10. HEALTH RISKS IN THE OCCUPATIONAL ENVIRONMENT AND THEIR CONSEQUENCES |
10.1 Organization of monitoring activities
This subsystem includes the follow-up of health-impairment amongst the workforce as a consequence of harmful factors in the occupational environment. In question is a newly introduced subsystem which includes nationwide monitoring data on the incidence of occupational diseases as well as that of occupational disease outbreak threats (monitoring of health effects), exposure monitoring (categorization of jobs and workplaces), and monitoring the negative influence of selected working conditions and the occupational environment factors on the health of the work-force. Namely, this is a question of unilateral, long-term and excessive physical load as well as exposure to chemical carcinogens, including the establishment of a database of workplaces and jobs where such substances are present.
Breakdown of subsystem VII:
10.2 Monitoring of health data on occupational diseases and job categorization
10.2.1 Monitoring of health effects
The register of occupational diseases and occupational disease threat
In 2003, 1,558 cases (972 males and 586 females) of occupationally-associated medical problems were reported in the Czech Republic; of these, 1,486 were occupational diseases and 72 occupational disease threats. In comparison with 1996–2002, the decreasing trend in incidence as well as overall number of reported occupationally-associated problems continued. The incidence of occupational problems (35.5 per 100,000 employees) dropped by 0.3 cases against 2002. The drop was primarily in occupational diseases, the number of reported cases being 45 cases (2.9 %) less than in 2002. On the other hand, the number of occupational disease threats increased by 3 cases (4.3 %). The trends in notified occupational diseases in recent years is presented in Tab. 10.1 and Fig. 10.1.
Once again, in 2003, the greatest number of reported occupational-linked health problems have come from the Moravian-Silesian Region (307, i.e. 19.7 % of cases). There the majority of cases were due to physical factors (182 cases). In question were primarily diseases due to vibrations (100 cases) and diseases due to long-term excessive unilateral load of the extremities (55 cases).
Just as in 2002, most occupationally-associated health problems originated in the healthcare sector (OKEČ N85 – 225, i.e. 14.4 % of cases). Coal mining (OKEČ C10) with 218, i.e. 14.0 % of cases reported, was in second place. The greatest increase in occupationally-associated problems (by 28 cases, i.e. by 38.4 %) in 2003 was recorded in the food and drink industry (OKEČ DA15). In 2003, the majority of occupationally-linked diseases were caused by physical factors. In decreasing frequency, there followed respiratory tract and pulmonary diseases, skin diseases, infectious and parasitic diseases, diseases caused by chemical substances, and diseases caused by other factors. The proportion of individual diseases according to the List of Occupational Diseases in the overall statistic is documented in Fig. 10.2, the distribution of occupational diseases in the regions in Tab. 10.2 and Figs. 10.3a and 10.3b.
The most frequent diagnoses among occupational diseases were pneumoconiosis due to particulate matter containing free silicon (item 3.1 – 168 cases) and injuries to the peripheral nerves due to excess load of the extremities (158 cases) and due to vibrations (132 cases). Impaired hearing due to noise (22 cases, i.e. 30.6 %) and peripheral nerve damage due to vibrations (20 cases, i.e. 27.8 %) were the most frequent occupationally-linked problems.
10.2.2 Monitoring of exposure
Monitoring exposure to individual factors in working conditions based on categorization of jobs and workplaces
During 2003 there continued the processing of drafts for the categorization of jobs and workplaces submitted by employers and the publishing of decisions by public health institutions. Finalization of this phase of occupational categorization is expected during 2004 in view of the supplementation of Decree No. 89/2001 Dig. by Decree No. 432/2003 Dig., which in part has changed categorization rules.
Selected data has been confirmed to enable follow-up and evaluation of the degree of exposure to individual factors according to working conditions in each district and region, including nationwide summaries. On the basis of analyses carried out in the Information System of Job Categorization it follows that in all as of May 13, 2004, there were included in categories 2, 2R, 3, and 4 a total of 1,548,636 persons, i.e. 32 % of all employees, that being 49,853/100,000 of the population. In the jobs at risk category (2R, 3, 4) 351,000 persons are registered representing 11,350/100,000 of the population. In category 4, workplaces at increased risk, 17,519 subjects are registered, i.e. 565/100,000 of the population, of those 1,920 are females.
The greatest number of employees exposed to hazardous work conditions is in Prague – 193,857; in the Ústí n/L region – 162,195; in central Bohemia – 150,912; in South Moravian – 147,727; and in the Olomouc region – 144,189. In relative figures, i.e. in calculations per 100,000 of the population, only four Regions do not exceed the nationwide average of 49,951 employees. The number of exposed employees in categories of work at risk (2R, 3, 4) by regions is presented in Table 10.3 and depicted in Fig. 10.4a.
The majority of exposed employees of all categories (2, 2R, 3, 4) are in the Physical Load file – 672,776 subjects, Mental Load – 591,691 subjects, and Noise – 563,815 subjects. At work under risk (2R, 3, 4) the majority of employees are categorized under risk factor Noise.
In Tab. 10.4 are presented the numbers of persons exposed simultaneously to 1–4 factors and to more than 4 factors. From the figures presented it follows that about one third of employees are exposed to more than one factor. Seven percent are exposed to more than four factors.
Of the overall number of 4,764,000 employees (Statistical Yearbook of the Czech Republic 2003), 32.5 % are registered under categories 2, 2R, 3, 4; and 7,4 % at work under risk (2R, 3, 4). The figures presented should be considered as being preliminary because the registration of jobs and types of work has not been finished yet.
10.3 Monitoring of selected parameters of exposure and health effects
10.3.1 Monitoring the health effects of selected occupational factors
Monitoring of excessive unilateral burden in relation to damage of the locomotion system
In the course of 2003 there has continued the task focused on the monitoring of professions that have an expected risk of local muscular overburdening. Attention has been devoted to activities that are presently being discussed in connection with the overburdening of the locomotor apparatus at work. The monitored types of jobs were based namely on the requirements of the public health service in connection with job categorization as to the local muscular load factor.
In the course of the year 2003 there have been newly assessed and evaluated the following types of activities: female warehouse workers, butcher in meat portioning, cashier in shopping malls, design engineer, and female clerks of the court. Besides rendering objective the work load and working conditions there has also been monitored the occurrence of subjective complaints and objectively proven disorders in the locomotory apparatus, in which profession-linked etiology is presumed to play a great role.
At selected workplaces there has been carried out the measuring and evaluation of the local muscular load of the forearm flexors and extensors by integrated electromyography. With all the employees at the selected workplaces, through structured interview, there has been filled in a questionnaire focused on subjective health complaints concerning the locomotion system to enable an assessment of the mutual relationship between their occurrence and working conditions. One of the objectives was to verify whether it is possible to utilize the increased occurrence of subjective complaints in workers as an auxiliary indicator of increased risk at work. Part and parcel of the project was also the examination of the locomotion apparatus as it is performed at the office of the enterprise physician. Another partial objective is to utilize thus obtained information also for the determination of the frequency and content of preventive physical examinations at workplaces that are at risk from the point of view of local muscle load. Investigated was also the influence of time factors (shift work, over-time hours, 12-hour shifts) on the appearance of subjective health complaints, objective findings, and eventual manifestations of disease.
In the year 2003 there has been carried out the measuring and evaluation of the local muscular load in the upper extremities and an overall evaluation of subjective complaints and objective findings regarding the locomotor apparatus in connection with various types of working activities at two industrial plants (sub-contractors in the automobile industry). In one of them, from the point of view of health risks, the key problem is the burden on the locomotion apparatus, in the other it is the characteristic work at assembly lines connected with a high rate of repetition tasks and great numbers, a high work tempo and monotony.
A similar evaluation has been carried out in a control group of subjects who do not work under conditions of local overburdening of the locomotion apparatus. The control series was selected in view of the same basic characteristics such as life style, locality of residence, age structure, etc. like in the exposed group. The results of the assessment in the control group should serve the comparison of the occurrence of each type of complaint concerning the locomotion apparatus in subjects with a presumed professional load and without it.
The obtained results of the measuring and evaluation of the local muscle load and of working conditions in view of overburdening of the locomotion apparatus have been utilized foremost as documentation for the overseeing organ of public health protection in carrying out the categorization of jobs in the given types of work. At the same time they have been and are being applied in the formulation of compensatory measures in those types of jobs to lower the work load in employees. A synoptic processing and evaluation of the results of the monitoring of excessive unilateral load in relation to damage in the locomotor apparatus shall be carried out in 2005.
10.3.2 The register of occupational exposure to chemical carcinogens, REGEX
In 2003 there was under way the program REGEX, operated within the framework of the Monitoring Program – Subsystem VII – Task 2.1.5.2: “Register of profession-linked exposures to carcinogens” (REGEX) at the Regional Public Health Institutes Ústí n/L, Plzeň, České Budějovice, Karlovy Vary, Hradec Králové, Jihlava, Zlín, Olomouc, and Ostrava. The volume of data introduced into the register depended, just as in the previous year, on the capacity of each of the competent workplaces, not on the scale and extent of exposure to carcinogens in the regions.
The number of exposed subjects in the central register of occupational exposure to carcinogens up to Dec. 31, 2003 amounted to 3,876 (3,360 in the preceding year), 5,253 entries (3,889 entries in the previous year). In Tab. 10.5 is presented the number of registered persons in each region where the program was under way. Table 10.6 contains the numbers of registered employees by substances, factors or workplace where exposure to carcinogens takes place.
From the point of view of the REGEX System’s objectives it is desirable that hitherto uncommitted regions join in. The System will be fully functional for application in public health and for analysis of objective risk in occupational exposure to carcinogens when all regions in the Czech Republic are covered.
Tab. 10.1 Notified professional diseases, 1996–2003
Calendar Year |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
Professional diseases total |
2,543 |
2,376 |
2,111 |
1,885 |
1,751 |
1,677 |
1,600 |
1,558 |
– occupational diseases |
2,519 |
2,350 |
2,054 |
1,844 |
1,691 |
1,627 |
1,531 |
1,486 |
– threat of occupational disease |
24 |
26 |
57 |
41 |
60 |
50 |
69 |
72 |
Professional diseases – males |
1,565 |
1,551 |
1,261 |
1,192 |
1,104 |
1,034 |
977 |
972 |
Professional diseases – females |
978 |
825 |
850 |
693 |
647 |
643 |
623 |
586 |
Incidence rate [number/100,000 |
55.2 |
51.6 |
45.8 |
40.9 |
38.3 |
37.1 |
35.7 |
35.5 |
Tab. 10.2 Notified professional diseases in regions, 2003
Region |
Professional diseases* |
Total |
|||||
A |
B |
C |
D |
E |
F |
||
Capital city of Prague |
3 |
10 |
7 |
25 |
19 |
1 |
65 |
Jihočeský |
6 |
43 |
7 |
23 |
22 |
1 |
102 |
Jihomoravský |
4 |
27 |
37 |
20 |
22 |
1 |
111 |
Karlovarský |
|
1 |
5 |
5 |
1 |
|
12 |
Královéhradecký |
2 |
29 |
20 |
30 |
16 |
|
97 |
Liberecký |
1 |
14 |
4 |
17 |
38 |
|
74 |
Moravskoslezský |
1 |
182 |
71 |
22 |
31 |
|
307 |
Olomoucký |
3 |
72 |
10 |
57 |
15 |
|
157 |
Pardubický |
11 |
7 |
15 |
35 |
32 |
1 |
101 |
Plzeňský |
3 |
59 |
15 |
18 |
11 |
|
106 |
Středočeský |
2 |
57 |
118 |
29 |
13 |
|
219 |
Ústecký |
1 |
23 |
3 |
12 |
41 |
|
80 |
Vysočina |
1 |
30 |
9 |
14 |
19 |
|
73 |
Zlínský |
|
22 |
8 |
16 |
8 |
|
54 |
Total |
38 |
576 |
329 |
323 |
288 |
4 |
1,558 |
* A – P. diseases caused by chemicals
B – P. diseases caused by physical factors
C – P. diseases of lung, pleura and peritoneum
D – P. diseases of skin
E – P. diseases infectious and parasitic
F – P. diseases caused by other factors
Tab. 10.3 Number of employees in categories of hazardous work (category 2R + 3 + 4) in regions, up to May 2004
Region |
Females |
Males |
Total |
Karlovarský |
2,843 |
6,439 |
9,282 |
Zlínský |
4,731 |
8,766 |
13,497 |
Olomoucký |
7,413 |
14,507 |
21,920 |
Vysočina |
3,560 |
9,794 |
13,354 |
Moravskoslezský |
8,052 |
36,821 |
44,873 |
Plzeňský |
4,268 |
12,875 |
17,143 |
Jihomoravský |
10,860 |
16,070 |
26,930 |
Liberecký |
8,052 |
12,223 |
20,275 |
Královéhradecký |
9,123 |
14,010 |
23,133 |
Pardubický |
6,242 |
13,825 |
20,067 |
Jihočeský |
8,500 |
20,168 |
28,668 |
Capital city of Prague |
15,931 |
22,227 |
38,158 |
Středočeský |
11,246 |
27,101 |
38,347 |
Ústecký |
13,250 |
24,332 |
37,582 |
Total |
114,071 |
239,158 |
353,229 |
Categories: 2R – potentially hazardous work, 3 and 4 – hazardous work.
Data stem from the jobs and workplaces categorization.
Tab. 10.4 Employees with multiple exposure to hazardous factors (according to categorization)
Number of hazardous factors |
Number of employees |
1 |
569,796 |
2 |
418,663 |
3 |
313,480 |
4 |
136,816 |
> 4 |
109,487 |
Total |
1,548,242 |
Tab. 10.5 Employees in Register of exposures to occupational carcinogens up to 12. 2003
Region |
Number of persons |
Moravskoslezský |
742 |
Jihočeský |
644 |
Zlínský |
460 |
Ústecký |
377 |
Plzeňský |
364 |
Vysočina |
306 |
Pardubický |
260 |
Středočeský |
203 |
Královéhradecký |
175 |
Karlovarský |
154 |
Olomoucký |
107 |
Tab. 10.6 Employees in Register of exposures to occupational carcinogens – most frequent exposures
Chemical, factor, workplace |
Number of persons |
Males (%) |
Females (%) |
Cytostatic agents |
946 |
14 |
86 |
Steel and iron foundry |
495 |
84.6 |
15.4 |
Benzene |
472 |
84.1 |
15.9 |
Formaldehyde |
247 |
25 |
75 |
Epichlorohydrine |
183 |
81.4 |
18.6 |
Cadmium and comp. |
173 |
45.1 |
54.9 |
Coal gasification |
160 |
80.6 |
19.4 |
Beta-naphtylamine |
153 |
76.5 |
23.5 |
Products of black coal processing |
113 |
100 |
0 |
Vinylchloride |
67 |
91 |
9 |
Ethylene oxide |
60 |
30 |
70 |
Asbestos |
55 |
80 |
20 |