

14. Problems of OHSs in the Czech Republic (3)
At the enterprise level (1):
Safety and health protection at work is not incorporated
into the enterprise management system.
Employers’ limited knowledge of their duties in
occupational health and safety
Reduction of an investment in the field of occupational
health and safety to the lowest possible level (and its
replacement by compensation for hazardous work)
Use of outdated machinery and equipment; purchase of the
cheapest types of personal protective means.
Pushing workers into overtime work, often requiring the
staff to take time off.
Stress resulting from fear of the staff of losing their job.
Consultative functions of OHSs are very limited (more
attention is paid to periodic medical examinations)

15. Problems of OHSs in the Czech Republic (4)
At the enterprise level (2):
The limited feedback from employees to OHSs provider
how satisfied they are, and what are their actual needs
and problems.
If ethical problems in provision of OHS services occur,
they should be dealt with in agreement with the ICOH
Code of Ethics, which was adopted by the Czech Society
of Occupational Medicine.

16. Foreseen developments and strategies aiming at
development of OHS (1)
Modification of the system of social insurance, health
insurance and health care, focusing on prevention, and
including health care of the working population, is needed.
Further restructuring, reorientation and renovation of the
national OHSs system should be encouraged, and
sufficient resources should be allocated for that purpose.
The awareness of policy-makers, employers and workers
about the importance of occupational health as a part of
socio-economic development should be increased.

17. POSSIBLE RECOMMENDATIONS
Appropriate obligatory postgraduate training
in occupational medicine of GP´s.
Key knowledge of working conditions for medical
aptitude/fitness assessment:
Minimum: Hazard identification (risk assessment) during
the workplace visits.
Occupational health/medical services Directive necessity
(EU)
Independent financing (injury insurance )
Liberalization of services (chain of medical
services) not possible without quality control!