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					    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主席兼圣玛丽大学职业健康与安全中心主任
           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。
                     Nunavut
                     鲁拉乌特地区
Yukon
    Northwestern
育空地区 Territories
           西北地区



 British                                       Prince
Columbia                              Quebec   Edward
不列颠哥伦Alberta
           Saskatchewan               魁北克省      Island
 比亚省 艾尔伯塔省 萨斯喀彻温省Manitoba
                   曼尼托巴省                       New Nova
                            Ontario          Brunswic
                                                  Scotia
                            安大略省               爱德华
                                                k
                                                 新斯科
                                             新布拉威克省
                                              王子岛
                                                     舍省
                                                 省
               The People                                                                 国民
   The Population 人                  口 加拿大人口统计                           Thousands 单位千
               persons (thousands)      2002               2003            2004            2005            2006

Canada                                   31,372.60        31,676.10       31,989.50       32,299.50       32,623.50
Newfoundland and Labrador纽芬兰省                    519.4            518.4           517.2            514            509.7
Prince Edward Island爱德华王子岛省                      136.9            137.3           137.9           138.2           138.5
Nova Scotia新斯科舍省                                 934.5            936.5            938            936.1           934.4
New Brunswick新布拉威克省                              750.3            751.2           752.1           751.5           749.2
Quebec魁北克省                                     7,445.70     7,494.70        7,548.60        7,597.80        7,651.50
Ontario安大略省                                12,102.00       12,262.60       12,416.70       12,558.70       12,687.00
Manitoba曼尼托巴省                                  1,155.60     1,161.90        1,170.50        1,174.10        1,177.80
Saskatchewan萨斯喀彻温省                               995.9            994.7           994.9            990            985.4
Alberta艾尔伯塔                                    3,116.30     3,161.40        3,207.00        3,277.60        3,375.80
British Columbia卑诗省                            4,115.40     4,155.40        4,203.30        4,257.80        4,310.50
Yukon Territory育空地区                                30.1            30.6            30.9            31.1            31.2
Northwest Territories西北地区                          41.5            42.2            42.8            42.6            41.9
Nunavut鲁拉乌特地区                                      28.7            29.2            29.6             30             30.8
Note: Population as of July 1. 2006
    The People                                     国民
• Canada’s Population is over 31.6 million people.
人口超过3160万
• 1.17 million people (4%) are Aboriginal Peoples:
   – First Nations (60%), Métis (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
• Canada’s 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
 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
  成的联邦体制: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 宪法中对市级政府的管理范围没有明确,只提
  到该级政府由省级政府负责
• There are about 4,000 municipal governments in
  Canada加拿大大约有4000个市政府
                                                             8
 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-仅限于管理当
  地事务


                                                                       9
         Economy                    加拿大的经济
•   the eight - largest trading nation • Natural Resources :
    世界第八大贸易国                              – Iron Ore
                                        –   Nickel
•   high-tech industrial society,
                                        –   Zinc
  Canada today closely                  –   Copper
• resembles the US 当今的加拿                –   Gold
  大是高新技术工业社会,和美国                        –   Lead
  十分相似
                                        –   Potash
                                        –   Silver
• advantages - natural resources,
  skilled labor force, and modern       –   Fish
  capital plant                         –   Timber
• 经济优势:自然资源、高技能的                        –   Wildlife
  劳工队伍和现代化的工厂                           –   Coal
                                        –   Petroleum
                                        –   Natural Gas
                                        –   Hydropower
Economy                    经济
                 GDP
                    1,062,951      1,183,900
          957,258
816,756




                                               GDP




1997
          2001
                    2005
                                2009
       The workforce 劳动力结构
Industry 行业              Number 人数

Goods Producing 商品生产     3,708,300
Agriculture 农业           321,900
Natural Resources 自然资源   310,700
Utilities 基础设施           149,900
Construction 建筑          1,178,000
Manufacturing 制造业        1,756,800
           The workforce劳动力结构
Industry   行业                 Number 人数    Industry 行业      Number
                                                             人数
Services 服务业                  13,086,400
Trade 贸易                      2,632,100    Accommodation/   1,034,500
                                           Food 酒店/食品
Transportation and            819,900      Other 其他         785,500
warehousing 交通和仓储
Finance, insurance, real      1,118,000    Public Admin     923,800
estate金融、保险和房地产                            公共管理
Professional专业技术人员            1,196,900
Business services商业服务         639,000
Education教育                   1,196,500
Health Care Social Services   1,955,100
公共卫生服务
          Occupational Injuries/diseases
               职业伤害/职业病
                                           Accepted Time-Loss Injuries     Fatalities
            Number of       Total Claims
            Workers Covered Reported       Total
                                                             % Time-Loss
r           (000s) (1)      统计的申报                            Injuries                    % Fatalities
            涉及到工人                 受理的误工 误工工伤比                                      死亡数
                            数字                                             Total
                                                                                         死亡率
                                  工伤    率
1996        10 758.6        947 776        377 885           39.9          703           0.07

1997        10 986.7        962 134        379 851           39.5          833           0.09

1998        11 259.4        970 224        375 360           38.7          798           0.08

1999        11 548.4        996 617        379 450           38.1          835           0.08

2000        11 781.8        1 050 226      392 502           37.4          882           0.08

2001        11 983.9        1 021 524      373 216           36.5          919           0.09

2002        12 148.8        997 691        359 174           36.0          934           0.09

2003        12 729.0        980 436        348 715           35.6          963           0.10

2004        12 708.2        977 118        340 502           34.8          928           0.09

2005        13 052.2        994 886        337 930           34.0          1 097         0.11

Average     11 895.7        989 863        366 459           37.0          889           0.09
            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人的同时大约有
              34人受伤误工
             900人受轻伤
            1500人侥幸脱险
         和20,000人次违法安全规定操作
      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高坠或摔倒-77人
•   Bodily reaction and exertion – 30 deaths
    身体反应及用力不当-30人
•   Fire or explosion – 19 deaths火灾或爆炸-19人
•   Assaults and violent acts – 21 deaths 施暴和其它攻击性暴力行为-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医疗保健(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)则属于联邦立法范围

• 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
  赔偿可以延续到退休以后
                      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控制类型
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 Controls 管理控制–CAN BE UNRELIABLE可能靠不住
         Scheduling/job rotation/rest periods日程安排/工作轮换/休息时间
         Work Practices工作实践
         Emergency preparedness应急准备
         Personal Hygiene个人卫生
Personal Protective Equipment (PPE) - CAN FAIL
                                             WITHOUT
                                             WARNING
个人防护用品-如果无警告可能无效
Public Health in Canada 加拿大的公共卫生
The role of the Public Health Agency of Canada is to:
          * Promote health;
          * Prevent and control chronic diseases and injuries;
          * Prevent and control infectious diseases;
          * Prepare for and respond to public health emergencies, and
          * Strengthen public health capacity in a manner
             consistent with a shared understanding of the
             determinants of health and of the common factors that
         maintain health or lead to disease and injury.
NO SPECIFIC ROLE IN OCCUPATIONAL HEALTH AND SAFETY
加拿大的公共卫生机构的职责是:
促进健康;
预防和控制慢性病和伤害;
预防和控制传染病;
公共卫生紧急事件应急准备和处理;
注重决定卫生的因素,增强对医疗保健,常见致病及工伤因素
的认识,以此加强加拿大的公共卫生能力;
政府并没有赋予卫生部门专门的职业卫生与安全的特别职能。
.

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