Primary Health Care & Workers’ Health

In coming months, WONCA News will feature regular articles on the subject of Occupational Health including useful resources for clinical practice. This month we revisit the recent statement on worker’s health.  Peter Buijs & Frank van Dijk are the authors - they are Dutch occupational physicians and former family doctors, and for many years active in ICOH.

Joint WONCA-ICOH Statement on workers’ health

This joint statement of WONCA and the International Commission on Occupational Health (ICOH) – the first one ever made together – was released on July 3, 2014, during the WONCA Europe conference in Lisbon, Portugal. It was presented by Prof Michael Kidd, WONCA President, in his keynote speech and included the pledge that follows.

See full story on WONCA and ICOH statement and pledge on workers and their families

Pledge The World Organization of Family Doctors (WONCA) and the International Commission on Occupational Health (ICOH) pledge to work with our partner organizations (including WHO and ILO) to address the gaps in services, research, and policies for the health and safety of workers and to better integrate occupational health in the primary care setting, to the benefit of all workers and their families.

This is an important statement, because not only the health of individual workers is at stake: in each country working people are the backbone of the economy. So their health is of great importance for themselves and their families – often depending on the earnings – as well as for the country’s prosperity and for provisions like food production, health care, social security and education.

This Statement also revitalises one of the phrases of the famous 1978 WHO Declaration of Alma Ata on Primary Health Care, aiming at “bringing health care as close as possible to where people live and work.” Yet, as the WONCA-ICOH Joint Statement says: “the health and safety of people at work are too often addressed separately from their health outside of work.”

Moreover, for many years not more than about 10-15 % of the global workforce has some kind of specific occupational health care (mostly workers in the more prosperous parts of the world) while the poorest workers and those most in need, with the most precarious working conditions, often have no work-related care at all.

The coverage of primary health care is, as we all know, about 70-80 % of the world’s population. Among them are many workers far out of reach of occupational care, like rural and migrant workers, and workers in the informal economies. But, it is also well known that many family doctors and other primary health care professionals have a kind of ‘blind spot’ for work-related health problems. On the other hand, in almost all countries with a social security system, workers have to visit their family doctor or another treating physician during sick leave, in order to get a sick note. So those professionals have to investigate the fitness for work under specific working conditions.

The WONCA-ICOH Joint Statement says: “to better integrate occupational health in the primary care setting, to the benefit of all workers and their families". Such action will create great new opportunities: when primary care professionals pay more attention to the work related health problems of their patients, many more workers could be reached with a kind of basic occupational health care than the 10-15 % mentioned before!
 
That will also mean that family physicians will have to reflect systematically on questions like: Are these health problems work-related? If so, is that relationship causal, which means that work causes occupational and work-related diseases such as chronic low back pain or aggravates existing health problems like COPD? Or is the health condition causal? What are the consequences of a disease or treatment (for e.g. asthma, myocardial infarction or diabetes) for the patient’s work? Can the working conditions be adapted to the limited capabilities of a worker with multiple sclerosis or a worker who survived cancer but is still having complaints? Where can I get reliable occupational health information on effects of pesticides or on risk factors for epicondylitis? To which clinic can I refer my patient with a chronic contact dermatitis or presumed latex allergy related to work?

In the coming editions of the WONCA News we will try to address these kinds of questions. The next time however we will first write about developments and events from the last decade, leading to this Joint WONCA-ICOH Pledge.

Peter Buijs
Frank van Dijk