Risks of chronic diseases in the

workplace and interventions to

reduce them

Professor Malcolm Sim

Centre for Occupational & Environmental Health

School of Public Health & Preventive Medicine

Monash University

• What are chronic diseases in the workplace? • Work-related

• Others which may impact on injury risk

• ‘Traditional’ workplace chronic diseases

• The ageing worker

• Proclaimed diseases

• Interventions: “What works?”

• The Cochrane Collaboration

Key points to cover

Non-infectious, degenerative conditions

which can impact on most organ systems

What are chronic diseases?

Non-infectious, degenerative conditions

which can impact on most organ systems

What are chronic diseases?

Noise induced Hearing Loss

www.coeh.monash.org

Costs NIHL claims

$9,000 $9,000

$12,360 $13,090 $13,490

$16,230 $17,030 $16,660

$17,880 $17,450

$5,850 $6,125 $5,980 $6,007 $6,123 $5,200

$5,717 $5,500 $5,900 $5,895

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

$20,000

1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08

Median claim cost

IB cost HA cost

Thorne PR et al. Epidemiology of noise-induced hearing loss in New Zealand.

N Z Med J. 2008 Aug 22;121(1280):33-44.

What about other countries?

Conclusion: “The substantial and

increasing societal costs despite

decades of NIHL control legislation

suggests that current strategies

addressing this problem are not

effective, inadequately implemented,

or both.”

Thorne et al. 2008

“Workers in Mining, Construction, and specific Manufacturing industries appear to

have a much higher prevalence of hearing loss……….”

“Although noise exposure in these industries has been regulated for decades

by OSHA and MSHA, these results suggest that the current regulations and

their enforcement need to be revisited.”

Noise prevention in workplaces

has a very well established

hierarchy of controls

So, why is occupational NIHL not

reducing and, in fact, apparently

increasing in many countries?

Focus groups workers/employers: • an over-reliance on personal hearing

protectors

• infrequent and/or improper use of personal

hearing protectors,

• lack of prominence of noise as a serious work

health and safety issue

• insufficient knowledge of the effects of loud

noise on hearing and quality of life

• belief that noise control costs too much

• belief that hearing loss is inevitable

• prominent in small/medium-sized businesses

Barriers to effective noise control programs

www.coeh.monash.org

Asbestos related diseases

Mesothelioma in Australia 2013 .

Report of the Australian Mesothelioma Registry

Future mesothelioma trends?

Clements MS, et al. Projected mesothelioma incidence in men in New South Wales. Occup Environ Med 2007;64:747-752.

Predicted years of

peak number in

NSW for the two

models were 2014

and 2021.

Many uncertainties!

www.coeh.monash.org

Pattern of affected workers shows major

increase is in tradespeople, not primary

asbestos workers

The ageing worker

Also evidence of longer period of recovery

WorkHealth Check participants

• Increased risk of diabetes as we age

• Increased risk of sickness absence for those with

diabetes

• Evidence mixed about impact on risk of work

injury

• BUT for those who are injured, recovery slower

• Some evidence of increased risk of diabetes in

long term claimants who reduce exercise level

and increase weight, so sequelum of work injury

Diabetes and workplace risks

Proclaimed or deemed diseases

Source is an old ILO list of occupational diseases from the

1950s, despite many updates to the ILO list since that time

Presumptive legislation

Many other examples where scientific

evidence exists for increased chronic

diseases in certain occupations

What do other countries do?

As well as a better evidence base for

workplace causes of diseases, we need a

better understanding of effective

interventions ie ‘What works?’

Need for better synthesis and application

of scientific evidence to reduce impact of

chronic diseases in workplaces

Recent Cochrane systematic review showed a lack of

good evidence for effectiveness of legislative and

workplace interventions to prevent occupational NIHL

(Verbeek et al, 2009 and 2012)

www.coeh.monash.org

Should surgeons use blunt

needles when operating on

patients to reduce the risk of

needlestick injury?

‘What works?’

www.coeh.monash.org

“Ten trials including 2961 surgeon-operations found a significant

reduction of glove perforations, with a relative risk (RR) of glove

perforation of 0.46 (95% confidence interval (CI) 0.38 to 0.54)”

www.coeh.monash.org

NIOSH eNews

The Monthly Newsletter of the National Institute for Occupational Safety and Health

Volume 10 Number 2 June 2012

Agencies Advocate for Use of Blunt Tip Suture Needles

In an effort to decrease the risk of needlestick injury, NIOSH, the Occupational Safety

and Health Administration (OSHA), and the Food and Drug Administration have issued

a new joint safety communication document that encourages healthcare professionals

to use blunt-tip suture needles as an alternative to standard suture needles when

suturing fascia and muscle. http://www.cdc.gov/niosh/topics/bbp/pdfs/Blunt-

tip_Suture_Needles_Safety.pdf

From the Director’s Desk

John Howard, M.D. Director, NIOSH

Cochrane OSH Review Group

Finnish Institute of

Occ Health

Monash University

A satellite of the Cochrane

OSH Review Group in Australia?

www.coeh.monash.org

Thank you for

your attention