産業医

The Development of Multi-Professional Occupational Health Services

During the last fifty years a need to reduce the rate of occupational accidents and diseases, and to address the economic burden that arises from workplace accidents and diseases onto the tax payer through the externalization of costs, has forced the organization of the national infrastructure to support employers to fulfill their legal obligation in health and safety at work. This was to a large extent guided by the International Labour Organization (ILO) conventions. The ILO Occupational Safety and Health Convention, No 155 (13) and its Recommendation, No 164 (14), provide for the adoption of a national occupational safety and health policy and prescribe the actions needed at the national and at the individual company levels to promote occupational safety and health and to improve the working environment. The ILO OH Services Convention, No. 161 and its Recommendation, No. 171 (33), provide for the establishment of occupational health services, which will contribute to the implementation of the occupational safety and health policy and will perform their functions at the company level.

EU legislation on the introduction of measures to encourage improvement in the safety and health of workers at work defines the employer's responsibilities for providing all of the necessary information concerning safety and health risks, and the protective and preventive measures required, obligation for consultation with and the participation of workers in health and safety, the employer's responsibility for providing training and health surveillance. The framework Directive also states that the employer shall enlist competent external services or persons if appropriate services cannot be organized for lack of competent personnel within the company.

Therefore, the framework Directive greatly strengthens the concept of addressing the issue of health and safety at work by using multi-professional occupational health services, and in encouraging the active participation of employers and employees in improving working conditions and environments.

The organization and scope of occupational health (OH) is constantly changing to meet new demands from industry and society, therefore the infrastructures which have been created for occupational health are also undergoing continuous improvement. OH is primarily a prevention-orientated activity, involved in risk assessment, risk management and pro-active strategies aimed at promoting the health of the working population. Therefore the range of skills needed to identify, accurately assess and devise strategies to control workplace hazards, including physical, chemical, biological or psychosocial hazards, and promote the health of the working population is enormous. No one professional group has all of the necessary skills to achieve this goal and so co-operation between professionals is required. OH is not simply about identifying and treating individuals who have become ill, it is about taking all of the steps which can be taken to prevent cases of work related ill-health occurring. In some cases the work of the occupational hygienist, engineer and safety consultant may be more effective in tackling a workplace health problem than the occupational health nurse or physician.

The multi-professional OH team can draw on a wide range of professional experience and areas of expertise when developing strategies, which are effective in protecting and promoting the health of the working population. Because 'OH largely evolved out of what was industrial medicine there is often confusion between the terms 'OH and 'Occupational Medicine'. The distinction between the two has recently been clarified in the WHO publication Occupational Medicine in Europe: Scope and Competencies.

In this document it states that "Occupational medicine is a specialty of physicians; occupational health covers a broader spectrum of different health protective and promotional activities." It is clear that the medical examination, diagnosis and treatment of occupational disease are the sole preserve of the occupational physician. It is only the physicians who have the necessary skills and 産業医 clinical experience to perform this function in the being paid to the prevention of hazardous exposure and improved risk management there should be less need for extensive routine medical examinations and hopefully fewer occupational diseases to diagnose in the future. Therefore, it is likely that more occupational physicians will want to move into the broader modern field of preventative occupational health than in the past.

However, at this point, where the physician stops using the skills learnt in medical school and starts to enter the workplace to examine working conditions, there is a much greater overlap between the core areas of knowledge and competence between occupational physicians, now practicing OH, and other OH experts, such as occupational hygienists, safety engineers and an increasing number of occupational health nurses.

The occupational physicians, in their scope and competencies acknowledge that there is no longer any requirement for the physician to be automatically chosen to manage the occupational health team. The person, from whatever discipline, with the best management skills should manage the multi-professional occupational health team in order to ensure that the skills of all of the professionals are valued and fully utilized.