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WHC4002 SUMMARY Strategies for Health Protection Disease prevention and Re-integration
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SUMMARY WHC4002 – Strategies for healthprotection, disease prevention and re-integration
Case 1 – the ageing workforce (Overview)
1. What levels of prevention are there?
Macro level (inter)national policiesinter)national policiesnational policies
Meso level organizational
Micro level individual
2. What are the types/stages of prevention? What is the difference between universal
and selective prevention?
Universal prevention everybody, whole population (inter)national policiesprimary prevention)national policies
Selective prevention no signs of ill-health , just at risk, monitoring
(inter)national policiesprimary/secondary prevention)national policies STOP: Substitution, Technical measures,
Organizational and Personal protective equipment.
Indicated prevention early sign of ill-health, screening, risk of labelling people,
quality of screening system important (inter)national policiessecondary prevention)national policies
Tertiary prevention medication or therapy
Gordon R (inter)national policies1983)national policies. An operational classification of disease prevention. Public Health Reports, 98,107-109
Types of prevention:
- Primary = practiced prior to the biologic origin of the disease.
- Secondary = practiced after the disease can be recognized, but before it has caused
suffering and disability
- Tertiary = practiced after suffering and disability have been experienced, in order to
prevent further deterioration (inter)national policiesverslechtering)national policies
The primary-secondary classification is attractive and simple, but it does not serve to
distinguish between preventive interventions which have different epidemiologic
justifications and require different strategies for optimal utilization (inter)national policiesbenutting)national policies. Another
classification of prevention can be used:
- Universal = the most generally applicable type is a measure that is desirable for
everybody. In this category fall all those measures which can be advocated confidently
for the general public and which, in many cases, can be applied without professional
advice or assistance. Maintenance of an adequate diet, dental hygiene, use of seatbelts
in automobiles, smoking cessation, and many forms of immunization would fall
clearly into the universal category for which benefits outweigh costs and risks for
everyone
- Selective = there are many measures in which the balance of benefits against risk and
cost is such that the procedure can be recommended only when the individual member
of a subgroup of the population distinguished by age, sex, occupation or other obvious
characteristics whose risk of becoming ill is above average. Examples would be active
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, rabies immunization for veterinarians, annual influenza immunization for the elderly,
use of safety goggles by machinists and the avoidance of alcohol and drugs by
pregnant women. As with universal preventive measures, most of these actions which
should be utilized among selected groups depend primarily on the motivation of the
individual who is being protected either to carry out or to seek out the preventive
measure, so that public education, in this case directed at the high-risk group, is an
essential aspect of the strategy for optimal public health practice
- Indicated = these preventive measures encompasses those that are advisable only for
persons who, on examination, are found to manifest a risk factor, condition or
abnormality that identifies them (inter)national policiesindividually)national policies as being at sufficiently high risk to
require the preventive intervention. Preventive measures that fall into this category are
not totally benign (inter)national policiesonschuldig)national policies or minimal in cost. If they were, the balance in the cost-
benefit analysis might favour wider application, including segments of the population
at lower risk of disease, and they would tend to move into the selective or universal
classes. The identification of persons for whom indicated preventive measures are
advisable is the objective of screening programs, and the cost, risks, availability, and
effectiveness of the preventive measure must be carefully weighed before a decision to
initiate screening is made. Preventive interventions in this class include control of
hypertension, dietary measures to reduce hypercholesterolemia, anti-tuberculous drugs
for recent skin test converters, and frequent, careful re-examination of persons from
whom a basal cell skin cancer or a colonic polyp has been removed. Indicated
prevention is most commonly applied in the clinical setting, as the indication is
ordinarily one discovered through medical examination or laboratory testing.
o The majority of these measures have been called secondary under the previous
classification, since in most cases the observable indication is related to the
biologic origin of the disease.
3. What is risk assessment and how is it linked to universal prevention?
European Agency for Safety and Health at Work (inter)national policies2008)national policies. Factsheet 80. Risk assessment. Bilboa: Author.
Although others can carry out the risk assessment, the employer is responsible.
Risk assessment — Legal context
The key role played by risk assessment (inter)national policiesassessing and managing risks)national policies is set out in the EU
framework directive which protects workers’ safety and health. Employers have a general
duty to ensure the safety and health of workers in every aspect related to work. Risk
assessments enable employers to take the measures necessary to protect the safety and health
of their workers. These measures include:
preventing occupational risks;
providing information and training to workers;
putting in place the organisation and means to implement the necessary measures.
The framework directive (inter)national policiesguideline)national policies has been transposed into national legislation. Member
States, however, have the right to enact more stringent provisions to protect their workers.
What is risk assessment?
Risk assessment is the process of evaluating the risks to workers’ safety and health from
workplace hazards. It is a systematic examination of all aspects of work that considers:
what could cause injury or harm,
whether the hazards could be eliminated and, if not,
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, what preventive or protective measures are, or should be, in place to control the risks.
- A hazard can be anything, whether work materials, equipment, work methods or
practices, that has the potential to cause harm;
- A risk is the chance, high or low, that somebody may be harmed by the hazard.
How to assess the risks
Risk assessment = bridge between universal and selective prevention, starts universal but the
preventive measures are most likely selective
The guiding principles that should be considered throughout the risk assessment process can
be broken down into a series of steps:
Step 1. Identifying hazards and those at risk = Looking for those things at work that
have the potential to cause harm, and identifying workers who may be exposed to the
hazards (inter)national policieswho are at risk)national policies.
Step 2. Evaluating and prioritising risks = Estimating the existing risks (inter)national policiestheir severity,
their probability, etc.)national policies and prioritising them in order of importance.
Step 3. Deciding on preventive action = Identifying the appropriate measures to
eliminate or control the risks.
Step 4. Taking action = Putting in place the preventive and protective measures
through a prioritisation plan (inter)national policiesmost probably all the problems cannot be resolved
immediately)national policies and specifying who does what and when, when a task is to be completed
and the means allocated to implement the measures.
Step 5. Monitoring and reviewing = The assessment should be reviewed at regular
intervals to ensure it remains up to date. It has to be revised whenever significant
changes occur in the organisation or as a result of the findings of an accident or ‘near
miss’ investigation.
Who does what?
The employer has a duty to:
- ensure the safety and health of workers in every aspect related to work;
- organise the risk assessment;
- select the person(inter)national policiess)national policies to carry out the assessment and ensure they are competent;
o The person carrying out the risk assessments can be:
the employer;
employees designated by the employers;
external assessors and services if there is a lack of competent personnel
in the workplace.
o The person should be competent. they do not need to be safety and health
experts, but they can demonstrate their competence by showing e.g. they have
an understanding of the general approach to risk assessment, can identify
health problems knows options to eliminate or reduce risk
- assess the risks and implement protective measures;
- consult the employees or their representatives about the organisation of the risk
assessment, and the persons carrying out the assessment and implementing the
preventive measures;
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, - be in possession of an assessment of the risks;
- draw up assessment records having consulted with the workers and/or their
representatives, or even involved them in the work, and make the records available to
them;
- ensure all persons affected are informed of any hazard, of any harm to which they may
be at risk and of all the protective measures taken to prevent such harm.
Workers and their representatives have the right/duty to:
- be consulted on arrangements for the organisation of the risk assessment and for the
appointment of those undertaking the task;
- participate in the risk assessment;
- alert their supervisors or employers about perceived risks;
- report changes in the workplace;
- be informed of the risks to their safety and health and of the measures required to
eliminate or reduce these risks;
- ask the employer to take appropriate measures and to submit proposals to minimise
hazards or to remove the danger at source;
- cooperate to enable the employer to ensure a safe working environment;
- be consulted by the employer when drawing up the records of assessments.
Risk assessment resources
There are many resources available to help carry out risk assessments. The choice of method
will depend on workplace conditions e.g. the number of workers, the type of work activities
and equipment, and any specific risks.
4. How could you follow up a risk assessment? (since it is not always done properly)
employers have to perform a risk assessment, but it is not mandatory to implement the
most effective strategies to reduce the identified risks.
Tinline, G., & Moss, B. (inter)national policies2009)national policies.Building interventions to improve staff well-being. In C.L. Cooper, J. Campbell
Quick & M.J. Schabracq (inter)national policiesEds.)national policies. International Handbook of Work and Health Psychology,3d ed. (inter)national policieschapter 19)national policies.
New York: Wiley.
Improving staff well-being in organisations:
1. building the business case Without a business case there is little hope of engaging
business leaders with the idea of investing in well-being.
Identify well-being stakeholders (inter)national policiesto ensure clear focus on the needs of staff groups)national policies
o Both external and internal
Understand your starting point How bad is it in the organisation/ how big is the
situation? Focus on the current organizational activity around well-being. Also focus
on organizational context.
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