Unit IB

Question 1

1.0 - Give the definition of “Health” as defined by the WHO

Answer 1

“a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.”

Question 2

1.0 - Give the definition of “Occupational Health” as defined by the ILO

Answer 2

Promote and maintain the highest degree of health for all workers;

to prevent loss of health caused by wor conditions;

to protect workers from health risks in work;

to place and maintain workers in a work environment adapted to their capabilities and needs;

in summary, to adapt work to the workers and each worker to his or her job.”

Question 3

1.0 - Give the definition of “Wellbeing” as according to the Economic and Social Research Council (ESRC)

Answer 3

“Wellbeing is a state of being with others, where human needs are met, where one can act meaningfully to pursue one’s goals, and where one enjoys a satisfactory quality of life.”

Question 4

1.1 - List the key categories of occupational health hazards and give examples

Answer 4

Chemical: Acids, alkalis, metals (lead and mercury), gases (carbon monoxide), dusts (silica) and fibres (asbestos).

Biological: Bacteria, viruses, fungi, and protozoa. Biological hazards can be found in humans, animals, and the environment.

Physical: Heat, lighting, noise, vibration, and radiation.

Psychosocial: Mental ill-health, stress, violence, and aggression.

Ergonomic: Repetitive movement activities, manual handling, poor job design, uncomfortable work station height, and poor body positioning.

Question 5

1.2 The Prevalence of Work-related Sickness and Ill-health.

Answer 5

• Data unreliable.
• Reasonably reliable information by a third of its 174 members.
• Many countries, reporting is very poor, or non-existent.
• Most work-related deaths occur from disease.

The main groups of work-related diseases are:

• cancers (29%)
• circulatory diseases (21%)
• infectious diseases (25%)
• Infectious diseases more common in Sub-Saharan Africa and India
• Circulatory diseases more common in the Former Socialist Economies and the Middle East
• Cancer main killer in the Established Market Economies and China

Musculo-skeletal conditions are the biggest cost outside of fatal accidents. Account for 40% of the total costs incurred.

Back pain can cause long absences from work, major financial burden for society.

Question 6

1.3 Links between Occupational Health and General/Public Health

Answer 6

Public health concerned with greater populations.

The UK National Institute for Health and Clinical Excellence (NICE) develop guidance on how to improve populations and individuals health.

May focus on a particular topic, population or setting.

Socio-economic inequalities major factor in health.

Unemployed people and those in unskilled work have a shorter life expectancy and experience more ill-health.

Integration of occupational health within framework of public health would allow for better undersanding of health inequalities.

Question 7

1.4 - Describe the Difference between a Disease Outbreak and an Epidemic?

Answer 7

A disease outbreak happens when a disease occurs in greater numbers than expected.

A single case can be considered an outbreak. If disease is unknown, new to a community, or has been absent for a long time.

An epidemic occurs when an infectious disease spreads rapidly to many people.

Question 8

1.4 - Describe National Arrangements for Tackling Epidemics

Answer 8

When an epidemic is identified, Public health takes priority over all other considerations.

National infection control has two parts:

• The identification of a health problem - Identify the source, infectious control teams
• take actions to control it - treatment, quarantine, hygiene, physical distancing

Most countries have legislation covering:

• Continual surveillance of infectious diseases
• Agencies to deal with problems observed

Question 9

1.4 - Describe Organisational Arrangements for Tackling Epidemics.

Answer 9

Change work so source of infection not needed.

Modify work to avoid creating hazardous by-products or waste.

Physical barriers.

Engineering controls such as exhaust ventilation systems.

PPE, clothing, gloves, footwear, and RPE.

Good hygiene, hand washing, avoiding hand to mouth contact, safe disposal of waste, decontamination methods.

Effective vaccines for infectious agents. Vaccination not a substitute for precautions above.

Question 10

1.4 - Outline Disease Risks and Controls for Healthcare Workers

Answer 10

Healthcare:

Main risk from contact with patients, or through handling contaminated body fluids or clinical waste.

Influenza, Norovirus.

Viral haemorrhagic fever such as Ebola virus, dengue fever, and Crimean-Congo haemorrhagic fever by contact with body fluids.

Mode of transmission and how contagious will affect types of controls.

For example:

• Isolation in a negative pressure suite.
• Isolation in a standard side room.
• PPE e.g. apron, gloves, surgical face mask, RPE’s.

Question 11

1.4 - Outline Disease Risks and Controls for Agriculture Workers

Answer 11

Risk of zoonotic infection.

Avian influenza, swine influenza, Q fever, E. coli, and TB.

Controls include:

• Gloves and good hand hygiene.
• RPE if animals are positive for infection.
• Vehicles have air filters to reduce the micro-organisms entering the cabs.
• The vaccination of animals.
• Utilising Salmonella-free pigs and poultry.

Question 12

1.4 - Outline Disease Risks and Controls for Office Workers

Answer 12

Risk of infection from their colleagues.

Open plan offices may dilute aerosols by sneezing colleagues. However, also increase exposure to infectious worker.

Controls Include:

• Good hand hygiene.
• Office cleaning procedures.
• Preventing staff from coming into work when symptomatic.

Question 13

1.4 - Outline Disease Risks and Controls for Transportation Workers

Answer 13

Risk of infection from other transport users.

Influenza.

Potential for spread may be greater as controls less likely to be in place.

Controls include:

• good hand hygiene
• surgical face masks
• Physical distancing

Question 14

2.0 - Describe The Basic Principles of the Bio-Psychosocial Model

Answer 14

The bio-psychosocial model of health and illness states that the interplay between:

• Biology: genetic makeup
• Psychology: mental health and behaviour
• Social World: socio-cultural environment

that determines people’s health-related outcomes.

Health promotion must address all three factors.

Health status, perceptions of health, and socio-cultural barriers all impact participation in health-promoting behaviours. (Diet, exercise, medical treatment)

Question 15

2.1 - Outline The Standards of Fitness to Work

Answer 15

Medical assessment done to determine if a worker can safely do a job or task.

Can handle work conditions

• After an illness or injury.
• After employment has been offered.
• As requested by the employer.
• As a condition of a job transfer or pre-placement

Clinical focus and clinical medical opinions. In some jurisdictions is illegal if used to exclude someone from job.

Assessment of the risk should be done before medical assessment, and any decisions about individuals should be objective and fair.

Well designed process will reduce risk and liability, avoid waste, discrimination, and exclusion.

Question 16

2.1 - Outline The Principles for a Fitness to Work Programme

Answer 16

Based on a risk assessment.

Aimed to match requirements worker to carry out that task.

Any tests and examinations should relate to an assessment of fitness for that task.

Should produce repeatable and consistent results.

Should apply equally to all who are required to do the work.

Must be safe and legal.

Question 17

2.2 - Outline The Role of Pre-Placement Assessment

Answer 17

• Ensures all new workers are fit for the job.
• May need to consider adjustments to assist the person in the role.
• Assess if the job may affect the new worker’s health, and if precautions are needed.
• Provides a starting point/baseline for future health comparisons.

The pre-placement assessment also offers the opportunity for new workers to:

• Understand their role more fully and be made aware of necessary precautions.
• Receive training on PPE.
• Introduction to the organisations H&S philosophy.

Question 18

2.2 - Outline The Benefits of Pre-Placement Assessment

Answer 18

• Pairing of applicant to the task.
• Discovery of health condition(s).
• Determines if any aids or adjustments that are needed (for example, sensory aids, special work stations, additional devices, relocation of a workstation, and/or special parking).
• A baseline for future measurements.
• Knowledge of family health problems lifestyle changes can be provided.
• Supervisors can be made aware of health conditions (for example, insulin-dependent diabetes, convulsive disorders).
• Compliance with local legal requirements for certain job categories.
• Measurement of psychological status.

Question 19

2.3 - Define Long-Term and Short-Term Frequent Sickness Absence

Answer 19

No common definition of long or short-term absence.

The UK National Institute for Health and Care Excellence (NICE) guidance defines:

• Short-term sickness absence less than four weeks.
• Recurring short-term absence is several episodes of absence, all less than four weeks.
• Long-term sickness absence more than four weeks.
• Recurring long-term absence is several episodes of absence, all more than four weeks.

Question 20

2.3 - Describe how Initial Enquiries should be made by the Employer.

Answer 20

Before 12 weeks (ideally after 2 to 6 weeks)

A suitably trained person should contact the worker:

• Reasons sickness absence.
• Have they received appropriate treatment?
• Will they return to work and when.
• Any barriers for returning to work.
• Do they need any adjustments made to accommodate their return.

Consider:

• worker’s age
• gender
• type of work they do.
• Incentives or financial issues which may encourage or discourage return to work.
• If a detailed assessment is needed to determine what interventions or services are required.
• Developing a return-to-work plan.

Question 21

2.3 - Describe Steps How a Detailed Assessment by the Employer Should be Carried Out.

Answer 21

The detailed assessment could include one or more of the following:

Getting specialist advice on diagnosis - more treatment, sick leave.

Use of a screening tool to assess likeliness of return.

A combined interview and work assessment.

Whether interventions or services are needed.

Developing a return-to-work plan.

Question 22

2.3 Outline the Steps to Taken in a Combined Interview and Work Assessment.

Answer 22

• Involve one or more specialists and the line manager.
• The worker’s health and social and employment situation: Organisational structure and culture (such as work relationships)
• How confident they feel about overcoming these problems.
• Previous experience of rehabilitation.
• Ability to carry out tasks.
• Any workplace or work equipment modifications needed.

Question 23

2.3 - Describe the Basic Principles of a Return-to-Work Plan.

Answer 23

Should identify the type and level of interventions and services needed (including psychological) and how frequently they are required.

It could also specify whether any of the following is required:

• A gradual return to the original job.
• A return to some of the duties of the original job.
• A move to another job within the organisation (on a temporary or permanent basis).

Question 24

2.4 - Define Vocational Rehabilitation

Answer 24

• Vocational rehabilitation is “a process that enables people with functional, psychological, developmental, cognitive, and emotional impairments or health conditions to overcome barriers to accessing, maintaining, or returning to employment or other useful occupation.”
• It’s whatever helps someone with a health problem to stay at, return to, and remain in work.
• Early intervention is central to vocational rehabilitation.
• Stepped/gradual approach - low cost, low intensity interventions

Question 25

2.4 Outline the Benefits of Vocational Rehabilitation.

Answer 25

• Fewer absences due to illness (20% to 60%).
• Rolls Royce estimated a saving of £11 million.
• Higher employment rates mean less welfare and taxpayer costs.
• Retention of staff.
• Workers who are working gain enhanced esteem.
• Workers who are working increased financial stability.

Question 26

2.5 - What does some evidence suggest that effective vocational rehabilitation depends on?

Answer 26

• Work-focused healthcare.
• Accommodating workplaces.
• Both are necessary. They are inter-dependent and must be coordinated.
• The concept of early intervention is central to vocational rehabilitation.

Question 27

2.5 - Give examples of issues could workers be concerned about before returning to work and how to address them?

Answer 27

• Returning to work will adversely affect their condition.
• May not be able to cope with the job demands.
• May not be support for them.
• Colleagues may not be sympathetic.

To remove these, and other, barriers employers should:

• Have a rehabilitation policy.
• Be able to offer suitable roles during the rehabilitation period.
• Provide help and advice (such as an occupational health nurse).
• Train managers and supervisors, to ensure they are able to manage the rehabilitation effectively and sympathetically.

Question 28

2.6 - Explain The Need to Undertake or Review Risk Assessments Prior to Return to Work.

Answer 28

• The work may be the primary cause of the sickness.
• It should be investigated like any other work-related injury.
• May not be work-related, but work could exacerbate the health condition.

A revised risk assessment must identify:

• Control measures to prevent a recurrence.
• If any job or organisational factors, that could prevent recovery or worsen the condition.

Question 29

2.7 - Outline Principles of Assessing and Managing Fitness for Work.

Answer 29

An assessment of fitness for work includes:

• The travel to and from.
• Activities carried out during work.
• The necessary interactions with colleagues.
• In some countries, a “Fit Note” is required from a doctor.

The Occupational Health staff can advise on the process, but cannot judge how that may fit with the possibilities available to the manager.

• Process best agreed individually for each person.
• May involve temporary assignment to alternative work within the department.
• Or a graduated re-introduction to the normal assigned work.
• Such arrangements are always temporary.
• Review progress regularly.
• Risk assessment (or a review of one) so rehabilitation does not expose worker to increased health and safety risks.
• HR usually in best position to judge the progress which someone makes if their work involves temporary secondment or assignment.
• Also can answer questions about salary structure and benefits, that may arise during extended absence.

Question 30

2.7 - Explain why it is better to return to work early.

Answer 30

• Workers are often able to begin doing restricted duties.
• Always better for people to keep in contact with their colleagues and their work as much as possible.
• To prevent loss of familiarisation.
• To maintain their interest in ongoing projects.
• Returning to work is the beginning of a rehabilitation process, rather than the end of recovery.

Question 31

2.8 - Explain The Role of Agencies that can Support Employers and Workers.

Answer 31

Many countries have vocational rehabilitation (VR) agencies that help individuals to meet their employment goals, and employers to rehabilitate workers.

Services include:

• Free services to manage work-related health issues.
• Free helpline.
• Free online health information including a health risk assessment tool.
• Help individuals with physical or mental disabilities to obtain employment.
• counselling.
• Medical and psychological services.
• Job training and other personalised services.

Question 32

3.0 - Outline The Role & Function of Occupational Health Services

Answer 32

The ILO Convention on Occupational Health Services (No. 161).

The ILO Recommendations on Occupational Health Services (No. 171).

Responsible for advising the employer, the workers, and their representatives on:

• Requirements for establishing and maintaining a safe and healthy work environment. Optimal physical and mental health.
• The adaptation of work to the capabilities of workers and their physical and mental health”.

The convention goes on to list the functions of an OHS, which are summarised as:

• Identification and assessment of the risks from health hazards in the workplace.
• Requires a systematic approach to the analysis of occupational “accidents”, and occupational diseases.
• Advising on planning and organisation of work and working practices, workplace ergonomics, choice, and maintenance of equipment and substances used at work.
• Providing advice, information, training and education, on occupational health, safety, hygiene, ergonomics, and on protective equipment.
• Surveillance of workers’ health in relation to work.
• Contributing to occupational rehabilitation and maintaining in employment people of working age.
• Assisting those who are unemployed because of ill-health or disability to returm to work.
• Organising first aid and emergency treatment.

Question 33

3.0 - Outline The Benefits of Occupational Health Services

Answer 33

• Protects and promotes the health and wellbeing of the working population.
• Creates a healthier workplace and a healthier workforce.
• Early intervention to help prevent absenses from ill- health.
• Provides support to effective absence management.
• Fulfils any national legal requirements.
• Helps maximise the productivity.
• Encourages the workforce to stay longer in active life.
• Enhances workers’ commitment to the business.
• Demonstrates business is socially responsible.
• Protects and enhances brand image and brand value.
• Helps businesses to meet customers’ health and safety expectations.
• Helps to reduce business costs and disruption.

Question 34

3.1 - Outline The Make- Up and Roles of a Typical Occupational Health Service

Answer 34

Importance of Determining Competency of the OHS.

• Processes to measure and record OSHW’s competence to carry out the proposed tasks by peer review, clinical audit, and outcome audits.
• OHSWs should maintain a personal development file which demonstrates their attainment of specific task-orientated skills.
• Must also ensure that they take part in an annual appraisal, and undergo a periodic clinical audit process.

The Occupational Health Physician.

• Role is to protect and promote the health and working ability of workers.
• The occupational physician is an expert adviser, sometimes part of the enterprise’s senior management team.
• They can assist in planning the work process with regard to health and safety, legal requirements, good business and human resources practice.
• The prime responsibility for the health and safety of workers rests with employers.
• The occupational physician cooperates with many professionals inside and outside medicine, within the broad disciplines of health and safety, especially with senior management, legislators and government.
• There must be proper arrangements in place to ensure they are competent.

The Occupational Health Nurse.

• The role of the specialist occupational health nurse is primarily orientated towards:
• The prevention of occupational injury and disease through a comprehensive pro-active occupational health and safety strategy.
• The promotion of health and work ability.
• Improving environmental health management.
• In some European Member States, occupational health nurses are required by legislation.

The Occupational Health Technician.

• Employers train an existing worker to take on basic OH responsibilities.
• Competent supervision required.
• Technicians should work under professional supervision within the guidance of established protocols and procedures.
• The role is likely to include agreed health screening and surveillance, health education and collection of health data.
• A registered OH practitioner would give employers flexibility to offer more to their workers.

Responsibilities can be to:

• Measure blood pressure, pulse, height and weight, including Body Mass Index.
• Do urinalysis.
• Interpret new starter questionnaires.
• Do audiometry.
• Measure visual acuity to occupational standard.
• Measure colour vision to occupational standard.
• Do lung function testing to include peak flow and spirometry.
• Assess mobility.
• Do drug and alcohol testing.
• Keep records.
• Use communication and IT skills.
• Venepuncture.
• ECG.
• Interpretation of food handler questionnaires.
• Chester step test.
• Skin assessment.
• Hand Arm Vibration Syndrome (HAVS) Assessment to level 1 and 2.
• Occupational health hazards and risk management.

Occupational Health Adviser.

• Are not a qualified doctor or physician, sometimes they are a qualified nurse.
• The main role of the adviser is to provide good quality advice and support to the organisation’s management.
• OH Advisers also help formulate the organisation’s vision for OH management. If the Senior Management agree with it, the OH Adviser then creates and implements the plans.

Question 35

3.2 - Outline the Typical Services Offered by an Occupational Health Service

Answer 35

Health promotion:

• Provision of advice on how to remain healthy. i.e.; diet etc
• To be successful, health promotion must have the participation of workers, management, and other stakeholders.
• Tend to focus on a single illness or risk factor (e.g. prevention of heart disease)
• There are multiple determinants of workers’ health. Personal, environmental, organisational, community, and societal factors on worker well-being.

Health Assessment.

Fitness for Work:

• Ensure an individual is fit to perform the tasks involved without risk to their own or others’ health and safety.
• It is not the intention to exclude a person from a job.
• To make any necessary reasonable modifications or adjustments to the job.
• An assessment may be required when:
• The individual’s health condition may limit or prevent them from performing the job effectively (e.g. musculoskeletal conditions that limit ability).
• The individual’s condition may be made worse by the job.
• The individual’s condition may make certain jobs and work environments unsafe to them personally.
• The individual’s condition may make it unsafe both for themselves and for others in some roles

Employment health assessment:

• In some countries (such as the UK and the Equality Act 2010) it is illegal for prospective employers to ask questions or issue health questionnaires as part of the recruitment process.
• Still permitted to make job offers conditional on satisfactory health checks.
• Employers may still ask health questions and require ­workers to do medical checks once a job has been offered.
• May lead to the organisation making reasonable adjustments to the person’s work or workplace.

Return to work.

• Reduce the risk of the absence becoming long-term. (1 month)
• Keeping in regular contact with the worker.
• Reviewing the situation.
• Return to work discussions.
• Staged return.

Job-related medical screening:

• This is a means of ensuring that workers do not have a health condition that could be detrimental to them carrying out a job or certain tasks.
• Pregnant workers.
• Is pregnant.
• Has given birth within the last six months.
• Is breastfeeding.
• Reduced hours, temporarily stopping shift work, removal from contact with certain hazardous agents, etc.
• Things to be considered during the assessment include:
• Physical risks:
• Chemical/Biological risks:
• Working conditions:
• Lifting and handling:
• Sitting or standing:

Advice to Management.

• Having an input to risk assessments where health issues are involved.
• Advising on health policy (such as smoking policy, or drugs and alcohol policy) and advising of promotion campaigns.
• Absence management.
• Treatment Services. eg. First Aid.
• Dental and Physiotherapy services.
• Counseling.

Health Surveillance.

Health surveillance is a way of monitoring any possible ill-health effects that could be related to work exposures.

Question 36

3.3 - Outline The Benefits of Health Needs Assessment.

Answer 36

The purpose:

• To identify the type and level of occupational health resources and services required to manage those issues.
• Raise issues, highlight problem areas, and engage workers and management.
• Should reflect the business plan objectives.

Should include:

• An analysis of each job, work processes, and associated potential hazards.
• The demands of the job, both physical and psychological.
• How an individual’s health may affect their work.
• Potential adverse effects on an existing health condition.
• Identifying when specific fitness standards are required and why.
• Consideration of special cases, such as age, pregnancy, and disability.

The benefits:

• A full understanding is obtained of workplace health risks.
• Planning of resources based on accurate information, which results in cost effective solutions.
• Management demonstrate a commitment to protecting the health of the workforce.

Question 37

3.4 - Explain The Importance of Auditing against Standards in Occupational Health Provision.

Answer 37

• “Safe, Effective, Quality Occupational Health Service” (SEQOHS) is a set of standards and a voluntary accreditation scheme for occupational health services in the UK and beyond.
• Demostrates Occupational health service provider has demonstrated that it has the competence to deliver the measures in the SEQOHS standards.
• The benefits of being audited and accredited against the SEQOHS standards are:
• Provide independent and impartial recognition that provider demonstrated competence, providing external validation, and a badge of quality.
• Identify good practice so that it may be furthered and built upon.
• Identify sub-optimal practice so that it may be improved.
• Provide a standard for all services to work towards, improving consistency across services.
• Identify gaps in existing services so that they may be remedied.
• Identify the staff and other resources required to deliver an effective service.
• Gather workload data systematically to inform optimal use of resources.
• Encourage networking through appropriate professional societies and groups.
• Establish evidence-based local referral guidelines and indications for referral.
• Develop cost-effective management guidelines and standardise care.
• Inform efforts by workers to get the local services workers require.