2. Introduction The trend in India is towards industrialization. As industries develop both in sizes & complexity occupational health will rise new & more difficult problems. It aims at the promotion & maintenance of high degree of physical, mental & social well being of workers in all occupations.

3. Occupational health is essentially preventive medicine. In the past,it was entirely in relation to factories & mines ; hence the terms “ Industrial Hygiene” or “ Industrial Health” were used. Modern concepts of Occupational health now embrace all types of employment including commercial & trades, Forestry & agriculture.

4. Occupational Health In1950, the joint ILO / WHO Committee on Occupational health decided upon broad definition “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”.

5. Ergonomics  It is relatively a new concept in occupational health.  It is derived from the greek ‘ Ergon’ meaning work & ‘ nomos’ meaning law. It simply means “ fitting the job to the worker”.

6. Objective of Ergonomics It is to achieve the best mutual adjustment of man & his work, for the improvement of human efficiency & well being. Outcome : There will be reduction in the industrial accidents & to the overall health & efficiency of the workers.

7. Occupational Environment It is meant the sum of external conditions & influences which prevail at the place of work & which have a bearing on the health of the working population. There are 3 types of interaction in a working environment : 1.Man & physical, chemical & Biological agents. 2.Man & Machine 3.Man & man.

8. Man & physical, chemical & Biological agents 1. Physical agents : Heat, Cold, Humidity, air movement, radiation, light, noise,vibrations & ionizing radiation. 2. Chemical agents : chemicals, toxic dusts, gases. 3. Biological agents : viral, bacterial & parasitic agents because of close contact with animals or their products.

9. Man & Machine Unguarded machines in Industries, Protruding machines Lack of safety measures & procedures which cause accidents.

10. Man & man Relationship among workers Between workers & management Ex. Psycho social factors include type of work, job satisfaction, security, communication, incentives, leadership style etc which cause stress. If stress not managed, it leads to psycho somatic ailments.

11. Health problems caused by Industrialization Environmental sanitation (Housing, Air & Water pollution, Sewage disposal) Communicable diseases (malaria, Filariasis, TB, AIDS etc.) Food & Sanitation ( typhoid, Hepatitis etc)

12. Mental Health ( delinquency etc) Accidents Social problems ( alcoholism, Drug addiction, substance abuse, prostitution etc ) Morbidity & mortality incidence of chronic diseases.

13. Physical Hazards Psycho social Hazards Mechanical Hazards Biological Hazards Chemical Hazards Occupational Hazards

14. 1. Physical hazards Heat - Exposure to excessive heat results in muscular fatigue, severe cramps, skin rashes and boils. Light – eye fatigue, Nystagmus (i.e. rapid involuntary oscillation of the eyeballs) because of low illumination and nervous symptoms like headache, insomnia, photophobia to marked mental depression. Radiation - mercury, uranium, thorium, arsenic, and other heavy metals resulting in Lung cancer, leukemia & sterility. Noise – increase BP, pulse rate.

15. 2. Chemical Hazards Gases - Release of carbon dioxide, Sulphur dioxide a greenhouse gas, which causes climate change and global warming. Inorganic Dusts - Pneumoconiosis ex. anthracosis Metals and their compounds - power plants emit mercury, selenium, and arsenic which are harmful to human health and the environment. Chemicals - ulceration, dermatitis, also cancer.

16. 3. Biological Hazards Risk of malaria and dengue fever is substantial at some remote mining locations. Leptospirosis and ankylostomiasis were common in mines, but eradication of rats and improved sanitation has controlled these hazards effectively.

17. 4. Mechanical Hazards Protruding equipments Moving parts of machines Unsafe placement of machinery in factories & industries constitute mechanical hazards.

18. B. Accidents and Injuries 5. Psychosocial Hazards – leads to stress, Industrial neurosis, hypertension, peptic ulcer, etc.

19. Occupational Diseases  Pneumonoconiosis  Lead poisoning  Occupational Cancer  Occupational dermatitis  Carbon di sulfide poisoning  Carbon mono oxide  Insecticide poisoning  Noise pollution  Radiation Hazards  Accidents  Diseases of Agricultural workers.

20. Pneumonoconiosis It is a lung disease which is caused by dust. Depending on the type of dust, diseases varies, It may be :  Silicosis (silica or silicon di oxide – mine workers)  Anthracosis ( Coal dust)  Asbestosis  Farmer’s lung  Bagassosis  Byssinosis

21. Silicosis All mine workers suffer because of inhalation of dust particles containing silica or silicon di oxide. Silicosis is nodular fibrosis & produces respiratory symptoms like cough, dyspnoea on exertion, pain in the chest etc. X-ray of upper zone of lungs will give the appearance of a ‘ snow storm’. It can’t be reversed. But workers can be shifted to less hazardous sections.

22. Anthracosis Coal dust 2 phases in coal miners pneumonoconiosis : 1.First phase is Simple pneumonoconiosis with little ventilatory impairment. This phase requires 12 years of work exposure.

23. 2. The second phase is characterized by progressive massive fibrosis (PMF); this causes severe respiratory disability & frequently results in death. If early diagnosis is done during the first phase & the worker shifted to less hazardous section, the second phase of the disease can be prevented.

24. Asbestosis It is a fibrous magnesium silicate mineral which is used in asbestos production. The fibers are insoluble settle in alveoli & cause fibrosis. It may even lead to death. X – ray reveal a “ ground glass” appearance.

25. Farmer’s lung Hay dust This occurs due to inhalation of actinomycetes or microbes in dusts from moldy ( decaying )hay. Symptoms similar to pneumonoconiasis.

26. Bagassosis Cane dust fibre. It is caused by an allergic response to bagasse, the fungi containing debris left after the syrup has been extracted from sugar cane. Symptoms are fever, dyspnoea & malaise.

27. Byssinosis Cotton dust fibre It is caused by inhalation of cotton dust fibre. This conditions an allergic reaction to dust or fungi in cotton. 7-8 % of textile workers suffer from this disease.

28. Lead poisoning Industrial workers are exposed to lead than any other toxic substances, ex. Storage battery, ship building, printing & dyeing industries. It occurs in 3 ways : 1.Inhalation of fumes 2.Ingestion through contaminated hands 3.Contact with the skin ( especially organic compounds)

29. Clinical symptoms Inorganic lead : produces abdominal colic, loss of appetite, bleeding of gums, anemia, wrist drop & foot drop. Organic lead: CNS symptoms like Insomnia, headache, mental confusion & delirium.

30. O ccupational Cancer Exposure to radiation, inhalation of fumes, contact with carcinogenic substances etc. Commonly seen is skin & lung cancer Skin cancer: 75% of cancers are skin cancers. Commonly found in Dyeing industry among gas workers, tar distillers & road workers.  Lung cancer : occur in gas industry, Asbestos & coal tar industry.

31. Cancer bladder Common in dyeing industry, in Gobar gas & electric cable industry. The aromatic iron absorbed by the body is excreted through urine & the bladder becomes the targeted organ. Leukemia It is caused by radiation & exposure to the chemical benzol which is used in many industries.

32. Control of occupational Cancer Elimination or control of industrial carcinogens like well designed building or machinery etc Medical examinations Inspection of factories Notification Licensing of establishments Personal hygiene measures Education of workers & management Research

33. Occupational Dermatitis This occurs when skin comes in contact with hazardous substances. The hazards may be physical, chemical or biological which act as irritants or sensitizing substances. Prevention: 1.pre selection examination, 2.protection like clothings, leather gloves, aprons & boots. 3.Personal hygiene & periodic examination

34. Radiation Hazards Use of Radium & other radio active substances. Ex; painting of luminous dials for watches & other instruments, R/A paints, X-Rays, Exposure to UV rays & IR rays ( welding) Effects: Burns, dermatitis, MALIGNANCIES, Genetic effects, lung cancer.

35. Preventive measures 1.Inhalation, swallowing or direct contact with skin should be avoided. 2.In case X-rays, shielding to be used 3.Employees to be monitored at intervals not exceeding 6 months by use of film badge or pocket electrometer devices. 4.Suitable protective clothing to prevent contact. 5.Ventilation of work place to prevent inhalation 6.Replacement & periodic examination of workers 7.Pregnant women should not be allowed to work in places of exposure to radiation.

36. Diseases of Agricultural workers They are exposed to : 1.Zoonotic diseases from cattle like brucellosis, TB, tetanus & anthrax 2.Accidents 3.Toxic hazards from insecticidal spraying ( insecticidal poisoning) 4.Physical hazards : exposure to light & solar radiation 5.Parasitic infestations : hook worm infestations from manure. 6.Respiratory diseases – farmers lung, bysinnosis, bagassosis, bronchitis & asthma 7.Insect bites & snake bites

37. Accidents It is common in most industries. Ex.. Coal & other mining industries, Quarries, construction work. Causes : Human and Environmental Environmental factors : Temperature, poor illumination, humidity, noise & unsafe machines.

38. Human factors 1) Physical : vision problem & hearing deficit. 2) Physiological : Sex : women prone to less accidents. Age : younger ages involved more in accidents than older age groups. Time : minimum in the beginning of the day & increase gradually. Experience :50 % of accidents occur in the first 6 months of employment & only 3% accidents as years exceeds. 3) Psychological : carelessness, Inattentiveness & over confidence.

39. Prevention  Pre placement examination Adequate job training Continuing education Safe working environment Periodic survey for finding out hazards. Maintenance of records & careful reporting.

41. General Measures for health Protection of workers ILO \ WHO committee recommended the measures for the general protection of workers as following : 1.Nutrition According to Factories Act, one canteen should be provided when employees number exceeds 250.

42. 2. Prevention of Communicable diseases Vaccinations & early treatment. The spread of TB, Malaria, typhoid, Viral Hepatitis, Amoebiasis, Intestinal parasites & STD should be controlled.

43. 3. Environmental Sanitation a)Water & food supply & toilet : b)General plant cleanliness : paint once in 3 years & washing walls atleast every 6 months. c)Sufficient space : 500 cubic feet per each worker to prevent respiratory diseases. d) Lighting : sufficient lighting should be provided. e) Ventilation / Temperature f) Protection against hazards : protective devices. g) Housing : adequate housing facilities.

44. 4. Mental Health Facilities for recreation Recognition for good work Measures to sustain the attitude of workers Incentives, promotion etc. Regular health check up & prompt treatment. Provision of counseling Rehabilitation of those who recover from illness.

45. 5. Measures for Women & Children Women worker require special protection because : 1.Females may be less suited for some tasks than men, if women becomes pregnant, her work output decreases. 2.Women tend to feed themselves less amount than men. 3.IMR is more among infants of working women employed in Industrial work.

46. The following types of protection are available for women workers in India : Maternity leave for 12 weeks, of which 6 weeks precede the EDD, during this period they are not allowed “maternity benefit”, which is a cash payment, under ESI Act, 1948. Provision of free Antenatal, Natal & post Natal services. Factories Act prohibits carrying excessive weight & prohibits night work B/W 7 pm to 6 am.

47. The Indian Mines Act (1923) prohibits work underground. The Factories Act 1976 provides Creches in Factories where more than 30 women are employed. No child below the age of 14 shall be employed to work in any factory or mine or engaged in any hazardous employment.

48. 6, Health Education 7, Family planning All contraceptives methods must be made available for workers & adopt the small family norm.

49. Specific Measures for Prevention of Occupational Diseases 1, medical Measures 2, Engineering Measures 3, Legislative Measures.

50. Medical measures Pre placement examination Periodical examination Medicare & Health services ESI, First aid, MCH, Family welfare, Immunization etc. Notification Supervision of working environment Health education & counseling.

51. Engineering Measures Design of the building floors, wall height, ceiling,roof,doors, windows, cubic space etc. Good house keeping water supply, washing, sweeping, disposal of waste, food hygiene etc. Mechanization instead of manual work use machines when handling harmful substances.

52. Substitution replacing harmful material by a harmless one in the manufacturing process ex. Silver salts instead of mercury salts Control of Dust watering in Drilling section reduces dust Isolation most harmful materials to be used in separate building. Enclosure proper space to be provided at all hazardous sections.

53. Local exhaust ventilation dust,gases & fumes to be sucked into a hood & conveyed through ducts into the collecting units. Protective devices ear plugs, ear muffs, helmets, safety shoes, aprons, gloves, gum boots, barrier creams, goggles, screens, lead aprons. Environmental & statistical monitoring to measure the dose of hazardous agents in the environment.

54. Social security by Legislation a)Workmen Compensation act, 1923 b)Employees State insurance act, 1948 c)The Factories Act, 1948

55. Workmen Compensation act, 1923 WCA The act provides for the payment of compensation by certain classes of employers to their workers who sustain (prolong) injuries by accidents during the course of their work.

56. Provisions of the Act Employers liability Employer liability exemption Amount of Compensation Notification of death or injury. Time limit for payment of compensation Occupational diseases such as injuries Power of commissioner (WCA)

57. 1. Employers liability If employee is injured caused by an accident during his job timing, his employer shall be liable to pay compensation. 2.Employer liability exemption The employer no need to pay compensation in the following reasons like : Alcohol or drugs, disobedient of an worker of an rules for the purpose of safety, willful removal of safety devices etc.

58. 3. Amount - based on the nature of injury or death 4. Notification – it should be given by the employer with in 7 days of death / serious injury of a worker to the commissioner, WCA. 5. Time limit _ the compensation amount shall be paid to the workers with in one month from the due date & in default the employer will pay simple interest or penalty as decided by the commissioner, WCA.

59. Employees State insurance Act, 1948 It is an important measure of social security & health insurance in the country. It provides certain cash & medical benefits to industrial workers in case of sickness, maternity, leave & employment injuries.

60. Scope Small power using – 10-19 persons Non power using - 20 or more persons Shops Cinema theatre Hotels & newspaper establishment

61. Organizational setup of ESI ESI Corporation Chairman, Union ministry of Labour Vice chairman, secretary to the Govt of India, Ministry of Labour Director General of ESI Insurance Commissioner Medical Commissioner Finance Commissioner

62. Benefits of the Act 1.Medical benefits 2.Sickness benefits (91 days allowed with payment) 3.Maternity benefits 4.Disablement benefits 5.Dependant benefits( payment done to a dependant of an insured person as a result of injury or death) 6.Funeral benefits (Rs 1000 given for funeral) 7.Rehabilitation benefits ( monthly payment of Rs 10 as rehabilitation allowance)

63. Rajiv gandhi Shramik Kalyan Yojana came into effect from 1 st April,2005 This schemes provides an unemployment allowance for the employees covered under ESI scheme who are rendered unemployed involuntarily due to retrenchment (reduction in production) or closure of factory or permanent invalidity arising out of non employment injury etc. During this period, he/she is eligible for himself & his/her family from ESI dispensaries, ESI clinics & ESI hospitals to which he/she was attached prior to the date of loss of employment.

64. 3, The Factories Act, 1948 To provide health, safety & welfare to the worker. Provisions of this Act : 1.Health, safety & Welfare 2.Employment of young persons 3.Hours of work 4.Leave with wages 5.Occupational disease 6.Safety management

65. Health, safety & Welfare Provisions of cleanliness, lighting and ventilation. Provision of safe drinking water Employment of sanitary workers for cleaning latrines. Provision of minimum space of 500 cu ft per person. Specific welfare measures – canteen, creches, rest rooms, lunch room, first aid appliances

66. Employment of young persons The Act prohibits employment of children below the age of 14 & declares 15 to 18 years of age as adolescence. An adolescent employee is allowed to work only B/W 6 am to 7 pm. Hours of work Total hours of work is 8 hours a day with rest for half an hour after 5 hours of continuous work. Total hours of work in a week shall not exceed 60.

67. Leave with wages Every worker is availed leave with wages after 12 months of continuous service, Adult : 1 day for every 20 days. Safety management I ndustries involving hazardous processes should constitute a committee for examining the service conditions of employees, allowing workers also to participate in any meetings.

68. Occupational Health Nurses Occupational Health Nurses (OHN)s are registered nurses who independently observe and assess the worker's health status with respect to job tasks and hazards. Using their specialized experience and education, these registered nurses recognize and prevent health effects from hazardous exposures and treat workers' injuries/illnesses.

69. Functions Observation and assessment of both the worker and the work environment Interpretation and evaluation of the worker's medical and occupational history, subjective complaints, and physical examination, along with any laboratory values or other diagnostic screening tests, industrial hygiene and personal exposure monitoring values Interpretation of medical diagnosis to workers and their employers

70. Contd … Appraisal of the work environment for potential exposures Identification of abnormalities Description of the worker's response to the exposures Management of occupational and non- occupational illness and injury Documentation of the injury or illness