Introduction to Occupational Health

Dr Alishna Jeyaratnam
Occupational Health Doctor & Health Screening Doctor

Definition of Occupational Health

The World Health Organization (WHO) and the International Labour Organization (ILO) define Occupational Safety & Health (OSH) as the promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations, the prevention of workers from leaving their jobs due to their working conditions, the protection of workers in their employment from risks resulting from factors adverse to health, and the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological capabilities.

Brief History

The father of OSH, Bernadino Ramazzini, a physician in Italy during the late 17th century, wrote the first comprehensive documentation of occupational diseases, De Morbis Artificum Diatriba (1760; Diseases of Workers), detailing health hazards workers were exposed to in 52 occupations.2 Sir Percival Pott, a surgeon in the 18th century, was another prominent figure in the early development of OSH. He was the first to associate cancer with occupational exposure, also widely known as ‘chimney sweep cancer’ (scrotal cancer).

Prevalence of Occupational Disease in Malaysia

Figure 1. National Occupational Accident and Disease Statistics 2021.

Sourced from Department of Safety and Health (DOSH) and SOCSO (Social Security Organisation).

Data obtained from the Department of Statistics Malaysia (DOSM) as seen in Figure 1 shows a total of 5,289 cases of occupational diseases and poisoning in 2021. The most prevalent ones are occupational noise-related hearing disorders, diseases caused by biological agents, and occupational musculoskeletal disorders. 

Legal Provisions

The OSH discipline in Malaysia is guided by several legal provisions, including the Occupational and Safety Act (OSHA) 1994, the Factories and Machinery Act 1967, Food Act 1983, the Atomic Energy Licensing Act 1984 and the Pesticides Act 1974, among others. The OSHA 1994 is a relatively flexible act that emphasises that the responsibility to ensure safety and health lies with those who create the risk and those who work with the risk, requiring joint responsibility from employers, employees and the government itself. The act covers all industries excluding the armed forces and crews on shipping vessels.

Three important regulations to take note under the OSHA 1994 are the Use and Standard of  Exposure of Chemicals Hazardous to Health (USECHH) Regulations 2000, the Noise Exposure Regulation 2019 and the Notification of Accidents, Dangerous Occurrences, Occupational Poisoning and Occupational Disease (NADOPOD) 2004. The USECHH serves to provide a legal framework for the employer to manage chemicals hazardous to health with respect to their usage and to set workplace exposure standards to protect employees at work. The regulations apply to all places of work covered by the OSHA 1994 except for the ones dealing with chemicals that are defined as radioactive materials, foodstuffs, pharmaceuticals, explosive/flammable properties and exposure to low temperature/high pressure. The duties of employers stated in the regulations are:

• Identifying chemicals hazardous to health 
• Complying with the permissible exposure limits 
• Carrying out chemical health risk assessment
• Taking action to control hazardous exposure
• Labelling and relabelling chemicals hazardous to health 
• Providing information, instruction, and training
• Monitoring employee exposure at the place of work
• Conducting health surveillance
• Posting of warning signs 
• Record keeping

The employer shall ensure that no individual is exposed to any chemical hazard above the ceiling limit at any one time or the 8-hour time-weighted average airborne concentration as specified by the regulations. Assessment of risk to health is carried out by a registered assessor before doing any work involving chemicals hazardous to health. Deviations from provisions of these regulations will lead to a fine not exceeding RM10,000 or imprisonment for one year (maximum).

The Noise Exposure Regulations 2019 works to protect individuals at the workplace from exposure to excessive noise. The employer is responsible for appointing a noise risk assessor (NRA) who conducts noise risk assessments. The NRAs will then submit a report on their findings and recommendations based on their expert assessments to the employer involved within a month. Recommendations should be implemented within 30 days of receiving the report. The employer should also provide yearly training and supervision to employees exposed to excessive noise. The employer must also equip employees with proper personal hearing protection gears and provide audiometric testing for employees (within 3 months after said employee has been exposed to loud noise at work) at no cost to the employees. The penalty for not complying with set regulations will lead to a fine of RM10,000 or imprisonment for a term not exceeding a year or both.

The NADOPOD 2004 provides a legal framework for employers to notify, report and keep record of work related to accidents, dangerous occurrences, occupational poisonings, and occupational diseases that had taken place at work. Any occupational accident involving dangerous occurrences, serious bodily injury, or death needs to be reported to the local DOSH office as soon as possible, via phone/fax. A written report must be submitted within 7 days. Any cases of occupational poisoning and occupational disease should also be reported to the local DOSH office within 7 days after being diagnosed by a registered medical practitioner. Failure to comply can lead to a fine not exceeding RM10,000 or imprisonment for a year or both.4

There are several OSH-related agencies in Malaysia including the:

• Department of Occupational Safety & Health (DOSH, Malaysia), which is generally in charge of enforcement of regulations.
• National Institute of Occupational Safety and Health (NIOSH, Malaysia), which handles training and research related to OSH
• Social Security Organisation (SOCSO) that deals with compensation and rehabilitation.

These three agencies are nestled under the umbrella of the Ministry of Human Resources Malaysia. The Ministry of Health (MOH) serves as the medical board for OSH in Malaysia.4 

The Role of the Occupational Health Team

The Occupational Health Team usually comprises of an occupational health doctor and nurse, industrial hygienist, occupational toxicologist and health epidemiologist, noise risk assessor, medical specialist, safety and health officer, ergonomic risk assessor, physiotherapist, etc. The occupational health doctor shoulders vital responsibilities that include:

• Providing advice to management regarding health legislation and compliance
• Health promotions and surveys
• Medical examinations (pre-employment & pre-placement assessment ) 
• Medical surveillance
• Assist in the management of Occupational Diseases & Poisoning including removal from work, treatment, rehabilitation, disability assessment, return to work and / or compensation.
• Notification of occupational disease and injuries to DOSH & employer 
• Record keeping

Occupational Hazards

Occupational hazards come in many different forms and include physical, biological, chemical, psychological, and ergonomic hazards. Examples under each category is as explained by the diagram below.

Figure 2. Types of occupational hazards.

Adapted from Guidelines on Occupational Health Services, Department of Occupational Safety and Health, Ministry of Human Resources, Malaysia, 2005.

The HIRARC (Hazard Identification, Risk Assessment and Risk Control) is used to identify, assess and control hazards/risks at the workplace. Figure 2 explains the general flow of the HIRARC process. 

Figure 3. The HIRARC process.

Adapted from Guidelines on Occupational Health Services, Department of Occupational Safety and Health, Ministry of Human Resources, Malaysia, 2005.

Hazard identification is done via first aid and minor injury records, workplace inspection report, employee complaints and reports, job hazard analysis and accident investigations. This is followed by risk assessment and control. 

Risk assessment is carried out based on likelihood of mishaps and potential severity of damage caused by them. 

Table 1 below shows how risk stratification is done with these two components.

Table 1. Risk assessment based on likelihood of incidence and severity of damage to individual health, environment and property.

Adapted from Guidelines on Occupational Health Services, Department of Occupational Safety and Health, Ministry of Human Resources, Malaysia, 2005.

Risk control is then achieved with the guide of hierarchy of controls as shown in Figure 4.

Figure 4. Hierarchy of controls

Adapted from Guidelines on Occupational Health Services, Department of Occupational Safety and Health, Ministry of Human Resources, Malaysia, 2005.

Medical Surveillance

This refers to the systematic monitoring of the health of employees who are exposed to a particular occupational health hazard at regular intervals. It is usually achieved via thorough clinical examination and laboratory tests/imaging. 

The purpose of medical surveillance is to identify how often occupational diseases/injuries affect employees besides detecting patterns of illness due to occupational exposure. It is also vital to ensure that health programmes and controls for health risks are effective.5

In a nutshell, OSH is a multidisciplinary entity that safeguards both employers and employees in the pursuit of safe working conditions by means of enforcement, training, outreach, education, and assistance. 

References

1. Occupational Health (Occupational Safety and Health) [Internet]. Ilo.org. 2019. Available from: https://www.ilo.org/safework/areasofwork/occupational-health/lang–en/index.htm
2. Bernardino Ramazzini | Biography & Facts | Britannica [Internet]. www.britannica.com. [cited 2021 Nov 14]. Available from: https://www.britannica.com/biography/Bernardino-Ramazzini
3. Sir Percivall Pott | English surgeon [Internet]. Encyclopedia Britannica. [cited 2020 Sep 10]. Available from: https://www.britannica.com/biography/Percivall-Pott
4. Guidelines on Occupational Health Services, Department of Occupational Safety and Health, Ministry of Human Resources, Malaysia, 2005.  
5. Guidelines on Safety and Health (Notification of Accident, Dangerous Occurrence, Occupational Poisoning and Occupational Disease) Regulations 2004 (NADOPOD)
6. Guidelines on Occupational Safety and Health Act 1994, Department of Occupational Safety and Health, Ministry of Human Resources, Malaysia, 2006.