Community Medicine

Occupational Health
Chapter 18

Atul K Shankar
31
ESSAY
Mention the various legislations in relation to occupational health. Discuss in detail
about the Employees State Insurance Act, 1948.
The various legislations related to occupation health are:

- The Factories Act, 1948

- The Employees State Insurance Act, 1948

EMPLOYEES STATE INSURANCE ACT 1948

The ESI Act is an important measure of social security and health insurance in this country. This Act
provides for certain cash and medical benefits to industrial employees in case of sickness, maternity
and employment injury

Scope:

- The Act extends to the whole of India

- It covers all power-using factories other than seasonal factories wherein 10 or more
persons were employed
- The provisions of the ESI were extended in the following classes of establishments:
o Small factories employing 10 or more persons, whether power is used in the process
of manufacturing or not
o Shops
o Hotels and Restaurants
o Cinemas and Theatres
o Road-motor transport establishments
o Newspaper establishments
o Private Medical and Educational Institutions

Administration:

- The administration of the ESI Scheme is entrusted to an autonomous body called the ESI
corporation
- Consists of members representing Central and State Governments, employers and
employee’s organisations, medical profession and Parliament
- There is a standing committee, constituted from the Members of the Corporation, which
acts as an executive body for the administration of the Scheme.
- The CEO of the corporation is the Director General who is assisted by 4 principal officers
o Insurance commissioner
o Medical Commissioner
o Financial Commissioner
o Actuary

Finance:

- The scheme is run by contributions by employees and employers and grants from Central
and State governments
- The employer contributes 4.75% of the total wage bill and the employee contributes 1.75%
- Employees getting daily wages of below Rs.137 are exempted from payment of contribution
Benefits to Employees:

- The Act has made provisions for the following benefits to insured persons or to other
dependents as the case may be:
o Medical Benefit
o Sickness benefit
o Maternity benefit
o Disablement benefit
o Dependent’s benefit
o Funeral expenses
o Rehabilitation allowance

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 dependents or
arranging for their medical care.
- Rebate under the Income Tax Act on contribution deposited in the ESI account
- Healthy work force.

Rajiv Gandhi Shramik Kalyan Yojna:

- The ESI corporation launched a new Yojna for the employees covered under the ESI scheme
- This scheme provides an unemployment allowance for the employees covered under ESI
scheme who are rendered unemployed involuntarily due to retrenchment/ closure of
factory etc.
- This scheme came to effect from 1st April 2005
- An insured person going out of insurable employment involuntarily, on account of the
closure of the workplace, retrenchment or permanent invalidity arising out of non-
employment injury, after rendering insurable employment and having contributed under
the scheme for 5 or more years
- the allowance can be availed in one spell or in different spells of not less than one month
- the daily rate of unemployment allowance is the standard benefit rate
- During the period for which a person is entitled for unemployment allowance, they are
eligible for medical care for himself and his/her family from ESI dispensaries, panel clinics
and hospitals to which they are attached prior to the date of loss of employment.
 What are the Various Health Problems due to Industrialisation? Discuss in detail the
various preventive measures adopted in industry to protect the health of the workers.
The various health problems due to industrialisation are:

- Environmental Sanitation Problems

o Housing
o Water pollution
o Air Pollution
o Sewage disposal
- Communicable Diseases
o Main diseases are tuberculosis, venereal diseases, food and water borne infections
- Food Sanitation
o Typhoid fever and viral hepatitis are common
- Mental Health
o Failure of adjustment to unfamiliar surroundings are mental illness, psychoneurosis,
behaviour disorders, delinquency
- Accidents
o Public health problem due to congestion, vehicular traffic and increased tempo of
life
- Social Problems
o Alcoholism, drug addiction, gambling, prostitution, increased divorces, breaking up
of home, juvenile delinquency
- Morbidity and Mortality
o Industrial areas are characterised by high morbidity and mortality from certain
diseases
o The incidence of chronic bronchitis and lung cancer is higher in industrialized areas
than in rural areas.

Measures for Health Protection of Workers:

The aim of occupational health is the promotion and maintenance of the highest degree of
physical, mental and social wellbeings of workers in all occupations. The measures to aid in this
objective are:

1) Nutrition
- Malnutrition is an important factor contributing to poor health among workers and low work
output
- May also affect the metabolism of toxic agents and also the tolerance mechanisms
- Under the Indian Factories Act, it is obligatory on the part of the industrial establishments
to provide a canteen when the number of employees exceed 250
- The aim is to provide balanced diets or snacks at reasonable cost under sanitary control
- it is important to combine this action with the education of the workers on the value of a
balanced diet

2) Communicable Disease Control

- The industry provides an excellent opportunity for early diagnosis, treatment, prevention
and rehab
- It is a general objective to detect the cases and to render them non-infectious to others by
treatment or removal from the working environment, or both.
3) Environmental Sanitation
- Water Supply
o Sufficient supply of wholesome drinking water is one of the basic requirements in all
industrial establishments
o Installation of drinking water fountains should be encouraged
- Food
o If food is sold, its sanitary preparation, storage and handling are essential
o Education of food handlers and other measures may be necessary to prevent
outbreaks of gastro-intestinal diseases
- Toilet
o There should be sufficient number of latrines and urinals of the sanitary type
o It is recommended that there should be at least 1 sanitary convenience for every
25 employees
o Garbage and waste disposal should be such to avoid the breeding of flies and
vermin
- General Plant Cleanliness
o The walls, ceilings and passages should be painted with water washable paint and
repainted at least once in 3 years and washed at least once in every 6 months.
o The dust which settles down on the floor and machinery should be promptly
removed by vacuum cleaners or by wetting agents before it is redistributed into the
atmosphere by the vibration of the machinery or buildings
o High standard of general cleanliness is one of the fundamentals of accident
prevention
- Sufficient Space
o Sufficient floor space and cubic space are essential to prevent not only respiratory
infections but also to ensure a comfortable working environment
o The recommended standard is min. 500 ft3 of space for every worker; space more
than 14 feet above the floor level is not to be taken into consideration
- Lighting
o The results of poor industrial illumination are workers’ eye fatigue, increased
accidents, decreased production and more rejections of a long period of time may
result in permanent impairment of vision
o There should be sufficient and suitable lighting, natural or artificial or both, in every
part of a factory where workers are working or passing through
- Ventilation and Temperature
o Poor ventilation increases the chances of infection from person to person but also
affects the mental and physical efficiency of the worker
o Proper ventilation is needed for the control of noxious vapours, fumes and dusts
and prevention of fatigue and industrial accident
o Effective and suitable provision should be made for maintaining adequate
ventilation by circulation of fresh air in every work room
o Temperature which will secure to workers therein
- Protection against Hazards
o There should be adequate environmental controls designed to protect the workers
against exposure to dusts, fumes and other toxic hazards
- Housing
o There is usually an acute shortage of housing in industrial areas
 o The housing of workers near a plant must be correlated to essential community
amenities and to social and sanitary facilities
o Town planning and zoning are highly desirable

4) Mental Health
- The objective of an occupational health service is not only to keep the workers physically
healthy, but mentally and psychologically stable
- Industrial workers are susceptible to the effects of love, recognition, rejection, job
satisfaction, rewards and discipline

5) Measures for Women and Children

- Women workers require special protection because:
o The developing embryo may be more susceptible to noxious agents than the
exposed mother
o Females may be less suited for some work tasks than men; pregnancy may decrease
the capacity to cope with many work factors
o Women tend to feed themselves less substantially than men and also restrict their
nourishment in difficult economic circumstances
o Infant mortality is higher amongst children of women employed in industrial work

6) Health Education
- Health education is a basic health need
- It is an important health promotional measure
- Health education in the industrial setting should be envisaged at all levels – the
management, supervisory staff, workers, trade union leaders and community
- The content varies from matters of personal hygiene and protection to participation of the
workers in the planning and operation of the total health service programme in industry

7) Family Planning
- Family planning is now recognized a decisive factor for the quality of life, and this applies to
industrial workers also
- The workers must adopt the small family norm.
SHORT NOTES
Occupational Cancers
Skin Cancer:

- Nearly 75% of occupational cancers are skin cancer

- They are an occupational hazard among gas workers, coke oven workers, tar distillers, oil
refiners, dye-stuff makers, road makers and in industries associated with the use of mineral
oil, pitch, tar and related compounds

Lung Cancer:

- It is an hazard in the gas industry, asbestos industry, nickel and chromium work, arsenic
roasting plants and the mining of radioactive substances
- Nickel, chromates, asbestos, coal tar, radioactive substances and cigarette smoking are
proved carcinogens for the lungs
- Arsenic, beryllium and isopropyl oil are suspected carcinogens
- More than 9/10 of lung cancer are attributed to tobacco smoking, air pollution and
occupational exposure

Cancer Bladder:

- Was first noted in the aniline industry in 1895

- Cancer of the bladder is caused by aromatic amines, which are metabolized in the body and
excreted in the urine
- Industries associated with cancer of the bladder include dye-stuffs and dyeing industry,
rubber, gas and electric cable industries
- The following carcinogens have been identified: beta-naphthylamines, benzidine, para-
amino-diphenyl, auramine and magenta

Leukaemia:

- Exposure to benzol, roentgen rays and radioactive substances can give rise to leukaemia
- Benzol is a dangerous chemical and is used as a solvent in many industries
- It may appear long after exposure has ceased
- Characteristics of occupational cancer are:
o Appears after prolonged exposure
o Period between exposure and development of the disease may be as long as 10-25
years
o Disease may develop even after the cessation of exposure
o The average age incidence is earlier than that for cancer in general
o Localization of the tumours is remarkably constant in any one occupation

Control of Industrial Cancer:

- Elimination or control of industrial carcinogens

- Medical examinations
- Inspection of factories
- Notification
- Licensing of establishments
- Personal hygiene measures
- Education of workers and management
 Sickness Absenteeism
Sickness Absenteeism is a serious health problem in industry. It may seriously impede production
with serious cost repercussions, both direct and indirect. Absenteeism tends to increase the adverse
repercussions and is a useful index in industry to assess the state of health of workers, and their
physical, mental and social well-being

Incidence:

- India has a working force of approximately 30 million in registered factories

- Research undertaken by National Productivity Council into absenteeism showed a marked
increase from 8-13% in the early 1950s to around 15-20% in recent years

Causes:

- The causes of sickness-absenteeism may not be entirely due to sickness

- Economic Causes
o Studies have shown that if the worker is entitled to sick leave with pay, they tend to
avail this privilege by reporting sick
- Social Causes
o Certain social factors appear to influence sickness absenteeism in India.
o There are the social and family obligations such as weddings, festivals, repair and
maintenance of ancestral house
- Medical Causes
o About 10% of the days lost were to be found due to occupational accidents
o Respiratory and alimentary illnesses have been found to be important causes
- Non-occupational Causes
o 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 of sickness absenteeism would result in better utilization of resources and
maximising the production.
- The methods of reducing sickness absenteeism include
o Good factory management and practices
o Adequate preplacement examination
o Good human relations
o Applications of ergonomics
 Silicosis
- Silicosis is the major cause of permanent disability and mortality.
- It is caused by inhalation of dust containing free silica or silicon dioxide
- It was first reported in India from the Kolar Gold Mines
- Ever since, its occurrence has been uncovered in various other industries

Pathogenesis:

- The particles are ingested by the phagocytes in the lung parenchyma, which accumulate
and blocks the lymph channels
- Pathologically, silicosis is characterised by a dense “nodular” fibrosis, with nodules ranging
from 3-4 mm in diameter.
- Clinically the onset is insidious
- Early manifestations include
o Irritant cough
o Dyspnoea on exertion
o Pain in the chest
- In more advanced cases, there is impairment of the total lung capacity
- X ray of the chest shows a characteristic snow-storm appearance in the lung fields
- It is a progressive disease, and predisposes susceptibility to pulmonary tuberculosis
(silicotuberculosis)

Treatment:

- There is no effective treatment for silicosis

- Fibrotic changes that occur cannot be reversed
- The only way that silicosis can be controlled is by
o Rigorous dust control measures
o Regular physical examination of workers

Pneumoconiosis
- Pneumoconiosis is a disease caused by inhalation of dust particles within the size range of
0.5-3 micron
- It may gradually cripple a man by reducing his working capacity due to lung fibrosis and
other complications.
- The hazardous effects of dust on the lungs depend upon a number of factors such as
o Chemical composition
o Fineness
o Concentration of dust in the air
o Period of exposure
o Health status of the person exposure
- The threshold limit values for different dusts are different
- The superimposition of infections like TB may also influence the pattern of pneumoconiosis
- The important dust diseases are silicosis, anthracosis, byssinosis, bagassosis, asbestosis,
farmer’s lung
- As no cure for pneumoconiosis is known it is essential to prevent these diseases from arising
 Social Security
Social Security is defined as “security that society furnishes through appropriate organization,
against certain risks to which its members are exposed”. The risk which social security covers in
most countries are sickness, invalidity, maternity, old age and death. Social Security also includes
social insurance and social assistance.

Social Security for Industrial Workers:

- The social security measures for industrial workers in India are contained in:
o Workmen’s Compensation Act, 1923
o Central Maternity Benefit Act, 1961
o Employees State Insurance Act, 1948
o The Family Pension Scheme, 1971

Social Security for Civil Servants:

- The employees of the Central and State government have pension, gratuity, provident fund
and family pension schemes
- The Central Government Health Scheme in Delhi provides comprehensive medical care to all
categories of Central Government Employees.
- The scheme has been extended to other cities also

Social Security for General Public:

- The risk of death, accident and fire are covered by the Insurance Schemes
- The Life Insurance Corporation (LIC) of India has many schemes for the general public
- There are also public provident fund and ESI schemes

Lead Poisoning
- Lead Poisoning may occur in 3 ways
o Inhalation – most cases of industrial lead poisoning is due to inhalation of fumes
and dust of lead or its compounds
o Ingestion – poisoning by ingestion is of less common occurrence
 Small quantities of lead trapped in the upper respiratory tract may be
ingested
 Lead may also be ingested in food or drink
o Skin – absorption through skin occurs only in respect of the organic compounds of
lead, especially tetraethyl lead
- Clinical Picture
o The clinical picture is different in the inorganic and organic lead exposures
o The toxic effects of inorganic lead exposure are abdominal colic, obstinate
constipation, loss of appetite, blue-line on the gums, stippling of red cells,
anaemia, wrist drop and foot drop
o The toxic effects of organic lead compounds are mostly on the central nervous
system – insomnia, headache, mental confusion, delirium
- Management
o The major objectives are the prevention of further absorption, removal of lead from
soft tissues and prevention of recurrence. Use of D-penicillamine has been reported
to be effective as a chelating agent to promote lead excretion in urine
 Occupational Hazards in Agricultural Industry
Zoonotic Diseases:

- The close contact of the agricultural worker with animals or their products increases the
likelihood of contracting certain zoonotic diseases such as Brucellosis, Anthrax,
Leptospirosis, Tetanus, Tuberculosis (bovine) and Q fever.
- The extent of the occupational occurrence of these diseases in most parts of the world is not
known.

Accidents:

- Agricultural accidents are becoming more frequent, even in developing countries as a result
of the increasing use of agricultural machinery.
- Insect and Snake bites are an additional health problem in India.

Toxic Hazards:

- Chemicals are being used increasingly in agriculture either as fertilizers, insecticides or

pesticides
- Agricultural workers are exposed to toxic hazards from these chemicals
- Associated factors such as malnutrition and parasitic infestation may increase susceptibility
to poisoning at relatively low levels of exposure

Physical Hazards:

- The agricultural workers may be exposed to extremes of climatic conditions such as

temperature, humidity, solar radiation, which may impose additional stresses upon him
- They may also have to tolerate excessive noises and vibrations, inadequate ventilation and
necessity of working in uncomfortable positions for long periods of time

Respiratory Diseases:

- Exposure to dusts of grains, rice husks, coconut fibres, tea, tobacco, cotton, hay and wood
are common where these products are grown
- The resulting diseases appear to be widespread
o Byssinosis, Bagassosis, Farmer’s Lung, Occupational Asthma