40: Disease Surveillance

INTRODUCTION

Disease surveillance in the context of occupational health focuses on acute and chronic illnesses attributable primarily to work. While fragmented and incomplete in the United States, these systems provide important information on patterns of work-related illness within occupations and/or industries, opportunities for prevention, and measures of intervention effectiveness. There is growing interest in broader disease surveillance among working populations, focused on chronic diseases, which interfere with productivity and drive health care costs. This places less emphasis on work as a causative factor but enhances awareness of work and the workplace as an opportunity for intervention and prevention.

An important component of comprehensive occupational disease surveillance is hazard surveillance, which can include environmental monitoring, hazardous material registries, industrial hygiene and engineering controls. Surveillance also requires action in response to information acquired. This can involve providing information to workers, employers, unions, health and safety organizations, and clinicians; it can involve the development or application of interventions to reduce or eliminate exposures associated with documented outcomes; or it can involve the development of guidelines, regulations, and policy.

Clinicians play critical roles in surveillance systems. The information they record regarding the health status of patients, diagnoses, functional status, and ability to work are essential to understanding the status of populations. In many states, reporting work-related illnesses and injuries is mandated, creating a system that alerts public health agencies to clusters of events and emerging hazards.

PURPOSE OF OCCUPATIONAL HEALTH SURVEILLANCE

The primary purpose of occupational health surveillance is the primary prevention of occupational and work-related diseases and injuries. As described in the Technical and Ethical Guidelines for Workers' Health Surveillance, the International Labor Office outlines five objectives of workers' health surveillance programs whose primary objectives are prevention:

1. Describe the health status of working populations and socio-economic groups, by estimating the occurrence of occupational injuries and diseases (frequency, severity, and trends in mortality and morbidity).

2. Stimulate occupational epidemiological studies and explain the causes of occupational injuries and diseases, by identifying the physical, behavioral, organizational, psychosocial, and occupational exposure factors that cause specific injuries and diseases or their respective risk factors.

3. Predict the occurrences of occupational injuries and diseases and their distributions in working populations, in order to determine the specific focus for prevention.

4. Prepare action-oriented research and intervention studies, to eliminate causal factors through prevention and to mitigate their consequences by curative and rehabilitative activities.

5. Assess the effectiveness of previously implemented control measures.

Public health surveillance systems seek to assess the burden and distribution of occupational diseases in the population. Unlike medical surveillance programs, which target specific groups of workers with known or possible exposures to specific risk factors, these systems survey the population at large to identify patterns and trends within industries, occupations, and workplaces. Population-based occupational health surveillance is most often conducted by federal, state or local health authorities with statutory authority to ...