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

1. Conference day 2
1 What is the role and the functions of primary-care centre regarding the
health of workers and under which conditions this role can be expanded?
Work healthy – should have relationship with PC
Relationship doctor – patient communication, GP knows the patient.
Self employed, informal sector, all people should have access to OH
Company doctors, treating families. GP responsible for all aspects of health
care, including OH.
PHC can do a lot, from prevention to disability assessment.
Who are the patients and what do they need
OH is specialty, special knowledge.
Not shifting OH to GP. GP can help. OH history. OH specialist assume GP does
not know about work. GP may know more than expected. When complete
annual exam: full OH history, then relevant. Use tools, integrate in electronic
record. Open MRS system – also access in developing countries.
Need for electronic system with all data, GP, OP and hospital
Register work with demographic data.
Training paramedics.
Summary: GP listen and know worker, collaboration, incentives, infrastructure,
funding, access to OH for everybody. Tool for GP to assist with info, what can
GP do for worker – integrate. Utilize guidelines, VE OH can be integrated, all HS
in one centre, including assessments. Limitation when injuries, hospital care.
OH Care is multidisciplinair.
Policy to educate GPs in OH.

2. 2 How to strengthen the collaboration between occupational health and
primary care providers, services, centres and what capacities, skills, and
support is needed for this?
Task GP: recognize OH problems and refer to OH specialist or actually treat OH
diseases?
Establish effective referral system between PC en OH
Education, knowledge
Legislation
Human resources
Projects that show benefit of collaboration
Training together (GP/OP)
Administrative issue: report to same source (GP/OP)
Make OH an important part of training GP (>150 hrs), possibilities: classes,
online, practice, CME.
Easy access for GP to OH-information by computer, integration occupational
disease in health information system, use same classification
Collaboration: multi-morbidity, mental disorders
Relationship with patient differs for GH /OH problems.
Identify stakeholders, let them see benefits of collaboration.
Summary: identify and involve stakeholders, enhance collaboration through
training, GPs and OPs should know each other and patients should know their
doctors, Doctors should work for the same population, lack of focus on
reintegration, administrative and financial barriers should be removed, need of
research on collaboration, joined committees for OC and PC.

3. 3 What support is needed to empower workers, work communities,
enterprises to take care of their health and what is the role of primary care
centres and occupational health services in providing such support?
Use media, modern techniques, to raise awareness, health promotion
campaign in the workplace. Keep in mind: sometimes no time for media (long
working days). Face-to-face communication also important, for example during
lunchtime in factory.
Workers can keep own record
Identify what kind of workers in community - involve workers/ community,
involve NGO’s, unions
Worker needs to know: what does it mean to me, etc. pres Richard. Patient
needs knowledge about what he should and can do, and capabilities to act on
it. Help with legal issues, how to deal with legal issues.
Barrier: not allowed to visit doctor during working time. Regulation for easy
access for workers to visit GP/OP
Education, orientation program, refresh courses
Promote participation
Worker satisfaction, involve workers. Ask workers what they need
Attention for women
CPD for workers, for example with bonus after reaching certain level
GPs and OPs should give a good example
WHO: program healthy work places, take care of their own health problems,
empower communities.
OH center for all workers with independent doctors/ public.
Where do you go with complaints? Who can protect the child who works with
poisonous substances

4. Summary: motivate workers to change behavior, use different techniques,
involve workers, involve stakeholders like unions, Ngo’s etc, consider individual
context. Legal issues. Ensure access to occupational health care.
4 What actions should be undertaken to move to people-centred care
regarding workers' health at the local, national and international level,
including research to fill knowledge gaps?
Legislation: good OH care for workers
Community based participatory research and action research, development of
tools
Medical schools: OH research involvement
Involve insurance companies
International independent survey on needs for empowerment, including
informal workers
Reach out to nurses, community health workers, allied health professionals
Education students, education prgram
Make it easy to do the right thing (food, exercise etc)
Needs assessment for local situation, culture sensitive
Start knowledge at school, medical students
Infrastructure
Evaluation
Partnership with people, gender specific
Change in management, educate bosses
Guidelines, instructions, protect quality
Global initiative increasing number of training centers, also in countries where
they do not have them now. Training should be accessible all over the world.
Training setting also needs services, residents need to see proper setup for

5. OHS. Sometimes training abroad necessary. Worldwide legislation. We should
train OH nurses.
Need of occupational health care needs to be accepted.
Appropriate obligatory postgraduate training in OHS of GPs
Hazard identification, risk assessment
Occupational health/ medical services Directive (EU)
Independent financing
Liberalization of services not possible without quality control
Attention for women workers
Coordinate across ministries, countries, continents
Technical support for physicians
Sum: research, legislation, training also providers, infrastructure, support