I would like an occupational physician to be one of the key persons in the health care system. Interview with Prof. Dr. Jolanta Walusiak-Skorupa, President of the Polish Society of Occupational Medicine
How can we use occupational medicine in connection with development of integrated approach to widely understood prevention? Do we in Poland make sufficient use of the possibilities offered by occupational medicine?
Obviously, occupational medicine, or more precisely occupational health care system, should be – much more than it is – used for preventive activities. Occupational medicine services in Poland cover about 16 million of workers, in whom more than 4.5 million obligatory prophylactic examinations – initial, periodical and control – are performed annually for the purposes specified in the Labour Code. At the same time it is that exceptional situation when an employee comes to the doctor despite feeling healthy, often in ignorance of existing risk factors or even early symptoms of various diseases. It is also known that medical personnel are more effective in convincing people to take pro-health measures. All this creates an excellent opportunity to implement any preventive actions and, above all, to ensure the implementation of the currently recommended strategy of total employee health, which aims to influence all elements determining the health and well-being of working people.
In addition, the COVID-19 pandemic situation has significantly changed the picture of the labor market and has influenced the emergence of new health problems for workers both in the field of mental health and related to the past infection and the changes that have occurred in the organization of our work and daily life. This creates new challenges for occupational health services, because in the era of telemedicine, the doctor providing preventive care to workers is often the first to identify a health problem “live”.
What is the current strategy to encourage Poles to preventive health care, to which we are quite resistant? What activities or campaigns are being conducted to encourage prevention of health problems occurring in the work environment?
Preventive actions have to be a permanent part of OHS. All occupational health professionals with special attention to physicians and nurses are prepared for such activities. The preparation starts during the specialization training and is continued through numerous in-service trainings after the specialist degree. For several years, within the framework of the National Health Programme, the Institute of Occupational Medicine has been carrying out tasks including initiatives for prevention of occupational and work-related diseases as well as education in health management of ageing workers and development and dissemination of instruments promoting health and health-promoting behaviour in the work environment. The basic strategy includes a comprehensive assessment of the worker’s health, identifying risk factors and health problems during preventive examinations for the Labour Code and proposing further actions – preventive and/or diagnostic. In this respect the possibilities of the occupational physician are very limited as the preventive care of the workers is financed by the employers and thus it depends on them whether additional measures are implemented. Usually the next diagnostic and therapeutic steps, after the occupational physician has identified the problem, are carried out in primary health care or in outpatient specialist care.
Could you tell us something more about the #TakeSelfCheck campaign? Are you directly involved in it?
The #TakeSelfCheck campaign is a continuation of an earlier collaboration between the Polish Society of Occupational Medicine, the Institute of Occupational Medicine, and the Citizens Healthily Engaged Foundation. In 2018, the report “Occupational Medicine in the Prevention of High Cholesterol Diseases” was produced to highlight the increasingly prevalent lipid disorders and to suggest a course of change to stem the trend. First of all, it was pointed out that the system of preventive care for employees has a great opportunity to increase the effectiveness of the management of both primary and secondary prevention of cardiovascular diseases.
The appearance of an amendment to Appendix 1 to the Ordinance of the Minister of Health of November 12, 2020, amending the Ordinance on the conduct of medical examinations of employees, the scope of preventive health care provided over them and medical certificates issued for the purposes provided for in the Labour Code (in which, for the first time, the determination of lipidogram was introduced, and not, as previously, the level of total cholesterol) made us decide to return to joint action, this time within the framework of the #WeGetSelfScreened Campaign. We have agreed that the subject of cooperation will be the dissemination and popularization of knowledge about the changes in the above mentioned Regulation of the Minister of Health and running an information campaign on cholesterol and glucose testing for employees. The activities include, among others, education of doctors who provide preventive care, employees, employers about the current state of medical research on cholesterol and glucose.
What challenges does the Polish Society of Occupational Medicine face in relation to systemic changes in occupational health? How have these challenges been affected by the pandemic?
The Polish Society of Occupational Medicine, together with the Institute of Occupational Medicine and the National Consultant for Occupational Medicine, develops proposals for changes in occupational health for the Ministry of Health and disseminates knowledge and new solutions among occupational medicine professionals. The modern occupational health approach is a holistic protection of all aspects of occupational health. Worker’s health” refers to policies, strategies, programmes and activities that integrate protection against work-related environmental risks and illnesses, including the promotion of preventive and health-promoting measures to enhance a worker’s well-being. Practically everything is changing. The work environment looks completely different than it did 20 years ago. We are talking about the fourth industrial revolution and the absolute digitization of our lives. Additionally, the next generations of employees have completely different expectations. Generation Y or Z wants a balance between work and private life much more than their parents did, and from the occupational physician they expect a comprehensive health assessment and recommendations delivered electronically. At the same time, work systems are changing in the 21st century. Although we often talk about the so-called employee market and the need to take care of it, on the other hand we have such phenomena as flexible forms of employment, which are convenient for the employer, but do not protect the employee, and this affects his health. On top of all this, for over a year and a half we have had a pandemic that has changed the work environment, adding issues related to protecting the employee from biological agents, remote working and all the aspects that go with it, and the adverse impact of the pandemic on employee health. The latter includes not only the direct consequences of COVID-19, but also the indirect effects that are already apparent in the form of excess deaths and increased mortality from various chronic diseases, reduced preventive diagnostic procedures, and a deterioration in the overall health of the worker.
All this means that the health care system has many tasks to fulfill in the near future, and the occupational health service, as one of the elements of this system, should approach its tasks with special care, as their implementation seems to be crucial for the public health system.
How does the job of the President of the Polish Society of Occupational Medicine look like in practice? What challenges does it involve?
In practice, I do not separate the tasks performed by PTMP and the institute’s work, because they have a common goal. It is, on the one hand, following the latest trends in our area of interest and, on the other hand, creating – together with our team – guidelines for preventive care of a worker, education of doctors, occupational medicine nurses and representatives of employers, most often occupational health and safety specialists. Many proposals are discussed with employers’ organizations and, above all, with the main decision-makers in the system – the Ministry of Health, the Chief Sanitary Inspector, the National Labour Inspectorate or the Health Insurance Institution.
What is the biggest challenge? I would like the occupational physician to be one of the key persons in the health care system – because of the preventive tasks he/she performs, and not only because of his/her statement about the lack of contraindications to work. It is necessary to convince everyone – some doctors who are used to a limited scope of activity, employers who sometimes only want to carry out obligatory examinations, and finally the employees themselves – that instead of being afraid and hiding their health condition from a preventive doctor, they should use this opportunity to learn as much as possible about their health. As our Finnish colleagues once summed it up, “the occupational health system works optimally when there is full cooperation between the occupational health physician and the employer, and the benefits of this cooperation are trilateral – because the most important thing in this system is the employee”.
Prof. Dr. Jolanta Walusiak-Skorupa – President of the Polish Society of Occupational Medicine
Specialist in occupational medicine and specialist in clinical toxicology, internist, expert in occupational health and occupational pathology. Long-term director of the Department of Occupational Diseases and Environmental Health, since 2020 Director of the Nofer Institute of Occupational Medicine.