Implementation

Three steps should be considered to implement primary prevention for occupational hazards nationally.

• Develop collaboration between the NCCP and government, industry and labor over mutual interests in controlling workplace hazards.

• Perform a study to determine current exposure of workers to known carcinogens in the workplace.
• Establish a primary prevention program for occupational hazards using the threefold strategy of education, legislation and national leadership as summarized on slide 9 and discussed in more detail below.

The following table summarizes selected occupations with occupational and industrial chemical exposures that carry a risk for cancer.

(From WHO, National Cancer Control Programmes, 1995)

Approximately 5-10% of all cancers results from occupational exposures and another 1-2% from environmental factors. In industrialized countries about 9% of all cancers in men result from workplace exposure to carcinogens, and the figure is lower for women. Since 20-30 years may elapse between exposure and manifest disease, the incidence becomes apparent from about age 50, and etiological effects can be hard to identify. As developing countries industrialize these occupational hazards appear and must be controlled by legislation, monitoring and education. Developing countries can learn from the experience of industrialized nations and avoid the emergence of these problems.

Controlling Occupational and Environmental Hazards

Existing hazards must be identified and assessed by government, scientific, industrial and labor organizations to agree on controls through legislation. Monitoring is done to be sure that quantitative standards of maximum exposure levels are not exceeded. International surveillance may be required to prevent industrial processes that require costly safeguards against exposure to carcinogens from being exported to developing settings where regulation is lacking. National cancer control programs generally do not undertake these activities alone, but rather cooperate with government occupational safety programs so that hazardous work exposures are controlled and hazardous waste is not dumped in such a manner as to contaminate water or air with carcinogens.

Evaluation

For control of occupational hazards WHO (1995) recommends the following indicators as examples.

Process Measures
Over half of workers get education about health and safety in the workplace.
Over half of workers are contacted about health and safety in the workplace.
Legislative measures for occupational safety are reviewed implemented.

Impact Measures
Over half of workplaces have a joint health and safety committee.
The toxicity and carcinogenicity of over 80% of industrial chemicals are identified.

Outcome Measures
Short term: Less than 10% of workers are exposed to known carcinogens in the workplace.
Medium term: None
Long term: Reduced incidence of diseases like lung cancer that can be occupationally induced.

WHO (1995) National Cancer Control Programmes: Policies and managerial guidelines. World health Organization, Geneva.
Landrigan PJ et al (1995) Cancer prevention in the workplace. In: Greenwald P, Kramer BS & Weed DL (Eds) Cancer prevention and control. Marcel Dekker, Inc. New York, p 393.
Consult the WHO Environmental Health Criteria series of over 160 monographs on environmental and occupational cancer hazards.
The consolidated list of products whose consumption and/or sale have been banned, withdrawn, severely restricted, or not approved by governments. United Nations, New York.

Click to return to slide 9.