Tuesday, January 10, 2012

What is the true incidence of work-related disease?

The following story from New Zealand (NZ) caught my eye:

New figures reveal work kills 1000 a year
(by Tom Hunt, Fairfax News, 19/12/2011)

Work is killing 1000 of us a year.
New figures, which also show there are 17,000 new case [sic] of work-related disease in New Zealand each year.

Think about that for a minute. New Zealand is a country with a population of 4.3 million — almost identical to the population of British Columbia — yet work-attributed fatalities and diseases in NZ far exceed those we accept at WorkSafeBC. What accounts for the difference?

When I tracked down the source report for the headline, the reasons became clear. NZ is taking a holistic approach to the issue of occupational illness: on a population basis, the incidence of occupational disease that can be attributed to work will always be greater than incident rates calculated from individual cases where causation must be adjudicated.

On a population basis, NZ finds:
about 700–1,000 deaths occur every year in New Zealand from occupational disease, particularly cancer, respiratory disease and ischaemic heart disease (such as coronary artery disease) 2–4 percent of deaths of all people over the age of 20 are due to occupational disease, and 3–6 percent of all cancer deaths in people aged 30 or older are due to occupational cancer
there are about 17,000–20,000 new cases of work-related disease every year.

What the population-incidence approach illustrates is that workers and society are paying a huge price for work-related illness and disease. If B.C. has a similar population-incidence ratio then the true cost of work-related disease is far greater than the 2,750 occupational disease claims first accepted and paid in 2010.

Leaving aside the under-recognition and under-reporting of many occupational diseases, this high incidence alone requires action. The NZ Action Plan proposes a focus on five specific hazards:
• occupational carcinogens;
• respiratory hazards;
• noise;
• skin irritants; and
• psycho-social hazards.

Exactly what actions will be taken to address each of these hazards will depend to some extent on the sector. To assess whether any of the actions has been effective will require data on exposure to health hazards in the working population. NZ is actively developing a surveillance system through the Centre for Public Health Research at Massey University.

Recognizing the true incidence of occupation disease changed the dialogue in NZ. The focus is not on claims costs but human and societal costs. More importantly, there is a refined focus on prevention rather than jurisdiction. It will be interesting to see how their strategy and surveillance systems develop. There may be important lessons for other jurisdictions.

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