Occupational Health Action Plan to 2013
2. Priority areas of focus
The previous section indicates that there is much to be done to improve occupational health in this country - there are a wide range of complex issues to be addressed. Bearing in mind the finite resources of both government and industry, it is imperative that we start by focusing our attention on areas that will have the biggest impact over the long term and build a foundation for future action.
This section outlines three areas that have been prioritised over the course of this Action Plan:
- reducing exposure to five occupational health hazards
- developing New Zealand’s capability to address occupational health issues; and
- building relationships between government, industry, and occupational health researchers and practitioners to work in partnership to improve occupational health.
2.1 Reducing exposure to health hazards
The main focus of this Action Plan is preventing occupational disease by reducing exposure to known occupational health hazards.
There are a wide range of workplace exposures and resultant conditions in need of attention, and many of the hazards that have an impact on occupational health are multi-causal in nature. It is important to identify and rank current and emerging risks and/or health hazards for immediate action.
The Department of Labour asked a panel of expert occupational health and safety researchers and practitioners to identify the issues which contribute most to the burden of injury and disease in New Zealand. Health hazards identified as a result of this process were considered alongside other relevant research and information (such as NOHSAC reports), and the following five were selected:
- cancer-causing agents in the workplace
- respiratory hazards
- noise
- skin irritants, and
- psycho-social hazards.
There are aggregated benefits for improving health and safety as a result of the fact that the hazards identified above are common problems across the five priority sectors. A profile of each of the five health hazards in New Zealand follows.
2.1.1 Cancer-causing agents in the workplace
International research has found that a wide range of workplace hazards are associated with an increased risk of cancer for specific occupational groups or industries. Within the European Union, it has been estimated that 13.8% of cancers in men and 2.1% of cancers in women can be attributed to work.
New Zealand studies have shown an increased risk of cancer for workers in a diverse range of occupations and industries, including foundries and heavy engineering, athletes, cooks, waiters and bartenders, hairdressers and beauticians, fishermen, hunters and general labourers. Risk factors include exposure to a wide range of chemicals and dusts, in industries as diverse as pulp and paper, forestry, health care, textiles and agriculture.
It has been estimated that there are 237–425 work-related deaths in New Zealand from occupational cancer each year[11]. These are caused by:
- lung cancer due to exposure to asbestos, arsenic, beryllium, cadmium, chromium, diesel fumes, nickel, silica and environmental tobacco smoke
- mesothelioma due to asbestos exposure
- leukaemia from benzene exposure, and
- bladder cancer from exposure to textile dyes, paints, pigments, leather, rubber, solvents and poly-cyclic aromatic hydrocarbons.
The most effective strategy to reduce occupational cancer is reducing the use of carcinogenic substances and processes at the workplace - replacing them wherever possible with less dangerous ones. If replacement of carcinogens is not possible, then it is necessary to take measures to avoid or reduce the exposure of workers to carcinogenic hazards. This is usually achieved by isolation, particularly the use of closed processes in which carcinogens are not released into the working environment.
To effectively decrease occupational exposure to carcinogens in the workplace, detailed information on current exposure and the effectiveness of control measures is essential.
2.1.2 Respiratory hazards
An estimated 200-205 deaths each year in New Zealand are thought to have been caused by chronic obstructive pulmonary disease (due to exposure to organic dust, microbial dust, endotoxins, welding fumes and environmental tobacco smoke), occupational asthma and asbestosis.
Occupational asthma is probably the most common work-related respiratory disorder in industrialised countries. It is associated with a wide range of agents, including some inorganic and organic dusts, biological hazards (such as grains, flour, insects and animal parts) and chemicals (including chlorofluorocarbons, isocyanates, metals and welding fumes). Occupational groups where studies have found an increased risk of asthma include sawmill and plywood mill workers, food processors, welders and farm workers.
To effectively decrease occupational exposure to allergens, detailed information on exposure determinants and effectiveness of control measures is essential. Research is currently underway in New Zealand to obtain real-time measurements for peak exposure to asthmagens in relation to work processes in sawmills. This will provide important information on tasks and activities related to peak exposure, identify control measures and other exposure determinants, and assess the potential impact of controls on reducing exposure.
2.1.3 Noise
The fact that noise (unwelcome and excess sound) leads to hearing loss has long been recognised.
Noise-induced hearing loss (NIHL) is common in work environments in which excessive noise is prevalent, such as manufacturing and construction. Excessive noise is also associated with other health conditions such as hypertension, sleep disturbance, anxiety, headaches and nausea. Noise-induced hearing loss is most commonly a degenerative condition that has a long latency, with symptoms worsening as a result of cumulative exposure. However, physical damage to the eardrum following a single peak exposure can also result in permanent hearing loss. It is a well-established occupational issue, and remains a major cause of disability and compensation in New Zealand. Recent research from the University of Auckland has estimated that more than 42,000 New Zealand workers suffer from NIHL (based on 2006 data).
The HSE Regulations 1995 require that no employee is exposed to noise greater than:
- 85 decibels averaged over an 8 hour period, or
- a peak level of 140 decibels.
Employers are required by the HSE Act to monitor noise exposure and ensure that they comply with exposure standards.
The most common way of managing noise exposure in New Zealand workplaces is the use of protective hearing equipment. More work is needed to eliminate the sources of noise through design processes.
In addition to noise levels, some chemicals have the ability to damage hearing. These are known as ototoxic substances and include some pharmaceuticals, solvents, asphyxiants and heavy metals.
2.1.4 Skin irritants
Skin irritants are common in many occupations and may result in dermatitis. Contact dermatitis occurs when an irritant is applied in a high enough concentration, or over time and frequently. Allergic dermatitis may occur when an allergic response develops to the irritant.
Dermatitis is commonly a result of “wet work”, particularly where that work involves exposure to chemicals such as cutting fluids and solvents. Occupations at high risk of dermatitis include professional cleaning, hairdressing, food handling and preparation (bakers, caterers, cooks and confectioners), health workers (especially nurses), construction industry workers, leather and shoe manufacturers, florists, gardeners and metal workers. ACC accepted 6124 claims for occupational contact dermatitis between 2005 and 2010.
Control of skin irritation that may lead to dermatitis can be achieved through preventing contact, using non-rubber gloves and using less irritating chemicals.
2.1.5 Psycho-social hazards
The International Labour Organisation (ILO) has recognised since 2010 that work-related psycho-social risk factors can result in ill health.
Psycho-social harm is an often hidden problem in the workplace but undoubtedly affects a significant number of workers. The recent review of the WHSS recommended more awareness and understanding of the psycho-social hazards that can have a serious effect on the health and wellbeing of workers. These effects can be exhibited as chronic fatigue, stress-related disorders (such as anxiety and depression), alcohol and drug abuse, heart disease, musculoskeletal disorders and suicide.
The 2002 amendment to the HSE Act recognised that harm may be caused by work-related stress and that workplace hazards can include a situation where a person’s behaviour may be a source of harm. A range of workplace factors may contribute to psycho-social harm - excessive workload, low job control, poor support, and aggression or violence at work among others[12]
International estimates suggest that work-related stress, depression and anxiety account for an estimated 13.8 million reported lost working days per year in Britain, and that 50–60% of all lost workdays in the European Union are due to stress-related disorders.
Until recently, very little data has been available in New Zealand on the incidence of psycho-social hazards and their impact on individual workers. A survey of more than 2,000 New Zealand workers was conducted for the first time in 2010, commissioned by the Department of Labour. The survey gathered information on a range of dimensions such as work demands, job satisfaction, burnout and stress. Further information can be found under action 3.7 in the following section. The findings can be used alongside those from research conducted in 2009 on the prevalence of bullying in the health, education, travel and hospitality sectors to identify target populations and interventions.
2.2 Developing Capability
Managing occupational health issues can be difficult for workplaces. Knowledge about exposure to health hazards at work often requires specialist health and scientific knowledge, and workplace managers and health and safety representatives do not always have easy access to this information (particularly in smaller businesses). The situation is made worse by the fact that:
- health care providers may not always consider occupational causes as a factor when dealing with the patient’s presenting symptoms
- not all Health and Safety practitioners and consultants are subject to professional registration, meaning it can be difficult for businesses to be assured that the people advising them on workplace health problems have sufficient expertise to do this competently. However, the Health Practitioners Competence Assurance Act 2003 does require that occupational health professionals (such as Occupational Health Nurses, Occupational Physicians, Occupational Physiotherapists and Occupational Therapists) are registered with and monitored by a professional body to maintain their specific health competencies[13], and
- information and data is not freely available to employers or those seeking occupational health expertise about the people working in the occupational health field, what their qualifications are, or the locations in which they work.
Developing our capability for dealing with occupational health issues requires long-term commitment. It involves three separate components:
- developing the knowledge and capability of workplace managers and health and safety representatives on the occupational health hazards present in their own workplaces
- improving the knowledge and skills of health care providers to recognise and refer those people presenting with symptoms suspected as being caused by a workplace exposure; and
- workforce development to continuously improve the expertise of the occupational health workforce, particularly as new toxicological or industrial hygiene information comes to hand, and new technologies for eliminating or reducing exposures are developed.
The National Action Agenda 2010-2013 also works towards this third aspect, outlining an action relating to the establishment of a Health and Safety Professional Alliance (HaSPA) in New Zealand in 2012.
2.3 Working in Partnership
Improving occupational health requires concerted action from all parties:
- occupational health and safety practitioners, whether working directly in workplaces or providing external advice
- occupational health professions and professional groups (such as Occupational Health Nurses and Occupational Physicians, Occupational Hygienists and Ergonomists, Medical Officers of Health, Departmental Medical Practitioners)
- occupational and public health researchers
- medical professionals
- employers and industry groups
- trade unions, and
- government agencies (particularly the Department of Labour, ACC and the Environmental Protection Authority).
Success in reducing the toll of occupational illness and disease will only happen if all these groups work together. It involves information sharing between experts with scientific and technical knowledge, and those with a practical operational focus. Research about the effectiveness of interventions to reduce exposure also needs to inform policy and decision-making processes.
The development and implementation of this Action Plan aims to foster common platforms for discussion, debate and consensus about occupational health, including the most effective use of resources.
Some partnerships for occupational health already exist. At a national level, the tripartite Workplace Health and Safety Council has oversight of the implementation of the Workplace Health and Safety Strategy, and provides advice and leadership on the strategic priorities.
The Occupational Health and Safety Industry Group (OHSIG) also acts as an industry forum and includes eleven professional associations all working in the occupational health and safety area from different disciplinary perspectives.
[11] Driscoll T, Mannetje A, Dryson E, Feyer A-M, Gander P, McCracken S, Pearce N, Wagstaffe M. The burden of occupational disease and injury in New Zealand: Technical Report. NOHSAC: Wellington, 2004
[12] For further information, go to: http://www.osh.govt.nz/publications/stress/index.asp or http://www.hse.gov.uk/msd/mac/psychosocial.htm
[13] For a full list of the health professionals covered by the Health Practitioners Competence Assurance Act 2003, go to: http://www.health.govt.nz/our-work/regulation-health-and-disability-system/health-practitioners-competence-assurance-act/responsible-authorities-under-act
