Far from enough: to tackle occupational disease all parties need to be involved

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Regardless of progress made during the past years, the number of people dying from work-related disease is significant. To improve occupational health in Britain we need to recognise the complexity of its causes and get each party involved.

Tackling occupational disease, including cancers and respiratory diseases, is high on HSE’s agenda. While the number of workplace fatalities continue to drop, the number of people dying prematurely each year because of occupational disease is still a significant problem.

Around 13,000 deaths from lung disease and cancer each year are estimated to have been caused by past occupational exposure, primarily to chemicals and dust at work. Current estimates, based on 2005 data, suggest there are at least 8,000 occupational cancer deaths each year in Great Britain. More than half of these cancer deaths were caused by past exposures to asbestos (either mesothelioma or asbestos-related lung cancer). The other significant categories of occupational cancer are lung cancer due to silica, diesel engine exhaust emissions, mineral oils and breast cancer due to shift work.

The term occupational respiratory disease covers a range of illnesses that are caused or made worse by breathing in hazardous substances at work that can damage the lungs. Exposure to dusts, fumes and gases at work can all cause harm if they are regularly inhaled; prolonged exposure can cause workers to die early, can permanently damage their lungs and drastically reduce their quality of life. The most common work-related respiratory diseases are chronic obstructive pulmonary disease (COPD), silicosis and asthma.

Research has suggested there are around 4,000 occupational COPD deaths currently each year in Great Britain and in 2013 there were an estimated 177 new cases of occupational asthma (asthma caused directly by work) seen by chest physicians. However, this is likely to be an underestimate, as other data sources suggest the total number of new cases in the wider category of work-related asthma (asthma caused or made worse by work) each year could be more than 10 times higher than this.

These diseases can have a devastating impact on an individual, and their family, preventing normal daily activity and can lead to various complications that can ultimately be fatal.

In 2013/14 an estimated 1.2 million people in the UK were suffering from an illness they believed was caused or made worse by their current or past work and 23.5m working days were lost due to work-related ill health.

Some cases of ill health, such as mesothelioma, can be clearly related to past work activities, for example in workers undertaking textile and gasket manufacture or in shipbuilding. For others the cause may be less clear.  There can be a period of up to 30 years between exposure and development of ill health and/or disease, making the links even more difficult to establish. This also means that after recognising the problem and making changes in working practices to reduce exposures there may be a long delay before a reduction in cases of ill health and death is realised. 

A bit better than the neighbours
When compared to other EU countries, the UK’s performance on occupational ill health appears positive. Rates of ill health resulting in sick leave were lower in the UK than in most other EU countries in a comparison with the most recent Eurostat standardised ill-health rates (2007). In the UK 2.9% of workers reported a work-related illness that resulted in sick leave, compared with 3.9% in Germany, 4.2% in Spain and the overall EU rate of 5.5%.  International comparison based on the Health and Safety Risk Index placed the UK as the sixth lowest-risk country out of 172. However, there is still much work to be done.

The regulatory framework is well established, for example, the Control of Substances Hazardous to Health Regulations (COSHH) require employers to prevent or control employee exposure to hazardous substances at work and there is a wealth of guidance from HSE available to assist employers, including a newly-updated Approved Code of Practice. COSHH has been in force for 25 years, and the statistics suggest that during this time there has been a reduction in the overall prevalence of work-related breathing and lung problems.

Many highly toxic substances such as vinyl chloride, formaldehyde and benzene are now rarely used or banned – legislative changes have resulted in many of these substances being phased out or restricted. However, there are still a number of industries and workplace activities with a high incidence and greater risk of occupational disease. These include construction, agriculture, welding, foundries, quarrying and stone working.

No job for one person
Occupational disease is a difficult topic to address and requires a long-term, sustained effort by a mix of different people and in some cases greater understanding of the nature of the links with work activity.

In March 2013 HSE brought together professionals from across the whole spectrum of health and safety to discuss and develop innovative ways to help prevent occupational disease. Just as with every other aspect of driving up health and safety performance, we cannot tackle things alone. We need a mix of public, private and third sector employers to work together tackling these issues and ensure that we have a range of activities in place if we are to make progress.

To improve occupational health in Great Britain, all of us should do what we are best placed to do to change the way we work.

HSE will continue to provide expert advice and guidance; it will inspect, investigate and of course prosecute those who flout the law and put people at risk. We will also continue to run initiatives to raise awareness, such as the recent Beware Asbestos campaign. However, if we can develop a common understanding of the challenges we face, we can better understand what we all might realistically achieve. We must identify issues and focus on solutions, share good practice, develop ideas and build networks that together tackle the root causes of occupational disease.

We are not starting from a blank page; work has already begun to address the issues. Over the last few years HSE has been working successfully with partnership groups within defined industry sectors. These partnerships are composed of large and small businesses, trade associations, unions, training organisations, suppliers and professional bodies, etc. The Construction Dust Partnership recently held events focusing on promoting improvements in controlling construction dust (primarily respirable crystalline silica); the Welding Fume Team have developed the ‘Badairday’ website and a Hazard Information Pack for welders; and the Quarries Partnership Team, with funding from HSE, recently developed an award-winning online animated film to highlight the health risks associated with respirable crystalline silica in quarries.

Despite all these interventions we cannot afford to be complacent and there are still many challenges ahead.

Gill Smart is a senior policy adviser in the Health and Safety Executive's Long Latency Health Risks Division.



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