Block-1-OHS - Basics of Health

ignou MEV-005
THE PEOPLE'S
UNIVERSITY Occupational
Indira Gandhi National Open University
School of Interdisciplinary and Health and Safely
Trans-disciplinary Studies
BASICS OF HEALTH 1
MEV-005
Occupational Health
Indira Gandhi National Open University
and Safety
School of Interdisciplinary and
Block
1
BASICS OF HEALTH
UNIT 1
Concepts of Human Health and Wellbeing 5
UNIT 2
Environment and its Impact on Health 26
UNIT 3
Overview of Occupational Health 39
UNIT 4
Burden of Disease and Plan of Action for
Environmental and Occupational Health 65
1
PROGRAMME DESIGN AND EXPERT COMMITTEE
Dr. (Ms.) Shyamala Mani Dr. Rachna Agarwal Dr. Sushmitha Baskar Dr. Deeksha Dave
Professor, National Institute of School of Vocational Education Environmental Studies Environmental Studies, School
Urban Affairs (NIUA) India Habitat and Training, Indira Gandhi School of Interdisciplinary and of Interdisciplinary and Trans-
Centre New Delhi National Open University, Trans-disciplinary Studies disciplinary Studies,
New Delhi Indira Gandhi National Open Indira Gandhi National Open
Prof. R. Baskar University, New Delhi University, New Delhi
Department of Environmental Prof. Daizy R Batish
Science & Engineering, Guru Department of Botany, Panjab Prof. Ruchika Kuba Dr. Shubhangi Vaidya
Jambheshwar University of University, Chandigarh School of Health Sciences, Indira School of Interdisciplinary and
Science & Technology, Hisar Gandhi National Open University, Trans-disciplinary Studies, Indira
Haryana Prof. M. Krishnan New Delhi Gandhi National Open University
Vice Chancellor, Madurai Kamraj New Delhi
Prof. H.J. Shiva Prasad University, Madurai, Tamil Nadu Prof. Nandini Sinha Kapur
Professor of Civil Engineering School of Interdisciplinary and Dr. Y.S.C. Khuman
College of Technology, G.B. Pant Dr. Chirashree Ghosh Trans-disciplinary Studies, School of Interdisciplinary and
University of Agriculture & Technology Department of Environmental Indira Gandhi National Open Trans-disciplinary Studies, Indira
Pant Nagar, Uttarakhand Studies, University of Delhi, University, New Delhi Gandhi National Open University
New Delhi New Delhi
Dr. T.K. Joshi Dr. Shachi Shah
Director, Occupational & Mr. Ravi Agarwal Dr. Sadananda Sahoo
Environmental Studies,
Environmental Programme, Centre Director, Toxic Link, Jangpura School of Interdisciplinary and
School of Interdisciplinary and
for Occupational & Environmental Extension, New Delhi Trans-disciplinary Studies, Indira
Health, Maulana Azad Medical Gandhi National Open University
Prof. Jaswant Sokhi Indira Gandhi National Open
College, New Delhi New Delhi
School of Sciences, Indira Gandhi University, New Delhi
Prof. Nilima Srivastava National Open University, Dr. V. Venkat Ramanan
School of Gender and Development New Delhi Environmental Studies
Studies, Indira Gandhi National Dr. B. Rupini School of Interdisciplinary and
Open University, New Delhi Environmental Studies, School Trans-disciplinary Studies
of Interdisciplinary and Trans- Indira Gandhi National Open
Prof. S.K. Yadav University, New Delhi
School of Agriculture disciplinary Studies, Indira Gandhi
Indira Gandhi National Open National Open University,
University, New Delhi New Delhi
BLOCK PREPARATION TEAM

Unit 1 Unit 2 Unit 3 Unit 4
Dr. Ravneet Kaur, Dr. Ravneet Kaur, Dr. Madhu Kumari Upadhyay Dr. Somdatta Patra
Centre for community Centre for community Department of Community Medicine University
medicine,All india Department of community
medicine,All india institute of
institute of medical medical sciences, New dDelhi. College of Medical Sciences & GTB medicine University College
Sciences, New Delhi. Hospital Dilshad Garden Delhi of Medical Sciences Delhii
Dr. G. Jayaraj
Managing Trustee, Occupational Health
FoundationTopaz-4, Par Royale, 26.K.K.Road,
Valmikinagar,Chennai
PROGRAMME COORDINATORS
Dr. B. Rupini Dr. Sushmitha Baskar Prof. Ruchika Kuba
Environmental Studies, School of Interdisciplinary Environmental Studies, School of Interdisciplinary School of Health Sciences,
and Trans-disciplinary Studies, Indira Gandhi and Trans-disciplinary Studies, Indira Gandhi Indira Gandhi National Open
National Open University, New Delhi National Open University, New Delhi University, New Delhi
COURSE COORDINATOR CONTENT EDITORS

Prof. Ruchika Kuba Dr. Bobby Joseph
School of Health Sciences, Professor & Head, Department of Community Heath,
Indira Gandhi National Open St. John Medical College, Bangalore-560034
University, New Delhi
FORMAT EDITORS
Dr. B. Rupini Dr. Sushmitha Baskar
Environmental Studies, School of Interdisciplinary and Environmental Studies, School of Interdisciplinary and Trans-
Trans-disciplinary Studies, Indira Gandhi National Open disciplinary Studies, Indira Gandhi National Open University,
University, New Delhi New Delhi
Secretarial/Technical Assistance: Ms. Sonali, SOITS, IGNOU, New Delhi; Mr. Vikram, SOITS, IGNOU. New Delhi
PRINT PRODUCTION
Mr. S. Burman Mr. Y. N. Sharma Mr. Sudhir
Deputy Registrar (P), IGNOU, New Delhi Asst. Registrar (P), IGNOU, New Delhi Section Officer (P) IGNOU, New Delhi
February, 2019
 Indira Gandhi National Open University, 2019
ISBN: 987-93-88498-91-3
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COURSE INTRODUCTION
You have already read about environmental health and the environment and
health hazards in details in the course 1 and course 2 respectively This course
focusses on the health of the employees in various occupations and the
measures that can be adopted for their safety. This not only includes the
strategies to be adopted by the employers, but also the responsibilities of
the employees, modification of the wok environment and preventive initiatives
to be undertaken. The course is divided into five blocks.
Block 1 gives a basic idea of health with special reference to environment
in general and occupational environment specifically. It also sensitises you
to the burden of the occupational diseases both nationally and internationally.
Block 2 deals with issues related to emergency, disaster preparedness and
management in industrial setting. It gives a broad overview of the factors
responsible for the major industrial accidents, and the strategies for accident
injury prevention. It is important for anybody trained in the occupational
safety to be aware of the Accidental Injuries Response and Management
including CPR and the Trauma Care and Burn Response in all kinds of
situations, which has been adequately covered here. Lastly there is a brief
information regarding the business continuity planning talks about role of
environmental and occupational health of employees.
Block 3 covers the various aspects of occupational safety and management
starting right from the employees duties and responsibilities. The various units
in this block deal with the prevention and management of occupational
hazards in different occupations including ergonomics and managing stress
at the work place. A separate unit is devoted specifically to the occupational
health of women and children.
Block 4 talks about collection, recording and notification of data on
occupational accidents and disease and the challenges for the same. You
are introduced to the Establishment of National System for Recording and
Notification of Occupational Diseases (NSRNOD), it’s stake and the steps
in recording and notification of occupational diseases. It is important to keep
in mind the ethical and legal issues when dealing with this sensitive data.
These issues have been covered in this block.
Block 5 block provides a systematic understanding of various concepts
of epidemiology, study methods in research and analysis, interpretation and
reporting of data. This block prepares you to be able to undertake research
so as to formulate and test your hypothesis. An ongoing e=research is an
important component for improving the preventive and management strategies
of occupational diseases and safety.
Environment and Ecology
BLOCK 1 INTRODUCTION
At some point of time in our lives we all work – though this may not always be
considered gainful employment. We “work” at school – sitting in classrooms and
studying, we “work” at home – attending to daily chores like cooking, cleaning,
washing and performing other activities of daily living. Then there is the formal
“work” that most humans are involved in – that which keeps us occupied for a
significant part of our waking hours, earns us our livelihood and which sustains us;
without which we will not be able to support ourselves or our families.
Sadly, though, this work that we do during the day can be the cause of much bodily
harm. This could be due to the very nature of the job at hand; it could be due to
the climatic conditions under which the work is carried out; the dangers may lie in
the environment in which the person is working; or in some cases, illnesses that a
person already has may get aggravated due to the work which he/she is doing.
This is your introductory block. It is meant to give you a basic idea of occupational
health, the role of the environment in health (with specific reference to the occupational
environment) and the burden of diseases caused by occupations. This block has
been divided into 4 units. To achieve all this the first unit will give you some basic
concepts of health and disease.
More specifically, the first unit will introduce you to the basic concepts of health
including an understanding of the definition of “health”. This unit will deal with the
various concepts of health and the dimensions of health – which will demonstrate
to you that health is not as simple as we imagine it to be. The unit will cover all those
factors that determine what makes an individual, the family and the community
healthy. Thereafter we will understand how we can measure health through indicators
that are commonly used for this purpose. Having covered health, you will also learn
about “disease” – what causes disease and the natural course of disease in humans.
We will end with some basic concepts of prevention.
Next, in the second unit you will be introduced to the role that the environment has
on health. It is important to understand that the environment that a person works
in, given that is more often than not affected by the human activity that happens
around it, has a very important role to play in the health of the individual. The unit
will discuss the steps to be taken to reduce the burden of diseases due to adverse
environmental conditions.
The third unit gives you an introduction to the concept of occupational health. You
will gain insight into occupational hazards and diseases that are commonly seen in
our country. You will learn about the prevention and control of occupational diseases
and also about the strategies that are in place to address the problems of occupational
health at a global level.
Finally, having gained knowledge about the health and disease in general, and about
environmental factors and occupational issues that have a role to play in the health
of employees, the last unit will impress upon you about the burden of occupational
diseases at the national and global level. The economic aspects of occupational
diseases and other nuances related to the pattern of occupational diseases as it is
today and what it may be in the future will provoke you to think about the role you
could play in reducing the burden of occupational diseases. To help you apply this
knowledge, you will also be briefly introduced to possible preventive interventions
at the occupational setting.
At the end of this block, which gives you a broad outline of occupational and
4 environmental health, you will be eager and encouraged to learn more about the
specific issues that concern this important aspect of health in the community.
UNIT 1 CONCEPTS OF HUMAN
HEALTH AND WELLBEING
Structure
1.0 Introduction
1.1 Objectives
1.2 Changing Concepts of Health
1.2.1 Biomedical Concept
1.2.2 Ecological Concept.
1.2.3 Psychosocial Concept
1.2.4 Holistic Concept
1.3 Definition of Health

1.4. Dimensions of Health
1.4.1 Physical Dimension
1.4.2 Mental Dimension
1.4.3 Social Dimension
1.4.4 Spiritual Dimension
1.4.5 Emotional Dimension
1.5 Positive Health

1.6 Concept of Well-being
1.6.1 Standard of Living
1.6.2 Level of Living
1.6.3 Quality of Life
1.7 Determinants of Health

1.8 Indicators of Health
1.8.1 Characteristics of Indicators
1.8.2 Use of Health Indicators
1.8.3 Classification of Indicators
1.9 Concept of Disease

1.10 Concept of Causation
1.11 Natural History of Disease
1.12 Prevention of Disease
1.13 Let Us Sum Up
1.14 Key Words
1.15 Answers to Check Your Progress
1.16 References and Suggested Further Readings 5
1.0 INTRODUCTION
You have read in details regarding the environment. In this unit, you will learn
about various dimensions of health, the principles of causation of diseases, and
their prevention. It is important to know what health is. An understanding of
health is the basis of all healthcare. There are various definitions of health.
Probably the oldest definition is the “absence of disease.” In some cultures,
health is also considered equivalent to harmony and defined as “being at peace
with the self, community, and the universe.” However, there is no clear definition
of health, and the knowledge of determinants of health is not clear. Modern
medicine allegedly focuses much on the study of disease, and the study of health
is often neglected. However, over the past few decades, there has been a
reawakening that health is a fundamental right, which is to be attained by all
people. In 1977, the World Health Assembly adopted the target of ‘Health for
All by 2000’, which means that all citizens of the world by the year 2000 A.D.
would attain a level of health that that will permit them to lead a socially
and economically productive life. However, this target is yet to be achieved.
1.1 OBJECTIVES
After going through this unit, you should be able to:
 outline the dimensions of health;
 enumerate and describe the determinants of health;
 discuss the concept of causation of disease;
 enumerate and explain the various indicators of health and disease; and
 describe the concepts of prevention of disease
1.2 CHANGING CONCEPTS OF HEALTH

Over the centuries, the concepts of health have been changing. It was earlier
thought to be an individual concern, but later Health for All emerged as a global
goal. Let us discuss the various concepts of health:
1.2.1 Biomedical Concept

According to this concept, health is “absence of disease.” If a person does not
have any disease, he is considered to be healthy. This concept views human body
as a machine, occurrence of disease is viewed as breakdown of machine. The
biomedical concept is based on the ‘germ theory of disease’, which was the
accepted theory in the 20th century. However, this concept is very narrow, as it
cannot describe many important health problems like malnutrition, chronic diseases
and accidents among others. Subsequent developments in medical and social
sciences highlighted that biomedical concept of health is inadequate, because it
did not take into consideration other determinants of health like environment,
psychological and socio- cultural factors.
1.2. Ecological Concept

According to this concept, health is a dynamic equilibrium between man and his
6 environment. Maladjustment of the human beings to the environment leads to
disease. The concept emphasizes the role of environment, and supports the need Concepts of Human
for clean air, safe water, ozone layer in the atmosphere, etc. to protect us from Health and Wellbeing
exposure to unhealthy factors. It indicates that improvements in human adaptation
to natural environment can lead to better health outcomes, irrespective of the
availability of modern health care services.
1.2.3 Psychosocial Concept
This concept emphasizes that health is not only a biomedical phenomenon. A
number of other factors i.e. social, psychological, cultural, economic and political
factors have an influence on health.
1.2.4 Holistic Concept
This concept considers all the three components i.e. biomedical, ecological, and
psychosocial concept. It defines health as a unified or multidimensional process
involving the wellbeing of the whole person in the context of his environment.
Holistic concept implies that, all sectors of the society have an effect on health.
1.3 DEFINITION OF HEALTH

Health has been defined in many ways by different agencies from time to time.
The Oxford dictionary defines it as “state of being well in body or mind”.
The Webster’s dictionary defines health as the “condition of being sound in body,
mind or spirit especially freedom from physical disease or pain.”
As defined by Perkins, health is “a state of relative equilibrium of body, form and
function which result from its successful dynamic adjustment to forces tending to
disturb it. It is not passive interplay between body substance and forces impinging
upon it but an active response of body forces working towards readjustment.”
The constitution of the World Health Organization (July 1948) defined health as
a “state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity”. To this has been added a further clause
that includes the “ability to lead a socially and economically productive life”.
However, this definition has faced a lot of criticism for bring too broad, and
difficult to measure. It has been debated that health cannot be defined as a
‘state’, as it is not a one-time phenomenon, but a continuous process.
Despite the limitation, the definition given by the World Health Organization (WHO)
sets out a standard, and represents an overall objective or goal, that all nations
should strive to achieve.
It is increasingly being recognized that health is a fundamental human right, is
essential to lead a productive life, is inter-sectoral, and is the responsibility of
individuals and nations.
1.4 DIMENSIONS OF HEALTH

As we have discussed earlier, health is multi-dimensional. The WHO definition
takes into account three dimensions – physical, mental and social. Recently, many
new dimensions like spiritual, emotional, vocational etc. have been identified.
These different dimensions interact with each other, each having a specific nature.
These different dimensions of health are being discussed briefly here: 7
Environment and Ecology 1.4.1 Physical Dimension
This dimension relates to the structure and functioning of the human body. According
to this dimension, health is the state of perfect functioning of body, in which every
cell and every organ is functioning at optimum capacity, and in perfect harmony
with the rest of the body.
The signs of physical health in an individual include a good complexion, clean skin,
bright eyes, lustrous hair with a body well clothed with firm flesh neither too thin
nor too fat, a sweet breath, a good appetite, sound sleep, regular activity of
bowels and bladder and smooth, easy coordinated movements. All the organs of
the body are unexceptional in size and function normally. All the special senses are
intact. The resting pulse rate, blood pressure and tolerance etc. are all within the
range of ‘normality’ in the context of the individual’s age and sex.
This dimension of health can be assessed by:
- enquiring about the signs or symptoms of any disease, or risk factors,
- asking about any use of medications, hospitalization,
- dietary assessment,
- clinical examination,
- biochemical and laboratory tests.
1.4.2 Mental Dimension
Mental health is not only absence of any mental disorder, but it is a state of
balance between individual and surroundings. Earlier, physical and mental dimensions
of health were considered as two separate entities, however, research has indicated
that both these dimensions are closely inter-related. The old saying “healthy mind
in a healthy body” confirms the inter-relationship between mental and physical
health. Poor mental health affects physical health and vice-versa. According to
WHO Technical Report (1964), the psychological factors are considered to play
a major role in disorders such as hypertension, peptic ulcer and asthma. A mentally
healthy person is free from internal conflicts and external mal-adjustments. He is
not swayed by emotions; and has good self-control. Assessment of mental health
is difficult, as we do not have precise tools to measure mental health unlike
physical health. However, standardized mental health questionnaires are available,
which can be used by trained interviewers. Mental health is a key to good health.
Unfortunately, our knowledge about mental health is limited.
1.4.3 Social Dimension
Social health is an aspect of health that includes social relationships as part of
broader concept of health. Social well-being means a state of harmony within the
individual and other members of the society. A person who plays social roles,
according to his/her status and is apt in establishing and maintaining harmonious
relationship in family and community, and at work is considered socially a healthy
person. On the contrary, when he fails to perform these roles, neglects social
relations, indulges in bad habits and gets involved in homicide, suicide, crime,
gambling, drinking etc., he is considered abnormal. A socially-integrated person
8 is less isolated, and has a greater sense of empowerment.
The Regional framework for health promotion in the Western Pacific Region Concepts of Human
Health and Wellbeing
2002-05 stresses the role of social capital in health promotion. Social capital
means the trust, social interaction & social connections that a person possesses.
The positive social environment is believed to have an important role in good
health.
1.4.4 Spiritual Dimension
Recently, it has been considered that the spiritual dimension plays an important
role in health and disease. Under this dimension, an individual feels committed to
some higher being, and strives to find the meaning and higher purpose in life. It
is a relatively newer concept and is difficult to explain.
1.4.5 Emotional Dimension
This dimension relates to the “feelings” of an individual. Earlier this dimension
was considered as an element of mental dimension itself, however, it is now being
seen as a separate element.
Besides all these dimensions of health, there are other dimensions e.g. cultural,
socio-economic, vocational, educational etc. that contribute to the positive health
of a person.
1.5 POSITIVE HEALTH

Let us now learn the concept of positive health.
— Positive health describes a state of “perfect functioning” of body and
mind. It is a state beyond the mere absence of disease. It is achieved by a
perfect combination of optimal biological, subjective, and functional
components.
— Positive health envisages increase in life expectancy, decreased expenditure
on health, better mental health, healthy aging, and better prognosis in case
of illness.
— Thus perfect positive health is a potential status and not a reality.
It has been stated that “perfect positive health” cannot become a reality because
man will never be so perfectly adapted to his environment that his life will not
involve struggles, failures and sufferings.”
1.6 CONCEPT OF WELL-BEING

Well–being of an individual or group has objective and subjective components.
- Objective components
o Standard of living
o Level of living
- Subjective component
o Quality of life
9
Environment and Ecology 1.6.1 Standard of Living
It refers to the usual expenditure, the goods consumed and the services enjoyed
by an individual. It includes the level of educational status, employment, food,
clothing, and comforts available to a person.
World Health Organization proposed that “standard of living is indicated by
income and occupation, standard of housing, sanitation and nutrition, the
level of provision of health, educational, recreational and other services.”
1.6.2 Level of living

This term is used in the United Nations. It consists of nine components:
- Health,
- Food consumption,
- Education,
- Occupation and working condition
- Housing,
- Social security
- Clothing
- Recreation and leisure
- Human rights
1.6.3 Quality of Life

It refers to a person’s subjective feelings of happiness or unhappiness of various
concerns of life. It is the condition of life resulting from a wide range of factors
that determine health, educational achievement, social attainments, living
environment, freedom of action, and freedom of expression. Quality of life is a
combined indicator of physical, mental and social well-being as perceived by each
individual or group of individuals. Governments all over the world are now
concerned about improving quality of life of the people. Quality of life is subject
to measurement. The common indices that are used include physical quality of life,
and now more commonly the human development index. Let us see what these
mean
a. Physical quality of life index (PQLI). PQLI is another index, which includes
- Infant mortality
- Life expectancy at age one and
- Literacy
For each of the components, the performance of each country is scored on a
scale of 0 to 100, where 0 indicates worst score and 100 represents the best
score. PQLI does not consider per capita GNP, indicating that ‘Money is not
everything’. It does not measure economic growth. It can however, measures
social, economic and political policies. The PQLI score of 100 is the ultimately
10 desired objective.
b. Human Development Index (HDI). This index is a refinement of the Concepts of Human
PQLI and combines three indicators representing three dimensions. Health and Wellbeing
- Longevity – It is measured as “Life expectancy at birth”

- Knowledge – It is indicated by adult literacy rate & mean year of
schooling.
- Income – It is measured by the real GDP Per Capita indicating Purchasing
Power Parity (PPP) in US dollars
The HDI value ranges from 0 to 1.
Check Your Progress 1
Note: a) Write your answer in about 50 words.
b) Check your progress with possible answers given at the end of the
unit.
1. The extended definition of “health” as expressed by the WHO is:
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2. List any three dimensions of health
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3. Name two indices that estimate the Standard of Living
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1.7 DETERMINANTS OF HEALTH

As we have seen, health is multidimensional. A large number of factors influence
health. These factors may lie within the individual, or externally in the physical and
social environment in which he lives. These factors interact with each other, and
influence the health of an individual or a group.
The important determinants of health include:
a. Biological determinants – These include the physical and mental traits of
human beings, which to some extent are determined by their genetic make-
up. Biological determinants are of importance in conditions like obesity,
diabetes, chromosomal abnormalities, certain types of cancers etc.
b. Behavioural and socio-cultural determinants – These include lifestyle
factors. Factors like diet, physical activity, smoking, or use of alcohol are
some examples of behavioural determinants of health and disease. 11
Environment and Ecology c. Environment – This may be the internal or the external environment. The
internal environment means various tissues, organs, organ systems and their
functioning. The external environment includes all that is external to the
individual human host. This environment can be divided into physical, biological
and psychosocial environment. All these components are not separate but
closely interact with each other.
d. Socio economic conditions – Economic status, income, education, status
in the society are other important determinants of health.
e. Health services – Availability and access of health care services also affects
health status of the community.
f. Demography – The composition of population is also a determinant of
health. Over the last few decades, the population of older individuals is
increasing. This may lead to increase in chronic diseases, and hence health
systems need to be prepared for this situation.
g. Other factors – These include factors outside the formal health care system,
which have a direct bearing on health e.g. food and agriculture, education,
engineering, information technology etc.
Figure 1.1 shows various determinants of health.
Fig. 1.1: Determinants of Health
1.8 INDICATORS OF HEALTH

A health indicator is a variable, that reflects the state of health of the subjects in
a community.
1.8.1 Characteristics of Indicators

A good health indicator should have the following characteristics:
12 a. Valid – The indicator actually measures what it is supposed to measure.

b. Reliable – It gives same result when measured by different people in similar Concepts of Human
circumstances. Health and Wellbeing
c. Sensitive – It is able to detect changes in the given situation.

d. Specific – It should reflect changes only in the situation concerned.
e. Feasible –It should have the ability to provide information when needed.
f. Relevant – It should be related to the concerned situation, and contribute
to the understanding of the situation or phenomenon of interest.
1.8.2 Use of Health Indicators
The health indicators are useful for-
- Measurement, description and comparison of the health of the community.
- Identification of health needs, and based on that planning of health programs
and interventions.
- Allocation of health resources.
- Measurement of performance of health interventions.
1.8.3 Classification of Indicators
There are various types of health indicators. Some of the indicators are used to
express death, some indicators reflect the burden of disease, while some indicators
tell indices tell about the availability and utilization of health services.
Broadly, health indicators are classified as below:
- Mortality Indicators
- Morbidity Indicators
- Disability Rates
- Nutritional Indicators
- Health Care Delivery Indicators
- Utilization Rates
- Indicators of Social and Mental Health
- Environmental Indicators
- Socio-economic Indicators
- Health Policy Indicators
- Indicators of Quality of Life
- Other Indicators
Some of these indicators are briefly described here.
1. Mortality Indicators
These indicators are related to the life span and the deaths in various categories
of people. The various mortality indicators are enumerated below 13
Environment and Ecology  Crude Death Rate (CDR)
 Expectancy of life - Life expectancy at birth
 Age Specific Death Rates (ASDR)
 Infant Mortality Rate (IMR)
 Child Mortality Rate
 Under-5 Proportionate Mortality rate
 Maternal Mortality Ratio
 Proportional Mortality Rate
 Case Fatality Rate
2. Morbidity Indicators
These are a set of indicators measuring the extent of sickness
a. Incidence
- It refers to occurrence of new events or cases of a disease in a defined
population, over a specified period of time.
b. Prevalence
- It is the proportion of individuals in a population who have a particular
disease or condition at a specified time. It includes both new and pre-
existing (old) cases in the given population.
3. Disability Indicators
These indicators give an indication of the extent of disability
 HALE (Health Adjusted Life Expectancy)
 QALY (Quality Adjusted Life Year)
 DALY (Disability Adjusted Life Years)
4. Nutritional Status Indicators
These indicators tell us abut the nutritional status of the group
a. Anthropometric measurements of pre-school children
- Weight
- Height
- Mid-arm circumference
b. Health Care Delivery Indicators
These indicators tell us about the distribution of health resources in different health
care settings. Some of these indicators are:
- Doctor-population ratio
- Nurse-population ratio
- Doctor-nurse ratio
- Population-bed ratio
14 - Population per PHC/sub center

Concepts of Human
Fig. 1.2: Common Indicators of Health

unit.
1. List three determinants of health

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2. List the six qualities of a good indicator of health
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3. Name two indicators that measure disability
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1.9 CONCEPT OF DISEASE

In the last section, you studied about health and its concepts. In this section, you
will be reading about disease. It is important to understand what is meant by
disease. There are many definitions of disease.
15
Environment and Ecology As defined in Webster’s Dictionary, disease is “a condition in which body
function is impaired. It is departure from a state of health, an alteration of
the human body interrupting the performance of the vital functions.”
- The Oxford English Dictionary defines disease as “the condition of body
or some organ of body in which its functions are disrupted or deranged”.
- In ecological terms, disease can be defined as “maladjustment of human
organism to the environment”.
- Simplest definition of disease is – “opposite to health”.
The WHO has defined health, but not disease. In fact, there is a spectrum of
disease from unapparent, subclinical cases to severe overt disease. Some diseases
are acute e.g. food poisoning, while some are chronic like diabetes, arthritis etc.
Fig. 1.3: The Health – Sickness Spectrum
1.10 CONCEPT OF CAUSATION

Before the discoveries in microbiology, a number of theories of disease causation
were in vogue, like
a. “Supernatural causes” and Karma – Disease due to sins committed by
a person
b. Theory of humors (humor means fluid) – Disease is caused due to imbalance
of fluids in the body.
c. The miasmatic theory of disease – Disease occurs due to bad air.
d. Germ theory – This theory gained momentum in 19th and 20th century. It
incriminated microbes as cause of disease.
e. Epidemiological Triad – This is based on the principle that interaction
between three types of factors – agent, host and environment are required
to produce a disease. For example, tuberculosis is caused by the bacterium
(Mycobacterium tuberculosis). However, not everybody exposed to this
bacterium suffers from tuberculosis. Certain host and environment factors
like malnutrition, over crowding etc. come into plat to cause tuberculosis.
16
f. Multi-factorial causation – As a result of advances in public health, and Concepts of Human
emergence of non-communicable diseases, ‘single cause idea’ had to be Health and Wellbeing
abandoned as it could not explain the cause of chronic diseases like coronary
heart disease, diabetes, cancer etc. It is now known that these diseases are
caused by multiple factors like excess intake of fat, physical inactivity, smoking
etc.
The term ‘agent’ is replaced by ‘causative factors.’
The multifactorial concept offers multiple approaches for prevention and
control of a disease.
Fig. 1.4: The epidemiological triad
g. Web of causation – This model was suggested by Macmohan and Pugh.

This model is ideally suited for the study of chronic diseases, where multiple
factors interact with each other to cause the disease. The following figure
shows the web of causation for coronary heart disease.
Fig. 1.5: Web of causation for coronary artery disease 17

1.11 NATURAL HISTORY OF DISEASE
We have seen that disease results from a complex interaction between man,
an agent (or causative factor), and the environment. The term natural history
of disease describes the way in which a disease evolves from its earliest phase
of pre pathogenesis to its termination as recovery, disability or death, in the
absence of treatment or prevention.
Fig. 1.6: Stages of Disease
Each disease has its own natural history, which may vary from individual to
individual. Let us consider the events that take place in the natural history of
disease.
Pre-pathogenesis phase – This is the phase prior to involvement of host. The
disease agent has not yet entered the host, but the factors which favour its
interaction with the human host are already existing in the environment.
Pathogenesis phase – The pathogenesis phase begins with the entry of the
disease “agent’’ in the susceptible human host. The disease agent multiplies and
induces tissue and physiological changes, the disease progresses through a period
of incubation and later through early and late pathogenesis.
Fig. 1.7: Natural history of Disease

18
After studying the disease process and natural history of disease, let us now Concepts of Human
discuss the concepts of prevention and control of disease. Health and Wellbeing
1.12 PREVENTION OF DISEASE

Prevention means all “actions aimed at eradicating, eliminating, or minimizing
the impact of disease and disability.”
The concept of prevention is best defined in the context of levels, traditionally
called primary, secondary, and tertiary prevention” There is also a concept of
primordial prevention. Let us get a brief understanding of these concepts here.
These have been discussed in more details in the unit 2 of block 3 course 5
1.12.1 Levels of Prevention

a. Primordial prevention
Primordial prevention consists of actions and measures that inhibit the
emergence of risk factors in the form of environmental, economic, social, and
behavioral conditions and cultural patterns of living etc.
b. Primary prevention
- Primary prevention can be defined as the action taken prior to the onset of
disease, which removes the possibility that the disease will ever occur.
- Primary prevention may be achieved by measures of “Health promotion” and
“specific protection”. See Figure 8 for examples of health promotion and
specific protection.
Approaches for Primary Prevention
- The WHO has recommended the following approaches for the primary
prevention of chronic diseases where the risk factors are established:
Fig. 1.8: Interventions under primary prevention
a. Population (mass) strategy is directed at the whole population irrespective

19
of individual risk levels. For example, studies have shown that even a small
Environment and Ecology reduction in the average blood pressure or serum cholesterol of a population
would produce a large reduction in the incidence of cardiovascular disease
b. High risk strategy aims to bring preventive care to individuals at special
risk. This requires detection of individuals at high risk and then applying
measures to prevent the disease in this group.
c. Secondary prevention
- Secondary prevention is defined as “action which halts the progress
of a disease at its incipient stage and prevents complications.”
- The specific interventions are: early diagnosis (e.g. screening tests,
and case finding programs) and adequate treatment.
d. Tertiary prevention
- Tertiary prevention is used when the disease process has advanced
beyond its early stages.
- It is defined as “all the measures available to reduce or limit
impairments and disabilities, and to promote the patients’ adjustment
to irremediable conditions.”
- Intervention in the stage of tertiary prevention are disability limitation,
and rehabilitation.
Disability is “any restriction or lack of ability to perform an activity in the
manner or within the range considered normal for the human being.”
Handicap means “a disadvantage for a given individual, resulting from an
impairment or disability, that limits or prevents the fulfillment of a role in the
community that is normal (depending on age, sex, and social and cultural factors)
for that individual.”
Impairment is “any loss or abnormality of psychological, physiological or anatomical
structure or function.”
Rehabilitation means “the combined and coordinated use of medical, social,
educational, and vocational measures for training and retraining the individual to
the highest possible level of functional ability.
You may like to understand the terms – disability, impairment, handicap, and
rehabilitation. These have been explained in the box 1.1.
Disability is “any restriction or lack of ability to perform an activity in the
manner or within the range considered normal for the human being.”
Handicap means “a disadvantage for a given individual, resulting from an
impairment or disability, that limits or prevents the fulfillment of a role in the
communitythat is normal (dependingon age, sex, and social and cultural factors)
for that individual.”
Impairment is “any loss or abnormality of psychological, physiological or
anatomical structure or function.”
Rehabilitation means “the combined and coordinated use of medical, social,
educational, and vocational measures for training and retraining the individual
to the highest possible level of functional ability.
20 Box 1.1: Terms associated with tertiary prevention
Check Your Progress 3 Concepts of Human
unit.
1. List three theories of disease causation

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2. List three examples each of “Health Promotion” and “Specific Protection”
Health Promotion
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3. Specific Protection
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4 List two interventions under “Tertiary Prevention”
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21
Fig. 1.9: Levels of Prevention
1.13 LET US SUM UP

In the present unit, we have learnt about the definition of health, different dimensions
of health and various factors that influence the health of a person. We also studied
various indicators of health.
The concepts of causation of diseases, various theories of diseases causation,
stages of disease in host have also been discussed.
Finally, we studied various levels of prevention of disease.
1.14 KEW WORDS

Health : A state of complete physical, social and mental
well-being, and not merely the absence of disease
or infirmity. (WHO)
Determinants of health : The range of personal, social, economic and
environmental factors, which determine the
health status of individuals or populations.
Community : A specific group of people, often living in a
defined geographical area, who share a common
culture, values and norms, are arranged in a
social structure according to relationships, which
the community has developed over a period of
time. Members of a community gain their personal
and social identity by sharing common beliefs,
values and norms which have been developed
by the community in the past and may be
modified in the future. They exhibit some
22 awareness of their identity as a group, and share
common needs and a commitment to meeting Concepts of Human
them. Health and Wellbeing
Health indicator : A health indicator is a characteristic of an

individual, population, or environment, which is
subject to measurement (directly or indirectly)
and can be used to describe one or more aspects
of the health of an individual or population
(quality, quantity and time).
Health status : A description and/or measurement of the health
of an individual or population at a particular
point in time against identifiable standards, usually
by reference to health indicators.
Quality of life : Quality of life is defined as individual’s
perceptions of their position in life in the context
of the culture and value system where they live,
and in relation to their goals, expectations,
standards and concerns. It is a broad ranging
concept, incorporating in a complex way a
person’s physical health, psychological state,
level of independence, social relationships,
personal beliefs and relationship to salient features
of the environment.
Health behavior : Any activity undertaken by an individual,
regardless of actual or perceived health status,
for the purpose of promoting, protecting or
maintaining health, whether or not such
behaviour is objectively effective towards that
end.
Risk factor : Social, economic or biological status, behaviours
or environments which are associated with or
cause increased susceptibility to a specific
disease, ill health, or injury.
Disease prevention : Disease prevention covers measures not only to
prevent the occurrence of disease, such as risk
factor reduction, but also to arrest its progress
and reduce its consequences once established.
Health promotion : It represents a comprehensive social and political
process, it not only includes actions directed at
strengthening the skills and capabilities of
individuals, but also action directed towards
changing social, environmental and economic
conditions so as to alleviate their impact on public
and individual health. Health promotion is the
process of enabling people to increase control
over the determinants of health and thereby
improve their health.
23
1.15 ANSWERS TO CHECK YOUR PROGRESS
Your answer should include the following points:
1. The extended definition of “health” as expressed by the WHO is a
“state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity in order that a man can lead a
socially and economically productive life”.
2. The three dimensions of health
Physical; Mental; Social; Spiritual; Emotional
3. The two indices that estimate the Standard of Living
Physical Quality of Life Index
Human Development Index
Check Your Pogress 2
1. The three determinants of health
Biology
Behaviour
Socio-cultural determinants
Environment
Socio economic conditions
Health services
Demography
2. The six qualities of a good indicator of health
Valid
Reliable
Sensitive
Specific
Feasible
Relevant
Name two indicators that measure disability
HALE (Health Adjusted Life Expectancy)
QALY (Quality Adjusted Life Year)
DALY (Disability Adjusted Life Years)
24
Check Your Progress 3 Concepts of Human
1. The three theories of disease causation
Supernatural causes
Theory of humors
Miasmatic theory
Germ theory
Epidemiological Triad
Multi-factorial causation
Web of causation
2. The three examples each of “Health Promotion” and “Specific
Protection”
Health Promotion
Health education
Environmental modifications
Nutritional interventions
3. The Specific Protection are
Immuno-prophylaxis
Chemoprophylaxis
Specific nutrient supplementation
Protection against occupational diseases
4. The two interventions under “Tertiary Prevention” are
Disability limitation
Rehabilitation
1.16 REFERENCES AND SUGGESTED

FURTHER READINGS
- Park’s Textbook of preventive and social medicine, 21st edition
- Textbook of Epidemiology, Leon Gordis, 4th edition.
- Textbook of public health and community medicine, AFMC,2009
- Measures of prognosis, Bloomberg School of Public Health,2008
- CDC, Principles of Epidemiology in Public Health Practice, 3rd Edition
25
UNIT 2 ENVIRONMENT AND ITS
IMPACT ON HEALTH
Structure
2.0 Introduction
2.1 Objectives
2.2 Components of Environment
2.3 Environmental Health
2.4 Environment Hazards
2.5 Impact of Environmental Hazards on Human Health
2.5.1 Air Pollution
2.5.2 Safe Water
2.5.3 Sanitation and Safe Excreta Disposal
2.5.4 Ecosystem Change
2.5.5 Climate Change & Health
2.5.6 Global Warming
2.5.7 Noise
2.5.8 Waste and Human Health
2.6 Waste and Human Health

2.6.1 Solid Waste
2.6.2 Hazardous Waste
2.6.3 E-Waste
2.6.4 Health Care Waste
2.7 Environmental Action

2.8 Let Us Sum Up
2.9 Key Words
2.11 References and Suggested Further Readings
2.0 INTRODUCTION
You have already read from the previous units that environment refers to all
the external conditions, circumstances, and influences surrounding and affecting
the growth and development of an organism or community.
Thus, environment is defined as “All that is external to the individual human
host, living and non-living, and with which he is in constant interaction”(John
M. Last)
The environment may be macro-environmentor macro-environment.
 The macro-environmentincludes broader factors, which affect community
as a whole. The broad environment is made up of six components:
demographic, economic, physical, technological, political-legal, and social-
26
cultural and environment.
Micro-environment is the immediate environment in which man lives. Environment and its
Impact on Health
You have already read about the concept of health and disease in the previous
unit. In this unit you will learn in detail about environment, various components
of environment, and the relationship between environment and health. You will
learn that how environmental factors play an important role in human health
and well-being. We will discuss that exposures to various physical, chemical
and biological risk factors result in diseases in human being. Due to industrial
revolution, increased use of chemicals in agriculture, and other human activities
there has been environmental degration in last few decades, which is resulting
in ecological imbalance and poor health. Environmental interventions are required
to reduce the disease burden.
2.1 OBJECTIVES
After going through this unit, you should be able to:
 define the term ‘environment’ and describe its physical, biological and
psychosocial components.
 discuss the influence of environment on human health.
 enumerate and discuss the environmental hazards affecting human health.
 discuss various environmental interventions for reducing the disease burden
2.2 COMPONENTS OF ENVIRONMENT

Environment can be divided into three components:
Physical: air, water, soil, housing, climate, geography, heat, light, noise, debris,
radiation, etc.
Biological: man, viruses, microbial agents, insects, rodents, animals and plants,
etc.
Psychosocial: cultural values, customs, beliefs, habits, attitudes, morals, religion,
education, lifestyles, community life, health services, social and political organization.
These components are closely related.
Human beings are in constant interaction with all these components of
environment, which have a bearing on health. (Fig 2.1)
27
Fig 2.1: Components of environment
Environment and Ecology Importance of environment in health
As discussed in the last chapter, environment is one of the components of the

epidemiological triad (Fig. 2.2). Various disease conditions appear when there
is an interaction of the agent, host and environment, including the human activities
affecting the environment.
Fig. 2.2: Environment and human health
We need safe, healthy and supportive environments for good health. The
environment in which we live is a major determinant of our health and wellbeing.
We depend on the environment for energy and the materials needed to sustain
life, such as, clean air, safe drinking water, nutritious food, safe places to live.
Many aspects of our environment – both built and natural environment – can
impact have an impact on our health.
2.3 ENVIRONMENTAL HEALTH

Environmental Health is the study and management of environmental
conditions that affect the health and well-being of humans.
Environmental health comprises those aspects of human health, including quality

of life, that are determined by physical, biological, social, and psychosocial factors
in the environment. These factors have been elaborated in the Fig 2.3. The
biological factors generally refer to the disease causing agents like the microbes.
The physical factors refer to the temperature, humidity, precipitation wind etc.
The chemical factors refer to the allergens, chemical, pollutants etc. The
psychological factors include the stress, interpersonal relationships etc. It also
refers to assessing, correcting, controlling, and preventing those factors in the
environment that can potentially affect adversely the health of present and future
generations.
28
Environment and its
Impact on Health
Fig 3: Different environmental factors affecting health

unit.
1. What do you understand by the term “Environment”?
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2. List various components of environment.
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2.4 ENVIRONMENTAL HAZARDS

Environmental hazards may be biological, chemical, physical, psychological,
sociological, or site and location hazards.
 Biological Hazards: These are living organisms or their products that are
harmful to humans
 Water-borne diseasesare diseases that are transmitted through drinking
watere.g. polio virus, hepatitis A virus, Salmonella, Shigella, cholera,
amoebic dysentery, Giardia, and Cryptosporidium.These disease organisms
can produce illness in those who consume untreated, contaminated water. 29
Environment and Ecology  Food-borne diseasese.g. Salmonella, serotype enteritidis, Escherichia coli
0157:H7, as well as other agents.
 Vector –borne diseases: Improper environmental management can cause
vector-borne disease outbreaks e.g. Malaria, dengue, filariasis, kala azar
etc.
 Arthropod borne diseases: Diseases transmitted by insects or other
arthropods e.g. Examples are St. Louis encephalitis and La Crosse
encephalitis transmitted by mosquitoes and plague and murine typhus
transmitted by fleas
Physical Hazards - These include airborne particles, temperature, humidity,
equipment design and radiation
Psychological Hazards
These are environmental factors that produce psychological changes expressed
as stress, depression, and other mental health conditions.
Sociological Hazards
These result from living in a society where one experiences noise, lack of privacy
and overcrowding.
unit.
1. What are various kinds of environmental hazards?
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2. List some health effects of common environmental hazards.
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2.5 IMPACT OF ENVIRONMENTAL HAZARDS

ON HUMAN HEALTH
There is growing concern about the links between the environment and health.
Human are responsible for polluting the environment which in turn has shown
its effect on the human health. The health and environment are interlinked.
It has been estimated that 24% of the global burden of disease and 23% of
all deaths were due to modifiable environmental factors (for example, pollution,
occupational risks, land use practices and sanitation).
(Source:http://cdrwww.who.int/quantifying_ehimpacts/publications/
preventingdiseasebegin.pdf
30
Table 1: Environmental hazards and related human health effects Environment and its
Impact on Health
Environmental hazard Examples of health effects
Outdoor air pollution Respiratory conditions, cardiovascular disease,

lung cancer
Unsafe drinking water Diarrhoeal (gastrointestinal) illnesses
Mosquitoes, ticks and Malaria, dengue fever, Rickettsial disease
other vectors
UV (ultraviolet light) Too much: melanoma, non-melanoma skin
exposure cancer, eye cataractsToo little: vitamin D
deficiency, leading to rickets, osteoporosis and
osteomalacia
Second-hand smoke Respiratory diseases, lung cancerIn children:
exposure asthma, lower respiratory infections, middle
ear infections
Household crowding Infectious diseases, including lower respiratory
infections
Cold and damp housing Excess mortality
Climate change Infectious diseases, including giardiasis,
cryptosporidiosis and salmonellosis; heat stroke
Hazardous substances Poisoning, burns, dermatitis
Lead In children: developmental delays, behavioural
problemsIn adults: increased blood pressure
Asbestos Breathing difficulties, lung cancer, mesothelioma
Noise Hearing loss, cardiovascular problems, insomnia,
psychophysiological problems
Environmental Catastrophes that resulted in high mortality

Minamata disease (1953-1961) “Methyl mercury poisoning
Bhopal (1984) “16.5 tons of toxic pesticide released
Chernobyl (1986) “Nuclear reactor accident
Milwaukee incident (1993) “Cryptosporidium in drinking water
In the least developed countries, one third of death and disease is a direct
result of environmental causes. The major causes of environment related
morbidity and mortality are discussed below:
2.5.1 Air Pollution

Clean air is a basic requirement of human health and well-being. According
to WHO, more than 2 million premature deaths occur each year due to air
pollution. More than half of this disease burden is borne by the populations
of developing countries. 31
Environment and Ecology Indoor Air Pollution
 More than three billion people worldwide continue to depend on solid fuels,
including biomass fuels (wood, dung, agricultural residues) and coal, for
their energy needs.
 Cooking and heating with solid fuels on open fires or traditional stoves
results in high levels of indoor air pollution.
 Indoor smoke contains pollutants, particulate matter and carbon monoxide,
which may be 20 times higher than accepted values.
 As per the world health report indoor air pollution is responsible for 2.7%
of the global burden of disease.
2.5.2 Safe Water

A large proportion of the world’s population is facing water scarcity. Shortage
of safe water is worsening due to population growth, urbanization and the
increase in domestic and industrial water use.
It has been indicated that by 2025, nearly 2 billion people will be living in
countries or regions with absolute water shortage.
Water scarcity forces people to rely on unsafe sourcesof drinking water. Poor
water quality can increase the risk of diarrhoeal diseases including cholera,
typhoid fever, salmonellosis, other gastrointestinal viruses, and dysentery. It also
promotes trachoma, plague and typhus.
Due to shortage of water, people have to store water in their homes. It can
increase the risk of household water contamination and provide breeding grounds
for mosquitoes, which are vectors for dengue, dengue haemorrhagic fever, and
malaria and other diseases.
2.5.3 Sanitation and Safe Excreta Disposal

Sanitation refers to adequate treatment and disposal of human excreta and
sewage. It prevents human contact with faces, and aims to protect human health
by providing a clean environment that will stop the transmission of disease,
especially through the fecal-oral route.
32
Figure 4: Sanitation Barrier
Sanitation is critical for preventing many diseases including diarrhoea, intestinal Environment and its
Impact on Health
worms, and trachoma that affect millions of people. Ensuring universal access
to sanitation in households is essential in reducing disease, enhancing safety, and
well-being, especially for women and girls. As per latest estimates, globally 2.3
billion people still lack a basic sanitation service and as many as 892 million
people practice open defecation. In India, Swachh Bharat Mission, which aims
to provide access to sanitary latrines to all is a step towards improving
environmental saniataion.
2.5.4 Ecosystem Change
 Land change due to damage by erosion, salination or chemicals - has
impacts on health.
 Increasing pressures of agricultural and livestock production are stressing
the world’s lands and pastures.
 Desertification affects human health through complex pathways, increased
poverty due to less nutrition, population displacement, water- food- and
vector- borne diseases, and air pollution.
2.5.5 Climate Change & Health
 Marked short-term fluctuations in weather can cause acute adverse health
effects.
 Extremes of heat and cold lead to heat stress or hypothermia, increasing
death rates from heart and respiratory diseases.
 Weather extremes-heavy rains, floods, and hurricanes, also have severe
impacts on health.
 Approximately 600,000 deaths occurred world-wide (weather-related
natural disasters in the 1990s; and 95% of these were in poor countries).
examples: frequent cyclones, earth quakes and other natural disasters in
various parts of the world.
 Climatic conditions affect diseases transmitted through water, and via vectors
such as mosquitoes.
2.5.6 Global Warming
 About two thirds of solar energyreaching earth is absorbed, and heats the
earth’s surface.
 The heat radiates back to the atmosphere, trapped by greenhouse gases,
such as carbon dioxide.This’greenhouse effect’ regulates surface temperature.
 Human activities, particularly burning of fossil fuels over the last many years,
have released large quantities of CO2 and other greenhouse gases to affect
the global climate.
 The atmospheric concentration of carbon dioxide has increased by more
than 30% since pre-industrial times, trapping more heat in the lower
atmosphere.
 It has resulted in melting of glaciers, rise in sea level, climate changes, which
in turn have led to displacement of habitation, increased diseases particularly
vector-borne and other communicable diseases. 33
Environment and Ecology 2.5.7 Noise
Globally, some 120 million people are estimated to have disabling hearing
difficulties. A large proportion of the world’s population lives in noisy surroundings.
Exposure to noise can have many health impacts. These are described as follows:
 Prolonged or excessive exposure to noise, can cause hypertension and
ischaemic heart disease.
 above 80 dB may increase aggressive behaviour,disturbed sleep etc.
2.6 WASTE AND HUMAN HEALTH

Improper waste management can have negative impacts on both environment
and public health. Negative impacts can be due to different handling and disposal
activities resulting in soil, water and air pollution. Inadequately disposed off or
untreated waste may cause serious health problems for populations surrounding
the area of disposal. Leaks from the waste may contaminate soils and water
streams, and produce air pollution through emissions of e.g. heavy metals and
persistent organic pollutants (POPs), ultimately creating health hazards. Other
nuisances caused by uncontrolled or mismanaged waste disposal which may
affect citizens negatively include impacts at local level, such as landscape
deterioration, local water and air pollution, as well as littering. Managing waste
properly and in an environmentally sound way is therefore important for health
reasons.
Unattended waste lying around attracts flies, rats, and other creatures that in
turn spread disease. Normally it is the wet waste that decomposes and releases
a bad odour. This leads to unhygienic conditions and thereby to a rise in the
health problems.
Various types of wastes are:
2.6.1 Solid Waste

has become contaminated either due to waste dumping or leakage from landfill
sites. Uncollected solid waste also increases risk of injury, and infection.In
particular, organic domestic waste poses a serious threat, since they ferment,
creating conditions favourable to the survival and growth of microbial pathogens.
Direct handling of solid waste can result in various types of infectious and chronic
diseases with the waste workers and the rag pickers being the most vulnerable.
Waste from agriculture and industries can also cause serious health risks. Disposal
of industrial hazardous waste with municipal waste can expose people to chemical
and radioactive hazards. Uncollected solid waste can also obstruct storm water
runoff, resulting in the forming of stagnant water bodies that become the breeding
ground of disease. Waste dumped near a water source also causes contamination
of the water body or the ground water source. Direct dumping of untreated
waste in rivers, seas, and lakes results in the accumulation of toxic substances
in the food chain through the plants and animals that feed on it.
2.6.2 Hazardous Waste

Annually, about 12 million tons of inert waste are generated in India from street
sweeping and construction and demolition debris waste and in the landfill sites,
34
it occupies about one-third of total MSW. Annually, about 12 million tons of Environment and its
Impact on Health
inert waste are generated in India from street sweeping and construction and
demolition debris waste and in the landfill sites, it occupies about one-third of
total MSW. Exposure to hazardous waste can affect human health, children being
more vulnerable to these pollutants. In fact, direct exposure can lead to diseases
through chemical exposure as the release of chemical waste into the environment
leads to chemical poisoning. Many studies have been carried out in various parts
of the world to establish a connection between health and hazardous waste.
2.6.3 E-Waste
E-waste like refrigerators, computers, washing machines etc. comprises a source
of a variety of materials that can be recovered and brought back into the
production cycle. Over 1,000 different chemicals (as heavy metals, polycyclic
aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and brominated
flame retardants) are identified in the e-waste streams. The population exposed
to potentially hazardous substances through inappropriate and unsafe management
practices related to e-waste is increasing. Given the pollutants involved, health
effects from treatment of e-waste may include neurodevelopmental outcomes.
A recent review recorded plausible outcomes related to alterations in thyroid
function, associations of exposure to chromium, manganese and nickel with lung
function, adverse birth outcomes (preterm birth, low birth weight, stillbirth, and
congenital malformations), behavioural alterations, as well as DNA damage and
chromosomal aberrations in lymphocytes. This relatively recent and growing
problem needs to be addressed by suitable epidemiological studies in vulnerable
populations (such as pregnant women and children).
2.6.4 Health Care Waste

Of the total amount of waste generated by health-care activities, about 85%
is general, non-hazardous waste comparable to domestic waste. The remaining
15% is considered hazardous material that may be infectious, chemical or
radioactive.Disposal of hospital and other medical waste requires special attention
since this can create major health hazards. This waste generated from the
hospitals, health care centres, medical laboratories, and research centres such
as discarded syringe needles, bandages, swabs, plasters, and other types of
infectious waste are often disposed with the regular non-infectious waste. Of
the total amount of waste generated by health-care activities, about 85% is
general, non-hazardous waste comparable to domestic waste. The remaining
15% is considered hazardous material that may be infectious, chemical or
radioactive.
Healthcare waste contains potentially harmful microorganisms that can infect
hospital patients, health workers and the general public. Other potential hazards
may include drug-resistant microorganisms which spread from health care facilities
into the environment.
Health-care waste is a reservoir of potentially harmful micro-organisms. Every
year, health care waste results in millions of Heaptitis B, HIV, and Hepatitis
C infections.
Wastes and by-products can also cause injuries, e.g. radiation burns or sharps-
inflicted injuries; poisoning and pollution (mercury, antibiotics, cytotoxic drugs
etc.) 35
Environment and Ecology Check Your Progress 3
unit.
1. What do you understand by the term sanitation barrier?

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2. Describe some impacts of climate change on human health.
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2.7 ENVIRONMENTALACTION
It is understood that healthier environments could significantly reduce the
incidence of cancers, cardiovascular diseases, asthma, lower respiratory infections,
musculoskeletal diseases, and road traffic injuries.
Reducing the disease burden through environmental interventions
Environmental health intervention helps to achieve reduction of the diseases in
several ways.
Providing sustainable sources of safe water and clean energy are key
environmental interventions.Environmental interventions will likely have a great
impact on improving the health of slum dwellers, who are among those most
affected by the combined health hazards associated with polluted water,
inadequate sanitation, urban ambient air pollution, and indoor air pollution from
solid fuel use.
Environmental health interventions can make a valuable and sustainable contribution
towards reducing the global disease burden and improving the well-being of
people
Much of the death, illness and disability could be prevented –
 Promoting safe household water storage,
 Provision of sanitary latrine and safe disposal of human excreta
 Use of cleaner and safer fuels.
 Other interventions for healthy environment: increasing the safety of buildings,
promoting safe, careful use and management of toxic substances at home
an in the workplace, and better water resource management.
36
Environment and its
2.8 LET US SUM UP Impact on Health
In the present unit, we have learnt about the definition of environment, different
components of environment and, influence of environment on health of a person.
We also studied various environmental hazards.
Various causes of environment related morbidity and mortality have also been
discussed.
Finally, we studied various environmental interventions to reduce disease burden

and improve health of populations.
2.9 KEY WORDS
Health Impact Assessment Health Impact Assessment is a combination of

procedures, methods and tools by which a policy, program or project may be
judged as to its potential effects on the health of a population, and the distribution
of those effects within the population.
Environmental Impact Assessment (EIA) was initiated by the National

Environmental Policy Act (NEPA) in 1969 in the USA,29,HYPERLINK “https:/
/jech.bmj.com/content/57/9/647” \l “ref-30” 30 and has since been introduced
widely throughout the world. An Environmental Impact Statement (EIS) is
the summary of the results of an EIA. A draft EIS is made available for the
public consultation process, after which a final version is prepared, and this
forms part of the subsequent decision making process.31 EIA is generally carried
out at a project level. In principle, consideration of human health outcomes should
form part of the assessment but this is frequently omitted or appraised in a
manner that is not considered satisfactory by public health specialists (A-B
Kobusch, et al,14th IAIA Conference, Quebec, 1994 and references32–
HYPERLINK “https://jech.bmj.com/content/57/9/647” \l “ref-34” 34). However,
an EIA can provide data that are useful for health, for example, on air pollution.
The results of a proposal on determinants of health (for example, air pollution)
are often referred to as effects, with the consequent results on health being
called impacts. Limitations of EIA are that project level assessment may be
too late in the process to influence broader policy, and the responsibility for
EIA is taken by the proponent of the project, so that its independence may
be compromised.
Health impact analysis is a purely quantitative approach that uses a decision

analysis framework to integrate mathematical models of the dispersal of industrial
pollutants into the environment with population health models. Although proponents
claim a transparency in decision making based on this analytical approach
because of the explicit outcomes modelled, with production of the “best” option,
it can be used only where there is extremely complete quantitative evidence
or restrictive assumptions.
37
Your answers should include the following points:
1. The environment refers to all the external conditions, circumstances, and
influences surrounding and affecting the growth and development of an
organism or community.
2. Environment can be divided into three components:
Physical: air, water, soil, housing, climate, geography, heat, light, noise, debris,
radiation, etc.
Biological: man, viruses, microbial agents, insects, rodents, animals and plants,
etc.
Psychosocial: cultural values, customs, beliefs, habits, attitudes, morals, religion,
education, lifestyles, community life, health services, social and political organization.
1. Environmental hazards may be biological, chemical, physical, psychological,
and sociological.
2. - Biological hazards can lead to various infectious diseases like diarrhoea,
salmonellosis, vector-borne diseases etc.
- Chemical hazards can lead to various types of cancers, respiratory
diseases
1. Sanitation Barrierrefersprevention human contact with feaces, and aims to
protect human health by providing a clean environment that will stop
the transmission of disease, especially through the fecal-oral route.
2. Climate change can lead to increase in natural disasters, desertification,
population displacement, under-nutrition and hunger, increase in water-borne
and vector- borne diseases, and air pollution.
2.11 REFERENCES AND SUGGESTED

FURTHER READINGS
 World Health Organization. 2016. Integrated Monitoring of Water and
Sanitation Related SDG Targets.
 Park’s Textbook of preventive and social medicine, 21st edition
 Textbook of Epidemiology, Leon Gordis, 4th edition.
 Textbook of public health and community medicine, AFMC, 2009
 Ministry of Drinking Water and Sanitation. Swachh Bharat Mission - Gramin
38
UNIT 3 OVERVIEW OF
OCCUPATIONAL HEALTH
Structure
3.0 Introduction
3.1 Objectives
3.2 Concept of Occupational Health
3.2.1 Definition and Concept
3.2.2 Problem Statement/Disease Burden
3.2.3 Ergonomics: Principles and Applications
3.2.4 Sickness Absenteeism
3.3 Occupational Hazards

3.4 Occupational Dermatosis
3.5 Occupational Lung Diseases
3.5.1 Occupational Asthma
3.5.2 Pneumoconioses
3.5.3 Silicosis
3.5.4 Anthracosis
3.5.5 Byssinosis
3.5.6 Bagassosis
3.5.7 Asbestosis
3.5.8 Farmer’s lung
3.5.9 Hypersensitivity Pneumonitis
3.5.10 Pleural Disease
3.6 Occupational Cancers

3.7 Prevention and Control of Occupational Diseases
3.7.1 Medical, Engineering and Legislative Measures
3.7.2 Medical Measures
3.7.3 Engineering Measures
3.7.4 Legislative Measures
3.8 Global Strategy on Occupational Health for All

3.9 Key Words
3.10 Let Us Sum Up
3.0 INTRODUCTION
The basic concepts of health and wellbeing and how environmental factors have
a bearing on health have been dealt with in the previous units. Have you ever
realized that many individuals spend nearly one-third of their adult life at their
workplace and the nature of work and the working environment could, in fact, 39
be an important determinant of their health and overall wellbeing. A wide array
Environment and Ecology of hazardous exposures can occur at workplace predisposing them to several
kinds of health risks or aggravating pre-existing diseases. Around 30-50% of
workers report different types of hazardous physical, chemical or biological
exposures or overload of unreasonably heavy physical work that may be
deleterious to health and to working capacity; an equal number of working people
report psychological overload at work resulting in stress symptoms. In addition
to unnecessary human suffering, the costs involved in these health hazards have
been estimated to amount up to several percent of some countries’ gross national
product (GNP). Moreover, rapid changes in the modem working life is associated
with increasing demands of learning new skills, need to adapt to new types of
work, pressure of higher productivity and quality of work, hectic job schedule
and with growing psychological workload and stress among the workforce. Such
developments require higher priority to be given to psychosocial aspects of work
and the work environment. Hence, occupational health and the well-being of
working people are crucial prerequisites for productivity and are of utmost
importance for overall socioeconomic and sustainable development.
3.1 OBJECTIVES
After going through this Unit, you should be able to:
 define occupational health and describe the importance of occupational health
and safety;
 enumerate the principles of ergonomics and its application in the work
environment;
 describe the various types of occupational hazards and how hazard analysis
and risk assessment is done in industries;
 describe important occupational diseases; and
 describe various modalities of prevention and control of occupational diseases.
3.2 CONCEPT OF OCCUPATIONAL HEALTH

Let us first understand the definition and concept of occupational health before we
can study the hazards and diseases associated with various occupation. In this section
you will also learn about the prevention and control of occupational diseases.
3.2.1 Definition and Concept
The Joint ILO/WHO Committee on Occupational Health, in its first session held
in 1950, gave the following 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; the prevention among workers of
departures from health caused by their working conditions; the protection of
workers in their employment from risks resulting from factors adverse to health;
the placing and maintenance of the worker in an occupational environment adapted
to his physiological and psychological equipment, and, to summarize, the adaptation
of work to man and of each man to his job’.
Occupational health deals with all aspects of health and safety in the workplace
and has a strong focus on primary prevention of hazards. The health of the
workers has several determinants, including not just the risk factors at the workplace
resulting in cancers, accidents, musculoskeletal diseases, respiratory diseases,
hearing loss, stress related disorders to name a few but also social and individual
40 factors and access to health services. Employment and working conditions in the
formal or informal economy embrace other important determinants like working Overview of Occupational
hours, salary, workplace policies concerning leaves, health promotion and protection Health
provisions, etc.
About 45% of the world’s population and 58% of the population over 10 years
of age belong to the global workforce. Their work sustains the economic and
material basis of society which is critically dependent on their working capacity.
Health at work and healthy work environments are among the most valuable
assets of individuals, communities and countries. Occupational health is an important
strategy not only to ensure the health of workers, but also to contribute positively
to productivity, quality of products, work motivation, job satisfaction and thereby
to the overall quality of life of individuals and society.
3.2.2 Problem Statement/Disease Burden
Global Burden
As per WHO, about 120 million occupational accidents with 0.2 million fatalities
are estimated to occur annually and some 68-157 million new cases of occupational
disease may be caused by various exposures at work. Occupational injuries
account for 0.9% of the global DALYs lost.
Burden of Occupational Diseases in India
The incidence of work related morbidity and mortality in India is very high. It is
estimated that 17 million occupational non-fatal injuries (17% of the world) and
45,000 fatal injuries (45% of the total deaths due to occupational injuries in
world) occur in India each year.
3.2.3 Ergonomics: Principles and Applications
Ergonomics is now a well recognized discipline and constitutes an integral part of
any advanced occupational health service. The term “ergonomics” is derived from
the Greek word ‘ergon’ meaning work and ‘nomos’ meaning law. Ergonomics
can be defined simply as the study of work. More specifically, ergonomics is the
science of designing the job to fit the worker, rather than physically forcing the
worker’s body to fit the job. It simply means: “fitting the job to the worker”.
Training in ergonomics involves designing of machines, tools, equipment and
manufacturing processes, lay-out of the places of work, methods of work and
environment in order to achieve greater efficiency of both man and machine. The
objective of ergonomics is “to achieve the best mutual adjustment of man and his
work, for the improvement of human efficiency and well-being”. The application
of ergonomics has made a significant contribution to reducing industrial accidents
and to the overall health and efficiency of the workers. Ergonomics draws on a
number of scientific disciplines, including physiology, biomechanics, psychology,
anthropometry, industrial hygiene, and kinesiology.
Applications: Industries increasingly require higher production rates and advances
in technology to remain competitive and stay in business. As a result, jobs today
can involve:
 Frequent lifting, carrying, and pushing or pulling loads without help from
other workers or devices;
 Increasing specialization that requires the worker to perform only one function
or movement for a long period of time or day after day;
 Working more than 8 hours a day;
 Working at a quicker pace of work, such as faster assembly line speeds; and
41
 Having tighter grips when using tools.
Environment and Ecology These factors—especially if coupled with poor machine design, tool, and workplace
design or the use of improper tools—create physical stress on workers’ bodies,
which can lead to injury. If work tasks and equipment do not include ergonomic
principles in their design, workers may have exposure to:
 undue physical stress, strain, and overexertion,
 vibration,
 awkward postures,
 forceful exertions,
 repetitive motion,
 extreme temperatures and
 heavy lifting.
Recognizing ergonomic risk factors in the workplace is an essential first step in
correcting hazards and improving worker protection. Ergonomists, industrial
engineers, occupational safety and health professionals, and other trained individuals
believe that reducing physical stress in the workplace could eliminate up to half
of the serious injuries each year. Employers can learn to anticipate what might go
wrong and alter tools and the work environment to make tasks safer for their
workers. Good ergonomics is good economics.
3.2.4 Sickness Absenteeism
Sickness absenteeism occurs when employees miss work for reasons stemming
from health problems. The rate of sickness absenteeism is linked to the overall
health of the workforce and also to specific factors in each individual profession.
Workplace policies and national standards also impact the rate of sickness
absenteeism as do cultural norms and personal attitudes among workers.
Sickness absence is an important health problem in industry. It may seriously
impede production with serious cost repercussions, both direct as well as indirect.
As the production techniques become more sophisticated, absenteeism tends to
increase the adverse repercussions.
Absenteeism is a useful index in industry to assess the state of health of workers,
and their physical, mental and social well-being. Absenteeism in workplace has a
multitude of reasons, with sickness being the key one. But then not all sickness
absenteeism is attributable to sickness. Thus, sickness absenteeism may not be a
true indicator of prevailing sickness in the work place. A better indicator of health
of the workers is the mortality statistics of workmen dying during their working
life-span and analysis of the mortality causes would help elicit the patterns of
diseases specific to different industries.
Incidence: India has a working force of more than 5 million in registered factories.
Research undertaken by the National Productivity Council (NPC) into absenteeism
showed a marked increase from around 8 to 13 per cent in the early 1950s to
around 15 to 20 per cent or even more in recent years. The rate of absenteeism
was reported to be 8 to 10 days per head per year.
Causes: The causes of sickness-absenteeism may not be entirely due to sickness:
 Economic causes: Studies have shown that if the worker is entitled to sick
leave with pay, he tends to avail of this privilege by reporting sick. It is so
well remarked that in industry the workers declare themselves fit or unfit for
42 work, at their choice.
 Social causes: Certain social factors appear to influence sickness absenteeism Overview of Occupational
in India. These are the social and family obligations such as weddings, festivals, Health
repair and maintenance of ancestral house and similar other causes. Some of
the workers who come from rural areas go back to their villages, for short
or long periods, during sowing and harvest seasons.
 Medical causes: About 10 per cent of the days lost were found to be due
to occupational accidents. Respiratory and alimentary illnesses have also
been found to be important causes.
 Non-occupational causes: Certain non-occupational causes such as nutritional
disorders, alcoholism and drug addiction have also been found to be
responsible for sickness-absenteeism.
Prevention: The prevention or reduction of sickness absenteeism would result in
better utilization of resources and maximizing the production. The methods for
reducing sickness absenteeism include:
 good factory management and practices
 adequate pre-placement examination
 good human relations and
 application of ergonomics.
3.3 OCCUPATIONAL HAZARDS

The “occupational environment” is a sum of external conditions and influences
which prevail at the place of work and which have a bearing on the health of the
working population. Basically, there are three types of interaction in a working
environment: (a) Man and physical, chemical and biological agents (b) Man and
machine; (c) Man and man
An industrial worker may be exposed to different types of hazards depending
upon his occupation as follows: (a) Physical hazards; (b) Chemical hazards; (c)
Biological hazards; (d) Mechanical hazards; (e) Psychosocial hazards. These have
been further elaborated in table 3.1.
Table 3.1: Types of Hazards in an industry
Type of Hazard Occupation/Industry Harmful Health Effects
where encountered
Direct effects of heat exposure are
Physical Radiant heat is the main
burns, heat exhaustion, heat
Heat problem in foundry, glass and
stroke and heat crampsIndirect
steel industriesHeat
effects are decreased efficiency,
stagnation is the principal
increased fatigue and enhanced
problem in jute and cotton
accident rates
textile industry
Cold Fishing & food processing Trench foot, frost bite, chilblains
industry
Light Poor illumination - Mines Acute effects of poor illumination

are eye strain, headache, eye pain,
lachrymation, congestion around
the cornea and eye fatigue.
Chronic effects on health include
“miner’s nystagmus”
43
Environment and Ecology Excessive brightness – Discomfort, annoyance and visual
Electronic industries particularly fatigue
watch making
Noise Most industries Auditory effects - temporary or
permanent hearing loss
Non--auditory effects-
nervousness, fatigue, interference
with communication by speech,
decreased efficiency and
annoyance
Vibration In work with pneumatic tools In range 10 to 500 Hz – White

such as drills and hammers Fingers due to capillary spasm
UV Rays Arc welding industry Intense keratitis & Conjunctivitis –

Welder’s flash
Ionizing Nuclear Plants, mining of Genetic changes, malformation,
Radiation radioactive material, X ray cancer, leukaemia, depilation,
technician ulceration, sterility and in extreme
cases death
Chemical
Gases Gas Poisoning
Acids & Burns

Alkalis
Solvents &
Dyes Occupational dermatosis and
cancer
Dusts Pneumoconiosis
Persons working among animal Brucellosis, leptospirosis, anthrax,
Biological hydatidosis, tetanus, psittacosis,
products (e.g., hair, wool,
hides), agricultural workers and encephalitis, fungal infections,
health care professionals schistosomiasis
Mechanical Most industries resulting from Accidents and injuries

man and machine interaction
Most industries resulting from Frustration, lack of job satisfaction,

Psychosocial man to man interaction insecurity, poor human relationships,
emotional tension
Let us now look at some of the occupational diseases that of public health
importance – those that significantly contribute to the morbidity pattern of a
particular location, townm, state or even the entire country.
3.4 OCCUPATIONAL DERMATOSIS

Occupational dermatosis is a big health problem in many industries. These are
skin disorders associated with exposure to toxic chemicals or other agents in the workplace.
Contact dermatitis is reported to comprise 90–95% of cases of occupational
dermatoses. It includes:
 irritant contact dermatitis (70–80%)
44  allergic contact dermatitis (20–25%), and
 contact urticaria (<5% including immediate hypersensitivity reactions to food Overview of Occupational
Health
proteins and latex allergy).
Other occupational dermatoses include infections, miliaria, psoriasis, paronychia,
photosensitivity, stasis eczema, acne, chloracne, and depigmenting disorders.
The causes of occupational dermatosis may be:
 Physical- heat, cold, moisture, friction, pressure, X -rays and other rays;
 Chemical - acids, alkalies, dyes, solvents, grease, tar, pitch, chlorinated
phenols etc.
 Biological- living agents such as viruses, bacteria, fungi and other parasites,
plant products - leaves, vegetables, fruits, flowers, vegetable dust, etc.
The dermatitis producing agents are further classified into:
 Primary irritants: e.g. acids, alkalies, dyes, solvents, etc. cause dermatitis
in workers exposed in sufficient concentration and for a long enough period
of time.
 Sensitizing substances: On the other hand, allergic dermatitis occurs only
in small percentage of cases, due to sensitization of the skin.
Prevention: Occupational dermatitis is largely preventable if proper control
measures are adopted:
 Pre--selection: The workers should be medically examined before
employment, and those with an established or suspected dermatitis or who
have a known pre-disposition to skin disease should be kept away from jobs
involving a skin hazard.
 Protection: The worker should be given adequate protection against direct
contact by protective clothing, long leather gloves, aprons and boots. The
protective clothing should be frequently washed and kept in good order.
There are also, what are known as barrier creams which must be used
regularly and correctly. There is no barrier cream so far invented which will
prevent dermatitis in all occupations.
 Personal hygiene: There should be available a plentiful supply of warm
water, soap and towels. The worker should be encouraged and. educated
to make frequent use of these facilities. Adequate washing facilities in industry
are a statutory obligation under the Factories Act.
 Periodic inspection: There should be a periodic medical check-up of all
workers for early detection and treatment of occupational dermatitis. If
necessary, the affected worker may have to be transferred to a job not
exposing him to risk. The worker should be educated to report any skin
irritation, no matter: how mild or insignificant.
3.5 OCCUPATIONAL LUNG DISEASES

Occupational lung diseases are occupational disorders affecting the respiratory
system due to harmful exposures at workplace including organic and inorganic
dusts, metals, moulds and fungal spores etc. and can be classified as follows: 45
Environment and Ecology  Obstructive occupational airway diseases: Occupational asthma
 Pneumoconioses: Coal worker’s pneumoconiosis, asbestosis, silicosis
 Hypersensitivity pneumonitis: Fungal pneumonitis like baggasosis, farmer’s
lung
 Occupational Respiratory Cancers: Bronchogenic carcinoma & mesothelioma
due to asbestos exposure
 Pleural Diseases: Pleural plaques due to asbestos
3.5.1 Occupational Asthma

Occupational asthma (OA) remains the most commonly recognized industrial lung
disease in the developed world; however, many cases remain unreported. The
symptoms are similar to other forms of asthma except that they are linked to
exposure to an agent that is encountered specifically in the occupational environment.
Occupational asthma refers to the development of asthma following exposure to
a known occupational sensitizer often with evidence of an elevated specific
immunoglobulin E [IgE] to the relevant occupational allergen. The first clue that
asthma may be linked to occupation is usually found in the history, if the patient
reports improvement in symptoms occurring at weekends and on holidays. Rhino-
conjunctivitis is often present and may precede the onset of lower respiratory
tract symptoms. Establishing the link between symptoms to an agent at work
often requires a methodical work-up including more detailed lung function tests.
Agents which can trigger OA are:
 Adhesives
 Metals (chemical coolants)
 Resins
 Isocyanates
 Flour and grain dust
 Colophony and fluxes
 Latex
 Animals (shellfish in particular)
 Aldehydes
 Wood dust (red cedar)
Occupations at risk of OA
 Animal handlers
 Bakers and pastry makers
 Chemical workers
 Food processing workers
 Hairdressers
46
 Paint sprayers Overview of Occupational
Health
 Nurses
 Timber workers
 Welders
3.5.2 Pneumoconioses
These are a group of chronic lung conditions characterized by fibrotic changes in
the lung tissue and other complications due to exposure to dusts of particle size
0.5 to 3 micron. The hazardous effects of dusts on the lungs depend upon a
number of factors such as:
 chemical composition
 fineness
 concentration of dust in the air
 period of exposure and
 health status of the person exposed.
Therefore, the threshold limit values for different dusts are different. Also the
period of exposure required for most pneumoconioses to develop ranges between
10 – 15 years but may vary markedly. Several classifications of peumoconioses
exists, however, to classify it on the basis of type of dust exposure and severity
would be useful. The different diseases which have been associated with the
inorganic and the organic dusts are presented in Table 3.2.
Table 3.2: Diseases associated with inorganic and organics dusts
Based on type of dust exposure
Inorganic dusts Diseases Organic dusts Diseases
Silica Silicosis Cotton dust Bysinosis
Asbestos Asbestosis Sugarcane dust Baggasosis
Coal dust Anthracosis Grain dust Farmer’s Lung
Iron dust Siderosis

The diseases associated with the different types of dust have been tabulated in
table 3.3
Table 3.3: Diseases associated with the different types of dust
Based on Severity
Severity Dust Type Radiograph
Pneumoconiosis mimic Siderosis Chest radiograph shows opacities

due
(Inert Dusts) Stannosis to retention of dust but no fibrosis
Baritosis or functional abnormality 47
Uncomplicated Aluminiosis Dusts cause fibrosis but no PMF*
Pneumoconiosis Aluminiosis
(without PMF) Berylliosis
Complicated Anthracosis Dusts causing fibrosis with PMF
Pneumoconiosis Silicosis
(with PMF) Asbestosis
*Progressive Massive Fibrosis
The most common pneumoconioses reported from India include silicosis, asbestosis,
coal worker’s pneumoconiosis, bysinosis and baggasosis. Extrinsic allergic alveolitis
are reported less probably due to lack of diagnostic facilities.
The diagnosis of pneumoconioses is based on symptoms of shortness of breath,
cough, history of exposure to occupational hazards, radiological evidence of
interstitial lung disease and restrictive ventilatory defects on lung function testing.
Salient aspects of some of the pneumoconioses are as follows:
3.5.3 Silicosis
 Among the occupational lung diseases, silicosis is the most important
pneumoconiosis reported from India and a major cause of permanent disability
and mortality.
 It is caused by inhalation of dust containing free silica or silicon dioxide
(SiO2). It was first reported in India from the Kolar Gold Mines (Mysore)
in 1947.
 Ever since, its occurrence has been uncovered in various other industries,
e.g., mining industry (coal, mica, gold, silver, lead, zinc, manganese and other
metals), pottery and ceramic industry, sand blasting, metal grinding, building
and construction work, rock mining, iron and steel industry and several
others.
 In the mica mines of Bihar, out of 329 miners examined, 34.1 per cent were
found suffering from silicosis. In a ceramic and pottery industry, the incidence
of silicosis was found to be 15.7 per cent.
 The incidence of silicosis depends upon the chemical composition of the
dust, size of the particles, duration of exposure and individual susceptibility.
The higher the concentration of free silica in the dust, the greater the hazard.
 Particles between 0.5 to 3 micron are the most dangerous because they
reach the interior of the lungs with ease. The longer the duration of exposure,
the greater the risk of developing silicosis. It is found that the incubation
period may vary from a few months up to 6 years of exposure, depending
upon the above factors.
 Pathologically, silicosis is characterized by a dense “nodular” fibrosis, the
nodules ranging from 3 to 4 mm in diameter.
 Clinically the onset of the disease is insidious. Some of the early manifestations
are irritant cough, dyspnoea on exertion and pain in the chest. With more
advanced disease, impairment of total lung capacity (TLC) is commonly
present.
48
 An X-ray of the chest shows “snow-storm” appearance in the lung fields. Overview of Occupational
There is no effective treatment for silicosis. Fibrotic changes that have already Health
taken place cannot be reversed.
 Prevention & Control: The only way that silicosis can be controlled (if not
altogether eliminated) is by:
o Rigorous dust control measures, e.g., substitution, complete enclosure,
isolation, hydroblasting, good house-keeping, personal protective
measures and
o Regular physical examination of workers.
o Silicosis was made a notifiable disease under the Factories Act 1948
and the Mines Act 1952.
3.5.4 Anthracosis
Previously it was thought that pulmonary “anthracosis” was inert. Studies indicate
that there are two general phases in coal miners pneumoconiosis –
 The first phase is labelled simple pneumoconiosis which is associated with
little ventilatory impairment. This phase may require about 12 years of work
exposure for its development
 The second phase is characterized by progressive massive fibrosis (PMF);
this causes severe respiratory disability and frequently results in premature
death. Once a background of simple pneumoconiosis has been attained in
the coal worker, a progressive massive fibrosis may develop out of it without
further exposure to it. From the point of view of epidemiology, the risk of
death among coal miners has been nearly twice that of the general population.
Coal-miners’ pneumoconiosis has been declared a notifiable disease in the
Indian Mines Act of 1952 ‘and also compensatable in the Workmen’s
Compensation (Amendment) Act of 1959.
3.5.5 Byssinosis
Byssinosis is due to inhalation of cotton fibre dust over long periods of time. The
symptoms are chronic cough and progressive dyspnoea, ending in chronic bronchitis
and emphysema. India has a large textile industry employing nearly 35 per cent
of the factory workers. Incidence of byssinosis is reported to be 7 to 8 percent
in three independent surveys carried out in Mumbai, Ahmedabad and Delhi.
3.5.6 Bagassosis
 Bagassosis is the name given to an occupational disease of the lung caused
by inhalation of bagasse or sugar-cane dust. It was first reported in India by
Ganguli and Pal in 1955 in a cardboard manufacturing firm near Kolkata.
India has a large cane-sugar industry. The sugarcane fibre which until recently
went to waste is now utilized in the manufacture of paper, cardboard and
rayon.
 Bagassosis has been shown to be due to a thermophilic actinomycete for
which the name Thermoactinomyces sacchari was suggested. The symptoms
consist of breathlessness, cough, haemoptysis and slight fever. Initially there
is acute diffuse bronchiolitis. Skiagram may show mottling in lungs or shadow.
49
There is impairment of pulmonary function. If treated early, there is resolution
Environment and Ecology of the acute inflammatory condition of the lung. If left untreated, there is
diffuse fibrosis, emphysema and bronchiectasis.
 Preventive measures:
 Dust Control: Measures for the prevention and suppression of dust

such as wet process, enclosed apparatus, exhaust ventilation etc., should
be used.
 Personal Protection: Personal protective equipment (masks or

respirators with mechanical filters or with oxygen or air supply) may be
necessary.
 Medical Control: Initial medical examination and periodical medical

check-ups of the workers are indicated.
 Chemical Control: By keeping the moisture content above 20 per

cent and spraying the bagasse with 2 per cent propionic acid, a widely
used fungicide, bagasse can be rendered safe for manufacturing use.
3.5.7 Asbestosis
 Asbestos is the commercial name given to certain types of fibrous materials.
They are silicates of varying composition; the silica is combined with such
bases as magnesium, iron, calcium, sodium and aluminium. Asbestos is of
two types - serpentine or chrysolite variety and the amphibole type.
 Ninety per cent of the world’s production of asbestos is of the serpentine

variety, which is hydrated magnesium silicate, the amphibole type contains
little magnesium. The amphibole type occurs in different varieties, e.g.,
crocidolite (blue), amosite (brown), and anthrophyllite (white,).
 Asbestos fibres are usually from 20 to 500 mm in length and 0.5 to 50 mm

in diameter.
 Asbestos is used in the manufacture of asbestos cement, fire-proof textiles,

roof tiling, brake lining, gaskets and several other items. Asbestos is mined
in Andhra Pradesh (Cudappah), Bihar, Jharkhand, Karnataka, and Rajasthan -
but most of it is imported from USSR, Canada, US and South Africa.
 Asbestos enters the body by inhalation, and fine dust may be deposited in
the alveoli. The fibres are insoluble. The dust deposited in the lungs causes
pulmonary fibrosis leading to respiratory insufficiency and death; carcinoma
of the bronchus; mesothelioma of the pleura or peritoneum; and cancer of
the gastro-intestinal tract.
 The disease does not usually appear until after 5 to 10 years of exposure.
The fibrosis in asbestosis is due to mechanical irritation, and is peri-bronchial,
diffuse in character, and basal in location in contrast to silicosis in which the
fibrosis is nodular in character and present in the upper part of the lungs.
 Clinically the disease is characterized by dyspnoea which is frequently out of

proportion to the clinical signs in the lungs. In advanced cases, there may be
clubbing of fingers, cardiac distress and cyanosis. The sputum shows “asbestos
bodies” which are asbestos fibres coated with fibrin.
50
 An X-ray of the chest shows a ground-glass appearance in the lower two Overview of Occupational
thirds of the lung fields. Once established, the disease is progressive even Health
after removal of the worker from contact.
 The preventive measures consist of: (1) use of safer types of asbestos
(chrysotile and amosite); (2) substitution of other insulants: glass fibre, mineral
wool, calcium silicate, plastic foams, etc.; (3) rigorous dust control; (4)
periodic examination of workers; biological monitoring (clinical, X-ray, lung
function), and (5) continuing research.
3.5.8 Farmer’s lung

Farmer’s lung is due to the inhalation of mouldy hay or grain dust. In grain dust
or hay with a moisture content of over 30 per cent bacteria and fungi grow
rapidly, causing a rise of temperature to 40 to 50 deg. C. This heat encourages
the growth of thermophilic actinomycetes, of which Micropolyspora faeniis the
main cause of farmer’s lung. The acute illness is characterized by general and
respiratory symptoms and physical signs. Repeated attacks cause pulmonary fibrosis
and inevitable lung damage and right heart failure. It is quite possible that this
condition might be widespread in India considering the bulk of the population
engaged in agricultural work.
3.5.9 Hypersensitivity Pneumonitis

Hypersensitivity pneumonitis (previously called extrinsic allergic alveolitis) refers
to an allergic inflammatory pneumonitis following the repeated inhalation of organic
material. Workers at risk include those with exposure to moulds or fungal spore
in agriculture, horticulture, forestry, cultivation of edible fungi or malt working,
those handling mouldy vegetables and those caring for or handling birds. Many
of the classical forms have memorable names such as farmer’s lung, malt worker’s
lung, mushroom worker’s lung and bird fancier’s lung. Recent attention has been
drawn to the role of metal working fluids (MWF) with three outbreaks reported
in the UK probably occurring as a result of microbial
contamination of MWF dispersed in the factory as a respirable mist. The disease
has two patterns: the acute form, which presents like a non-specific pneumonic
illness, and the chronic form, which is manifested by a fibrotic disease affecting
the upper lobes. History taking is crucial as most biochemical tests have a low
yield. Lung biopsy characteristically shows a mixture of three pathologies: lung
fibrosis, alveolitis and granuloma formation.
3.5.10 Pleural Disease

Asbestos-related pleural disease
Pleural plaques are the most common manifestation of past asbestos exposure.
They are discrete circumscribed areas of hyaline fibrosis found on mainly parietal
pleura. They are virtually always asymptomatic, and identified as an incidental
finding on a chest radiograph or thoracic CT scan, particularly when partially
calcified.
3.6 OCCUPATIONAL CANCERS

Occupational cancer is caused wholly or partly by exposure to a cancer causing
agent (carcinogen) at work, or by a particular set of circumstances at work. 51
Environment and Ecology Globally, 19% of all cancers are attributable to the environment, including work
setting, resulting in 1.3 million deaths each year. WHO’s International Agency for
Research on Cancer (IARC) has classified 107 agents, mixtures, and exposure
situations as carcinogenic to humans. Most of the exposure risks for occupational
cancer are preventable. It is estimated that occupational cancers are a leading
cause of work-related death worldwide. It is difficult to determine a true figure
for occupational cancers because of the latent nature of the disease. An individual
might be exposed to a cause of cancer and not develop any noticeable
symptoms until many years later. Certain characteristics common to most
occupational cancers:
 Duration of exposure required for most occupational cancers range from 10
– 25 years
 Age incidence of occupational cancers is much earlier as compared to the
same cancer in general population
 Site of cancer or the organ involved remains fixed in a particular industry
 Manifestations of the cancer may occur even after the person has left that
industry
Occupational cancer is caused by exposure to carcinogens in the
workplace. Carcinogens are agents that cause the development or increase the
incidence of cancer. There are three different types of occupational carcinogens:
 Biological carcinogens – some micro-organisms such as viruses have been
known to cause cancer, either by damaging cells directly or by decreasing
the body’s ability to control abnormal cells, for example Hepatitis B, HIV
viruses and so on.
 Chemical carcinogens – a number of chemicals are known to be
carcinogenic. These chemicals may occur naturally, such as asbestos, be
manufactured like vinyl chloride, or be by-products of industrial processes,
for example, polycyclic aromatic hydrocarbons.
 Physical carcinogens – agents such as ionizing and ultraviolet (UV) radiation
have the potential to cause cancer. Examples of ionizing radiation include X-
rays and alpha, beta and gamma radiation. UV radiation can be divided into
a number of bands such as UV-B, UV-C etc, some of which are known to
cause skin cancer.
Table 3.4: Types of agents implicated for the different occupational
cancers
Types of Occupational Cancers Agents Responsible
Skin Cancer Most common occupational cancer

Dyes, Radiation and solvents (particularly
those derived from coal tar)
Lung Cancer Asbestos, arsenic, nickel, chromium,

berrylium, mining of radioactive material
Bladder Cancer Aniline dyes like benzidine, beta-

naphthylamine, auramine, magenta
52
Overview of Occupational
Leukemias Benzol, Radiation and mining of Health
radioactive material
Liver Cancer Vinyl Chloride
Nasopharyngeal Carcinoma Wood dust
Mesotheliomas Asbestos (crocidolite variety)
Brain & Central Nervous Ionizing radiation

system Cancer

unit.
1. Classify occupational hazards
...............................................................................................................
...............................................................................................................
...............................................................................................................
2. Classify Pneumoconioses
...............................................................................................................
...............................................................................................................
3. List out occupations at risk of occupational asthma
...............................................................................................................
...............................................................................................................
4. List out the various types of occupational cancers
...............................................................................................................
...............................................................................................................
3.7 PREVENTION AND CONTROL OF

OCCUPATIONAL DISEASES
In some regions, only 5 - 10% of workers in developing countries and 20-50%
of workers in industrialized countries (with a very few exceptions) have access to
occupational health services in spite of an evident need virtually at each place of
work. The need for occupational health services is particularly acute in the
developing and newly industrialized countries (NICs). Furthermore, approximately
eight out of 10 of the world’s workers live in these countries. Such services, if
organized appropriately and effectively for all workers, would contribute positively
not only to workers’ health, but also to overall socioeconomic development,
productivity, environmental health and well-being of countries, communities, families
and dependents. Also the control of unnecessary costs from sickness absenteeism 53
Environment and Ecology and work disability, as well as costs of health care and social security can be
effectively managed with the help of occupational health.
3.7.1 Medical, Engineering and Legislative Measures

The various measures for the prevention of occupational diseases may be grouped
under three heads: medical, engineering and statutory or legislative (Table 3.5).
Table 3.5 Measures for prevention of occupational diseases
Medical Measures Engineering Measures Legislative Measures

 Pre-placement  Design of building  The Factories Act,
examination  Good housekeeping 1948
 Periodical  General ventilation  The Employees’ State
examination·  Mechanization Insurance Act, 1948
Medical and health  Substitution  Maternity Benefits
care services Act, 1961
 Wet Processes
 Notification  The Mines Act, 1952
 Enclosure
 Supervision of work  Isolation
environment  Local Exhaust
 Maintenance and Ventilation
analysis of records  Protective devices
 Health education
and counseling  Research
3.7.2 Medical Measures

 Pre-placement examination – Pre-placement examination is the cornerstone
of any efficient occupational health service. It is done at the time of employment
to assess the worker’s suitability for a particular industry and includes the
worker’s medical, family, occupational and social history; a thorough physical
examination and a battery of biological and radiological examinations, e.g.,
chest X-ray, electro-cardiogram, vision testing, urine and blood examination,
special tests for endemic disease. A fresh recruit may either be totally rejected
or given a job suited to his physical and mental abilities. The purpose of pre-
placement examination is to place the right man in the right job, so that the
worker can perform his duties efficiently without detriment to his health. This
is ergonomics. The following is a list of some occupations in which it is risky
to employ men suffering from certain diseases.
Type of Exposure Undesirable conditions
(1) Lead Anaemia, hypertension, nephritis, peptic ulcer

(2) Dyes Asthma; skin, bladder and kidney diseases;
precancerous lesions
(3) Solvents Liver and kidney disease, dermatitis, alcoholism
(4) Silica Healed or active tuberculosis of lungs, chronic lung
disease
54 (5) Radium and X-rays Signs of ill-health, especially any blood disease
Pre-placement examination will also serve as a useful bench-mark for future Overview of Occupational
Health
comparison.
 Periodical examination: The exposure to the harmful agents in the work
environment begins once the worker is recruited in a particular industry.
Many diseases of occupational origin require months or even years for their
development. Their slow development, very often, leads to their non-
recognition in the early stages and this is harmful to the worker. This is the
reason why a periodical medical check-up of workers is very necessary
when they handle toxic or poisonous substances.
The frequency and content of periodical medical examinations will depend
upon the type of occupational exposure. Ordinarily workers are examined
once a year. But in certain occupational exposures (e.g., lead, toxic dyes,
radium) monthly examinations are indicated. Sometimes, even daily
examinations may be needed such as when irritant chemicals like dichromates
are handled. The periodical examinations may be supplemented, where
necessary by biological and radiological examinations.
 Medical and health care services: The medical care of occupational
diseases is a basic function of an occupational health service. In India, the
Employees State Insurance Scheme provides medical care not only for the
worker but also his family. Within the factory, first aid services should be
made available. Properly applied first aid can reduce suffering and disability
and hasten recovery.
 Notification: The main purpose of notification in industry is to assess the
magnitude of occupational diseases so as to initiate measures for prevention
and protection and ensuring their effective application; and to investigate the
working conditions and other circumstances which have caused or suspected
to have caused occupational diseases. National Laws and Regulations
(Factories Act, 1976; Mines Act, 1952; Dock Labourers’ Act, 1948; etc.)
require the notification of cases and suspected cases of occupational disease.
In the Factories Act, a list of 22 diseases is included while in the Mines Act
3 diseases and in the Dock Regulations 8 diseases are listed. These diseases
are also recognized internationally for the purpose of workmen’s compensation.
 Supervision of working environment: Periodic inspection of working
environment provides information of primary importance in the prevention of
occupational disabilities. The physician should pay frequent visits to the factory
in order to acquaint himself with the various aspects of the working environment
such as temperature, lighting, ventilation, humidity, noise, cubic space, air
pollution and sanitation which have an important bearing on the health and
welfare of the workers. He should be acquainted with the raw materials,
processes and products manufactured. He should also study the various
aspects of occupational physiology such as occurrence of fatigue, night work,
shift-work, weight carried by the workers and render advice to the factory
management on all matters connected with the health and welfare of the
workers. For studies of this kind the physician should enlist the cooperation
of safety engineers, industrial hygienists and psychologists.
 Maintenance and analysis of records: Proper records are essential for
the planning, development and efficient operation of an occupational health
service. The worker’s health record and occupational disability record must 55
Environment and Ecology be maintained. Their compilation and review should enable the service to
watch over the health of the workers, to assess the hazards inherent in
certain types of work and to devise or improve preventive measures.
 Health education and counseling: Ideally, health education should start
before the worker enters the factory. All the risks involved in the industry in
which he is employed and the measures to be taken for personal protection
should be explained to him. The correct use of protective devices like masks
and gloves should also be explained. Simple rules of hygiene – hand washing,
paring the nails, bodily cleanliness and cleanliness of clothes, should be
impressed upon him. 2.
3.7.3 Engineering Measures

 Design of building: Measures for the prevention of occupational diseases
should commence in the blue-print stage. The type of floor, walls, height,
ceiling, roof, doors and windows, cubic space are all matters which should
receive attention in the original plan of the building which is put up by the
industrial architect.
 Good housekeeping: Good housekeeping is a term often applied to industry,
and means much the same as when used domestically. It covers general
cleanliness, ventilation, lighting, washing, food arrangements and general
maintenance. Good housekeeping is a fundamental requirement for the control
or elimination of occupational hazards.
 General ventilation: There should be good general ventilation in factories.
It has been recommended that in every room of a factory, ventilating openings
shall be provided in the proportion of 5 sq. feet for each worker employed
in such room, and the openings shall be such as to admit a continued supply
of fresh air. In rooms where dust is generated there should be an efficient
exhaust ventilation system. Good general ventilation decreases the air-borne
hazards to the workers, especially hazards from dusts and gases. The Indian
Factories Act has prescribed a minimum of 500 c. ft. of air space for each
worker.
 Mechanization: The plant should be mechanized to the fullest possible
extent to reduce the hazard of contact with harmful substances. Dermatitis
can be prevented if hand-mixing is replaced by mechanical devices. Acids
can be conveyed from one place to another through pipes.
 Substitution: By substitution is meant the replacement of a harmful material
by a harmless one, or one of lesser toxicity. A classical example is the
substitution of white phosphorus by phosphorus sesqui-sulphide in the match
industry, which resulted in the elimination of necrosis of jaw (Phossy jaw).
Zinc or iron paints can be used in place of’ harmful lead paints; silver salts
can be used in place of mercury salts; acetone can be used in place of
benzene. But substitution is not always possible in industry.
 Dusts: Dusts can be controlled at the point of origin by water sprays, e.g.,
wet drilling of rock. Inclusion of a little moisture in the materials will make
the processes of grinding, sieving and mixing comparatively dust-free. Wet
methods should be tried to combat dust before more elaborate and expensive
methods are adopted.
56
 Enclosure: Enclosing the harmful materials and processes will prevent the Overview of Occupational
escape of dust and fumes into the factory atmosphere. For example, grinding Health
machinery can be completely enclosed. Such enclosed units are generally
combined with exhaust ventilation.
 Isolation: Sometimes it may be necessary to isolate the offensive process
in a separate building so that workers not directly connected with the operation
are saved from exposure. Isolation may not be only in space, but also in the
fourth dimension of time. Certain operations can be done at night in the
absence of the usual staff.
 Local exhaust ventilation: By providing local exhaust ventilation dusts,
fumes and other injurious substances can be trapped and extracted “at source”
before they escape into the factory atmosphere. The heart of the local exhaust
ventilation is the hood which is placed as near as possible to the point of
origin of the dust or fume or other impurity. Dusts, gases and fumes are
drawn into the hood by suction and are conveyed through ducts into collecting
units. In this way, the breathing zone of workers may be kept free of dangerous
dust and poisonous fumes.
 Protective devices: Respirators and gas masks are among the oldest devices
used to protect workers against air-borne contaminants and they are still
used for that purpose. There are two classes of respirators: (i) those which
remove contaminants from air, (ii) those to which fresh air is supplied. The
workers should know what kinds to use, and when and how to use. The
other protective devices comprise ear plugs, ear muffs, helmets, safety shoes,
aprons, gloves, gum boots, barrier creams, screens and goggles.
 Environmental monitoring: An important aspect of occupational health
programme is environmental monitoring. It is concerned with periodical
environmental surveys, especially sampling the factory atmosphere to determine
whether the dusts and gases escaping into the atmosphere are within the
limits of permissible concentration. The use of “permissible limits” has played
an important part in reducing occupational exposure to toxic substances.
Thermal environment, ventilation, lighting would also have to be monitored.
 Statistical monitoring: Statistical monitoring comprises review at regular
intervals of collected data on health and environmental exposure of
occupational groups. The main objective of these reviews is to evaluate the
adequacy of preventive measures and occupational health criteria, including
permissible exposure levels.
 Research: Research in occupational health offers fertile ground for study
which can provide a better understanding of the industrial health problems.
There are two kinds of research -pure research and research for the
improvement of, or in connection with a manufactured product. Both are
important. Study of the permissible limits of exposure to dusts and toxic
fumes, occupational cancer, accident prevention, industrial fatigue and
vocational psychology are some aspects of research in occupational health.
3.7.4 Legislative Measures

The important legislations to safeguard the health and welfare of the industrial
workers in India are follows:
57
Environment and Ecology  The Factories Act, 1948
 The Employees’ State Insurance Act, 1948
 Maternity Benefits Act, 1961
 The Mines Act, 1952
All these Acts lay down certain standards to which the employer must comply to
ensure health and safety of workers.
The Factories Act, 1948
Objective To consolidate and amend the law regulating the workers
working in the factories. To safeguard the interest of workers
and protect them from exploitation, the Act prescribes certain
standards with regard to safety, welfare and working hours
of workers, apart from other provisions
Applicability Extends to whole of India
Coverage The Act defines factory as an establishment employing 10 or

more workers where power is used, and 20 or more workers
where power is not used.
Guidelines with regard to working condition in factories
Category of
Worker Adult Workers Adolescents Children
Working Prohibits
Conditions Male Female Male Female employment
of children
Hours of Not more Not more Not Not
upto 14 yrs.
work than48 hrs / than 48 hrs more more
wk, not / wk, not than than 41/
exceeding exceeding 41/2 hrs 2 hrs
9hrs / day 9hrs / day per day per day
Maximum Maximum
60hrs / wk if 60hrs / wk
overtime is if overtime
paid is paid
Working Anytime Anytime Between Between

Hours 6am to 6am to
7pm 7pm
Overtime @ twice the @ twice NA NA

wage the wage
Interval Rest for at Rest for

least 1/2 at least 1/2
hour after 5 hour after
hours of 5 hours of
continuous continuous
work work
58
Overview of Occupational
Leave with One day for every 20 One day for every Health
wages days of work besides 15 days of work
weekly holiday. The besides weekly holiday.
leave can be The leave can be
accumulated up to The leave can be
30 days 40 days
Per Capita A minimum of 500 Cu.ft of space for each worker has been
Space prescribed.
Availability For factories installed before the 1948 Act, a minimum of 350
Cu.ft of space has been prescribed.
Welfare Factory with >1000 employees must have a Safety Officer

Measures Factory with >500 employees must have a Welfare Officer
Factory with >250 employees must have a Canteen
Factory with >30 women employees must have a Creche
The Employees State Insurance Act, 1948
Objective Is an important measure of social security and health
insurance in India.It provides for certain cash and medical
benefits to industrial employees in case of sickness,
maternity and employment injury.
ESI Applicability Extends to whole of IndiaApplicable to non-seasonal

factories employing 10 or more personsScheme has been
extended to shops, hotels, restaurants, cinemas including
preview theatres, road-motor transport undertakings and
newspaper establishments employing 10* or more
persons.Scheme has been extended to Private Medical
and Educational institutions employing 10* or more persons
in certain States/UTs.
ESI Eligibility The existing wage limit for coverage under the Act is Rs.
21,000/- per month ( w.e.f. 01/01/2017)
ESI Benefits Medical Benefit

Sickness Benefit
Maternity Benefit
Dependents Benefit
Disablement Benefit
Funeral Benefit
Rehabilitation Benefit
Rajiv Gandhi Shramik Kalyan Yojna
59
Environment and Ecology Rate of ESI Contribution
Contribution by Employers & Contribution by GovernmentState

Employees Employer contributes Government contributes 1/8th while ESI
4.75 per cent of total wage Corporation contributes 7/8th of the
billEmployee contributes 1. 75 per expense incurred in providing Medical
cent of wages Benefit
Benefits to employers –
 Exemption from the applicability of Workmen’s Compensation Act 1923
 Exemption from Maternity Benefit Act 1961
 Exemption from payment of Medical allowance to employees and their
dependants or arranging for their medical care
 Rebate under the Income Tax Act on contribution deposited in the ESI
Account
 Healthy work-force.
3.8 GLOBAL STRATEGY ON OCCUPATIONAL

HEALTH FOR ALL
The Global Strategy on Occupational Health for All presents a short situation
analysis by using available occupational health indicators, identifies the most evident
needs for the development of occupational health and safety, including the priority
areas at both national and international levels, and proposes the priority actions
for WHO’s Workers’ Health Programme.
The 10 priority objectives proposed by the strategy are as follows:
1. Strengthening of international and national policies for health at work and
developing the necessary policy tools
2. Development of healthy work environment
3. Development of healthy work practices and promotion of health at work
4. Strengthening of occupational health services (OHS)
5. Establishment of support services for occupational health
6. Development of occupational health standards based on scientific risk
assessment
7. Development of human resources for occupational health
8. Establishment of registration and data systems, development of information
services for experts, effective transmission of data and raising of public
awareness through public information
9. Strengthening of research
10. Development of collaboration in occupational health and with other activities
and services
60
Global Plan of Action on Workers Health (2008 – 2017) Overview of Occupational
Health
The Sixtieth World Health Assembly, having considered the draft global plan of
action on workers’ health, endorsed the global plan of action on workers’ health
2008–2017 with the following objectives:
1: to devise and implement policy instruments on workers’ health
2: to protect and promote health at the workplace
3: to improve the performance of and access to occupational health services
4: to provide and communicate evidence for action and practice
5: to incorporate workers’ health into other policies
WHO, supported by its network of Collaborating Centres for Occupational Health
and in partnership with other intergovernmental and international organizations,
will work with the Member States to implement this plan of action by:
 promoting and engaging in partnership and joint action with ILO and other
organizations of the United Nations system, organizations of employers, trade
unions and other stakeholders in civil society and the private sector in order
to strengthen international efforts on workers’ health;
 consistent with the actions undertaken by ILO, setting standards for protection
of workers’ health, providing guidelines, promoting and monitoring their use,
and contributing to the adoption and implementation of international labour
conventions;
 articulating policy options for framing national agendas for workers’ health
based on best practices and evidence;
 providing technical support for tackling the specific health needs of working
populations and building core institutional capacities for action on workers’
health;
 monitoring and addressing trends in workers’ health;
 establishing appropriate scientific and advisory mechanisms to facilitate action
on workers’ health at global and regional levels.
Progress in implementing the plan of action will be reviewed and monitored using
a set of national and international indicators of achievement.
unit.
1. Enlist the various engineering measures for prevention of occupational diseases
.............................................................................................................
.............................................................................................................
2. Enlist the benefits of the ESI Scheme for the employees
.............................................................................................................
............................................................................................................. 61
3.9 KEY WORDS
Occupational health : promotion and maintenance of the highest
degree of physical, mental and social well-being
of workers in all occupations; the prevention
among workers of departures from health
caused by their working conditions; the
protection of workers in their employment from
risks resulting from factors adverse to health;
the placing and maintenance of the worker in
an occupational environment adapted to his
physiological and psychological equipment,
and, to summarize, the adaptation of work to
man and of each man to his job
Ergonomics : “ergonomics” is derived from the Greek word
‘ergon’ meaning work and ‘nomos’ meaning
law
Occupational environment : a sum of external conditions and influences
which prevail at the place of work and which
have a bearing on the health of the working
population
Hypersensitivity pneumonitis : an allergic inflammatory pneumonitis following
the repeated inhalation of organic material
3.10 LET US SUM UP

In this unit, you have learnt about the definition and the concept of occupational
health and the burden of occupational diseases. The concept of ergonomics and
its applications in improving the health at workplace have also been described in
detail. You have been familiarized with the concept and reasons of sickness
absenteeism. Further, various types of occupational hazards, their impact on health
and how hazard analysis and risk assessment of occupational environment can be
done have been explained in detail. Various kinds of diseases which can be
acquired at the work place and the exposures responsible have been discussed
at length. You have also learnt about the modalities of prevention and control of
occupational diseases and the legislations and organization existing in India to
safeguard the health and welfare of the industrial workers.

1. (a) Physical hazards;
(b) Chemical hazards;
(c) Biological hazards;
(d) Mechanical hazards;
62 (e) Psychosocial hazards

2. Classification of Pneumoconiois Overview of Occupational
Health
Inorganic dusts Diseases Organic dusts Diseseas
Silica Silicosis Cotton dust Bysinosis
Asbestos Asbestosis Sugarcane dust Baggasosis
Coal dust Anthracosis Grain dust Farmer’s Lung
Iron dust Siderosis
3. Animal handlers
Bakers and pastry makers
Chemical workers
Food processing workers
Hairdressers
Paint sprayers
Nurses
Timber workers
Welders
4. Skin cancer
Lung cancer
Bladder cancer
Leukemias
Liver cancer
Naso-pharyngeal cancer
Mesotheliomas
Brain and Central Nervous System cancers
1. Engineering measures for prevention of occupational diseases
 Design of building
 Good housekeeping
 General ventilation
 Mechanization
 Substitution
 Wet Processes
 Enclosure
 Isolation
 Local Exhaust Ventilation
 Protective devices
 Research 63
Environment and Ecology 2. Benefits of the ESI Scheme for the employees
 Medical Benefit
 Sickness Benefit
 Maternity Benefit
 Dependents Benefit
 Disablement Benefit
 Funeral Benefit
 Rehabilitation Benefit
 Rajiv Gandhi Shramik Kalyan Yojna
3.12 REFERENCES AND SUGGESTED FURTHER

READINGS
 Park, K., Park’s Textbook of Preventive and Social Medicine, 23rdedn.
2015, Banarsi Das Bhanot Publishers, Jabalpur, M.P.
 Global Strategy on Occupational Health for All, Recommendation of the
Second Meeting of the WHO Collaborating Centres in Occupational Health,
11-14 October 1994, Beijing, China, WHO Publications, 1995, Geneva.
 Workers’ health: global plan of action, Sixtieth World Health Assembly,
WHO Publications, 2007, Geneva.
64
UNIT 4 BURDEN OF DISEASE AND
PLAN OF ACTION FOR
ENVIRONMENTAL AND
OCCUPATIONAL HEALTH
Structure
4.0 Introduction
4.1 Objectives
4.2 Concept of Occupational Environment
4.3 Burden of Occupational and Environmental Diseases
4.3.1 Related Definitions
4.3.2 Measures of Burden of Disease for Occupational and Environmental Health
4.3.3 Areas of Concern: Estimation of Burden of Occupational Diseases
4.3.4 Disease Burden: Global and Indian
4.3.5 Economic Cost
4.3.6 Changing Pattern of Occupational Diseases
4.3.7 Gender Difference
4.3.8 High Burden/Emerging Occupational Diseases of Public Health Interest
4.4 Plan of Action for Environmental and Occupational Health

4.4.1 Concept of Prevention: Primary, Secondary and Tertiary
4.4.2 Health Education in Occupational Health
4.4.3 Occupational Safety in Accident Prevention
4.4.4 Early Detection of Occupational Diseases
4.4.5 Occupational Ergonomics
4.4.6 Existing Legislation and Policies at Country Level
4.4.7 An Integrated Approach
4.5 Key Words

4.6 Let Us Sum Up
4.0 INTRODUCTION
In the previous units, you were introduced to the concept of environmental and
occupational health. You are aware that occupational factors are linked with
environmental factors. Potential illness causing agents are present almost everywhere,
at home, at our work place. This includes physical, chemical and biological factors
around us and in our working environment.
Now it is time to understand how our health is affected by a compromised
occupational environment. In this unit we are going to discuss some important
health problems caused by environmental risk factors which are linked to
occupation. You see, risks includes the factors which are modifiable i.e. the 65
Environment and Ecology environmental factors which, we can change either in short or long term.
We shall discuss what can be done to prevent these problems.
This unit introduces you to the burden of disease and plan of action for occupational
and environmental health.
4.1 OBJECTIVES
After going through this unit you should be able to:
 explain the concept and importance of Occupational environment;
 discuss the burden of diseases in relation to environment and occupational
health;
 describe high burden/emerging occupational diseases; and
 describe plan of action to reduce burden of disease in context of occupational
health.
4.2 CONCEPT OF OCCUPATIONAL

ENVIRONMENT
The term occupational environment means all conditions that prevails at work
place and which have a bearing effect on the worker. There is a continuous two-
way interaction between the worker and the physical and psychological environment
at work place. The work environment may affect the health of the worker either
in a positive or negative direction. On the other hand, the well being of the worker
influences the productivity and quality of work. A healthy motivated workforce is
the key for sustainable development of a society. Usually we see three types of
interaction in working environment
a. Man and different physical, chemical and biological agents
b. Man and machine
c. Man and man
a. Man and physical, chemical and biological agents
Physical agents: These include excessive levels of noise, vibration, dust, temperature,
ionizing and non-ionizing radiation.
Chemical agents: Large number of chemicals are associated with occupational
diseases. Chemicals usually enter our body via inhalation (respiratory route),
ingestion (by oral route), or dermal (skin) contact. Inhalational and dermal exposure
represent the main pathways of exposure to hazardous substances at work.
Biological agents: we can divide them in 2 major groups (1) Agents causing
occupational diseases of the respiratory tract and skin. These diseases are common
mostly among agricultural workers; and (2) agents causing zoonoses and other
infectious diseases that could be spread by tick or insect vectors. Zoonosis are
a group of diseases which are transmitted from animal to man.
b. Man and machine
Can you think of any activity where machines are not involved? There is involvement
66 of machines in virtually all work places now. Many new types of machineries are
also introduced each year. Working for long hours with different types of machines Burden of Disease and
definitely affects the health of the worker. Plan of Action for
Environmental and
c. Man and Man Occupational Health
For many people it is the working environment where they spend most of the
waking hours. Usually a worker interacts with colleagues, superiors and other
supporting staffs at work place. Poor human relationship often results in job
frustration, stress anxiety and depression.
4.3 BURDEN OF OCCUPATIONAL AND

ENVIRONMENTAL DISEASES
4.3.1 Related Definitions
1. Occupational diseases: group of diseases having a specific or a strong relation
to occupation, generally with only one recognized causal agent.
2. Work-related diseases: Group of diseases with multiple causal agents, where
factors in the work environment may play a role, together with other risk
factors, in the development of such diseases.
3. Occupational injury: Any injury, disease or death resulting from an
Occupational accident.
4. Occupational accident: It is an unexpected and unplanned occurrence, including
acts of violence, in connection with work which results in any worker incurring
an injury, disease or death.
4.3.2 Measures of Burden of Disease for Occupational

and Environmental Health
Let us first understand what is meant by environmental and occupational burden
of disease. This means the amount of disease caused by environmental and
occupational factors. A range of measures or indicators are used to express
burden of disease for occupational and environmental health
a) Mortality (number of deaths),
b) Morbidity: disease proportion, incidence – total number of new cases,
prevalence (total cases))
c) Quality of life: Disability-Adjusted Life Years – DALY. The latter measure
combines the burden due to death and disability in a single index. We use
this index so we can compare the burden due to various environmental risk
factors with other risk factors or diseases. One DALY means one lost year
of healthy life
d) Economic costs.
4.3.3 Areas of Concern: Estimation of Burden of

Occupational Diseases
Some important issues that you should keep in mind about estimation of total
magnitude of the problem are:
a. Data on occupational accidents and diseases are not easily available and
under-reporting is a major problem. 67
Environment and Ecology b. Usually information for occupational diseases is obtained from different sources
like insurance institutions, labor inspectorates, occupational health services,
or other authorities and bodies.
c. Most of the time workers in rural areas, small and medium-sized enterprises
(SMEs), and those in the informal sector are excluded from the existing
reporting system
d. Workers employed in temporary, casual and part-time jobs are often not
included in existing reporting system.
e. Nowadays workers are changing jobs frequently and thus their exposure to
various agents are also changing. This makes it difficult to determine the
association of the disease with occupation and environment.
f. Some diseases may appear long after the workers retirement from a particular
job.
g. Some workers may have developed some diseases which may be due to
exposure of some substances which are still not known as hazardous.
unit.
1. What do you understand by occupational environment?
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2. Define Occupational disease and work-related disease.
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3. Name indicators to measure burden of disease in context to occupational
health.
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4.3.4 Disease Burden: Global and Indian
Global Burden
According to the ILO estimates, every year more than 2.3 million workers die at
work from an occupational injury or disease. Africa has the highest number of
deaths in occupational accidents of approximately 16.6 per 100,000 persons in
the labour force, followed by Asia of about 12.7 per 100,000 persons in the
labour force. Europe had the lowest fatality rate among the 5 regions, with a rate
of 3.61 per 100,000 persons. Occupational communicable diseases and accidents
are more prevalent in developing countries. More than 313 million workers suffer
serious injuries from non-fatal accidents with 4 days absence from work.
68 Occupational injuries account for 0.9% of the global DALYs lost. Every day
approximately 6,400 people die from occupational accidents or diseases and that Burden of Disease and
860,000 people are injured on the job. Plan of Action for
Environmental and
Burden in India Occupational Health
In India major occupational diseases are silicosis, musculo-skeletal injuries, coal

workers’ pneumoconiosis, chronic obstructive lung diseases, asbestosis, byssinosis,
pesticide poisoning and noise induced hearing loss. The incidence of work-related
morbidity and mortality in India is very high. It is estimated that 17% of the non
fatal injuries and 45% of the total deaths due to occupational injuries in world
occur in India each year.
4.3.5 Economic Cos
The International Labour Organization (ILO) has estimated that the total costs of
occupational accidents and work-related diseases are about 4% gross national
product (GNP) at a global level. Some diseases like musculo-skeletal disorders
have a high impact in work related absence and common among young population.
Occupational diseases have their effect on workers, their families, employers and
society in large. You can easily understand the effect of illness, sickness and injury
is often devastating on their families. Economic costs are not always visible and
difficult to estimate. There are costs related to compensation, lost working time,
interruption of production, training and retraining, medical expenses, and so on.
4.3.6 Changing Pattern of Occupational Diseases
In last few decades there have been rapid changes in technology affecting work
profile and thus the pattern of occupational diseases. Well-known occupational
diseases, such as pneumoconiosis are still present but relatively less identified
occupational diseases, such as musculoskeletal disorders (MSDs) and mental
health disorder, are on the rise. There is definitely a rise of workers who are
involved in sedentary work. Increased involvement of automation and computers
in different industries have exposed workers to postures which involve prolonged
standing and sitting. There is also increasing report of work-related stress,
depression, anxiety.
4.3.7 Gender Difference
Often you will notice some difference in pattern of occupational diseases and
gender. What do you think is the reason? This may be due to the fact that more
men are often involved in factories, construction and mining. Though the situation
is changing fast as now we often notice both genders being involved in all types
of works. Usually occupational cancers, occupational injuries, noise related hearing
loss are more common in men. Occupational skin diseases are more common in
females. Women of reproductive age being exposed to different toxic elements in
the work place are susceptible to adverse effects on reproduction, like abortions,
foetal malformation and infertility. There is increasing evidence that these problems
may affect the male workers too.
4.3.8 High Burden/Emerging Occupational Diseases of
Public Health Interest
Occupational Injuries
WHO estimates every year there are 350,000 deaths due to fatal occupational
accidents. Around 313 million workers are involved in non-fatal accidents causing
serious injuries and absenteeism from work. 69
Environment and Ecology Industries and services with highest risk of occupational injuries include the
construction industry, manufacturing and trade. Certain occupational activities, like
fishing and farming (agriculture workers) are at a higher risk.
Work Related Diseases
According to an estimate work-related disease represent the main cause of death
at work, killing almost six times more workers than occupational accidents. The
diseases classified under this category are those which do not have a single causal
agent and are often caused or aggravated by occupation. This means that multiple
factors including the individual’s occupation are responsible for development of
work-related diseases. The diseases are
- musculoskeletal disorder
- mental and behavioural disorder
- hypertension
- coronary heart disease
- peptic ulcer
- chronic obstructive pulmonary disease and asthma
Musculoskeletal Diseases: The term musculoskeletal disorders denotes disorders
of locomotor system which includes involvement of muscles, bones, tendons,
cartilages, nerves, etc. International Labour Organization estimates musculoskeletal
diseases represents 40% of global compensation costs of occupational injuries
and work-related diseases. Work-related musculoskeletal disorders (MSDs) include
all musculoskeletal disorders which are induced or aggravated by work and the
circumstances of its performance. Repetitive work, painful tiring position, carrying
people or heavy load, exposure to vibration, prolonged standing or sitting are
often risk factors for this. They are a cause of concern because not only they are
common disorder but also because of economic loss and societal impact. Musculo-
skeletal disorders have a high impact in work related absence. Treatment and
recovery are often unsatisfactory especially for more chronic causes. The end
result can even be permanent disability, with the loss of employment. The main
groups are back pain and work-related upper limb disorders, Lower limbs can
also be affected. Certain occupations carry a higher risk of developing low back
pain. These include heavy manual work, mining, docking, nursing and policing.
These jobs require material handling, awkward postures and postures that have
to be maintained for prolonged periods or involve frequent bending, twisting or
whole-body vibration. These occupations require proper selection, physical training,
proper placement and adoption of safe criteria for load lifting.
Mental and behavioural disorders: A growing number of workers are
complaining that they are suffering from depression, sleep deprivation, anxiety,
stress and job burn out. There are many risk factors for mental health that may
be present in the working environment. Organizational and managerial environment
and policies often contribute to this. Some examples are, poor communication,
low levels of support from employers, inflexible working hours. Bullying and
psychological harassment are commonly reported causes of work-related stress
and depression by workers Mental health disorders can lead to harmful use of
substances or alcohol, absenteeism.
70
Hypertension Burden of Disease and
Plan of Action for
In over 90% of patients with hypertension, the disease is called “essential Environmental and
hypertension” and no cause can be identified. Genetic predisposition is an important Occupational Health
risk factor. Occupational lead exposure e.g. in mining and processing industries
and also non-occupational exposure to lead e.g. in traffic exhaust can increase
blood pressure. Other environmental and occupational factors which have been
linked with development of stroke are exposure to arsenic, environmental noise.
It has also been suggested that psychosocial stress is a factor in the development
of hypertension. Other risk factors in the development of hypertension include
dietary habits (excess salt and fats), obesity and physical inactivity
Coronary heart disease (GHD)
Heart diseases are becoming more common among young working population. It
is more common in men than women below 45 years of age, but in older age the
two sexes may be equal.
The risk of coronary heart disease is associated with hypertension, high dietary
fat intake, high serum cholesterol and being overweight. A coronary- heart disease
personality is usually type A personality. This personality has been described as
aggressive, competitive person who is anxious, impatient and concerned with time
management. Overload at work is known as to be associated with coronary heart
disease.
Psychosocial stress increases serum cholesterol, causes hypertension and enhances
clot formation. Other occupational factors related to CHD are sedentary work,
exposure to carbon disulfide, carbon monoxide and nitrates and chronic exposure
to noise, heat and cold.
Peptic ulcer
Several risk factors have been associated with the development of gastric and
duodenal ulcers. These include use of certain medicines (analgesics and non-
steroidal anti-inflammatory drugs), smoking, medical illness, surgical procedures,
type A personality, local infection (Helicobacter pylori) and occupation.
Occupational factors associated with the risk of developing peptic ulcers include
jobs with a high degree of responsibility, heavy workloads, long working hours,
workplace stress, irregular shift work and stress at work.
Chronic Obstructive Pulmonary Disease and Asthma are diseases of lung
characterized by inflammation and loss of lung function. So, you understand what
happens when lungs cannot work properly, it becomes difficult to breathe. Risk
factors are environmental and occupational including dusts and chemicals in the
work place. Occupations with high risk for COPD are coal and hard rock
mining, metal smelting, tunnel and construction work, manufacture of concrete,
plastic, textile, rubber, leather, transportation and trucking, automotive repairs,
and farming. Allergens are allergy causing agents – such as pollen from some
flowers. A large number of agents in the workplace are supposed to be responsible
for asthma e.g. cleaning agents, disinfectants, flour, wood dust, metals etc.
Cancer
More than 20 environmental and occupational agents are proven lung carcinogens.
It is estimated that 36% of lung cancers are contributed by environmental factors
with 20% in high income countries and 46% in low- and middle-income countries.
71
Environment and Ecology Occupational exposure to asbestos, silica, aluminium production, painting increases
the chance of having lung cancer. Diesel engine exhaust is another important
contributor of lung cancer.
Lymphoma and leukaemia are different types of blood cancers. Different
environmental exposures e.g. exposure to benzene, formaldehyde, chemicals in
rubber manufacturing processes, various pesticides and herbicides (diazinon,
glyphosate, malathion) chemicals (solvents such as dichloromethane, trichloro
methane) and occupational exposure to petroleum refining. High benzene exposure
occurring e.g. for the production of many organic chemicals and in the production
of some rubber, dyes, pesticides or detergents is associated with threefold increase
risk of childhood leukaemia. Pesticide exposure at home and among pregnant
women is associated with increased risk of leukaemia. Also X-rays and gamma
radiation causes leukaemia.
Other different cancer types associated with environmental or occupational factors
are colon cancer, breast cancer, cervix, ovarian prostate, liver, stomach and
thyroid. Low physical activity or inactivity is responsible for colon and breast
cancer. You can understand that our ability to do physical activity gets affected
by environmental factors like availability of roads for walking, use of gadgets at
home. Hence people who are in sedentary jobs will be at high risk of developing
these particular types of cancer. Exposure to Plutonium and vinyl chloride are
associated with liver cancer. Aflatoxin a toxin material produced by certain fungus,
associated with agricultural work causes liver cancer.
Cancer of mouth and throat cancer is seen among asbestos workers, miners,
tailors, blacksmiths, carpenters, transport workers. The risk factors are exposure
to polycyclic aromatic hydrocarbons, engine exhausts, textile dusts and working
in rubber industry, wood dust and working in rubber industry.
Certain occupations like painters, dry cleaners, textile manufacturers are at higher
risk of bladder cancer. Exposure to aromatic amines is responsible for it. Also
note that aromatic amines are present in diesel exhaust too.
unit.
1. Name some occupations where workers often develop musculoskeletal ..
disorders.
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2. List 3 cancers that are associated with exposure to chemicals at work.
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Occupational Communicable Diseases
Occupational communicable diseases are caused by work-associated exposure
to different biological agents, e.g. bacteria, virus, fungus and parasite. An infection
is described as occupational when some aspect of the work involves contact with
a biological agent.
72
Exposure is common among health care workers in hospitals, laboratories, among Burden of Disease and
veterinarians and agricultural workers in animal husbandry and dairy farms and Plan of Action for
Environmental and
pet shop and workers in the leather industry. Occupational Health
(Occupational) pulmonary tuberculosis

You must be familiar with the term TB or Tuberculosis. Health care workers in
hospitals, in laboratories and in veterinary clinics are particularly are particularly
susceptible to this. They usually get the infection coming in contact with an infected
person, animal or some specimen (in laboratory condition). The disease is caused
by Mycobacterium tuberculosis, a bacteria and is transmitted occupationally usually
by respiratory route. The organism enters the body through the respiratory tract
or abraded skin where it causes a skin ulcer.
The disease usually affects the lungs but can also affect the gastrointestinal tract,
bones, kidneys, meninges, pleura and peritoneum. Pulmonary tuberculosis is
manifested by fever, cough, haemoptysis, loss of weight, loss of appetite, night
sweats. It can be diagnosed by examination of the sputum.
Health education is important and proper disposal of infected material should be
observed.
Brucellosis
Brucellosis is caused by bacteria which usually infect cattle, sheep and pigs. The
disease causes recurrent abortion in animals. The disease causing agent is present
in animal secretion like milk and urine. Exposed workers are veterinarians, workers
in agriculture and animal husbandry, shepherds and laboratory and slaughterhouse
workers. Most occupational cases occur through contact with infected animal or
consumption of raw dairy products.
The acute stage (undulant fever) presents with fever, joint pain, enlarged spleen
and lymph nodes. In the chronic phase occasional fever is the only symptom and
the disease in this stage is difficult to diagnose. Periodic medical examination of
all exposed workers should be carried out using serological tests.
Workers should wear protective clothing and observe proper cooking of animal
products and boiling of milk. The disease needs to be controlled among animal.
Anthrax
Exposed workers are those in agriculture and animal husbandry, slaughter houses,
tanneries and those working in the manufacture of goods from wool, hair, bones
and leather.
Infection can occur through the skin, the lungs or the intestine. Infection through
the skin causes a “malignant pustule”. A pustule with surrounding swelling and
local lymph node enlargement. Infection through the lung occurs in wool stores
causing severe fatal pneumonia. Infection through the intestines causes septicaemia.
Animal products intended for use in industry should be carefully examined and
disinfected.
Viral hepatitis B and C
Health care workers who are likely to come into contact with the blood and body
fluids of infected persons are at great risk of infection.
73
Environment and Ecology The infection with the virus often results in chronic active hepatitis: liver cirrhosis,
hepatic failure and liver carcinoma.
The infection usually gets transmitted through contact with contaminated blood
and thus contaminated equipment, such as needles. Strict infection control
procedures need to be followed for surgical and invasive medical procedures.
Workers at increased risk of hepatitis B infection should receive hepatitis B
immunization.
Acquired immunodeficiency syndrome (AIDS)
Acquired immunodeficiency syndrome (AIDS) gets transmited through sexual
contact, from an infected mother and through contaminated blood or blood
products. The virus is not transmitted through casual, non-intimate workplace
contact or social encounters, such as eating in restaurants or using public
transportation or bathroom facilities.
The following groups are at potential risk of contact with HIV-infected body
fluids: blood bank technologists, dialysis technicians, emergency room personnel,
dentists, medical technicians, surgeons and laboratory workers. In addition, certain
occupational groups like truck drivers can also be affected because of their
possible high-risk behaviours.
unit.
1. List work related diseases
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2. Name three occupational communicable diseases.
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4.4 PLAN OF ACTION FOR ENVIRONMENTAL

AND OCCUPATIONAL HEALTH
4.4.1 Concept of Prevention: Primary, Secondary and
Tertiary
Prevention of occupational diseases can be by primary, secondary and tertiary
prevention. You have already read about the levels of prevention in the unit 1 of
this block. You will also read more about these concepts in the unit 2 of block
3 of this course. You may just like to recap that primary prevention means that
we have to reduce the risk factors of a disease to such a level that the disease
74 should not happen. Secondary prevention involves presence of occupational disease
before they become clinically apparent (i.e. before workers report feeling ill) and Burden of Disease and
starting the treatment process. The third level of prevention - tertiary prevention Plan of Action for
Environmental and
involves reducing the adverse effects of any hazardous agent on health of a Occupational Health
person.
4.4.2 Health Education in Occupational Health

Health education means providing specific information about different hazards
prevalent at workplace and also to change workers behaviors in such a way
which will be more conducive to health.
In the “Workers’ Health: Global Plan of Action”, World Health Organization
recommends occupational health education as an essential component of health
care. It is a method of promoting health and preventing occupational disease.
Importance of Health Education to prevent Occupational diseases
A study done among the welders exposed to flying sparks and particles in
India reported very low levels of awareness of hazards and practice of safety
precautions. Studies have also reported poor hygiene among workers who are
exposed to chemical agents, non-usage of personal protective equipment among
factory workers, poor handling of pesticides by agriculture workers.
Providing necessary information to the workers helps them to understand the
hazards at work and adopt available preventive measures. For example
employees working in noisy areas should know the health hazards of noise exposure
and how to protect themselves by using appropriate equipment, employees working
with chemicals substances should know diseases arising from them and how to
prevent occurrence of these diseases.
Aim of health education is to develop a system capable of reducing occupational
diseases. Once we start providing health education we also should evaluate our
work. The effectiveness of such a system should be assessed by determining to
what extent the incidence of health injuries, disease or disorders are reduced.
Principles to be followed for health education for occupational diseases
Workers need to be trained to identify and control hazards at working place.
Behaviour change communication should be targeted to the workers to use personal
protective equipments. Employers also need to be responsible for encouragement
of behaviours which are conducive to health and reporting of any untoward event
to the appropriate authority.
The following principles need to be followed:
a) Ensure that the information is provided in the language(s) and at a literacy
level that all involved can understand.
b) Talk to employers, supervisors and workers and listens carefully to their
problems
c) Find out attitudes and behaviors which can cause such problems
d) Try to find out the reasons for people’s behaviour and health problems
e) Invite workers to give their ideas on solving health problems
f) Encourage employers, employees and supervisors to select ideas appropriate 75
of their situations.
Environment and Ecology g) Provide information on the safety and health hazards of the workplace and
the controls for those hazards.
h) How to report hazards, injuries, illnesses
i) What to do in an emergency
j) The employer’s responsibilities under the country s national program
k) Workers’ rights as mentioned in different schemes and acts
unit.
1. Name different levels of prevention in occupational diseases.
.............................................................................................................
.............................................................................................................
2. What is the importance of health education in the preventing occupational
diseases?
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4.4.3 Occupational Safety in Accident Prevention

We discussed in the burden of occupational diseases the human, social and
economic costs of occupational accidents, injuries and diseases. This is definitely
a for concern at all levels from the individual workplace to the national and
international level. Safety at workplace is right of a worker. Occupational accidents
are caused by preventable factors. We can eliminate them by following already
known and available measures and methods. A much lower accident rate in
developed countries is a proof of this. Risk assessment, prevention and control
measures are the backbone of occupational safety and accident prevention.
Components of accident prevention and occupational safety
- Recording and Investigating accidents: Employers and authorities need to
record and investigate occupational accidents in order to: (a) identify the real
causes of injury (b) develop effective methods of preventing future similar
accidents.
- Evaluation of safety policy: Occupational safety policy and codes of practice
are needed for the workers’ safety. The management and employer should
take responsibility for enforcement. Once implemented the policy need to be
evaluated.
4.4.4 Early Detection of Occupational Diseases

So far what you have studied you can understand that occupational diseases are
unique in the sense that many causative agents are known. We have identified
many substances which have potential to cause disease. So, you can say that
76 occupational diseases are entirely preventable as exposure can be controlled or
prevented. However, this does not occur in practice, and occupational diseases Burden of Disease and
continue to occur. Plan of Action for
Environmental and
Occupational Health
To minimize the damage caused by occupational diseases, the best alternative is
early detection of pathological changes at a stage when they are reversible.
Importance of early detection
Many diseases are associated with early clinical, functional or biochemical changes
which, when detected early, are reversible. Tests are available to detect these
early changes.
You also have to keep in mind that, unfortunately, not all the changes are reversible.
Some conditions might not be associated with reversible changes.
The progress of pneumoconiosis can be slowed down considerably if exposure

is discontinued. Also, it is well known that detection of occupational cancer at an
early stage improves prognosis. Therefore, regardless of the reversibility early
detection of occupational disease is desirable.
Early Detection, Screening and surveillance
Screening is designed to identify diseases or pre-clinical conditions in individuals

who are apparently healthy but may be having a specific disease (occupational),
and who could benefit from early treatment. Screening tests are not meant to be
diagnostic. Depending on the test results physicians decide whether to conduct
some more investigations for a given disease.
Periodic examinations are done in order to identify work-related health impairments

/ diseases . The periodicity of examinations varies with the type of exposure.
Diseases with conditions which progress rapidly, e.g. changes in choline-esterase
activity in those working with pesticides should be monitored at monthly intervals
or even more frequently. Changes to the blood picture due to ionizing radiation
can be monitored at periods ranging from 1 to 6 months depending on the
exposure dose. For diseases that start to appear after many years, e.g. noise-
induced hearing loss, periodic examination can help identify the problem early.
Occupational health surveillance is the ongoing systematic collection, analysis, and

dissemination of exposure and health data on groups of workers for the purpose
of preventing illness and injury.
Elements of occupational surveillance
1. An initial medical examination and collection of medical and occupational

histories.
2. Periodic examinations and tests at regularly scheduled intervals.
3. More frequent and detailed medical examinations, as indicated on the basis

of findings from these examinations.
4. Ongoing data analyses to evaluate collected information
5. Worker training to recognize symptoms of exposure.
6. A written report of medical findings.

77
Environment and Ecology 7. Employer actions in response to the identification of potential hazards and
risks to health.
Example of Early Detection of Occupational Disease

Pneumoconiosis
You have read about this condition earlier. The condition comprises of group of
diseases due to inorganic and organic dust particles.
Early diagnosis of byssinosis is made using a special questionnaire which
demonstrates the presence of chest tightness on the first day after the weekend
leave. X-ray examination in cases of byssinosis yields negative results and the
demonstration of airway obstruction by pulmonary function testing is not specific.
In the case of exposure to fibrogenic dust, after a satisfactory occupational history
has been elicited, a positive X-ray is the main tool for early diagnosis. This is
applicable in the case of silicosis, asbestosis, talc pneumoconiosis. It should be
noted, however, that once a positive X-ray is obtained, these diseases are
irreversible. In the case of extrinsic allergic alveolitis (bagassosis, farmers’ lung),
the diagnosis of acute, subacute and chronic cases can be confirmed by X-ray
examination. Serological examination also may help.
4.4.5 Occupational Ergonomics

Ergonomics is fitting the job to the worker as compared to the more usual
practice of compelling the worker to fit the job. The goal of an occupational
ergonomics programme is to establish a safe work environment by designing
facilities, furniture, machines, tools and job demands to be compatible with workers’
attributes (such as size, strength, aerobic capacity and information processing
capacity) and expectations.
Importance of following ergonomic principles
The workers will benefit by decreased probability of accidents, injuries and errors.
Application of ergonomic principles however, is not only beneficial to workers.
The benefits to employers are equally significant and are both visible and measurable
in terms of increased efficiency, higher productivity, reduction in work time lost
due to illness or injury and decreased insurance costs.
4.4.6 Existing Legislation and Policies at Country Level

In India, we have specific legislation to provide occupational health services.
These include The Factories Act, 1948, The Mines Act, 1952, and The Dock
Workers (Safety, Health, and Welfare) Act, 1986. Other legislations such as the
Workmen’s Compensation Act, 1923, and the Employees State Insurance Act,
1948, are directed toward compensation after injury, disease or accident.
The National Policy on Safety, Health and Environment at Work Place was
declared by the Ministry of Labour and Employment, Government of India in
February 2009. This Policy has a set of goals and objectives in order to improve
health and environment at workplace. The areas where specific emphasis has
been given under this policy are
Enforcement of existing legislation
Developing national standards
78
Compliance to the existing policies Burden of Disease and
Plan of Action for
Creating awareness Environmental and
Occupational Health
Research and development in the field of occupational health
Occupational safety
Development of skills for occupational health services
Data collection.
4.4.7 An Integrated Approach

A primary health service approach through government machinery has been
followed in many countries. This means that all the workers have access to care
and coverage on the basis of need. The service is based on principles of equity,
social justice and involves worker’s participation.
A holistic approach which has components like prevention, early diagnosis and
screening, accident prevention and occupational safety and follows the principles
of ergonomics is needed. The process of recording, investigation and reporting
of an accident need to be strictly followed. It must now be clear to you that
occupational diseases involves preventive, promotive curative and rehabilitative
services. Along with services emphasis needs to be given to data generation and
analysis.
unit.
1. What is the importance of early diagnosis in context of occupational health.
..............................................................................................................
..............................................................................................................
2. What do you understand by screening, surveillance and periodic examination.
..............................................................................................................
..............................................................................................................
4.5 KEY WORDS

COPD (Chronic Obstructive : Diseases of lung characterized by inflammation
Pulmonary Disease) and loss of lung function.
DALY (Disability Adjusted: This is a indicator used to measure burden of
Life Years). This is a indicator used to measure burden of
diseases. It combines the burden due to death
and disability in a single index.means one lost
year of healthy life
Ergonomics: Fitting the job to the worker by having a safe
work environment by designing facilities, furniture,
79
Environment and Ecology machines, tools and job demands to be
compatible with workers’ attributes (such as size,
strength, aerobic capacity and information
processing capacity).
Musculoskeletal Disorders These are disorders of locomotor system which
includes involvement of muscles, bones, tendons,
cartilages, nerves, etc. Occupational environment
means all conditions that prevails at work place
and which have a bearing effect on the worker.
Occupational accident: It is an unexpected and unplanned occurrence,

including acts of violence, in connection with
work which results in any worker incurring an
injury, disease or death.
Occupational diseases: Group of diseases having a specific or a strong

relation to occupation, generally with only one
recognized causal agent.
Occupational injury: Any injury, disease or death resulting from an

Occupational accident.
Pneumoconiosis: This condition comprises of group of diseases of

lung due to exposure to inorganic and organic
dust particles.
Screening : Finding out diseases or pre-clinical conditions in

apparently healthy population and who could
benefit from early treatment.
Surveillance: Ongoing systematic collection, analysis, and

dissemination of exposure and health data for
the purpose of preventing illness and injury and
management of clinical conditions.
Work-related diseases: Group of diseases with multiple causal agents

occupational environment together with other
risk factors may play a role in the development
of such diseases.
Zoonosis: Are a group of diseases which are transmitted

from animal to man.
4.6 LET US SUM UP

In this unit you have understood the concept and importance of occupational
environment. You have read about the burden of occupational diseases. You are
now familiar with the indicators used to measure burden of occupational diseases.
The changing pattern of occupational diseases and emerging occupational diseases
have been discussed. Various kinds of cancer and occupational communicable
diseases which can be contacted at work place were discussed at length. You
80 have also realized that exposure to many of these factors can be prevented or
controlled. Further the plan of action: levels of prevention, early diagnosis, health Burden of Disease and
Plan of Action for
education, occupational safety and accident prevention, ergonomics, existing Environmental and
legislation and policy were elaborated. Occupational Health

1. The indicators to measure burden of disease in context to occupational
health include
Mortality (number of deaths) morbidity (proportion, incidence, prevalence
of occupational diseases), DALY, economic cost
1. Some occupations where workers often develop musculoskeletal disorders
include
Heavy manual work, mining, docking, material handling, desk work, office
work, works which involve prolonged standing and sitting, works which
involve awkward postures like kneeling or hand held at high position.
2. 3 cancers that are associated with exposure to chemicals at work.
Lymphoma, Leukemia, Oral and throat cancer, Bladder Cancer
1. Some high burden/emerging occupational diseases are
Occupational injuries, Work Related Diseases, Cancer, Occupational
communicable diseases
2. Some work related diseases are
Musculoskeletal disorder, Ischemic heart disease, peptic ulcer, chronic
obstructive pulmonary disease, hypertension, mental and behavioural disorder
3. Three occupational communicable diseases are
Pulmonary Tuberculosis, Brucellosis, Anthrax, viral hepatitis B and C
1. The levels of prevention in occupational diseases are
Primary, Secondary and Tertiary levels of prevention
1. Screening is designed to identify diseases or pre-clinical conditions in
individuals who are apparently healthy but may be having a specific disease
(occupational), and who could benefit from early treatment.
Occupational health surveillance is the ongoing systematic collection, analysis,
and dissemination of exposure and health data on groups of workers for
the purpose of preventing illness and injury.
81
4.8 REFERENCES AND SUGGESTED FURTHER
READINGS
1. Park, K., Park’s Textbook of Preventive and Social Medicine, 23rd edn.
2015, Banarsi Das Bhanot Publishers, Jabalpur, M.P.
2. Occupational health: A manual for primary health care workers, World

Health Organization, 2001
82

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COURSE COORDINATOR CONTENT EDITORS

1.3 Definition of Health

1.5 Positive Health

1.7 Determinants of Health

1.9 Concept of Disease

1.2 CHANGING CONCEPTS OF HEALTH

1.2.1 Biomedical Concept

1.2. Ecological Concept

1.3 DEFINITION OF HEALTH

1.4 DIMENSIONS OF HEALTH

1.5 POSITIVE HEALTH

1.6 CONCEPT OF WELL-BEING

1.6.2 Level of living

1.6.3 Quality of Life

- Longevity – It is measured as “Life expectancy at birth”

1.7 DETERMINANTS OF HEALTH

Fig. 1.1: Determinants of Health

1.8 INDICATORS OF HEALTH

1.8.1 Characteristics of Indicators

12 a. Valid – The indicator actually measures what it is supposed to measure.

c. Sensitive – It is able to detect changes in the given situation.

14 - Population per PHC/sub center

Fig. 1.2: Common Indicators of Health

Check Your Progress 2

1. List three determinants of health

1.9 CONCEPT OF DISEASE

Fig. 1.3: The Health – Sickness Spectrum

1.10 CONCEPT OF CAUSATION

Fig. 1.4: The epidemiological triad

g. Web of causation – This model was suggested by Macmohan and Pugh.

Fig. 1.5: Web of causation for coronary artery disease 17

Fig. 1.6: Stages of Disease

Fig. 1.7: Natural history of Disease

1.12 PREVENTION OF DISEASE

1.12.1 Levels of Prevention

Fig. 1.8: Interventions under primary prevention

a. Population (mass) strategy is directed at the whole population irrespective

1. List three theories of disease causation

Fig. 1.9: Levels of Prevention

1.13 LET US SUM UP

1.14 KEW WORDS

Health indicator : A health indicator is a characteristic of an

1.16 REFERENCES AND SUGGESTED

2.6 Waste and Human Health

2.7 Environmental Action

2.2 COMPONENTS OF ENVIRONMENT

As discussed in the last chapter, environment is one of the components of the

Fig. 2.2: Environment and human health

2.3 ENVIRONMENTAL HEALTH

Environmental health comprises those aspects of human health, including quality

Fig 3: Different environmental factors affecting health

Check Your Progress 1

2.4 ENVIRONMENTAL HAZARDS

2.5 IMPACT OF ENVIRONMENTAL HAZARDS

Outdoor air pollution Respiratory conditions, cardiovascular disease,

Environmental Catastrophes that resulted in high mortality

2.5.1 Air Pollution

2.5.2 Safe Water