加拿大职业病管理概况

Occupational Disease in Canada 加拿大职业病管理概况,E. Kevin Kelloway, Ph.D.柯乐威 教授 Canada Research Chair in Occupational Health Psychology加拿大职业健康心理学研究中心主席,Overview概况,OVERVIEW OF CANADA加拿大概况 REGULATORY ENVIRONMENT立法环境 DEFINITION定义 COMPENSATION赔偿 TREATMENT治疗 PREVENTION预防,The Land 国土,10 million square kilometers - second largest nation on Earth, after Russia 1000万平方公里世界上第二大国仅次于俄罗斯 North to south 4,800 km - more than two thirds of its residents live within 300 km of its southern border with 12 states of the United States 南北跨度4800公里-三分之二多的人口居住在和美国12个州接壤的南部300公里以内的边界地带。,The People 国民,The Population 人 口 加拿大人口统计 Thousands 单位千,The People 国民,Canadas Population is over 31.6 million people. 人口超过3160万 1.17 million people (4%) are Aboriginal Peoples: First Nations (60%), Mtis (33%), Inuit (4%) and Other (3%) 117万（4%）为土著居民：-原住民（60%），米提人（法裔土著混血33%），因纽特人（4%） 6.2 million people (20%) are Immigrants. 620万（占人口20%）移民 Canadas population growth (1997-2005) is attributable to: 加拿大的人口增长（1997-2005）主要来自于： 3 million births, 2 million deaths and over 2 million new immigrants. 出生人数300万，死亡人数200万，超过200万的新移民 Most Canadians live in urban settings - over 80% reside in towns and cities.大部分加拿大人居住在城市环境-80%的人居住在城镇和城市中,8,The Canadian Constitution加拿大宪法,Canada is a federation with three levels of government: federal, provincial and municipal加拿大是由三级政府组成的联邦：联邦、省、市 Under the Canadian Constitution, powers are divided between the federal and provincial governments根据加拿大宪法，联邦和省级政府分权 Municipalities are not recognized in the Constitution except to the extent that they are the responsibility of provinces There are about 4,000 municipal governments in Canada加拿大大约有4000个市政府,9,The Canadian Constitution加拿大宪法,The federal government maintains the “peace, order and good government” of the whole country by making laws with respect to immigration, unemployment insurance, trade and commerce, national defence, native affairs, and criminal law. 联邦政府通过制定关于移民、失业保险、商贸、国防、少数民族事务和刑法等法律，来维持整个国家的“和平、秩序和良政”。 Provincial governments are empowered to control regional and local affairs including education, health, social services, property rights, administration of justice, local public works, and municipal institutions. 省级政府被授权管理地区和地方事务，包括：教育、卫生、社会服务、财产权、司法管理、地方公共设施和市级机构。 Some responsibilities are shared between the federal and provincial governments such as immigration, agriculture, and pensions. 在有些领域中，联邦和省政府共同承担责任，如移民、农业和养老金。 Municipal governments - strictly local matters市政府-仅限于管理地方事务,Economy 经济,the eight - largest trading nation 第八大贸易国 high-tech industrial society, Canada today closely resembles the US 高新技术工业社会，和美国经济尤其相似 advantages - natural resources, skilled labor force, and modern capital plant 经济优势：自然资源、高技能的劳工队伍和现代化的工厂 Natural Resources : Iron Ore Nickel Zinc Copper Gold Lead Potash Silver Fish Timber Wildlife Coal Petroleum Natural Gas Hydropower,Economy 经济,The workforce劳动力结构,The workforce劳动力结构,Occupational Injuries/diseases 职业伤害/职业病,The Accident Pyramid 事故金字塔结构,For every one workplace death there are 34 injuries resulting in lost time, 900 minor injuries, 1,500 near misses, and 20,000 unsafe actions. 作业点每死亡1人有34人受伤误工 900人受轻伤 1500人侥幸脱险 和20000人有危险操作,Cause of workplace fatality 作业点死亡原因统计 (2005),Exposure to harmful substances or environments 512 deaths (asbestos is the single leading cause)接触有害物质或环境-512人（石棉是最主要的原因） Transportation accidents 229 deaths交通事故-229人 Contact with objects and equipment 142 deaths 接触物体及操作设备致死-142人 Falls 77 deaths高坠或滑倒-77人 Bodily reaction and exertion 30 deaths 身体反应及用力-30人 Fire or explosion 19 deaths火灾或爆炸-19人 Assaults and violent acts 21 deaths 暴力行为-21人 Other (events or exposures, unknown or simply not specified) 67 deaths其他（事故或接触 ，情况不明或不具体）-67人死亡,Regulatory Environment立法环境,HEALTH CARE医疗卫生 Canada has 1 Federal and 13 provincial and territorial governments 加拿大有1个联邦政府和13个省级和特区政府 Constitution says that a health care is a provincial/territorial responsibility and that b all Canadians have access to the same level of health care no matter where they live 宪法规定，医疗卫生由省级或特区政府管理，无论居住在哪个地方，所有加拿大人都享有同样水平的医疗卫生服务 Role of the Federal government is to provide funding, ensure equality and ensure compliance with the Canada Health Care Act 联邦政府的职责是提供资金，确保平等并且加拿大公共卫生法得到执行,Regulatory Environment立法环境,Occupational Health and Safety职业卫生与安全 Regulated mostly at the provincial level (over 80% of workers) 主要由省政府立法（涵盖超过80%的工人） Workers in some industries (e.g., banking, inter-provincial transportation) are federally regulated有些行业（如银行、省际交通）则由联邦立法 Great deal of collaboration between provincial and federal agencies so regulations are very similar (but not exactly the same) across jurisdictions省级和联邦机构之间进行了大量协作-所以各个管辖区的法规非常相似（但是并不完全相同）,Definition of Occupational Disease职业病的定义,Two main elements are present in the definition of an occupational disease: 职业病的定义包括两个要素 the causal relationship between exposure in a specific working environment or work activity and a specific disease; and某一疾病与接触某一工作环境或从事某一工作存在的因果关系 the fact that the disease occurs among a group of exposed persons with a frequency above the average morbidity of the rest of the population. 接触特定环境工作的人群患某一疾病频率高于其他人群,Classes of Occupational Disease (ILO)职业病的分类,1. Diseases caused by agents由不同因素导致的职业病 1.1 Diseases caused by chemical agents 化学因素导致的职业病 1.2 Diseases caused by physical agents 物理因素导致的职业病 1.3 Diseases caused by biological agents 生物因素导致的职业病 2. Diseases by target organ特定器官疾病 2.1 Occupational respiratory diseases职业呼吸道疾病 2.2 Occupational skin diseases职业皮肤病 2.3 Occupational musculoskeletal diseases职业骨骼疾病 3. Occupational cancer职业性癌症 4. Others其它,Some problematic characteristics存在的一些问题,Results from cumulative (chronic) rather than acute exposure 结果来自长期积累（慢性）而非急性接触 Delayed onset conditions推迟了发作因素 Not unique to occupational exposures有些职业病不仅限于职业接触引起,Compensation赔偿,Applied for (typically) after diagnosis 诊断后申请 Application likely to be successful if a employed in a known high risk occupation for specific condition; b documented exposure to hazard; and c clinical diagnosis/impairment 如具备以下条件申请可能成功：1.受雇于高危行业；2.有接触致危因素的条件；3.医疗诊断/损伤 Most WCBs recognize presumptive cases (firefighters and some cancers, coal miners and silicosis, construction workers and HAVS) 大多数工伤赔偿局接受以下推理的情况为职业病（消防员与一些癌症，煤矿工人与矽肺病，建筑工人与手臂振动综合症 Can extend into retirement 赔偿可以延期到退休,Treatment治疗,Occurs in the regular health care system在正规医疗卫生系统进行 Not tied to compensation but if pensionable, then award may include medical costs (e.g., drugs) not normally paid for in health care system与赔偿无关，如果可以领养老金，赔偿则会包括医疗卫生系统通常不会支付的医疗费用（如某些药品） Some specific occupational clinics in larger centres (e.g., occupational medicine, HAVS etc), by referral, additional costs paid for by insurer大中心的一些特定职业诊所（如职业药物、手臂振动综合症等）的转诊病人，额外费用由保险公司支付 Some specialized clinics (e.g., pain clinics) by referral, additional costs paid by insurer一些特定门诊（如疼痛门诊）的转诊病人，额外费用由保险公司支付 Insurer may institute active return to work policies including treatment, job accomodation, ergonomic redesign etc保险公司会遵守相关规定，包括治疗、重新安排工作、根据人体工学重新设计等。,Prevention预防,Dealt with under the OHS legislation no distinction made between occupational accidents and occupational disease针对职业卫生与安全立法-没有将职业事故和职业病加以区别 Since all occupational disease results from exposure to a hazard, prevention focuses on controlling the exposure:因所有职业病都由接触致危因素导致，预防的重点主要为控制接触 At the source elimination, engineering and administrative controls源头上-消除、工程和管理控制 Along the path elimination, engineering and administrative controls过程中- 消除、工程和管理控制 At the worker personal protective equipment (PPE)工人-个人防护用品,Types of control控制内型,Engineering Controls工程控制 -MOST EFFECTIVE最有效 Process control change how job is done 过程控制-改变工作方式 Isolation/enclosure of emission source隔离/关闭排放源 Ventilation通风 Administrative Contro