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Occupational safety and health
Occupational safety and health (OSH) also commonly referred to as occupational health and safety (OHS) or workplace health and safety (WHS) is an area concerned with the safety, health and welfare of people engaged in work or employment. The goals of occupational safety and health programs include to foster a safe and healthy work environment.[1] OSH may also protect co-workers, family members, employers, customers, and many others who might be affected by the workplace environment. In the United States the term occupational health and safety is referred to as occupational health and occupational and non-occupational safety and includes safety for activities outside of work.[2]
Occupational safety and health can be important for moral, legal, and financial reasons. In common-law jurisdictions, employers have a common law duty (reflecting an underlying moral obligation) to take reasonable care for the safety of their employees,[3] Statute law may build upon this to impose additional general duties, introduce specific duties and create government bodies with powers to regulate workplace safety issues: details of this will vary from jurisdiction to jurisdiction. . Good OSH practices can also reduce employee injury and illness related costs, including medical care, sick leave and disability benefit costs.
- 1 Definition
- 2 History
- 3 Workplace hazards
- 4 By industry
- 5 Workplace fatalities statistics
- 6 Management systems
- 7 National legislation and public organizations
- 8 Professional roles and responsibilities
- 9 Differences across countries and regions
- 10 Identifying safety and health hazards
- 11 Contemporary developments
- 12 Education
- 13 World Day for Safety and Health at Work
- 14 See also
- 15 References
- 16 Further reading
- 17 External links
As defined by the [4] Health has been defined as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."[5] Occupational health is a multidisciplinary field of healthcare concerned with enabling an individual to undertake their occupation, in the way that causes least harm to their health. Health has been defined as It contrasts, for example, with the promotion of health and safety at work, which is concerned with preventing harm from any incidental hazards, arising in the workplace.
Since 1950, the World Health Organization (WHO) have shared a common definition of occupational health. It was adopted by the Joint ILO/WHO Committee on Occupational Health at its first session in 1950 and revised at its twelfth session in 1995. The definition reads:
"Occupational health should aim at: the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; the prevention amongst workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological capabilities; and, to summarize, the adaptation of work to man and of each man to his job.
"The main focus in occupational health is on three different objectives: (i) the maintenance and promotion of workers' health and working capacity; (ii) the improvement of working environment and work to become conducive to safety and health and (iii) development of work organizations and working cultures in a direction which supports health and safety at work and in doing so also promotes a positive social climate and smooth operation and may enhance productivity of the undertakings. The concept of working culture is intended in this context to mean a reflection of the essential value systems adopted by the undertaking concerned. Such a culture is reflected in practice in the managerial systems, personnel policy, principles for participation, training policies and quality management of the undertaking."—Joint ILO/WHO Committee on Occupational Health[6]
Those in the field of occupational health come from a wide range of disciplines and professions including medicine, psychology, epidemiology, physiotherapy and rehabilitation, occupational therapy, occupational medicine, human factors and ergonomics, and many others. Professionals advise on a broad range of occupational health matters. These include how to avoid particular pre-existing conditions causing a problem in the occupation, correct posture for the work, frequency of rest breaks, preventative action that can be undertaken, and so forth.
The research and regulation of occupational safety and health are a relatively recent phenomenon. As labor movements arose in response to worker concerns in the wake of the industrial revolution, worker's health entered consideration as a labor-related issue.
In 1833, HM Factory Inspectorate was formed in the United Kingdom with a remit to inspect factories and ensure the prevention of injury to child textile workers.
In 1840 a Royal Commission published its findings on the state of conditions for the workers of the mining industry that documented the appallingly dangerous environment that they had to work in and the high frequency of accidents. The commission sparked public outrage which resulted in the Mines Act of 1842. The act set up an inspectorate for mines and collieries which resulted in many prosecutions and safety improvements, and by 1850, inspectors were able to enter and inspect premises at their discretion.[7]
Otto von Bismarck inaugurated the first social insurance legislation in 1883 and the first worker's compensation law in 1884 – the first of their kind in the Western world. Similar acts followed in other countries, partly in response to labor unrest.[8]
Workplace hazards
Although work provides many economic and other benefits, a wide array of workplace hazards also present risks to the health and safety of people at work. These include but are not limited to, "chemicals, biological agents, physical factors, adverse ergonomic conditions, allergens, a complex network of safety risks," and a broad range of psychosocial risk factors.[9]
Physical and mechanical hazards
Physical hazards are a common source of injuries in many industries.[10] They are perhaps unavoidable in certain industries, such as construction and mining, but over time people have developed safety methods and procedures to manage the risks of physical danger in the workplace. Employment of children may pose special problems.[11]
Falls are a common cause of occupational injuries and fatalities, especially in construction, extraction, transportation, healthcare, and building cleaning and maintenance.[12]
An engineering workshop specialising in the fabrication and welding of components has to follow the Personal Protective Equipment (PPE) at work regulations 1992. It is an employers duty to provide 'all equipment (including clothing affording protection against the weather) which is intended to be worn or held by a person at work which protects him against one or more risks to his health and safety'. In a fabrication and welding workshop an employer would be required to provide face and eye protection, safety footwear, overalls and other necessary PPE.
Machines are commonplace in many industries, including manufacturing, mining, construction and agriculture,[13] and can be dangerous to workers. Many machines involve moving parts, sharp edges, hot surfaces and other hazards with the potential to crush, burn, cut, shear, stab or otherwise strike or wound workers if used unsafely.[14] Various safety measures exist to minimize these hazards, including lockout-tagout procedures for machine maintenance and roll over protection systems for vehicles.[14] According to the United States Bureau of Labor Statistics, machine-related injuries were responsible for 64,170 cases that required days away from work in 2008. More than a quarter of these cases required more than 31 days spent away from work. That same year, machines were the primary or secondary source of over 600 work-related fatalities.[15] Machines are also often involved indirectly in worker deaths and injuries, such as in cases in which a worker slips and falls, possibly upon a sharp or pointed object. The transportation sector bears many risks for the health of commercial drivers, too, for example from vibration, long periods of sitting, work stress and exhaustion. These problems occur in Europe but in other parts of the world the situation is even worse. More drivers die in accidents due to security defects in vehicles. Long waiting times at borders cause that drivers are away from home and family much longer and even increase the risk of HIV infections.[16]
Confined spaces also present a work hazard. The National Institute of Occupational Safety and Health defines "confined space" as having limited openings for entry and exit and unfavorable natural ventilation, and which is not intended for continuous employee occupancy. Spaces of this kind can include storage tanks, ship compartments, sewers, and pipelines.[17] Confined spaces can pose a hazard not just to workers, but also to people who try to rescue them.
Noise also presents a fairly common workplace hazard: occupational hearing loss is the most common work-related injury in the United States, with 22 million workers exposed to hazardous noise levels at work and an estimated $242 million spent annually on worker's compensation for hearing loss disability.[18] Noise is not the only source of occupational hearing loss; exposure to chemicals such as aromatic solvents and metals including lead, arsenic, and mercury can also cause hearing loss.[19]
Temperature extremes can also pose a danger to workers. Heat stress can cause heat stroke, exhaustion, cramps, and rashes. Heat can also fog up safety glasses or cause sweaty palms or dizziness, all of which increase the risk of other injuries. Workers near hot surfaces or steam also are at risk for burns.[20] Dehydration may also result from overexposure to heat. Cold stress also poses a danger to many workers. Overexposure to cold conditions or extreme cold can lead to hypothermia, frostbite, trench foot, or chilblains.[21]
Electricity poses a danger to many workers. Electrical injuries can be divided into four types: fatal electrocution, electric shock, burns, and falls caused by contact with electric energy.[22]
Vibrating machinery, lighting, and air pressure can also cause work-related illness and injury. Asphyxiation is another potential work hazard in certain situations. Musculoskeletal disorders are avoided by the employment of good ergonomic design and the reduction of repeated strenuous movements or lifts
Biological and chemical hazards
Biological hazards
Chemical hazards
- Heavy metals
- Solvents
- Petroleum
- Fumes (noxious gases/vapors)
- Highly-reactive chemicals
- Fire, conflagration and explosion hazards:
- Explosion
- Deflagration
- Detonation
- Conflagration
Employers in most OECD countries have an obligation not only to protect the physical health of their employees but also the psychological health. Therefore as part of a risk management framework psychological or psychosocial hazards (risk factors) need to be identified and controlled for in the workplace. Psychosocial hazards are related to the way work is designed, organised and managed, as well as the economic and social contexts of work and are associated with psychiatric, psychological and/or physical injury or illness.[23] Linked to psychosocial risks are issues such as occupational stress and workplace violence which are recognized internationally as major challenges to occupational health and safety.[24]
According to a survey by the European Agency for Safety and Health at Work, the most important emerging psychosocial risks are:
- Precarious work contracts
- Increased worker vulnerability due to globalization
- New forms of employment contracts
- Feeling of job insecurity
- Aging workforce
- Long working hours
- Work intensification
- Lean production and outsourcing
- High emotional demands
- Poor work-life balance[23]
By industry
Specific occupational safety and health risk factors vary depending on the specific sector and industry. Construction workers might be particularly at risk of falls, for instance, whereas fishermen might be particularly at risk of drowning. The United States Bureau of Labor Statistics identifies the fishing, aviation, lumber, metalworking, agriculture, mining and transportation industries as among some of the more dangerous for workers.[25] Similarly psychosocial risks such as workplace violence are more pronounced in certain occupational groups such as health care employees, correctional officers and teachers.[26]
Construction is one of the most dangerous occupations in the world, incurring more occupational fatalities than any other sector in both the safety of workers and compliance with HSE construction requirements.[30] Health and safety legislation in the construction industry involves many rules and regulations. For example, the role of the Construction Design Management (CDM) Coordinator as a requirement has been aimed at improving health and safety on-site.[31]
The 2010 [32]
Agriculture workers are often at risk of work-related injuries, lung disease, noise-induced hearing loss, skin disease, as well as certain cancers related to chemical use or prolonged sun exposure. On industrialized farms, injuries frequently involve the use of agricultural machinery. The most common cause of fatal agricultural injuries in the United States is tractor rollovers, which can be prevented by the use of roll over protection structures which limit the risk of injury in case a tractor rolls over.[33] Pesticides and other chemicals used in farming can also be hazardous to worker health, and workers exposed to pesticides may experience illnesses or birth defects.[34] As an industry in which families, including children, commonly work alongside their families, agriculture is a common source of occupational injuries and illnesses among younger workers.[35] Common causes of fatal injuries among young farm worker include drowning, machinery and motor vehicle-related accidents.[36]
The 2010 NHIS-OHS found elevated prevalence rates of several occupational exposures in the agriculture, forestry, and fishing sector which may negatively impact health. These workers often worked long hours. The prevalence rate of working more than 48 hours a week among workers employed in these industries was 37%, and 24% worked more than 60 hours a week. Of all workers in these industries, 85% frequently worked outdoors compared to 25% of all U.S. workers. Additionally, 53% were frequently exposed to vapors, gas, dust, or fumes, compared to 25% of all U.S. workers.[37]
Service sector
As the number of service sector jobs has risen in developed countries, more and more jobs have become sedentary, presenting a different array of health problems than those associated with manufacturing and the primary sector. Contemporary problems such as the growing rate of obesity and issues relating to occupational stress, workplace bullying, and overwork in many countries have further complicated the interaction between work and health.
According to data from the 2010 NHIS-OHS, hazardous physical/chemical exposures in the service sector were lower than national averages. On the other hand, potentially harmful work organization characteristics and psychosocial workplace exposures were relatively common in this sector. Among all workers in the service industry, 30% experienced job insecurity in 2010, 27% worked non-standard shifts (not a regular day shift), 21% had non-standard work arrangements (were not regular permanent employees).[38]
Mining and oil & gas extraction
According to data from the 2010 NHIS-OHS, workers employed in mining and oil & gas extraction industries had high prevalence rates of exposure to potentially harmful work organization characteristics and hazardous chemicals. Many of these workers worked long hours: 50% worked more than 48 hours a week and 25% worked more than 60 hours a week in 2010. Additionally, 42% worked non-standard shifts (not a regular day shift). These workers also had high prevalence of exposure to physical/chemical hazards. In 2010, 39% had frequent skin contact with chemicals. Among nonsmoking workers, 28% of those in mining and oil and gas extraction industries had frequent exposure to secondhand smoke at work. About two-thirds were frequently exposed to vapors, gas, dust, or fumes at work.[39]
Healthcare and Social Assistance
Healthcare workers are exposed to many hazards that can adversely affect their health and well-being. Long hours, changing shifts, physically demanding tasks, violence, and exposures to infectious diseases and harmful chemicals are examples of hazards that put these workers at risk for illness and injury.
According to the Bureau of Labor statistics, U.S. hospitals recorded 253,700 work-related injuries and illnesses in 2011, which is 6.8 work-related injuries and illnesses for every 100 full-time employees.[40] The injury and illness rate in hospitals is higher than the rates in construction and manufacturing – two industries that are traditionally thought to be relatively hazardous.
The Occupational Health Safety Network (OHSN) is a secure electronic surveillance system developed by the National Institute for Occupational Safety and Health (NIOSH) to address health and safety risks among health care personnel. OHSN uses existing data to characterize risk of injury and illness among health care workers. Hospitals and other healthcare facilities can upload the occupational injury data they already collect to the secure database for analysis and benchmarking with other de-identified facilities. NIOSH works with OHSN participants in identifying and implementing timely and targeted interventions. OHSN modules currently focus on three high risk and preventable events that can lead to injuries or musculoskeletal disorders among healthcare personnel: musculoskeletal injuries from patient handling activities; slips, trips, and falls; and workplace violence. OHSN enrollment is open to all healthcare facilities.
Workplace fatalities statistics
European Union
In most countries males comprise the vast majority of workplace fatalities. In the EU as a whole, 94% of death were of males.[41] In the UK the disparity was even greater with males comprising 97.4% of workplace deaths. In the UK there were 171 fatal injuries at work in financial year 2011-2, compared with 651 in calendar year 1974; the fatal injury rate declined over that period from 2.9 fatalities per 100,000 workers to 0.6 per 100,000 workers[42]
United States
The Bureau of Labor Statistics of the United States Department of Labor compiles information about workplace fatalities in the United States. In 1970, an estimated 14,000 workers were killed on the job – by 2010, the workforce had doubled, but workplace deaths were down to about 4,500.[43]
The Bureau also compiles information about the most dangerous jobs. The most recent information comes from the year 2006, during which 5,840 people died on the job.
Fatalities per
100,000 employees
|Timber cutter
|Structural metal workers
|Waste collectors
|Farmers and ranchers
|Power-line workers
|Truck drivers
|All occupations
Management systems
In 2001, the [44]
The ILO management system was created to assist employers to keep pace with rapidly shifting and competitive industrial environments. The ILO recognizes that national legislation is essential, but sometimes insufficient on its own to address the challenges faced by industry, and therefore elected to ensure free and open distribution of administrative tools in the form of occupational health and safety management system guidance for everyone. This open access forum is intended to provide the tools for industry to create safe and healthy working environments and foster positive safety cultures within the organizations.
assessment specification for occupational health and safety management systems. It was developed by a selection of leading trade bodies, international standards and certification bodies to address a gap where no third-party certifiable international standard exists. This internationally recognized specification for occupational health and safety management system operates on the basis of policy, planning, implementation and operation, checking and corrective action, management review, and continual improvement.
The British Standards – Occupational Health and Safety management Systems Requirements Standard BS OHSAS 18001 was developed within the framework of the ISO standards series. Allowing it to integrate better into the larger system of ISO certifications. ISO 9001 Quality Management Systems and ISO 14001 Environmental Management System can work in tandem with BS OHSAS 18001/18002 to complement each other and form a better overall system. Each component of the system is specific, auditable, and accreditable by a third party after review.[45]
Also Standards Australia and the Association Française de Normalisation (AFNOR) in France have developed occupational safety and health management standards.[46]
United Kingdom
Guidance note HSG65: Successful Health and Safety Management, published by the British non-departmental public body [47] This systematic approach allows flexibility for the company through good business planning to strategically apply resources according to risk priorities.
National legislation and public organizations
Occupational safety and health practice vary among nations with different approaches to legislation, regulation, enforcement, and incentives for compliance. In the EU, for example, some member states promote OSH by providing public monies as subsidies, grants or financing, while others have created tax system incentives for OSH investments. A third group of EU member states has experimented with using workplace accident insurance premium discounts for companies or organisations with strong OSH records.[48]
European Union
In the productivity and quality). In 1996, the European Agency for Safety and Health at Work was founded.
Member states of the European Union have all transposed into their national legislation a series of directives that establish minimum standards on occupational health and safety. These directives (of which there are about 20 on a variety of topics) follow a similar structure requiring the employer to assess the workplace risks and put in place preventive measures based on a hierarchy of control. This hierarchy starts with elimination of the hazard and ends with personal protective equipment.
However, certain EU member states admit to having lacking quality control in occupational safety services, to situations in which risk analysis takes place without any on-site workplace visits and to insufficient implementation of certain EU OSH directives. Based on this, it is hardly surprising that the total societal costs of work-related health problems and accidents vary from 2.6% to 3.8% of GNP between the EU member states.[50]
In [53]
In Sweden, occupational safety and health is regulated by the Work Environment Act. The Swedish Work Environment Authority is the government agency responsible for issues relating to the working environment. The agency should work to disseminate information and furnish advice on OSH, has a mandate to carry out inspections, and a right to issue stipulations and injunctions to any non-compliant employer.[54]
United Kingdom
In the UK, health and safety legislation is drawn up and enforced by the Health and Safety Executive and local authorities (the local council) under the Health and Safety at Work etc. Act 1974[55][56] (HASAWA). HASAWA introduced (section 2) a general duty on an employer to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all his employees; with the intention of giving a legal framework supporting 'codes of practice' not in themselves having legal force but establishing a strong presumption as to what was reasonably practicable (deviations from them could be justified by appropriate risk assessment). The previous reliance on detailed prescriptive rule-setting was seen as having failed to respond rapidly enough to technological change, leaving new technologies potentially un-regulated or inappropriately regulated.[57][58] HSE has continued to make some regulations giving absolute duties (where something must be done with no 'reasonable practicability' test) but in the UK the regulatory trend is away from prescriptive rules, and towards 'goal setting' and risk assessment. Recent major changes to the laws governing asbestos and fire safety management embrace the concept of risk assessment.
For the UK, the government organisation dealing with occupational health has been the Health and Work Service - was created to provide advice and assistance to employers in order to get back to work employees on long-term sick-leave.[59] The service, funded by government, will offer medical assessments and treatment plans, on a voluntary basis, to people on long term absence from their employer; in return, the government will no longer foot the bill for Statutory Sick Pay provided by the employer to the individual.
United States
In the United States, President Richard Nixon signed the Occupational Safety and Health Act into law on the 29th day of December 1970. The act created the three agencies that administer it. They include the Occupational Safety and Health Administration, National Institute for Occupational Safety and Health, and the Occupational Safety and Health Review Commission.[60] The act authorized the Occupational Safety and Health Administration (OSHA) to regulate private employers in the 50 states, the District of Columbia, and territories.[61] The Act establishing it includes a general duty clause (29 U.S.C. § 654, 5(a)) requiring an employer to comply with the Act and regulations derived from it, and to provide employees with "employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees."
OSHA was established in 1971 under the Department of Labor. It has headquarters in Washington, DC and ten regional offices, further broken down into districts, each organized into three sections; compliance, training, and assistance. Its stated mission is to assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.[62] The original plan was for OSHA to oversee 50 state plans with OSHA funding 50% of each plan. Unfortunately it has not worked out that way. There are currently 26 approved state plans (4 cover only public employees)[43] and no other states want to participate. OSHA manages the plan in the states not participating.[43]
OSHA develops safety standards in the Code of Federal Regulation and enforces those safety standards through compliance inspections conducted by Compliance Officers; enforcement resources are focussed on high-hazard industries. Worksites may apply to enter OSHA's Voluntary Protection Program (VPP); a successful application leads to an on-site inspection ; if this is passed the site gains VPP status and OSHA no longer inspect it annually nor (normally) visit it unless there is a fatal accident or an employee complaint until VPP revalidation (after 3–5 years)[43](VPP sites have injury and illness rates less than half the average for their industry).
It has 73 specialists in local offices to provide tailored information and training to employers and employees at little or no cost[63] Similarly OSHA produces a range of publications, provides advice to employers and funds consultation services available for small businesses.
OSHA's Alliance Program enables groups committed to worker safety and health to work with it to develop compliance assistance tools and resources, share information with workers and employers, and educate them about their rights and responsibilities. OSHA also has a Strategic Partnership Program that zeros in on specific hazards or specific geographic areas.[43] OSHA manages Susan B. Harwood grants to nonprofit companies to train workers and employers to recognize, avoid, and prevent safety and health hazards in the workplace. Grants focus on small business, hard-to-reach workers and high-hazard industries.
In Canada, workers are covered by provincial or federal labour codes depending on the sector in which they work. Workers covered by federal legislation (including those in mining, transportation, and federal employment) are covered by the Canada Labour Code; all other workers are covered by the health and safety legislation of the province in which they work. The Canadian Centre for Occupational Health and Safety (CCOHS), an agency of the Government of Canada, was created in 1966 by an Act of Parliament. The act was based on the belief that all Canadians had "...a fundamental right to a healthy and safe working environment." CCOHS is mandated to promote safe and healthy workplaces to help prevent work-related injuries and illnesses. The CCOHS maintains a useful (partial) list of OSH regulations for Canada and its provinces.[64]
In Malaysia, the Department of Occupational Safety and Health (DOSH) under the Ministry of Human Resource is responsible to ensure that the safety, health and welfare of workers in both the public and private sector is upheld. DOSH is responsible to enforce the Factories and Machinery Act 1967 and the Occupational Safety and Health Act 1994.
People's Republic of China
In the People's Republic of China, the Ministry of Health is responsible for occupational disease prevention and the State Administration of Work Safety for safety issues at work. On the provincial and municipal level, there are Health Supervisions for occupational health and local bureaus of Work Safety for safety. The "Occupational Disease Control Act of PRC" came into force on May 1, 2002.[65] and Work safety Act of PRC on November 1, 2002.[66] The Occupational Disease Control Act is under revising. The prevention of occupational disease is still in its initial stage compared with industried countries such as the US or UK.
South Africa
In South Africa the Department of Labour is responsible for occupational health and safety inspection and enforcement in commerce and industry apart from mining and energy production, where the Department of Mineral Resources is responsible.
The main statutory legislation on Health and Safety in the jurisdiction of the Department of Labour is Act No. 85 of 1993: Occupational Health and Safety Act as amended by Occupational Health and Safety Amendment Act, No. 181 Of 1993.
Regulations to the OHS Act include:
- Certificate of Competency Regulations, 1990[67]
- Construction Regulations, 2003
- Diving Regulations 2009[68]
- Driven Machinery Regulations, 1988[69]
- Environmental Regulations for Workplaces, 1987[70]
- General Machinery regulations, 1988[71]
- General Safety Regulations, 1986[72]
- Noise induced hearing loss regulations, 2003[73]
- Pressure Equipment Regulations, 2004
In Australia, the Commonwealth and each state and territory has enacted and administers harmonised Work Health and Safety Legislation in accordance with the Intergovernmental Agreement for Regulatory and Operational Reform in Occupational Health and Safety.[74] Each jurisdiction has a Work Health & Safety Act and Work Health and Safety Regulation that are based on the Model WHS Laws and common Codes of Practice developed by Safe Work Australia.[75] Mine safety is not covered by these laws and separate legislation is applicable.
Professional roles and responsibilities
The roles and responsibilities of OSH professionals vary regionally, but may include evaluating working environments, developing, endorsing and encouraging measures that might prevent injuries and illnesses, providing OSH information to employers, employees, and the public, providing medical examinations, and assessing the success of worker health programs.
In Norway, the main required tasks of an Occupational Health and Safety Practitioner include:
- Systematic evaluations of the working environment
- Endorsing preventative measures which eliminate reasons for illnesses in the work place
- Giving information in the subject of employees' health
- Giving information on occupational hygiene, ergonomics and also environmental and safety risks in the work place[76]
In the Netherlands, required tasks for health and safety staff are only summarily defined, and include:
- Voluntary medical examinations
- A consulting room on the work environment for the workers
- Health check assessments (if needed for the job concerned)[77]
'The main influence on the Dutch law on the job of the safety professional is through the requirement on each employer to use the services of a certified working conditions service to advise them on health and safety'.[77] A 'certified service' must employ sufficient numbers of four types of certified experts to cover the risks in the organisations which use the service:
- A safety professional
- An occupational hygienist
- An occupational physician
- A work and organisation specialist.[77]
It shows in Table 1 (based on the European Network of Safety and Health Practitioner Organisations [ENHSPO] survey to) that in Norway, 37% of Health and Safety practitioners had a MSc education level, and 14% in the Netherlands; 44% were BSc graduates and 63% in the Netherlands; and 19% were of a Technician level and 23% in the Netherlands.[77]
The main tasks undertaken by the OHS practitioner in the USA include:
- Develop processes, procedures, criteria, requirements, and methods to attain the best possible management of the hazards and exposures that can cause injury to people, and damage property, or the environment;
- Apply good business practices and economic principles for efficient use of resources to add to the importance of the safety processes;
- Promote other members of the company to contribute by exchanging ideas and other different approaches to make sure that every one in the corporation possess OHS knowledge and have functional roles in the development and execution of safety procedures;
- Assess services, outcomes, methods, equipment, workstations, and procedures by using qualitative and quantitative methods to recognise the hazards and measure the related risks;
- Examine all possibilities, effectiveness, reliability, and expenditure to attain the best results for the company concerned[78]
Knowledge required by the OHS professional in USA include:
- Constitutional and case law controlling safety, health, and the environment
- Operational procedures to plan/develop safe work practices
- Safety, health and environmental sciences
- Design of hazard control systems (i.e. fall protection, scaffoldings)
- Design of recordkeeping systems that take collection into account, as well as storage, interpretation, and dissemination
- Mathematics and statistics
- Processes and systems for attaining safety through design[79]
Some skills required by the OHS professional in the USA include (but are not limited to):
- Understanding and relating to systems, policies and rules
- Holding checks and having control methods for possible hazardous exposures
- Mathematical and statistical analysis
- Examining manufacturing hazards
- Planning safe work practices for systems, facilities, and equipment
- Understanding and using safety, health, and environmental science information for the improvement of procedures
- Interpersonal communication skills[79]
Differences across countries and regions
Because different countries take different approaches to ensuring occupational safety and health, areas of OSH need and focus also vary between countries and regions. Similar to the findings of the ENHSPO survey conducted in Australia, the Institute of Occupational Medicine found that in the UK, there is a need to put a greater emphasis on work-related illness.[80] In contrast, in Australia and the USA a major responsibility of the OHS professional is to keep company directors and managers aware of the issues that they face in regards to Occupational Health and Safety principles and legislation. However, in some other areas of Europe, it is precisely this which has been lacking: "Nearly half of senior managers and company directors do not have an up-to-date understanding of their health and safety-related duties and responsibilities."[81]
Identifying safety and health hazards
Hazards, risks, outcomes
The terminology used in OSH varies between countries, but generally speaking:
- A hazard is something that can cause harm if not controlled.
- The outcome is the harm that results from an uncontrolled hazard.
- A risk is a combination of the probability that a particular outcome will occur and the severity of the harm involved.
"Hazard", "risk", and "outcome" are used in other fields to describe e.g. environmental damage, or damage to equipment. However, in the context of OSH, "harm" generally describes the direct or indirect degradation, temporary or permanent, of the physical, mental, or social well-being of workers. For example, repetitively carrying out manual handling of heavy objects is a hazard. The outcome could be a musculoskeletal disorder (MSD) or an acute back or joint injury. The risk can be expressed numerically (e.g. a 0.5 or 50/50 chance of the outcome occurring during a year), in relative terms (e.g. "high/medium/low"), or with a multi-dimensional classification scheme (e.g. situation-specific risks).
Hazard identification
Hazard identification or assessment is an important step in the overall risk assessment and risk management process. It is where individual work hazards are identified, assessed and controlled/eliminated as close to source (location of the hazard) as reasonably as possible. As technology, resources, social expectation or regulatory requirements change, hazard analysis focuses controls more closely toward the source of the hazard. Thus hazard control is a dynamic program of prevention. Hazard-based programs also have the advantage of not assigning or implying there are "acceptable risks" in the workplace. A hazard-based program may not be able to eliminate all risks, but neither does it accept "satisfactory" – but still risky – outcomes. And as those who calculate and manage the risk are usually managers while those exposed to the risks are a different group, workers, a hazard-based approach can by-pass conflict inherent in a risk-based approach.
Risk assessment
Modern occupational safety and health legislation usually demands that a risk assessment be carried out prior to making an intervention. It should be kept in mind that risk management requires risk to be managed to a level which is as low as is reasonably practical.
This assessment should:
- Identify the hazards
- Identify all affected by the hazard and how
- Evaluate the risk
- Identify and prioritize appropriate control measures
The calculation of risk is based on the likelihood or probability of the harm being realized and the severity of the consequences. This can be expressed mathematically as a quantitative assessment (by assigning low, medium and high likelihood and severity with integers and multiplying them to obtain a risk factor), or qualitatively as a description of the circumstances by which the harm could arise.
The assessment should be recorded and reviewed periodically and whenever there is a significant change to work practices. The assessment should include practical recommendations to control the risk. Once recommended controls are implemented, the risk should be re-calculated to determine of it has been lowered to an acceptable level. Generally speaking, newly introduced controls should lower risk by one level, i.e., from high to medium or from medium to low.
Contemporary developments
On an international scale, the World Health Organization (WHO) and the International Labour Organization (ILO) have begun focusing on labour environments in developing nations with projects such as Healthy Cities.[82] Many of these developing countries are stuck in a situation in which their relative lack of resources to invest in OSH leads to increased costs due to work-related illnesses and accidents. As a 2007 Factsheet from the European Agency for Safety and Health at Work states: "Countries with less developed OSH systems spend a far higher percentage of GDP on work-related injury and illness – taking resources away from more productive activities . . . The ILO estimates that work-related illness and accidents cost up to 10% of GDP in Latin America, compared with just 2.6% to 3.8% in the EU."[83]
Nanotechnology is an example of a new, relatively unstudied technology. A Swiss survey of one hundred thirty eight companies using or producing nanoparticulate matter in 2006, resulted in forty completed questionnaires. Sixty five per cent of respondent companies stated they did not have a formal risk assessment process for dealing with nanoparticulate matter.[84] Nanotechnology already presents new issues for OSH professionals that will only become more difficult as nanostructures become more complex. The size of the particles renders most containment and personal protective equipment ineffective. The toxicology values for macro sized industrial substances are rendered inaccurate due to the unique nature of nanoparticulate matter. As nanoparticulate matter decreases in size its relative surface area increases dramatically, increasing any catalytic effect or chemical reactivity substantially versus the known value for the macro substance. This presents a new set of challenges in the near future to rethink contemporary measures to safeguard the health and welfare of employees against a nanoparticulate substance that most conventional controls have not been designed to manage.[85]
There are multiple levels of training applicable to the field of Occupational Health and Safety (OSH). Programs range from individual non-credit certificates, focusing on specific areas of concern, to full doctoral programs. The American Industrial Hygiene Association (AIHA) offer individual certificates on many different subjects from forklift operation to waste disposal and are the chief facilitators of continuing education in the OSH sector. In the U.S. the training of safety professionals is supported by National Institute for Occupational Safety and Health through their NIOSH Education and Research Centers.
World Day for Safety and Health at Work
On April 28 The [87] to raise awareness of safety in the workplace. Occurring annually since 2003,[88] each year it focuses on a specific area and bases a campaign around the theme.[89]
See also
- Examinetics - mobile occupational health screening
- Occupational disease
- Occupational stress
- Prevention through design
- Product stewardship
- Public safety
- Seoul Declaration on Safety and Health at Work
- Work accident
- Workers' compensation
Government organizations
- Canadian Centre for Occupational Health and Safety (Canada)
- European Agency for Safety and Health at Work (EU)
- Federal Coordination Commission for Occupational Safety (Switzerland)
- Federal Institute for Occupational Safety and Health (Germany)
- Health and Safety Executive (UK)
- International Labour Organization (United Nations)
- Japan Industrial Safety and Health Association (Japan)
- Korea Occupational Safety & Health Agency (South-Korea)
- National Institute for Occupational Safety and Health (US)
- National Institute of Occupational Health (Norway)
- National Institute of Occupational Safety and Health (JNIOSH) (Japan)
- Occupational Safety and Health Administration (US)
- Occupational Safety and Health Council (Hongkong)
- Workplace Safety & Health Council (Singapore)
- Workplace Safety & Insurance Board (Ontario, Canada)
- Safe Work Australia
- WorkSafe Victoria, Australia
- Worksafe Western Australia
- Department of Mines and Petroleum Western Australia
- Workplace Safety & Health Council, Singapore
Related fields
- ^ Oak Ridge National Lab Safety Document
- ^ Fanning, Fred E. (2003). Basic Safety Administration: A Handbook for the New Safety Specialist, Chicago: American Society of Safety Engineers
- ^ "Guidance note: General duty of care in Western Australian workplaces 2005". Government of Western Australia. Retrieved 15 July 2014.
- ^ http://www.wpro.who.int/topics/occupational_health/en/
- ^ http://www.who.int/about/definition/en/print.html
- ^ "Occupational Health Services And Practice". Ilo.org. Retrieved 2013-02-15.
- ^ USA; Edmonds, EL (2013-01-30). "An Account of the Founding of H.M. Inspectorate of Mines and the Work of the First Inspector Hugh Seymour Tremenheere". British Journal of Industrial Medicine (Ncbi.nlm.nih.gov) 20 (3): 210–217.
- ^ Abrams, Herbert K. (2001). "A Short History of Occupational Health". Journal of Public Health Policy 22 (1): 34–80.
- ^ Concha-Barrientos, M., Imel, N.D., Driscoll, T., Steenland, N.K., Punnett, L., Fingerhut, M.A.,Prüss-Üstün, A., Leigh, J., Tak, S.W., Corvalàn, C. (2004). Selected occupational risk factors. In M. Ezzati, A.D. Lopez, A. Rodgers & C.J.L. Murray (Eds.), Comparative Quantification of Health Risks. Geneva: World Health Organization.
- ^ "Hazardous Work". International Labour Organization. Retrieved December 26, 2012.
- ^ International Programme on the Elimination of Child Labour (IPEC) (2011). Children in hazardous work What we know What we need to do. International Labour Organization.
- ^ "Fall Injuries Prevention in the Workplace". NIOSH Workplace Safety and Health Topic. National Institute for Occupational Safety and Health. Retrieved July 12, 2012.
^ "International Hazard Datasheets on Occupations (HDO)". International Labour Organization. Retrieved December 26, 2012.
The International Hazard Datasheets on Occupations is a multipurpose information resource containing information on the hazards, risks and notions of prevention related to a specific occupation. The datasheets are intended for those professionally concerned with health and safety at work.
- ^ a b "Machine Safety". NIOSH Workplace Safety and Health Topics. National Institute of Occupational Safety and Health. Retrieved 11 July 2012.
- ^ Harris, James R. and Richard S. Current. "Machine Safety: New & Updated Consensus Standards". Prof Saf 2012 May; 57(5):50-57. http://www.asse.org/professionalsafety/pastissues/057/05/F1Har_0512.pdf
- ^ Ute Papkalla (December 2012). "Understimated production factor". D+C Development and Cooperation/ dandc.eu.
- ^ "Confined Spaces". Workplace Safety & Health Topics. National Institute of Occupational Safety and Health. Retrieved 3 August 2012.
- ^ "Noise and Hearing Loss Prevention". Workplace Safety & Health Topics. National Institute for Occupational Safety and Health. Retrieved 3 August 2012.
- ^ John R. Franks, Mark R. Stephenson, Carol J. Merry (June 1996). "Preventing Occupational Hearing Loss: A Practical Guide". National Institute for Occupational Safety and Health. Retrieved 3 August 2012.
- ^ "Heat Stress". NIOSH Workplace Safety and Health Topics. National Institute of Occupational Safety and Health. Retrieved 8 August 2012.
- ^ "Cold Stress". NIOSH Workplace Safety and Health Topics. National Institute of Occupational Safety and Health. Retrieved 9 August 2012.
- ^ "Electrical Safety". NIOSH Workplace Safety and Health Topics. National Institute of Occupational Safety and Health. Retrieved 7 August 2012.
- ^ a b https://osha.europa.eu/en/publications/reports/7807118
- ^ EU-OSHA (2007). Expert forecast on emerging psychosocial risks related to occupational safety and health. Luxembourg: Office for Official Publications of the European Communities.
- ^ "Injuries, Illnesses, and Fatalities 2010". Injuries, Illnesses, and Fatalities. Bureau of Labor Statistics. Retrieved 9 August 2012.
- ^ http://www.ccohs.ca/oshanswers/psychosocial/violence.html
- ^ a b c "Construction Safety and Health". Workplace Safety & Health Topics. National Institute of Occupational Safety and Health. Retrieved 3 August 2012.
- ^ "Health and safety at work statistics". eurostat. European Commission. Retrieved 3 August 2012.
- ^ "OSHA's Fall Prevention Campaign". Occupational Safety and Health Administration. Retrieved 6 August 2012.
- ^ Health, Safety and Environment Management, Retrieved 11/25/2013
- ^ "Health and safety in the Construction Industry". Veritas Consulting. 11 March 2009. Retrieved 20 March 2013.
- ^ "CDC – NHIS – Construction Sector Profile Page – NIOSH Workplace Safety and Health Topic". National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. June 28, 2013. Retrieved July 16, 2013.
- ^ "NIOSH Workplace Safety & Health Topic: Agricultural Injuries". Cdc.gov. 2012-07-13. Retrieved 2013-02-15.
- ^ "NIOSH Pesticide Poisoning Monitoring Program Protects Farmworkers". Cdc.gov. 2009-07-31. Retrieved 2013-02-15.
- ^ "NIOSH Alert: Preventing Deaths, Injuries, and Illnesses of Young Workers" (PDF). Retrieved 2013-02-15.
- ^ "NIOSH Workplace Safety & Health Topic: Agriculture". Cdc.gov. Retrieved 2013-02-15.
- ^ "CDC – NHIS – Agriculture, Forestry and Fishing Sector Profile Page – NIOSH Workplace Safety and Health Topic". National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. June 28, 2013. Retrieved July 16, 2013.
- ^ "CDC – NHIS – Services Sector Profile Page – NIOSH Workplace Safety and Health Topic". National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. June 28, 2013. Retrieved July 16, 2013.
- ^ "CDC – NHIS – Mining and Oil and Gas Extraction Sectors Profile Page". National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. June 28, 2013. Retrieved July 16, 2013.
- ^ Occupational Safety and Health Administration. Facts About Hospital Worker Safety. https://www.osha.gov/dsg/hospitals/documents/1.2_Factbook_508.pdf Retrieved February 3, 2014.
- ^ "The Vienna Declaration on the health of men and boys in Europe". European Men's Health Forum. Retrieved 20 March 2013.
- ^ "Historical picture : Trends in work-related injuries and ill health in Great Britain since the introduction of the Health and Safety at Work Act (HSWA) 1974". Health & Safety Executive. Retrieved 15 July 2014. : of course the period saw the virtual disappearance from the UK of some historically risky industries (deep sea fishing, coal mining)
- ^ a b c d e "All About OSHA". Retrieved 15 July 2014.
- ^ a b http://www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/@publ/documents/publication/wcms_publ_9221116344_en.pdf
- ^ "BS OHSAS 18001 Occupational Health and Safety". BSI Group. Retrieved 2013-02-15.
- ^ Pun, K.-F., R.C.M. Yam & W.G. Lewis (2003): "Safety management system registration in the shipping industry", International Journal of Quality & Reliability Management, Vol. 20, No. 6, pp. 704–721.
- ^ "Successful health and safety management – HSG65". Hse.gov.uk. 2012-06-18. Retrieved 2013-02-15.
- ^ See European Agency for Safety and Health at Work (2004): "Effectiveness of economic incentives to improve occupational safety and health", Forum # 14, Bilbao, Spain: European Agency for Safety and Health at Work, ISBN 92-9191-119-4, http://osha.europa.eu/en/publications/forum/14/view or Elsler, D. (2007): "European Comparison of Economic Incentives in Occupational Safety and Health", in C. Berlin & L.-O. Bligård (Eds): Proceedings of the 39th Nordic Ergonomics Society Conference, October 1 – 3 2007 in Lysekil, Sweden, downloadable from: http://www.nes2007.se/papers/A67_Elsler.pdf.
- ^ Based on p. 475 of European Agency for Safety and Health at Work (2000): Monitoring the state of occupational safety and health in the European Union – Pilot Study, Bilbao, Spain: European Agency for Safety and Health at Work, ISBN 92-95007-00-X, downloadable from: http://osha.europa.eu/en/publications/reports/401 and p. 148 of European Agency for Safety and Health at Work (2001): Monitoring the state of occupational safety and health in the EFTA Countries – Pilot Study, Bilbao, Spain: European Agency for Safety and Health at Work, ISBN 92-95007-19-0, downloadable from: http://osha.europa.eu/en/publications/reports/403.
- ^ See p. 2-4 of European Agency for Safety and Health at Work (2001): "Quality of Work 'A future Community strategy for safety and health at work', FORUM # 1, downloadable from: http://osha.europa.eu/en/publications/forum/1/view.
- ^ Danish government web page "How a good working environment is secured in Denmark", http://www.nyidanmark.dk/en-us/Integration/online_danish/working_in_denmark/occupational_safety_and_health_at_the_workplace/how_a_good_working_environment_is_secured_in_denmark.htm.
- ^ English web pages of the Danish Working Environment Authority, http://arbejdstilsynet.dk/en/engelsk/wea.aspx
- ^ The inspection results can be found from the main page of the Danish Working Environment Authority at: http://arbejdstilsynet.dk/da/ under the heading "Smiley Status". See also http://arbejdstilsynet.dk/en/engelsk/inspection/smiley-26-6-07.aspx.
- ^ "Welcome to Swedish Work Environment Authority".
- ^ "Health and Safety at Work etc. Act 1974 (1974.c37)". legislation.gov.uk. Retrieved 15 July 2014.
- ^ Health and Safety Executive (2009): A Guide to Safety and Health Regulation in Great Britain. 4th edition. ISBN 978-0-7176-6319-4, http://www.hse.gov.uk/pubns/web42.pdf.
- ^ see Second Reading debate - "HEALTH AND SAFETY AT WORK ETC. BILL". Hansard House of Commons Debates. 871 cc1286-394. 3 April 1974. Retrieved 15 July 2014.
- ^ see -for example- the section on The Board of Trade's Administration Commissioner for Wrecks (1912). "Report on the Loss of the "Titanic." (s.s.)". Titanic Inquiry Project. London: Board of Trade. Retrieved 15 July 2014.: regulations had been made on both provision of lifeboats and subdivision by watertight bulkheads and had not been updated to keep pace with increases in ship size - the BoT was in the process of consulting interested parties
- ^ http://www.bbc.co.uk/news/uk-26105246
- ^ Della-Giustina, Daniel E. (2000). Developing a Safety and Health Program, New York: Lewis Publishers.
- ^ U. S. Department of Labor, Occupational Safety and Health Administration. Retrieved on November 28, 2003 from http://www.osha.gov
- ^ "About OSHA". OSHA. US Department of Labor. Retrieved 15 July 2014.
- ^ Fanning, Fred E.(2003). Basic Safety Administration: A Handbook for the New Safety Specialist, Chicago: American Society of Safety Engineers
- ^ Canadian enviroOSH Legislation page
- ^ "Occupational Disease Control Act of the People's Republic of China" http://www.gov.cn/banshi/2005-08/01/content_19003.htm
- ^ "The Work Safety Act of the People's Republic of China" http://www.gov.cn/ztzl/2006-05/27/content_292725.htm
- ^ Government Notice. R: 533, 16 March 1990
- ^ Diving Regulations 2009 of the South African Occupational Health and Safety Act, 1993. Government notice R41, Government Gazette #32907 of 29 January 2010, Government Printer, Pretoria
- ^ Government Notice. R: 295, 26 February 1988
- ^ Government Notice. R: 2281, 16 October 1987
- ^ Government Notice. R: 1521 of 5 August 1988
- ^ Government Notice. R: 1031, 30 May 1986
- ^ Government Gazette, No. R. 307 7 March 2003
- ^ http://www.coag.gov.au/node/276
- ^ http://www.safeworkaustralia.gov.aus/swa/model-whs-laws/pages/model-whs-laws
- ^ Hale A, Ytehus I, 2004, 'Changing requirements for the safety profession: roles and tasks', Journal of Occupational Health & Safety – Australia and New Zealand
- ^ a b c d Hale, A et alia. 2004
- ^ Board of Certified Safety Professionals, 2012, "Safety Fundamentals" and "Comprehensive Practice" blueprints, accessed 17 February at http://www.bcsp.org/csp
- ^ a b Board of Certified Safety Professionals, 2012
- ^ Anonymous. 2008. 'Occupational Health', Health and Safety News: In Brief, Vol 60, Iss. 3; UK. pg. 6
- ^ Paton, Nic. 2008. 'Senior Managers Fail to Show Competence in Health and Safety' Occupational Health, Vol. 60, Iss. 3; p. 6
- ^ Swuste, P., Eijkemans, G. "Occupational safety, health, and hygiene in the urban informal sector of Sub-Saharan Africa: An application of the prevention and control exchange (PACE) program to the..." International Journal of Occupational and Environmental Health. Abel Publications Services Inc. 2002.
- ^ European Agency for Safety and Health at Work (2007): Facts 76/EN National economics and occupational safety and health. Bilbao, Spain: European Agency for Safety and Health at Work, ISSN 1681-2123.
- ^ "Risks and nanotechnology: the public is more concerned than experts and industry". Nature Publishing Group. 2007. Retrieved 20 March 2013.
- ^ "Nanotechnology risks – the real issues". Nanowerk.com.
- ^ "University of Connecticut Online OSH Certificate". Retrieved 11 March 2013.
- ^ World Day for Safety and Health at Work
- ^ "The World Day for Safety and Health at Work". Citation Ltd. 2013-04-23.
- ^ The World Day for Safety and Health at Work in 2013 focuses on the prevention of occupational diseases
Further reading
- Health and Safety Executive (2009): A Guide to Safety and Health Regulation in Great Britain. 4th edition. ISBN 978-0-7176-6319-4
- Koester, Frank (April 1912). "Our Stupendous Yearly Waste: The Death Toll of Industry".
- OSAH Safety 1
- OCLC 317650570, 50016270 and 163149563
- Roughton, James (2002). Developing an Effective Safety Culture: A Leadership Approach (1st ed.). Butterworth-Heinemann.
- Viscusi, W. Kip (2008). "Job Safety". In
- OHSAS 18000 series: (derived from a British Standard, OHSAS is intended to be compatible with ISO 9000 and 14000 series standards, but is not itself an ISO standard)
External links
- (US) CDC page on Workplace Safety & Health
- (EU) Health-EU Portal – Health and Safety at work
- ILO International Occupational Safety and Health Information Centre
- American Journal of Industrial Medicine
- Articles needing additional references from November 2010
- All articles needing additional references
- Articles needing cleanup from July 2012
- All pages needing cleanup
- WorldHeritage list cleanup from July 2012
- All articles with unsourced statements
- Articles with unsourced statements from July 2012
- Articles prone to spam from February 2013
- Occupational safety and health
- Risk management
- Industrial hygiene
- Safety engineering
- Environmental social science
- Labor


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SAMJ: South African Medical Journal
versão On-line ISSN 2078-5135
versão impressa ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.98 no.1 Cape Town Jan. 2008
Implementation of the Mental Health Care Act (2002) at district hospitals in South Africa: Translating principles into practice
J K Burns
MB ChB, MSc, FCPsych (SA); Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban
Legislation prior to 2002 tended to reinforce the alienation, stigmatisation and disempowerment of mentally ill patients in South Africa. In line with international developments in mental health legislation, the Mental Health Care Act (2002) was promulgated in South Africa. Its core principles - human rights for users; decentralisation and integration of mental health care at primary, secondary and tertiary levels of care; and a focus on care, treatment and rehabilitation - are progressive and laudable. However, the task of implementing the requirements of the Act at community and district hospital levels is fraught with problems. Lack of infrastructure, inadequate skills and poor support and training undermine its successful implementation. Health workers already burdened with enormous workloads and inadequate resources struggle to manage mentally ill patients at district hospitals. The 72-hour observation is a particular area of difficulty throughout the country. This paper outlines the rationale and sense behind this legislation, discusses the problems encountered at the 'rock face', and offers solutions to the problem of translating principles into practice.
Historical background of mental health treatment in South Africa
Previous South African legislation relating to mental health (the Mental Health Act No. 18 of 1973) (MHA 1973) unashamedly focused on control and treatment of patients. Like most international mental health legislation before 2000, the over-riding concern was the welfare and safety of the community. Human rights of patients was not a priority and was not addressed, as 'protection of society' was given priority over the rights of the individual. A reasonable degree of suspicion of mental disorder was sufficient to have a stranger, neighbour or relative 'certified' to a psychiatric institution, often far from the individual's home. Certification was wide open to abuse - jealousies, vendettas and prejudices often lay behind the certification of so-called 'patients' and the withdrawal of their personal liberty. At times, this form of detention was used for political ends to incarcerate and silence individuals or 'dissidents'. Once certified, patients had virtually no recourse to assistance from the law, and could languish in hospital, against their will, for weeks or months. Patients had no meaningful right of appeal or representation. Against this backdrop of human rights infringements, psychiatrists were forced to be doctor and gaoler.
Furthermore, the MHA 1973 reinforced the separation of mental health care from general health care. Psychiatric services were stand-alone and not integrated into primary health care. Generalist medical practitioners were not required to take any responsibility for mental health. This resulted in many cases of behaviourally disturbed patients, who were desperately ill with serious medical disorders such as meningitis, delirium and metabolic disturbances, slipping through the net and being sent to psychiatric institutions lacking optimal medical care. Fatalities occurred, with patients dying of sepsis or metabolic disorders in the seclusion rooms of psychiatric hospitals.
Psychiatric services were also centralised in urban-based tertiary psychiatric institutions, far from the homes and communities of most patients. Mental illness in a rural village or remote town often meant transfer over great distances and lengthy incarceration far from home, family and place of employment. There was little or no care within the community.
Patients entering the health services system with acute mental disorders experienced a form of systemic traumatisation or structural violence.1 Whether intentionally or not, the structure of the system disempowered, alienated and stigmatised the mentally ill. While individual intentions were usually good and humane, the structural evils inherent in mental health services and legislation meant that admission was a traumatic and damaging experience. Psychiatric service provision under the MHA 1973 was not truly based on the ethical principles of autonomy, beneficence, non-maleficence and justice.
The Mental Health Care Act of 2002
The Mental Health Care Act of 2002 (MHCA 2002)2 was promulgated in South Africa against a backdrop of positive international developments in mental health legislation.3-5
Emanating from a new culture focusing on human rights within South Africa after the pivotal year of 1994, it was one of the legislations enacted to rid the country of its apartheid legacy. And with its history of mental health treatment, South Africa was in dire need of an act that reflected the new spirit.
The MHCA 2002 is based on a number of important principles:
1. People with mental health problems are regarded as 'users', since any individual is a potential user of mental health care services.
2. Services should offer care, treatment and rehabilitation to users.
3. The human rights of the mental health care user (MHCU) are not inferior to the welfare of general society.
4. All health care practitioners are also regarded as mental health care practitioners (MHCPs) and should take some responsibility for mental health needs.
5. Mental health care should be fully integrated with primary health care.
6. Users have a right to be treated near to their homes and within their communities, as far as possible.
7. Users have a right to be provided with care, treatment and rehabilitation, with the least possible restriction of their freedom.
8. Users have a right to representation, knowledge of their rights, and the right of appeal against decisions made by MHCPs.
9. Mental health review boards should be created to act as independent 'ombudsmen' [sic] concerned with the rights of the user, to review decisions made in terms of the Act, and to respond to and investigate appeals.
Implementing the MHCA 2002
Anticipating the promulgation of the MHCA 2002, the KwaZulu-Natal Department of Health developed a strategic plan to guide the implementation of the Act in that province.6
Primary mental health care should be provided at community, primary health care (PHC), community health care (CHC) and district hospital levels. Generalists would therefore now be required to take an active role in offering care, treatment and rehabilitation to MHCUs. This includes outreach to CHC and PHC, outpatient care, screening and follow-up, appropriate referral and provision of short-term inpatient care for a period of 72 hours. This last requirement - the '72-hour observation' - proved to be a controversial and difficult function to implement.
The secondary level of mental health care should be located at regional hospitals, where a psychiatric unit with dedicated beds should be available. The regional team (including a psychiatrist) is responsible for inpatient and outpatient care as well as provision of support and outreach to all clinics and district hospitals in that region.
Tertiary care should be located at designated psychiatric hospitals providing specialised services such as forensic psychiatry, child and adolescent psychiatry, addiction treatment and psychogeriatrics.
The 72-hour observation
A major responsibility of district hospitals, in terms of the MHCA 2002, is to provide 72-hour admission and observation for MHCUs. This requirement has given rise to many problems, shared by most district hospitals throughout the country, which are very practical in nature and relate to operational aspects of implementing this legal requirement. The problems do not relate to the idea or concept of an observation period, but to their translation into practice.
In defence of the principle of a 72-hour observation period, there are several good reasons for this practice:
1. The most important is that, within a general medical environment, it allows for exclusion of medical causes of behavioural or psychiatric disturbance.
2. Many users recover sufficiently to be discharged within the first 72 hours (e.g. in substance intoxication or withdrawal, acute trauma, parasuicide and brief psychotic disorders). Unnecessary admission to a psychiatric institution is unfair on users as it may cause humiliation and shame.
3. Many MHCUs can receive care and treatment close to their homes and communities.
Problems in managing 72-hour MHCUs
The reality of providing 72-hour observations at district hospitals is that most institutions encounter serious problems leading to suboptimal levels of care and occasional disasters, such as:
1. MHCUs heavily sedated throughout the observation period, preventing adequate review.
2. Highly agitated or psychotic MHCUs inadequately sedated and difficult to contain within general ward settings, leading to unsafe conditions.
3. Inappropriate medications or doses of medications used for behavioural control of MHCUs, sometimes leading to iatrogenic problems.
4. Inadequate screening of medical conditions; having been labelled 'a psych patient', the MHCU is thereafter neglected in terms of routine examination and investigation.
5. Failure, at district hospital level, to comply with the requirements of the MHCA 2002 with regard to completion of MHCA forms.
These problems are generic to district hospitals throughout the country and, importantly, relate to the practical implementation rather than the validity of the Act. The principles are sound; it is their day-to-day realisation that is problematic. Considering the deficiencies in district hospital service that conduce to these common practical problems, it is apparent that the following infrastructural and functional shortcomings exist:
1. Inadequate facilities for containing disturbed, aggressive MHCUs.
2. Inadequate skills of health workers in managing psychiatric patients.
3. Poor understanding and knowledge of the MHCA 2002 and its forms.
4. Inadequate medications, treatment protocols and guidelines as well as awareness of referral options.
5. The roles of the South African Police Services (SAPS) and Emergency Medical Rescue Services (EMRS) in respect of the management of MHCUs are not clear, and their involvement is often unhelpful.
Solutions for improving mental health care at district hospitals
Translating legislation into reality with regard to the care of MHCUs at district hospitals has been difficult owing to practical deficiencies and lack of preparedness at service level. Other nations also struggle with the painful realities of implementing legislation within poorly resourced and inadequately prepared circumstances. Deinstitutionalisation in the USA became a politically expedient (and necessary) project, commencing during the 1960s. Large numbers of chronically institutionalised patients were discharged from psychiatric institutions with little planning or preparation in terms of community services, and many ended up on the streets as homeless people, or in prison.7 In the UK, deinstitutionalisation during the 1980s was also difficult, but it was perhaps better prepared with its policy of 'Care in the community'.8 So South Africa is not alone in the often painful task of transforming and modernising legislation and services in accordance with ethical principles of care.
Legislation is not easy to change, and many would argue that good legislation should not be changed but rather accommodated. This is true with regard to the MHCA 2002. Acknowledging that preparation at the 'rock face' was not adequate, the solution is not to discard the Act's principles or intentions but rather to accommodate its requirements in part through improvisation and in part through careful planning. This requires a commitment from health workers at all levels and, importantly, also requires commitment from administrators and Government. Mental health care has been sorely neglected in South Africa, and transformation of the services requires political leadership and adequate funding. While we face many health challenges, that of providing a high and ethical standard of mental health care to all users should not be ignored.
Given the real problems encountered in managing MHCUs, what are some of the 'improvisations' possible at district hospital level? I suggest some of the following actions:
- At least 2% of beds in general wards at district hospitals should be made available for the care of MHCUs.
- Every district hospital should have at least one seclusion room for the care of aggressive, disruptive MHCUs during 72-hour observation.
- Every district hospital should have a dedicated psychiatric outpatient clinic.
Human resources
- District hospitals should ensure that they have at least one medical officer with expertise in managing MHCUs and who is proficient in the practical application of the MHCA 2002.
- District hospitals should have full-time psychiatric nurses and part-time occupational therapists, psychologists and social workers for psychiatric services.
- District hospitals should insist on outreach and support visits from regional or tertiary MHCPs.
Education and training
- District and community health workers require regular training updates on the MHCA 2002 and the use of MHCA forms. This must be repeated 6-monthly, as staff change regularly and the complexity of the Act requires refresher training. This is the responsibility of regional or tertiary MHCPs and the district office.
- Treatment protocols for managing mental disorders should be developed regionally for distribution to district and community level health workers.9 Regular training updates should be provided on these protocols.
- District hospitals should second medical officers for occasional periods to tertiary psychiatric hospitals for training in the management of mental disorders. The value of achieving such skills and qualifications (e.g. Diploma in Mental Health) cannot be over-estimated.
- Local SAPS and EMRS personnel should receive regular training in their roles in respect of MHCUs and the requirements of the MHCA 2002. This is the responsibility of the district office.
- Copies of the MHCA 2002 and MHCA forms must be available at all district and community health institutions.
This is the responsibility of institutional managers and the district office.
- A District Mental Health Forum should be established in every district, including health workers, administrators, SAPS and EMRS representatives, community organisations and MHCU representatives.
- Regional or tertiary MHCPs have a responsibility to provide outreach consultation-liaison services, teaching and service development to secondary and primary services (e.g. monthly MHCP visits to district and regional hospitals).
1. Farmer P. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press, 2005 29-50. [ Links ]
2. Mental Health Care Act (2002). Pretoria: Department of Health. http://www.info.gov.za/gazette/acts/2002 (accessed 29 October 2007). [ Links ]
3. Mental Health Act (2007). London: Department of Health. http://www.opsi.gov.uk/acts/acts2007 (accessed 29 October 2007). [ Links ]
4. Mental Health (Care and Treatment) (Scotland) Act 2003. Edinburgh: Department of Health for Scotland. http://www.opsi.gov.uk/legislation/scotland/acts2003 (accessed 29 October 2007). [ Links ]
5. Mental Health Act (1998). Kingston: Jamaica Ministry of Health. http://www.moj.gov.jm (accessed 29 October 2007). [ Links ]
6. Strategic and Implementation Plan for Delivery of Mental Health Care Services in KwaZulu-Natal. Pietermaritzburg: KwaZulu-Natal Department of Health, 2003. [ Links ]
7. Steadman HJ, Monahan J, Duffee B, Hartstone, E, Clark Robbins P. The impact of state mental hospital deinstitutionalization on United States prison populations, 1968-1978. J Crim Law Criminol 1984; 75(2): 474-490. [ Links ]
8. Leff J. Why is care in the community perceived as a failure? Br J Psychiatry 2001; 179: 381-383. [ Links ]
9. Burns J, King H, Saloojee S. KZN Treatment Protocols for Mental Health Disorders. Pietermaritzburg: KwaZulu-Natal Department of Health, 2007. [ Links ]
J Burns
Accepted 4 October 2007.


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WASHINGTON — Key Republican lawmakers oppose efforts to scale back a proposed cut in the corporate income tax rate to pay for other tax breaks, complicating efforts to appease Republicans from high-tax states.
Both the House and Senate tax packages would reduce the corporate income tax rate from 35 per cent to 20 per cent. However, negotiators have been discussing whether to set the corporate rate at 22 per cent to help pay for an expanded deduction for state and local income taxes and other provisions.
President Donald Trump opened the door to scaling back the corporate tax cut over the weekend.
Both the House and Senate tax packages would provide steep tax cuts to businesses and more modest tax breaks for families and individuals.


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Breville Infuser Espresso Machine
Known as "The Infuser," the Breville BES840XL is engineered to deliver optimal espresso flavor in every cup. It pre-infuses ground coffee with low, steady water pressure before extraction, gently expanding the grinds before stepping up to high pressure. The result is a more even extraction, which produces beautifully rich, balanced coffee flavor. Select automatic one- or two-shot volumes at the touch of a button, or set your own volume with manual control.
- Easy programmable control offers preset 1 & 2 shot volumes, manual override, or reprogrammable volumes.
- An Italian 15-bar pump delivers water at the ideal pressure, while the 1600W stainless-steel Thermocoil and electronic PID temperature control ensure precise temperature during extraction for fullest flavor.
- Low-pressure pre-infusion gradually increases water pressure to gently expand grinds for an even extraction, balanced flavor and thick crema.
- Auto purge automatically adjusts water temperature after steam for optimal espresso extraction temperature.
- Stainless-steel swivel steam wand froths milk for lattes and cappuccinos.
- On-board removable tamper.
- Dispenses hot water instantly for Americanos.
- Dry Puck feature removes excess water from ground coffee after extraction for easy disposal.
- 61-fl.-oz. removable water tank with handle and replaceable water filter.
- Stainless steel housing.
- Designed and engineered in Australia, Made in China.
Espresson Machine includes:
- Stainless-steel frothing jug.
- Single- and dual-wall filter baskets.
- Coffee scoop.
- Cleaning discs and tablets.
- Clean tool and Allen key.
- Water filter and filter holder.
Use & Care
- Hand-wash removable parts.
- Wipe base clean with a damp cloth.
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Williams Sonoma Price Match Guarantee
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If you find a lower price on any of our products, we'll match it—guaranteed. Click here for details.
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UPS can deliver most in-stock items within 3–5 business days. UPS is unable to deliver to P.O. boxes.
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For an additional charge of $26 per address, we can expedite delivery to most destinations. This service is not available for some oversize items, items shipped directly from the supplier (including perishable and custom-manufactured items), out-of-stock items and items to be shipped outside the contiguous 48 states.
Orders received by 9:00 p.m. ET Monday through Thursday will arrive the next business day; orders placed Friday through Sunday will arrive on the following Tuesday.
Return Policy
At Williams Sonoma, we take great pride in the quality and craftsmanship of our products. Attention to design, materials, safety and construction are our priority. Upon receipt, please inspect your purchase and notify us of any damage; we will arrange for a prompt replacement.
If within 30 days, you are dissatisfied for any reason, you may return your purchase for a refund of the merchandise value. An original receipt or gift receipt is required for all returns and exchanges. Returns with a gift receipt will be refunded in the form of a Merchandise Credit for the amount indicated on the gift receipt. Returns with original receipt will be refunded in the original form of payment, cash and check refunds over $100 will be issued as a company check (may take 14 business days from time of request).
For all cutlery returns (knife sets, single knives, cutting boards, knife sharpeners and knife storage), please contact us at 888.922.4108 to initiate the return.
We cannot accept returns on monogrammed, personalized, special-order items, custom upholstery, food, items shipped direct from the vendor or on items damaged through normal wear and tear. Final sale items ending in .97 or .99 cannot be returned.
Made to Order and Final Sale Furniture items are non-returnable and cannot be cancelled once the order is placed.
For returns of items purchased from your Williams Sonoma Gift Registry, we will gladly provide a refund or exchange for the merchandise within 90 days of your event or within 90 days of purchase, whichever date is later. View Full Returns Policy.
Breville Infuser Espresso Machine
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|Breville Infuser Espresso Machine
|Sugg. Price $800 Our Price $499.95
|Breville Espresso Maker BES840XL, Black Sesame
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Signed March 2nd, 2013 by Hall of Famer Charley Taylor. Comes with a photo COA from LeaderInSports.com with the date and location of the signing listed. Also has the matching LeaderInSports.com hologram on the back of the helmet.
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We have a vision of the body of Christ rising up to glorify their Heavenly Father and reflect His merciful heart by extending this gift to orphans through adoption. We see the fatherless discovering their identities in Christ through finding love in family. Will you take this journey with us, sowing into a life for a bountiful harvest? Please help us tend this garden and revive the brokenhearted with the love of Jesus.
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text: DURHAM — The University of New Hampshire Celebrity Series will present the Keller Quartet on April 21 at 7 p.m. at the Paul Creative Arts Center's Johnson Theatre. Formed in Budapest in 1987 the Keller Quartet has performed in major venues throughout the world. Their concert in New York last year garnered them an excellent review in The New York Times. Their program will include quartets by Bartok, Tchaikovsky, and Brahms. Tickets can be purchased on line at www.unharts.com or by calling 603-862-7222. Tickets will not be mailed; they can be picked up at the PCAC Box Office. The hours of operation are Monday-Friday, 10 a.m.-5 p.m. as well as one hour before each event.


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I. Meeting called to order
II. Roll call
III. Approval of minutes
IV. Kim Donahue, Business Development Specialist, U.S. Small Business Administration Emma Wilson, Lead Lender Relations Specialist, U.S. Small Business Administration Presentation on SBA programs for veterans
V. Skip Gebhart, West Virginia Higher Education Policy Commission Update on veteran friendly campuses
VI. SB/HB ****- Interstate Compact on Educational Opportunity for Military Children
VII. Miscellaneous business
VIII. Adjournment


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Trim:SLT Crew Cab SWB 4WD
Mileage: 42,505
Trans:8 Speed Automatic
Stock #:PC390
Engine:Intercooled Turbo Diesel V-6 3.0 L/182
Color:Bright Silver Metallic Clearcoat
Drive Train:4WD
Estimated By E.P.A.
Actual Mileage May Vary
SLT Crew Cab SWB 4WD
Drive Train:
Stock #:
Intercooled Turbo Diesel V-6 3.0 L/182
8 Speed Automatic
Bright Silver Metallic Clearcoat
SLT Crew Cab SWB 4WD
8 Speed Automatic
Stock #:
Intercooled Turbo Diesel V-6 3.0 L/182
Bright Silver Metallic Clearcoat
Drive Train:
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The new Aqua-Dec EasyFit solves the potential installation problem of the drainage point being obstructed by joists within timber floors. A unique, patent protected drainage feature allows the installer torotate the drain aperture to any position that will avoid the joist, or any other under floor obstruction. The Aqua-Dec EasyFit requires no underboarding and will support over 300kg (47 stone) when fitted directly to standard floor joists. It is the ideal solution for wheelchair showering and can be covered with vinyl flooring or tiled when used in conjunction with a membrane covering first.
The new Impey Aqua-Dec EasyFit has a computer designed celluar structure, which is compression moulded from high glass content SMC to provide the strongest nmost rigid construction on the market.
It requires no under boarding and will support over 300kg (47 stone) when fixed directly to standard floor joists.
The Aqua-Dec EasyFit is designed to provide the gradient required in the showering area for water drainage. What makes them so special is their extreme strength and rigidity, whilst only being 22mm thick at the outer rim.
The low profile is specially engineered to be the same depth as standard floorboards. You simply remove the floorboards and fix the Aqua Dec to the floor joists.
The revolutionary rotating drain point allows the drain position to be rotated through 360° to any position to avoid joists. If you need to trim or cut the Aqua Dec to avoid an obstruction it can be cut wioth a universal hand saw and drilled to provide additional screw fixing holes.
All Aqua-Dec EasyFits come with a tiled floor gully horizontal outlet drain as standard. The gully is a high quality water trap featuring a 50mm water seal, flexible 50mm outlet and a 50-40mm solvent weld reducer.
The height adjustable rings adjust to suit tile depths between 6mm and 26mm depending on waterproof membrane and adhesive thickness. The tanking ring secures the waterproofing membrane into place creating a secure watertight seal at the drainage point. The drain comes complete with a high quality, 4mm thick, stainless steel grate. Alternatives are available for vinyl flooring etc.
All Impey Aqua-Dec EasyFit bases carry a lifetime guarantee if installed according to the manufacturers instructions.
Please note:
If finishing the floor with TILES a tanking membrane such as Impey Waterguard will need to be laid first.
- Suitable for VINYL or TILED* floors
- Size: 800 x 800mm
- No under boarding required
- Supports over 300kg (47 Stone)
- 22mm thick
- Lightweight yet strong
- Rotating drain through 360° to allow for the avoidance of joists
- Can be trimmed by up to 30mm and drilled
- Lifetime Guarantee
- Drain Included - Tiled / Horizontal outlet.
- Designed & Manufactured in the UK
*Tiled floors will require a tanking membrane such as Impey WaterGuard to be laid before the tiles.
Rotating drain
The EasyFit drain plate can rotate 360 degrees and avoid all underfloor wet room obstructions. The eccentric drain also features three locating rings, to provide superior hold between the Dec and the rotating drain plate.
Unbeatable strength
The new Aqua Dec / Level Dec EasyFit wet room Dec is stronger than the original Aqua-Dec and requires NO UNDER BOARDING
The Aqua Dec / Level Dec EasyFit is over 20% lighter than the original Aqua-Dec. The unique EasyFit material is also stronger but lighter.
Easily trimmable
The Aqua Dec / Level Dec EasyFit wet room Dec can be cut anywhere up to the solid surround with a standard handsaw.
EasyFit is 22mm thick
The new Level Dec / Aqua Dec EasyFit is consistently 22m thick around the perimeter.
Underside cellular structure
The underside spoke pattern provides increased rigidity to the structure of the Dec.
Wooden or concrete floor installation
Aqua Dec / Level Dec EasyFit can be fitted on wood and concrete floors as the spoke structure bonds well with wet concrete.
Impey AquaDec EasyFit - The easiest way to install a wet room.
Before the Impey AquaDec EasyFit, a typical installation of a wetroom floor former initially required the wetroom area to be under boarded with a ply-wood board. Eliminating this process with AquaDec EasyFit, has significantly reduced installation time.
Download the Impey AquaDec EasyFit Installation Guides:
Impey AquaDec EasyFit for Tiled Floors (PDF)