Historically, the emphasis in occupational safety and health (OSH) has been on safety, and the health aspect hasn’t received the same level of attention, with the exception of some industrial diseases. A possible explanation for this is that safety is more immediate, ie, an accident occurs quickly, its effects are usually immediately visible, and it is easier to determine causes and therefore corrective action. In the case of health effects on workers, many of these develop over time and it can therefore be more difficult to apportion causes long after the health effect started developing. Occupational health (OH) issues have historically been under-reported for this reason.
This situation has been changing in recent years, in recognition of the fact that far more workers are made ill by their work, or have existing conditions exacerbated, than are injured in workplace accidents. It has been estimated that in 2017 2.78 million deaths globally were attributed to work and, within this figure, work-related diseases accounted for 2.4 million (86.3%) of these deaths.
OH is a wide field. The WHO definition of services for occupational health, which reiterates the definition in International Labour Organization (ILO) Convention 1985 (No. 161) is:
‘primary, secondary and tertiary health prevention and promotion services, plus responsibility for advising the employer and workers on:
- the requirements for establishing and maintaining a safe and healthy working environment which will facilitate optimal physical and mental health in relation to work
- the adaptation of work to the capabilities of workers in the light of their state of physical and mental health’.
The ILO defines the range of occupational health as shown in Figure 1. It lists the aspects of occupational health that will be addressed in the content of this guide. Since OH covers so many aspects of work which lead to such significant illness absence with associated costs to organisations, addressing such matters will have many benefits.
The main functions of an occupational health service are to:
- identify and assess the risks from health hazards in the workplace
- watch for factors in the work environment and working practices that may affect workers’ health, such as sanitary installations, canteens and housing provided by the employer
- advise on work planning and organization, including workplace design and the choice, maintenance and condition of machinery, and other equipment and substances used in work
- participate in the development of programmes for the improvement of work practices
- collaborate in testing new equipment and evaluating its health aspects
- advise on occupational health, safety and hygiene, and on ergonomics and protective equipment
- monitor workers’ health in relation to work
- try to make sure that work is adapted to the worker
- contribute to vocational rehabilitation
- collaborate in providing training and education in occupational health and hygiene, and ergonomics
- organize first aid and emergency treatment
- participate in the analysis of occupational accidents and occupational diseases.
Figure 1: ILO definition of OH 
Occupational health provides benefits to workers:
|Who||What we do||Outcome|
|Person offered a job||Health assessment||Workers who can perform their job safely considering any health issues or disabilities they may have – eg, drivers, healthcare workers, pilots|
|People with a disability or a health condition can perform the offered work effectively through suitable work and/or workplace adjustments|
|Employees exposed to hazards at work eg, chemicals, noise radiation||Education and training||Employees who understand health hazards and risks and personal measures to protect their health|
|Health surveillance||Early identification of any health changes to ensure the cause is investigated and improvements made in the workplace to prevent progression to disease and permanent ill health in that worker and among co-workers|
|Employees exposed to infection risks||Immunisation and medicines||At-risk groups of employees, eg, business travellers, healthcare workers, are better protected against exposure to infectious diseases|
|Employees with a work- related health concern||Consultation||Employees are supported to address work-related health concerns eg, stress at work or to cope with work when they have stresses outside of work|
|Employees with a health condition||Health assessment||Maintained employment and earnings through workplace adjustments; or suitable alternate work where a worker cannot perform their normal job, either temporarily or on a permanent basis|
|Employees on long- term sick leave||Case management||Earliest return of functional capacity and return to work by working with the employee’s doctors and employers eg, by offering changes to the job and/or work schedule|
|Health assessment||Ill health retirement when that is in the employee’s best interest and if they meet the medical criteria within the pension fund rules|
|All employees||Health promotion||Employees who are in optimal health through leading healthier lifestyles|
Figure 2: what OH offers to workers
And it provides benefits to businesses.
|What we do||Key business partners||Outcome|
|Health risk assessment||Health and safety, occupational hygienists||Required statutory and appropriate employer health surveillance programmes implemented properly|
|Health needs assessment||Human resources (HR)||Health programmes are designed and resourced to address the main lifestyle health risks; top causes of sickness absence, etc|
|Professional advice||Managers, HR||Advice and support for matters relating to health and work|
|Policy development||HR, Legal||Policies, practices and cultures that maintain and promote employee health and compliance with relevant health and safety legislation|
|Change management||Managers, HR, toxicologists||Assess significant changes eg, in shift patterns; the development or introduction of a new chemical|
|Business continuity planning||HR, health and safety||Ensure contingency plans are in place to deal with health risks eg, emergency medical response for disasters, pandemics|
Figure 3: what OH offers to businesses