concept of occupational health has greatly changed from
yesterday’s concept of industrial health and now it is fast
changing to environmental health because of greater awareness of
the ecological problems arising from rapid industrialisation, the use of
complex processes and hazardous chemicals in industries, and
International Labour Organisation/World Health Organisation Committee on
Occupational Health, in the course of its first session held in 1950
stated: "Occupational health should aim at the promotion and maintenance
of the highest degree of physical, mental and social well-being of workers
in all occupations; the prevention among workers of departures from health
caused by their working conditions; the protection of workers in their
employment from risks resulting from factors adverse to health; the
placing and maintenance of the worker in an occupational environment
adapted to his physiological and psychological equipment, and, to
summarise, the adaptation of work to man and of each man to his job."
The first book on occupational medicine, De Morbis Artificum Diatriba
(meaning “Diseases of Workmen”), was published in 1700 in Italy by the
“father of occupational medicine” Bernardino Ramazzini (1633-1714). It
contained accurate descriptions of occupational diseases linked to various
types of jobs.
Then came the Industrial Revolution in England (1760-1830), which gave
pace to the occupational health movement. Dr. Alice Hamilton played a
great role in the development of industrial hygiene in America during the
early part of the 20th century. The Office of Industrial Hygiene and
Sanitation was established in 1914 in the USA. In 1919, the ILO came into
being in Geneva, Switzerland, with a Department of Occupational Safety,
Health and Welfare. Subsequently, the WHO in Geneva, Switzerland, also set
up a Department of Occupational Medicine.
The first Factories Act was passed in 1881 in British India. The act was
amended in 1891, 1911, 1923, 1934 and 1948 to bring the legislation in
line with that of the British Factory Act. The Bhopal Gas tragedy (1984)
was a turning point towards legislation pertaining to occupational health
and safety in India. The Factories Act was amended (1987) and stipulated
the qualifications/strength of occupational health staff in hazardous
industries. At present 29 diseases have been included as “notifiable”
occupational diseases under this Act.
There is a dearth of qualified occupational health physicians in our
country. Awareness about occupational health is at a low level even in the
organised sector. Most affected is the unorganised and small-scale sector.
The Indian Association of Occupational Health is the leading NGO in the
field of occupational health in India.
THE CAUSES OF OCCUPATIONAL DISEASES:
There are various modes of development of occupational diseases. Some are
only occupational in origin, such as silicosis or asbestosis, which are
caused by exposure to silica dust or asbestos fibres, respectively. In
some diseases the occupation is one of the causal factors whereas in
others the occupation is a contributing factor (for example: chronic
bronchitis). There are also cases in which an individual’s occupation may
aggravate a pre-existing condition (as in bronchial asthma).
may be exposed to five types of hazards, depending upon his/her
hazards: Heat, cold, light, noise, vibration, ultraviolet radiation
and ionising radiation are all known to give rise to problems if the
individual is exposed to levels beyond acceptable limits without
hazards: Toxic, corrosive, allergenic and carcinogenic chemicals act
by local action, inhalation and ingestion on exposure to concentrations
beyond the threshold limit value (TLV).
Biological hazards: Workers may be exposed to infectious and parasitic
agents at the workplace. Persons working with animal products and
agricultural workers are likely to be exposed to biological hazards.
Mechanical hazards: The mechanical hazards in industry centre round
machinery, protruding and moving parts and the like. About 10 per cent of
industrial accidents are due to mechanical causes.
Psychosocial hazards: These arise from the workers’ failure to adapt
to an alien psychosocial environment. Frustration, lack of job
satisfaction, insecurity, poor human relationships and emotional tension
are some of the psychosocial factors that may undermine both the physical
and mental health of workers.
In addition to
the above, new technologies like video display units and computers also
bring with them new hazards and problems such as repetitive strain injury
or musculoskeletal disorders if not used properly. Ergonomics plays an
important role in the prevention of such diseases.
THE ROLE OF OCCUPATIONAL HEALTH SERVICES (OHS):
The scope of occupational health services includes
preventing occupational hazards at work, protecting workers
against hazards at work, help in adapting work and the work
environment to the capabilities of the worker, promoting the
physical, mental and social well-being of workers, and cure and
rehabilitation of accidental occupational injuries.
objectives of the OHS may include the following:
Occupational Health should get the importance and
attention it deserves. OHS should adopt proactive strategies for medical
surveillance of workers in the industry. These need to extend beyond
statutory provisions to promote the working capacity and health of the
employees. The OHS department should regularly undertake health promotion
campaigns. It can initiate special programmes or monitoring for employees
suffering from chronic diseases like diabetes, hypertension, etc., to
prevent complications and preserve productivity of employees.
STATUS OF OCCUPATIONAL HEALTH IN INDIA:
India has a population of over 1 billion, approximately 33 per cent of
which is working class. Out of more than 2 lakh registered factories
around 5,000 are classified as chemical industries with more than 5 lakh
Apart from large and medium industries, small industries play an important
role in the economy of the nation. The small-scale sector contributes 45
per cent of the country’s total production.
The Ministry of Labour, Government of India, is responsible for matters
relating to the safety, health and welfare of workers in the country and
it also administers the relevant statutes/legislation, and the
occupational health care system. A large portion of the working population
is employed in the unorganized sector like agriculture and allied fields,
whose occupational health needs have not been addressed so far. Hence,
promoting the occupational health of the country’s large workforce is a
Given the country’s vast human resources potential, the Government of
India has accorded a prominent position to occupational safety and health.
The Directorate General, Factory Advice and Labour Institutes, Mumbai,
under the Ministry of Labour, Government of India, provides statutory
regulations, assistance to the enforcing agencies, training and education
in thefield of occupational health and safety, and conducts occupational
health studies to assess the prevalence of occupational health disorders
and occupational diseases. The State-level health care of workers is
ensured by medical inspection services of the State Factory Inspectorates
and medical examination by the certifying surgeons.
In the industrial population, health care is usually provided by the
management through the Employees State Insurance Scheme. As per the
amended Factories Act, provision of an Occupational Health Centre is
mandatory in factories carrying out hazardous processes. Many progressive
industries have established preventive occupational health services to
look after their workers’ occupational health needs.
CHALLENGES IN THE 21st CENTURY:
With new and sophisticated technology and newer work methods, systems and
processes, the occupational health of the worker has come under severe
stress. Outsourcing of manufacturing activities from developed to
developing countries has added new dimensions on the health front.
Globalisation of manufacturing practices is resulting in cross-border
transition of the workforce from one country to another causing tremendous
stress in terms of cultural conflicts, new health and environmental
hazards and other psychosocial problems. In addition, as more hazardous
industries are set up in the country, the environmental pollution
increases as do accidents, occupational diseases and catastrophic risks.
The approach towards health is now changing from cure to prevention. The
engineering approach is to ensure safer processes, an integrated systems
approach and better occupational environment, whereas the medical approach
emphasizes identifying the health risks and their prevention. Ergonomic
interventional techniques are receiving due importance in the prevention
of occupational diseases.
There is an increasing use of Information Technology for mass awareness
and education. The Government as well as enterprises are formulating
comprehensive health, safety and environment policies. While enterprises
are trying to integrate health and safety management systems with quality
assurance systems, the progressive governments are aiming at the
integration of occupational health with primary health care in the
country. We need to develop a national network on occupational health in
Looking at the trend of globalisation, we need technical cooperation and
collaboration in OHS matters at the global level.
In this integrated and interdependent global market environment, safety,
health and environmental issues are going to be transnational, and the
challenges in the field of occupational health are going to be enormous.
Therefore, we as a nation, i.e. the Government, employers and employees
have to wage a total war on occupational diseases
through various multidisciplinary interventions and proactive strategies
to promote occupational health and improve the quality of work-life of our