HSE focus on respiratory disease and occupational cancer
The Health and Safety Executive (HSE) has published on its website a paper outlining its current and future plans to tackle occupational disease as a “critical issue”, with particular focus to be on the priority areas of respiratory disease and occupational cancer.
The document is earmarked for presentation at the meeting of HSE’s Board on 5th March 2014, which has how to tackle occupational disease listed as a key item on the agenda.
In the case of respiratory disease, the paper notes that work-related respiratory disease covers a range of illnesses that are caused or made worse by breathing in hazardous substances that damage the lungs such as dusts, fumes and gases. The most prevalent of these diseases are said to be chronic obstructive pulmonary disease (COPD), asthma and silicosis.
A number of industries and workplace activities are linked to a high incidence and greater risk of respiratory disease and the paper sets out priority areas in this regard as:
- Construction workers
- Foundry workers
- Welders
- Quarry and stone workers
- Vehicle paint sprayers
- Bakery workers.
In respect of occupational cancer, priorities for future activity are listed as:
- Asbestos
- Shift work
- Respirable crystalline silica
- Welding
- Painters
- Diesel engine exhaust emissions
- Solar radiation
- Polycyclic aromatic hydrocarbons (coal tars and pitches)
- Tetrachloro-ethylene
- Radon.
Future subjects for developing stakeholder working partnerships are suggested as “breast cancer associated with shift work (night work) and cancer in painters” where the paper argues there is a “need to develop a better understanding of the causal link/exposure scenarios and continuing developing relationships on the topic of work aggravated asthma”.
Quoting the recent triennial review of the HSE, the paper also notes the review’s recommendation that, “HSE continues to seek new and innovative ideas for interventions that maximise its impact on the continuing high levels of work-related ill health.”
Legislative Requirements
The Control of Substances Hazardous to Health Regulations 2002 (COSHH), as amended, provide a comprehensive approach to the control of all potentially hazardous substances in the workplace, including those substances that cause lung disease and occupational cancers. The regulations set out responsibilities for employers to prevent, control and assess hazards. In addition, COSHH sets limits for exposure to a wide variety of substances.
All substances capable of causing occupational lung disease or cancer are covered by these limits, which are given as workplace exposure limits (WELs). WELs are constantly subject to revision and are issued annually in the HSE publication, EH40 Workplace Exposure Limits.
Some substances are sufficiently hazardous to warrant individual legislation, eg the Control of Asbestos Regulations 2012.
Reporting Occupational Lung Disease and Cancer
Occupational lung disease and cancers should only be diagnosed by an occupational or chest physician. Once diagnosed, they can be reportable industrial diseases in accordance with the requirements of the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) — the onus being on the employer to make the notification.
“Invisible” deaths
There are around 200 different types of cancers that affect various parts of the body, with a variety of causes. For example, smoking is a cause of lung cancer; significant exposure to solar radiation from the sun can cause skin cancer; and poor diet is associated with other cancers.
Asbestos is a known carcinogen that can cause three lung diseases, one of which is lung cancer. Consider a worker who smokes and is exposed to asbestos and then develops lung cancer. The question arises as to which factor caused the cancer: smoking, asbestos or a combination of both? Recent evidence from a pilot scheme on assessing death certificates (“Inaccurate cause of death recorded in one in four patients”, The Guardian, 10 August 2012) indicated that doctors failed to give an accurate cause of death in 25% of cases: it was also indicated that in 1 in 10 cases the doctor may give the “wrong type of disease”. Hence it is likely that deaths related to occupational diseases are significantly underestimated.
A fatal accident at work is immediate, often linked directly to an employer, visible in the workplace, reportable, investigated, and may often result in a prosecution. There are several points in this process where publicity may arise. On the other hand, a death caused by an occupational cancer can be “invisible” to the public because:
- It may not be recognised as such by a doctor
- The link between a specific exposure to a carcinogen and an individual’s cancer can very rarely be established
- The time between being exposed to a carcinogen and the development of symptoms may Take many years, and by the time the cancer has developed people may not associate it with their work
- As cancer becomes more prevalent in society generally, it becomes more difficult to identify work-related causes.
Controlling the risk
Risk assessments must be carried out to clarify the nature of the hazards, identify who is impacted, and to highlight what processes need to be in place to eliminate, control and manage the risk.
All exposure to hazardous substances should be prevented or avoided. This means the:
- Removal of toxic materials, where possible
- Substitution with less toxic materials, where possible
- Elimination of processes that might cause exposure
- Enclosure of harmful processes with automatic operation, if possible.
Where exposure cannot be avoided or prevented, the following options should be considered:
- Isolation of harmful processes from the remainder of the plant and appropriate personal protection for designated workers.
- Local exhaust ventilation (fume hoods/cupboards).
- General extraction ventilation.
- Control of dusts by wetting or precipitation.
- Limiting exposure hours by shorter working periods or rotation of jobs.
- Planned maintenance to ensure machinery and dust control systems are working to specification.
- Personal protective equipment (respirators, suits, etc) and ensuring any equipment is used appropriately.
- Warning signs and notices.