Developing countries are changing at a mind boggling pace… by design as well as default! With births of ‘Danica’ in Philippines and ‘Nargis’ in India, the world population has crossed 7 billion on 31^st October 2011. It is more than a coincidence that these ‘seven billionth’ babies were from developing countries. While it took a century for the world population to quadruple, another 2.2 billion would be added over next 40 years; almost exclusively from developing countries. This population explosion is bound to affect ‘developing’ nations and impact OSH (occupational safety & health) situation.

Currently, over 90% working population in developing countries is engaged in the informal economy, mainly agriculture and home work while less than 10% work in the formal, organized sector; mainly industry, mining and services.  Addition of workforce consequent to this burgeoning population would mean a huge number in the unorganized sector; where occupational health is largely unheard of.

Unfortunately, most industries in this part of the world consider employee health as a welfare activity and focus on treating general illness & managing accidents. Occupational illness is either not recognized or is ignored. Industrial Physicians also appear to tow this line, willingly or unwillingly.

Work-Life Scenario and Developing Countries

The three most important OSH needs in the developing world are: legislation to extend OSH coverage to all sectors of working life including the unorganised sector; the spread of awareness about OSH among stakeholders; the development of OSH infrastructure and OSH professionals.

Liberalisation, privatisation and globalisation have affected the working life and present new OSH challenges. With the advent of an open market economy, manufacturing is shifting base to developing countries where there is less government control. The economy is going through a transition from Agriculture to Manufacturing to Services. A decline in public sector employment has also resulted in a decline in OSH, in some cases.

Increasing proportion of females in the workforce adds to the traditional OSH issues. Women are subjected to a dual burden of home work and occupation. Mass migration from rural to urban areas in search of employment creates a situation of high employment of migrants in high risk work.

Added to all this, is a paradigm shift from “Diseases of Occupation” to “Occupation as a component cause of Disease”. New exposures are leading to new occupational health problems & diseases. While old occupational diseases like Silicosis are still highly prevalent, new diseases such as MSD, Stress, Lifestyle related diseases are assuming importance.

Thus a combination of old and new occupational health challenges are currently faced by developing countries.

Occupational Physician in Developing Countries

In past, the occupational physician was treated as a necessary evil, his/her role revolving around legal compliance, liaison, first aid during accidents and welfare. As the economy is growing and industry is maturing, enterprises are giving increasing importance to various quality systems (ISO, OHSAS) and medical surveillance especially medical examinations. Improved education and awareness levels have put the focus on health promotion. Progressive industries are increasingly focusing on primary prevention and control of work environment with occupational health as line responsibility besides wellness promotion and targeted interventions for noncommunicable diseases. The service sector & corporate offices have a high prevalence of Lifestyle issues and Stress resulting in need for Wellness Promotion and Employee Assistance Programs.

This has opened up new skill demands such as health risk assessment, exposure monitoring,   health incident reporting & investigation, health impact assessment, audit and review functions etc. The occupational physician has to play a major role in establishing priorities in occupational and environmental health. He/she needs to adapt & respond to these fast paced changes by becoming a change agent and acting as a facilitator. The occupational physician also needs to play a proactive role in development of a preventative culture with occupational health as a part of line responsibility in the industry.

The roles and function of the occupational physician have undergone several changes. The perception of various stake holders is also changing with more cross functional responsibilities coming up. He/she is required to lead various innovative interventions at the workplace. Various occupational health service models are seen in developing countries ranging from public sector model, regional hospitals for small and medium enterprises, large company model, and part time occupational physicians on a visiting basis.  Though the numbers of private consultants in occupational health are increasing, full-fledged private occupational health services and centres are slow to develop.

Threats & Opportunities

An occupational physician in developing countries faces threats to his/her survival with economic recession leading to overall manpower reduction. There are increasing trends of outsourcing and less ‘full time’ jobs.  Where jobs exist, demand is for physicians familiar with environmental and legal issues. Familiarity with Information Technology is no longer just a desirable but an essential attribute.

Of course, there are opportunities too! With the entry of multinational companies, awareness and demand about occupational health is increasing. There is a growing need (though not necessarily jobs) for occupational health professionals. With globalization of workforce, opportunities are available beyond the national boundaries.

While all this is true for the organized sector (where occupational physician is generally available), there is obviously a huge unmet need in the unorganized sector. One possible solution is to train primary care physicians in occupational health.

Changing Role of the Occupational Physician

In this changing scenario, the occupational physician has to be a jack of all trades while retaining mastery over his core competence. Manager, leader, team player (for HSE), industrial hygienist, conscience keeper for the organization; are some hats he/she wears!

In industry, the occupational physician is in a unique position with insight to real problems and access to the top management which can be used to facilitate Innovative Interventions. The occupational physician also needs to develop linkages with the line management. He/she has to assume the roles of a Partner, Collaborator, Coach and Counselor in the enterprise going beyond the usual boundaries of work-life and extending to family and personal issues of employees when required.

How do you do it?

In view of a threat to survival, the occupational physician has to change, innovate, strategize and market occupational health to various stake holders. Knowledge, innovation and passion are the key attributes to succeed in the fast changing scenario. He/she has to convince the management that occupational health makes business sense by protecting and improving productivity.

Promoting, facilitating and actively participating in building the professional organization in occupational health provides access to two important stakeholders; Government and Society.

During his experience of 30 years as an occupational health physician in India, the author was fortunate to be a part of some innovative and path breaking initiatives at various stages. He will share a few important case studies detailing intervention measures and strategies adopted, illustrating a transition in the role being played by the occupational physician.

Conclusion

As the worklife scenario in developing countries in evolving, the role of the occupational physician is changing rapidly. From the historical role in legal compliance, liaison and injury management, the occupational physician now has to evolve into a facilitator in developing a the preventative culture in the enterprise. There is tremendous scope to put the OH research into practice and prevent occupational illnesses, ensuring a healthy and productive work-life.

To achieve these objectives, the occupational physician has to be both passionate and innovative. Over and above this, marketing skills to win over various stakeholders can help him/her become an integral & indispensible part of the overall business scenario.

Choices for the Occupational Physician from the developing world are very clear:

Stand Still & Perish or Change, Innovate & Flourish!