1. Prevention The Medical
Approach
Presented By: Dr. Kalicharan Ramnarine

2. OUTLINE
INTRODUCTION
/DEFINITION
HEALTH SURVEILLANCE
PROGRAMME
STRESS IN THE WORKPLACE
(SYMPTOMS)
DETERMINANTS OF STRESS
MANAGEMENT OF
WORKPLACE STRESS
CONCLUSION

3. INTRODUCTION
Occupational Health is the promotion and maintenance of
the highest degree of physical, mental and social well-
being of workers in all occupations by preventing
departures from health, controlling risks and the
adaptation of work to people, and people to their jobs.
(ILO/WHO 1950)
The concept of workplace health surveillance is new to
Occupational health and is different from medical
screening.

4. INTRODUCTION CONT
Health screening refers to the early detection and
treatment of diseases associated with particular
occupations.
NIOSH defines occupational health surveillance
as “the tracking of occupational injuries, illnesses,
hazards, and exposures.”
The National Institute for Occupational Safety and Health (or NIOSH).

5. INTRODUCTION CONT:
 The Joint ILO/WHO Committee on
Occupational Health at its 12th Session in 1995
defined an occupational health surveillance
system as “a system which includes a
functional capacity for data collection,
analysis and dissemination linked to
occupational health programmes.
This means having a system to look for early signs
of ill health caused by hazards at work.

6. INTRODUCTION CONT:
It includes health records for individuals and
may involve questionnaires or medical
examinations to inform the employer.
Corrective action may involve referral for
treatment and/or adaptations to work for
individuals affected.
Serve as an indication that controls may be
failing, review of risk management and action.

7. OCCUPATIONAL HEALTH SURVIELLANCE
It is essential to the planning, implementation and
evaluation of occupational health programmes and control
of work-related ill health and injuries and the protection
and promotion of workers’ health.

8. SURVEILLANCE PROGRAMME
You must decide whether the work you do needs
health surveillance. Ask yourself whether any of your
workers are at risk from:
 noise or vibration
 solvents, fumes, dusts, biological agents and other
substances hazardous to health
 asbestos, lead or work in compressed air
 ionizing radiations or commercial diving – these
require a particular type of high-level medical
surveillance.

9. DEVELOPING A HEALTH SURVEILLANCE PROG (HSE)

10. SURVEILLANCE PROGRAMME CONT
NIOSH defined three indicators of workplace
health surveillance programme.
Availability of easily obtainable data
Public health importance of the occupational
health effect or exposure to be measured
Potential for intervention activities

11. SURVEILLANCE PROGRAMMES
Major limitations:
 underreporting of occupational health disorders (very
common in most of the undeveloped and developing
countries)
 inability to diagnose the etiology by the occupational
health care workers and
 availability of the data such as death records.

12. WORK STRESS

13. INTRODUCTION/ BURDEN
High job demands and unjust effort-reward
are risk factors for mental and physical
health problems.
Studies have indicated that work stress is
associated with heart disease, depression,
and musculoskeletal disorders .
Leads to increased spending on healthcare.
Prevention and management of this
psychosocial risk not priority.

14. WORK STRESS
Definition:
“Work-related stress is the response
people may have when presented with
work demands and pressures that are
not matched to their knowledge and
abilities and which challenge their
ability to cope.”
WHO 2007.

16. IMPACT OF WORK STRESS
 According to Marmot & Wilkinson, 2006 the
working environment and the nature of work itself
are both important influences on health.
 Systematic reviews shows stress at work is
associated with heart disease, depression, and
MSDs ( Melchoir et al.2007)
 Leads to absences from work and also presenteeism,
(although present at work, the performance is poor and
sometimes even hazardous to themselves as well as
others around them).

17. LEGISLATION
 T&T - OSHA
 The Occupational Safety and Health Act, 2004
 No mention of work stress

18. EFFECTS OF WORK STRESS
Physical symptoms
Mental health symptoms
Social symptoms
Emotional health symptoms

19. SYMPTOMS OF WORK STRESS
PHYSICAL BEHAVIOURAL
Ulcers (G. I.)
Weight loss
High blood pressure
Heart disease
Musculoskeletal disorders
Pain (generalized)
An increase in alcohol
consumption
difficult' in the workplace
less co-operative,
 more accident prone,
 less sociable.
 inability to cope with
family/domestic roles,
 neglect of personal
appearance

20. LOOK OUT FOR THESE SIGNS
PSYCHOLOGICAL
Memory Loss
Depression
Mental Confusion
Difficulty Concentrating
Loss of Sexual Desire
Irritability
Insomnia
Feelings of guilt and uselessness

22. DETERMINANTS OF WORK STRESS
PSYCHOSOCIAL HAZARDS
Workload
Work Schedule/Pressure (urgency/competing demands)
Surveillance (by management)/ control
Job insecurity
Structural and Managerial Changes
Physical conditions (environment)/ Equipment.
Job design
Work organization/ Work-home interface

23. DETERMINANTS OF WORK STRESS
Job content
Lack of variety or short work cycles, fragmented
or meaningless work, under use of skills, high
uncertainty, continuous exposure to people
through work
Workload & work pace
Work overload or under load, machine pacing,
high levels of time pressure, continually subject to
deadlines

24. DETERMINANTS OF WORK STRESS
Work schedule
Shift working, night shifts, inflexible work
schedules, unpredictable hours, long or
unsociable hours
Control
Low participation in decision making, lack of
control over workload.

25. DETERMINANTS OF WORK STRESS
Environment &equipment
Inadequate equipment availability, suitability or
maintenance; poor environmental conditions
such as lack of space, poor lighting, excessive
noise
Organisational culture& function
Poor communication, low levels of support for
problem solving and personal development .

26. DETERMINANTS OF WORK STRESS
Interpersonal relationships at work
Social or physical isolation, poor relationships
with superiors, interpersonal conflict, lack of
social support, bullying, harassment
Role in organization
Role ambiguity, role conflict, and responsibility
for people

27. DETERMINANTS OF WORK STRESS
Career development
Career stagnation and uncertainty, under
promotion or over promotion, poor pay, job
insecurity, low social value to work
Home-work interface
Conflicting demands of work and home, low
support at home, dual career problems

28. STRUCTURAL/MANAGERIAL CHANGES IN
THE MODERN WORLD
Privatization
Globalisation
Mergers/acquisitions
Downsizing
Growing too rapidly
Technological introduction
All contribute to work stress !

29. Management of WORK STRESS
An effective risk assessment approach is
necessary
Measure the current situation (using surveys
and/or other techniques)
Work in partnership with employees and their
representatives to make practical improvements
Agree and share an action plan with employees
and their representatives
Regularly review the situation to ensure it
continues to improve

30. Management of Work stress
 Medical Management of physical sign /symptoms.
 Employee Assistance Programme
 Present in many larger organizations in Trinidad
and Tobago.
 Confidential
 UK National model for work stress (see slide below)

32. Stress Management cont:
HSE developed the Management Standards for
dealing with work-related stress in an organization
whatever the size or type.
The Standards identify six factors to be addressed:
Demands – including issues such as workload, work
patterns and the work environment
Control – how much say the person has in the way they
do their work
Support – including the encouragement, sponsorship
and resources provided by the organization, line
management and colleagues

33. STRESS MANAGEMENT CONT
Relationships – including promoting positive
working to avoid conflict and dealing with
unacceptable behaviour
Role – whether people understand their role within
the organisation and whether the organisation
ensures that they do not have conflicting roles
Change – how organisational change (large or small)
is managed and communicated

34. ACTIVITIES THAT CAN IMPROVE
EMOTIONAL HEALTH
Read something you enjoy
Listen to soothing music
Do breathing exercises
Walk
Experience nature
Take a relaxing bath
Play with a pet
Tend to your body
Engage in a physical activity

36. CONCLUSION
During the implementation of a health surveillance
system, involve your workers and their
representatives at an early stage, so they understand
its purpose and their roles and responsibilities in any
resulting health surveillance programme.
Ask for advice from a competent occupational health
professional in developing a health surveillance
programmer

37. CONCLUSION CONT:
Work-related stress is the response people may
have when presented with work demands and
pressures that are not matched to their knowledge
and abilities and which challenge their ability to
cope. (WHO, 2003)
Psychosocial risks (work-related stress ) are major
challenges to occupational health and safety (EU-
OSHA, 2007