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SPE 108573

Occupational Illness: Challenges Faced


Surya Kuma, Shell Health

Copyright 2007, Society of Petroleum Engineers

Occupational Health

This paper was prepared for presentation at the SPE Asia Pacific Health, Safety, Security and
Environment Conference and Exhibition held in Bangkok, Thailand, 1012 September 2007.
This paper was selected for presentation by an SPE Program Committee following review of
information contained in an abstract submitted by the author(s). Contents of the paper, as
presented, have not been reviewed by the Society of Petroleum Engineers and are subject to
correction by the author(s). The material, as presented, does not necessarily reflect any
position of the Society of Petroleum Engineers, its officers, or members. Papers presented at
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Abstract
What is Occupational Health?

Occupational Health involves predicting vulnerabilities,


promoting good health and protecting the workforce.
Exposure levels of many substances in the workplace can be
much higher than those in general environment. Occupational
health deserves more focus because ill-health effects may not
manifest for a long period of time. The Health Risk
Assessment identifies, evaluates and seek ways to control the
impact of occupational risks on the worker; hence preventing
illnesses that can be acquired through such direct workplace
exposures. A responsible company goes beyond occupational
health to promote general health and well-being.
Occupational Illness

A simple definition of health is as follows: a state of


physical, mental and spiritual well-being. Occupational
health is a state of such well-being at the workplace.
Occupational health comprises three main components. They
include occupational illnesses, illnesses that can be affected by
factors at the workplace and illnesses that are unlikely to be
affected by the workplace. Examples of occupational illnesses
include lead poisoning, asbestosis and noise-induced deafness.
Illnesses that may be affected by workplace factors include
asthma and some liver diseases, depending on exposures in the
working environment. Although technically possible in some
cases, many medical conditions are not usually affected by
factors within most workplaces. These include lifestyleassociated and hereditary diseases such as diabetes and high
blood pressure.
Health Determinants
What determines your health? Firstly, ones genes or who you
are play a very important role. A family history of certain
illnesses enables us to predict ones risk of certain diseases
such as diabetes and high blood pressure and cancers such as
breast and cervical cancer. Secondly, ones lifestyle and habits
such as diet, exercise and smoking do, of, course change your
risk for certain lifestyle- associated diseases. Health promotion
takes care of this element. Thirdly, factors in the environment,
including the work environment, can determine ones health as
well. We need to protect individuals, including the worker,
from these adverse factors.

Occupational illnesses occur when there is excessive exposure


in terms of dosage and duration to a agent at the workplace.
To be classified as a occupational illness, the outcome must be
attributable to the workplace. Using noise induced deafness as
an example, there are factors outside of the workplace that
could also cause the condition. Frequent exposure to loud
music could be the cause. It is often difficult to ascertain
whether the outcome is due to exposure at the workplace.
Depending on the type of occupational illness, it could take
one exposure of several exposures to cause it and the duration
between exposure to illness can be days to years. Occupational
illnesses may be classified under the following categories:
upper limb and neck disorders, back and lower limb disorders,
respiratory conditions, skin conditions, noise-induced
deafness, mental ill health, cancers, infectious diseases,
poisoning, and others.
Evolution of Occupational Illnesses
Prevention, identification, management, and reporting of
occupational illnesses (OIs) are (and should rightfully be) an
integral part of business in the Oil and Gas Industry. We have
come a long way in addressing classical or traditional OIs
related to chemical exposures. Illnesses related to exposure to
benzene and Polyaromatic hydrocarbons, fortunately, are
indeed few and far in between. In recent years, however,
objective and anecdotal evidence suggests a relative (and often
real) increase in new generation occupational illnesses such
as repetitive stress injuries and work-related psychological
stress. These are often difficult to diagnose as occupational
illnesses in view of the multi-factorial causation. Factors
outside of the workplace do play a part as well in many

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SPE 108573

instances. Attention must be paid to OIs in order to ensure that


our workforce is well looked after and to create a positive
reputation for the Industry.
Challenges Faced
There are significant challenges to the identification,
investigation and reporting of occupational illnesses. First of
all, there must be a diagnosis of a specific medical condition.
Symptoms alone is not sufficient. There must also be
reasonable evidence that the illness is indeed caused by
exposures at the workplace. Many suspected occupational
exposures are also found at home, leisure and in the
environment. Examples include noise, benzene, ergonomic
factors and respiratory irritants. Psychological stress is a good
example. In addition to psychological stress at the workplace,
there are social, marital and financial stressors as well at
home. It is often very challenging when having to decide
whether a case of mental illness such as depression caused by
psychological stress is primarily caused by stress at work. The
decision to classify as a occupational illness is quite often
judgmental.
Another common challenge is the willingness of employees to
surface an illness as one that could have been caused by
factors at the workplace. This is particularly common in many
Asian countries where many employees feel that occupational
illness is a sign of weakness and may even affect their current
jobs and future employability. It is even more serious in
communities where unemployment is an issue and workers
want to guard their jobs. This fear of losing ones job is
something we need to do something about.

The main factor that impedes the identification and reporting


of OIs is a lack of awareness amongst employees, managers
and health staff (especially third party contracted and retainer
health staff). Whilst it might sound simplistic enough to
ensure knowledge and awareness, it is not always the what but
very often the how and who. Awareness and educational
messages must be targeted and focused.
What needs to be done?
The key to success is undoubtedly education and awareness.
This has to be assured at all levels of the workforce. The
training of health staff in asking the right questions and
probing all suspected cases in crucial. Challenges to
implement ting a robust system for awareness include
language, culture, time availability and rapid turnover of staff.
Training and education must also be targeted at health
professionals. In many countries, the traditional curriculum for
doctors and nurses do not necessarily cover occupational
health adequately. This includes the suspicion and diagnosis of
occupational illnesses. In many ways, that could be the major
blocker as, if a OI is missed by the physician, we will never
know about it.
We must also ensure that we create an environment where all
perceptions of potential discrimination and insecurity over job
retention due to OIs are negated. The presence of a robust
investigation and reporting system is critical.

Employers too can be major blockers to the identification and


reporting of occupational illnesses. The fear of repercussions,
including legal and financial, lead to cover-ups everywhere.
We know that this is happening and we certainly need to
address this. Employers must be made to develop a culture of
preventing the next occurrence rather that trying to justify
away the current case in hand. This is a strong accusation but
indeed this does occur in industry.

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