AASCIF - july-august-september 2004

By Roberta Ellis
Vice President, Investigative and Review Divisions
Workers Compensation Board of British Columbia

Although recent events such as SARS and Avian Flu have raised the public’s awareness of the importance to protect against infectious diseases, in public health terms, environmental and occupational disease still remains the undiscovered country.

Although we don’t know the role workplaces play in the development of many occupational diseases, we have made great strides to identify causal factors for some of them. Once we identify causal factors, we can work to develop prevention strategies.

For example, we now have comprehensive control strategies for workers who may be exposed to mould during remediation projects. Much of this information was developed in New York state during the early 1990s. The New York protocol is used around the world—and here in British Columbia—as a public health policy instrument to help workers and employers implement control strategies for exposure to mould during building remediation projects.

Just as New York waded into previously uncharted territory and developed guidelines for assessment and remediation of fungi in indoor environments, the WCB of BC is beginning a journey of its own into the uncharted world of occupational disease.

Increasing proportion of claims
In British Columbia we have made great progress in reducing the numbers of occupational injuries. However, claims for occupational diseases are increasing as a proportion of long-term disability claims.

And while deaths from traumatic injuries have decreased, the overall number of work-related deaths in British Columbia each year has not changed. The reason is that work-related disease deaths have been increasing over the past two decades.
In the last 10 years, occupational diseases in British Columbia have taken 474 lives, produced 26,000 claims to the workers’ compensation system and cost the British Columbia economy 750,000 days of lost productivity. The monetary costs to the workers’ compensation system amount to nearly $350 million.

However, the under-reporting of occupational disease claims along with latency issues would lead us to conclude that these estimated costs are quite conservative—likely only a fraction of the real numbers. Many workers do not make the connection between the disease and their occupation, especially since exposure may have occurred years before.

Under-reporting of occupational diseases occurs for many reasons. Many occupational diseases are associated with lengthy latency periods, making it difficult to establish a connection between employment and an illness.

Causes for others, such as asthma, are multi-factorial having both occupational and non-occupational causes. It is also often difficult to determine which ailments are caused by which exposures.

Aging is another confounder. How do we separate work-related diseases from diseases that are part of the aging process?

Costs paid elsewhere
When the connection is not made between exposure at work and a resulting illness, a worker’s occupational disease is not captured and compensated for by the workers’ compensation system.

The result is that costs for treatment of occupational diseases are inappropriately apportioned to other entities. In British Columbia our publicly funded medical systems pick up most of the tab. Costs are also borne by other entities such as private providers of long-term disability insurance, employer-funded sick-leave, social services programs, and affected workers and their families.

The ideal solution is that we prevent occupational diseases from happening in the first place. However, prevention is difficult because they are often so hard to identify. Much of the time there is very limited available information about the causes that give rise to their occurrence, which is why there’s such an under-reporting problem.

Without understanding the causes, appropriate prevention strategies cannot be implemented. It’s a vicious circle.

Centre for tracking diseases
In order to have access to information and expertise that would assist in identifying and tracking diseases of occupational origin, we and our counterparts at the BC Centre for Disease Control and the University of British Columbia School of Occupational and Environmental Hygiene have begun exploring a Centre for Environmental and Occupational Health. Our vision for the centre is that it would provide us with:

  • Occupational disease surveillance.
  • A centralized repository for occupational exposure data.
  • “Real-time” science and evidence-based information.
  • Multidisciplinary expertise and assessment capacity.

We’re hoping that a comprehensive occupational disease surveillance system will allow us to identify types and trends in occupational diseases, and the jobs and industries where they are most likely to occur.

Similar surveillance has been established by the New York City Department of Health and Mental Hygiene to monitor residents of New York City who were exposed to the events of 9/11. The WTC Health Registry is to allow health professionals to track and investigate possible trends in illness and recovery, and help create guidelines that can save lives and reduce injuries in future disaster settings.

By tracking occupational exposures to chemical, biological and physical hazards, we hope to identify groups of workers that are at greatest risk of over-exposure to hazardous agents. Then we can implement exposure abatement strategies before exposures become problematic.

Called upon for advice
At the WCB, we’re often called upon to provide advice on the hazards associated with newly emerging, complex or unusual exposures, and to provide guidance and “best practices” for exposure control strategies. Lack of information and the urgency with which information is required often does not allow for reliance on traditional academic research. The recent SARS outbreak in British Columbia is a good example. We hope that by having access to “real-time” research, we will be able to respond with urgency to these issues.

We also need access to a multidisciplinary resource team that could be coordinated to deal with emerging, unusual or complex issues. This will allow us to investigate emerging or complex issues in a comprehensive manner. We anticipate that a resource team might include experts such as epidemiologists, toxicologists, occupational hygienists, occupational physicians and engineers.

If it had any virtue, SARS was a warning flag to health practitioners and the public of the serious impacts of occupational exposure to our frontline workers. It put us on notice about the critical need for rigorous surveillance and hazard identification—along with well understood, well articulated and well executed preventive protocols and exposure control plans.

Author Roberta Ellis can be reached at rellis@wcb.bc.ca or (604) 279-7536.

Occupational disease In this uncharted world, we’re beginning to take steps toward much-needed disease prevention strategies

Occupational disease
In this uncharted world, we’re beginning
to take steps toward much-needed
disease prevention strategies