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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
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
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.
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)
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 !!!!
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.
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.
Rt 2 occup health and primary care the hague tucek 2011
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.
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.
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.
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).
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).
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)
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.
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.
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!
Rt 2 occup health and primary care the hague tucek 2011

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Rt 2 occup health and primary care the hague tucek 2011

  • 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!