Occupational Health - China and Thailand

WONCA News has begun a regular feature on the subject of Occupational Health including useful resources for clinical practice. Peter Buijs (right) & Frank van Dijk (left) are the promotors and main authors. They are Dutch occupational physicians and former family doctors, and for many years active in ICOH (1).

In their last contribution, they dealt with their review, commissioned by the WHO, on interventions in Primary Health Care regarding the health of workers. In this edition, they tell about two good practices, described in the report, where PHC is paying more attention to work issues, coming from two newly industrialized countries: China and Thailand.

The first publication by Chen et al. (2010) describes the stepwise integration of so called ‘basic occupational health services’ (BOHS) in the primary health care (PHC) system, in the Chinese province of Baoan. Capacity building, training and education have had the aim to realize surveillance of workplaces and of workers’ health, risk assessment, control and evaluation activities.

This model provides essential occupational health care, especially to underserved workers like migrants and those who work in the ‘informal economy’ and in small- and medium-sized enterprises. The authors conclude that the ‘Baoan model’ has proved to be effective and also cost-effective. The care for workers’ health is integrated in PHC, supported by government, employers and employees. In 2006, 3,700 factories had BOHS-coverage and 610,000 workers received health surveillance. In 2008, these figures were about tripled: respectively 9,200 factories and 1.9 million workers. The coverage rate for factories increased from 35% to 82%, and for workers from 29% to 81%. Chen and colleagues conclude “This strategy might be a feasible and effective way of protecting the health of workers confronted with occupational hazards.”

As in many other developing or newly industrialized countries, in Thailand most work is still agricultural, informal or self-employed, without access to occupational health provisions. In their publication ‘Basic Occupational Health Services (BOHS) and the National Program for Farmers’ (2011) Chancharoen and colleagues state that it is crucial to include (parts of) OHS in primary health care, because PHC is close to informal workers in the communities. They are mostly working in agriculture and small industries, or offering services, and are often exposed to serious occupational risks. Income losses of this group are seldom covered by social security schemes in the case of occupational diseases, work accidents or work disability.

In 2008, a pilot project started to integrate OHS into 16 primary care units by capacity building, training and supervision. In 2010, the units were able to provide essential services for workers’ health (BOHS) including health examinations and interviews of workers with occupational diseases or injuries. Risk assessments showed that infectious diseases were the highest occupational risk - and not NCDs (2) - since most farmers worked in contaminated areas, often with animals. The project demonstrated that BOHS can be included in primary care, offering not only secondary and tertiary prevention activities such as screening of occupational diseases, health examinations and treatment of such diseases and injuries; but also primary prevention. This includes walk-through surveys at workplaces with an observation checklist and risk assessment. Collaboration with the local authority and health volunteers in the community was very important.

In 2010, 156,975 workers accessed the services (72% of them farmers). They mostly worked in poor postures, and in environments with a high risk for biological (63%), noise (49%) and chemical exposure (43%). Farmers had been injured from sharp tools or equipment (30%), slipping (21%), chemical splashes (13%) and electricity (11%). The most common health problems were pesticide poisoning, muscular pain and occupational injuries.

In 2011, the Public Health Ministry decided that primary care units in high-risk areas will provide BOHS, including risk interviews, health examinations, screening tests for pesticide poisoning, risk communication and training of health volunteers. The goal: reaching 800,000 farmers through 1,000 Primary Care Units.
Overall conclusion and ‘take home message’

Experiences in Thailand and China show, that with a programmatic approach, it is very feasible – at least in newly industrialized countries – to “... integrate occupational health in the primary care setting, to the benefit of all workers and their families.” (WONCA ICOH Pledge, Lisbon, 5-7-15)

(1) ICOH: International Commission on Occupational Health (about the ‘WONCA’ for occupational physicians)

(2) NCDs: non-communable diseases

Chen Y, Chen J, Sun Y, et al. Basic Occupational Health Services in Baoan, China. Journal of Occupational Health. 2010;52:82-8. http://joh.sanei.or.jp/pdf/E52/E52_1_11.pdf

Chancharoen S, Siriruttanapruk S, Untimanon O. Basic Occupational Health Services (BOHS) and the National Programme for Farmers. In: Vainio H, Lehtinen S (eds). Proceedings of OH&S Forum 20–22 June 2011 in Espoo Finland. Helsinki: Finnish Institute of Occupational Health; 2012, page 136-139. http://www.ttl.fi/en/publications/Electronic_publications/Documents/Forum2011_proceedings.pdf.