This chapter will discuss surveillance and health screening in occupational health and the common principles that guide program performance.
SURVEILLANCE IN OCCUPATIONAL HEALTH
Surveillance in occupational health, as in other public health endeavors, involves the systematic and ongoing collection, evaluation, interpretation, and reporting out of health-relevant information for purposes of prevention. Surveillance can help establish the extent of a problem, track trends, identify new problems or causes, help set priorities for preventive interventions, and provide the means to evaluate the adequacy of the interventions. Surveillance programs can focus on an enterprise, an industry, or on the general population.
At the national level, surveillance data can be used to identify high-risk industries. One of the few sources of national data is collected by the Bureau of Labor Statistics (BLS) in the Department of Labor, which surveys a representative sample of private sector employers with more than 11 employees each year.1 The number of occupational illnesses and injuries is collected from each surveyed employer. This system is periodically revised to improve the classification of occupational diseases and to collect more information about the etiology of diseases and injuries.
The most effective workplace surveillance systems have both health and hazard or exposure components. While hazard surveillance may be less common than health surveillance, it is vital. Hazard surveillance provides the opportunity to identify and intervene on hazardous exposures before an injury or disorder develops. Both health hazard surveillance efforts are often characterized by their speed and practicality. Indications of abnormality generally need confirmation or further validation.
Health surveillance within an enterprise often involves analysis of the information gathered in baseline or pre-placement examinations and periodic screening testing. In addition, administrative records such as health insurance data, work absence records, workers’ compensation claims, or worksite “incident reports” may provide insight into the health of the workforce. Records from poison control centers and from emergency room visits have been used for population-based occupational injury surveillance as well. Population-based workforce data can be analyzed for rates of disease or injury, so areas of unusual occurrence within an enterprise, a community, or a country can be identified and investigated. Some conditions such as silicosis are so characteristically occupational that all cases should be investigated. These are known as sentinel events.2
Hazard surveillance (systematic monitoring of the workplace for hazardous exposures) is an important part of occupational surveillance activities. The identification of potentially harmful levels of exposure to hazardous substances or conditions before work-related diseases or injuries have developed or are recognized provides the opportunity for prevention through workplace redesign and implementation of engineering or administrative controls to reduce risk.
Hazard surveillance information can be collected by worker interview, walk-through inspections, or environmental sampling. As a result of hazard surveillance ...