Essential occupational health interventions - for the few or for all?

There is still a considerable global burden of occupational diseases and injuries that leads to many fatalities each year. It is not well known which interventions are most effective in preventing these occupational diseases and injuries. Such interventions would be essential to a successful basic occupational health and safety system.    Therefore, I carried out a systematic search in Pubmed and Medline to locate systematic reviews of effects of essential preventive interventions to reduce the global burden of occupational diseases and injuries. The search was restricted to work-related cancer, dust-related diseases, occupational asthma, COPD, noise-induced hearing loss, back pain and occupational injuries as these contribute most to the burden of disease and injuries. Primary prevention of those diseases occurs through reduction of the exposures that lead to these diseases. These interventions are categorised as environmental, behavioural and clinical.     The systematic reviews show that there are many technical measures available to reduce exposure that is known to lead to work related cancer, dust-related diseases, asthma, COPD, noise and injuries. However, to effectuate this technical potential, better implementation is needed. Better regulation and enforcement and incentives for employers are effective interventions for implementation. Feedback and rewards for workers probably help in reducing occupational injuries. Personal protective equipment also has technical potential to reduce chemical and noise exposure but without proper use and instruction this can not be realised. The available systematic reviews do not provide evidence that back pain can be prevented. Education and training has not been shown to prevent occupational diseases and injuries. Clinical interventions such as drugs and health examinations have little to offer for primary prevention of occupational diseases and injuries.    Interventions to better implement technical measures to reduce chemical exposure, noise and dangerous situations at work are essential to a successful basic occupational health and safety system.