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					TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




Version                Date                          Author          Comments: TITLE
0                      05/11/03               Likar, M, MD           Specific socio-economic and public health aspects in zones
                                              Bauer, M. Mag.sci.     with highly polluting and high energy - intensive industrial
                                                                     units: professional diseases
1                      15/12/03               Likar, M, MD
                                              Bauer, M. Mag.sci.
2




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TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES



                                      [The content of the deliverable chapters]



            Specific socio-economic and public health aspects in zones with highly polluting
                   and high energy - intensive industrial units: professional diseases
                                             Likar M, MD and Bauer, M Mag sci.

Contents
1. Introduction
2. Global environmental change
3. Environment and health
4. Europe's environment and health
5. Environment and health in Slovenia
6. Development of occupational health
7. International issues in occupational health
8. Principal tasks of occupational health
9. Occupational health in clinical praxis
10. Occupation and the New Public Health
11. Summary
    References
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




1. Introduction

Contamination of the environment by biological, chemical, physical or other diseases – causing agents in the external environment and
the workplace are major public health and political concerns as we are entering 21st century. Public consciousness regarding these
issues has increased during the past several decades. Environmental concern has become an important part of accepted public
philosophy in a number of developed countries. In developing countries the efforts to expand economically and struggling with severe
problems of population growth and basic services have a high priority. In a number of eastern European countries industrialization has
contributed to degradation of environment. The observations are not new as this also occurred in other today developed countries
during their industrial development and urbanization.

There is a growing concern about the links between the environment and health. Worldwide one quarter to one third of the burden of
disease appears to be attributable to environmental factors. Vulnerability and exposure, however, differ markedly between different
groups and areas, with children and the elderly being particularly at risk.

There is reasonable understanding of cause and effect relationship between water, air pollution and human health. However the health
consequences of other environmental factors and exposures such as those resulting from climate and chemicals in the environment, are
a result of complex interactions between the environment and humans that that far less understood? For some chemicals, such as
endocrine disrupting substances, the effects on humans are particularly difficult to unravel but the impacts on wildlife have been
substantial, with implications to human health. Other chemicals in the environment, the disposal of wastes and noise continue to cause
worry.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




2. Global environmental change

In 1985 the European region of WHO issued consensus statement on health targets for the year 2000. Some of them are listed below
and represent a broad social commitment to stop environmental degradation.

Global environmental challenges for the 21st century

l. Population growth;
2. Economic growth:
3. Food production and distribution;
4. Environment and health in Slovenia;
5. Energy and resource depletion;
6. Soil erosion/desertification;
7. Deforestation;
8. Shortages of water supply;
9. Air pollution;
10. Chemical /toxic wastes;
11. War armament /terrorism costs;
12. Ozone depletion;
13. Global warming;
14. Social, economic and political inequalities nationally;
15. Inequalities between industrial and non - industrial countries.

WHO report 1992.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




The effects of global environmental changes cannot be predicted with certainty, as they require an international response rather than
the local efforts alone. Poverty, low level of education, and rapid population growth in the poorest countries with limited food
production potential are an incredible contrast to high level of consumption and energy used and low rates of population growth in the
industrialized countries.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




3. Environment and health

The concept of environmental health has been widened in recent decades by the spectrum of global changes to the environment as a
result of man – made environmental pollution, and natural events. The greenhouse effect is the warming of the global environment and
occurs partly as a result of the thinning of the ozone layer of the stratosphere. Disposal of toxic and radiological waste constitutes
difficult public health challenges in many countries. Land degradation, loss of topsoil, deforestation, groundwater depletion, and
acidification of water and soil are all challenges in environmental health for the new 21st century.

In the developed countries the 10 most frequent work-related diseases and injuries are: l lung diseases; 2. musculoskeletal injuries; 3.
cancers; 4. severe trauma; 5. cardiovascular disorders; 6. disorders of reproduction; 7. neurotoxic disorders; 8. noise related hearing
loss; 9.dermatologic conditions; 10. psychological strain and boredom.

The idea that health transcends geographic, political, economic and natural barriers is gaining ever-wider support. It is also obvious
that developing world would never achieve economic and political stability unless the health of its people improved. If not addressed,
the health problems of the developing world would pose a global threat.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




4. Europe , s environment and health

European environment agency recently (2003) published the third assessment of the state of the environment at the pan - European
level. The second report published in 1998 made it clear that the policy measures that had been taken up to the mid-1990s had not yet
produced a significant improvement in the state of the environment overall. Most progress on environment improvement continues to
come from actions under well-established international conventions and legislation, or as a result of economic recession and
restructuring. These gains will be lost again if economic growth continues to be based on traditional, environmental damaging
activities. This is a particular risk for the EU accession countries and countries of eastern Europe, Caucasus and central Asia to which
large amounts of manufacturing industry have been transferred from western Europe and elsewhere in the world.

The accession countries face the major challenge of managing with limited resources, and again competing economic, social and
environmental priorities, the transitions to EU membership, sectoral integration and sustainable development at the same time. The
eastern European countries have a much lower GDP per capita than elsewhere in Europe, but arguably and competing calls on limited
resources yet have relatively limited access to the capital markets for finance to improve the social and economic welfare.

Facts and figures illustrate some of the main problems:

- occupational exposure to certain pesticides may increase the risk of Parkinson's disease (or Parkinsonism) by 15 to 2o %;
- worldwide, it has been estimated that 3 million people die prematurely because of air pollution;
- in Europe asthma affects one child in seven. Allergies, notably asthma, have continued to increase dramatically over the past 30
years;
- environmental tobacco smoke increases the risk of lung cancers in non-smokers by 20 to 30 %;
- some 10 million people in Europe are exposed to environmental noise that can result in hearing loss;
- in some European countries testicular cancer is increasing in prevalence and an increasing number of young men face a low sperm
counts, but there is so far no clear evidence that environmental exposure to these chemicals affects male reproductive health in
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES



humans.

Many of the environmental issues are complex and will require recognition and action by a wider range of players than was necessary
for sulphur emissions. Examples include climatic change, biodiversity loss and soil degradation. The start of the Kyoto protocol target
period for limiting gas emissions is now five years away, the target dates for significantly halting biodiversity loss and to prevent soil
degradation have yet to be agreed. New approaches such as the precautionary principle and the ECU's proposals on impact assessment
should be considered further to help reduce the lead times between early warning, scientific and policy action and the resulting
improvement.

Recommendations for future development in order to improve the environmental monitoring capacities in Europe and allow for a real
pan - European monitoring and reporting process are among others to :

- develop indicators which would need to be widely agreed;
- focus on the new information gathering on key issues and perspectives;
- maintain the framework for cooperation on environmental reporting;
- ensure an appropriate level of investment in basic environmental monitoring infrastructure;
- encourage international collaboration to enhance cross border and international compatibility of information;
- strive towards the effective implementation of relevant legal instruments such as Aarchus convention and its new protocol on
pollutant release and transfer register.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




5. Environment and health in Slovenia

What is the today's situation in Slovenia? The government has recently issued a preliminary report on the state of environment in
Slovenia for 2002. The report has been prepared in accordance with the law for the preservation of the environment. The content and
the structure of the report follow the system of European Union for its report on Environmental Outlook for a period of three years. A
shorter report is published yearly with Environmental Signals for the future prospects. We will attempt to summarize the main changes
in the environment for Slovenia.

Water. The northwestern part of Slovenia has an ample atmospheric rainfall and snowfall but the eastern part suffers in the summer
from severe droughts. Potentially each inhabitant of Slovenia can use an average of 16 000 m 3 of water each year what is much higher
than in European Union. Underground water is disproportionately divided, as some water is lost in territories with karst. Superficial
waters have been classified as to the pollution and the majority belong to class II - III (ARSO 2002). Atrazin has become the main
pollutant for the underground water. Limits for all pesticides have reached 0,5 ug/l in the first few years of 21 st century.

Air. The emission for S0 2 has been reduced in the last twenty years for 59 %, the emissions of N0x are increasing (the main source
being motor vehicles), the emissions of lead have been reduced as from 2001 the gasoline with lead is prohibited. The emissions of
CO2, CH 4, N 2O, CF4,C 2 F6 HFC, SF6 have reached a minimum in 1991 and 1992 and later started to increase from unknown reasons.

Soil. The main problem in Slovenia is the loss of fertile land. In the period between 1993 -1998 the land used for new buildings and
roads has increased for over 4 000, and woods for nearly 75 000 hectares. In contrast the land used for agriculture has decreased for
approximately 80 000 hectares.

Noise. The noise in natural and populated settings is increasing. The main source of the noise is the transport noise in urban areas.
Ambiental sound levels are steadily increasing as a result of the growing numbers of road trips, kilometers driven in motor vehicles
and higher speeds of motor vehicles.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES



Radioactivity. The radon concentrations have been measured in some apartment houses and in some of the schools. In the majority of
buildings (over 70 %) the concentrations of radon were >100 Bq/ m 3. Only in 2% the values of radon were higher than 800 Bq/ m3.
Some areas in the Alps were contaminated with radioactive 137Cs immediately after Chernobyl disaster but after ten years the surface
radioactivity diminished as 137Cs were partly washed by the rainfall to lower zones of the earth.

It is obvious that Slovenia is facing in general identical problems as the central European countries. Some changes in the environment
have been expected.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




6. Development of occupational health

Occupational health is one of the oldest sectors of public health, dating back to Roman times. Ramazzini began documentation of
occupational diseases in 1700.

                         Ramazzini on silicosis,1700

“ We must not underestimate the maladies that attack stonecutters, sculptors, quarrymen and other such workers. When they hew and
cut marble underground or chisel it to make statues and other objects, they often breathe in the rough, sharp, jagged splinters that
glance off, hence they are usually troubled with cough, and some contract asthmatic affections and become consumptive.”

RamazziniB.De Morbis Artificium Diatriba, 1700, as quoted in Hunter D, 1969.

Historic examples of work related health hazards and diseases include scurvy among sailors, cancer of the scrotum in
chimneysweepers, black lung in coal miners, and mercury poisoning in hat makers. Byssinosis in cotton mill workers and
mesothelioma in asbestos workers. The list is long and extends to musculoskeletal injuries and hepatitis B in hospital workers, spinal
disorders in typists and medial neuritis in computer workers (carpal tunnel syndrome). Recently Republic of Slovenia has accepted a
register of occupational diseases. The register divides occupational diseases in three groups: 1.Occupational diseases caused by
chemical, physical, and biologic factors, 2.occupational diseases affecting specific body systems and 3.occupational disease caused by
cancerogenic substances, preparations and energy.

Government responsibility for setting standards, monitoring, intervention and regulating compensation grew slowly over past century.
Case reports, epidemiological studies, and advocacy regarding the effects of lead, asbestos, vinyl chloride, silica, an dust fibers led to
steps to reduce the hazards to workers and provided the professional support for legislative initiatives. International labor organization
(IL0), and other international organizations promoted development of this field.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




Thomas Legge ,s axioms on worker , s health and modern equivalent

Legge, s axioms                                   Modern version

Unless and until the employer has done everything         Don, t blame the victim; the health of
workman can do nothing.                                   workers is responsibility of the
                                                          management.
Practically all industrial lead poisoning is due to       If you stop the exposure you stop the
inhalation of dust and fumes.                             poison.
External influences depend on the will of the             Educate workers about risk reduction.
workers to use them (respirators,goggles and
washing conveniences ).
Modified from Hunter D, 1969.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




7. International issues in occupational health

Occupational health has become an international issue as the global economy transfers manufacturing from one country to another
with great speed and ease. This is often motivated by lower wages, but also by lower occupational and environmental regularity
controls, and less stringent or nonexistent legal protection against toxic exposures and child labor in developing countries. Transfer of
occupational hazards from industrialized to non-industrialized countries has become an issue in international cooperation and trade
agreements. Developing countries have stricter environmental regulations and worker organizations than developing countries that are
trying to open job-producing industry at any price.

In the global economy occupational health issues are of a vital importance. It is often said that in the developed country workers health
benefits cost more than the steel to make a car. As a result there is a growing trend to transfer technology from industrial to developing
countries or areas within the country, to use child labor, to overuse pesticides, to inadequate health and safety measures in developing
countries. Experiences in the past have shown benefits from promoting workers health through improved nutritional monitoring of
canteens and cafeterias, antismoking activities, and physical fitness programs. The management interest in a healthier work force to
restrict rising health care costs has become a part of the modern corporate culture. The primary responsibility however, legally and
morally lies with management, in addition to protecting the workers by monitoring risks, providing a safe environment and care at the
time of injury.

Government responsibilities are principally legislative: substitute or ban and define legal responsibility (civil and criminal) and
compensation, enforce standards for toxic emissions and control, test environment and workers, label hazardous materials, monitor
health of workers.

Management is responsible among other tasks to substitute less dangerous materials, to monitor general ventilation and health of
workers and good manufacturing practices.

Occupational injuries and illnesses are social as well as engineering and management concern. Compensation, litigation, class action
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES



suits and union action are all associated with increasing awareness of toxic and trauma effects on workers. The field is made more
complex because some occupational illness may occur long after the exposure: silicosis, asbestosis-related mesothelioma, and
asbestosis may develop after a long latency of up to 20 – 30 years following exposure. Follow - up of exposed workers may be
difficult, and issues such as compensation may also be complicated.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




8. Principal tasks of occupational health

Citing all the tasks would be nonproductive therefore we are limiting the list to the following:

- anticipation of preventive measures as facilities are planned;
- surveillance and monitoring occupational disease and injury;
- right-to-know for all concerned;
- epidemiologic analysis;
- exposure reduction to established limits;
- substituting toxic with less toxic substances;
- promoting awareness at government, management, worker and consumer levels;
- compensating for illness and loss of life;
- recognizing that worker participation in health and safety is of mutual benefit.

Toxicity at the work place and in the environment

Toxic substances are widely used in industry, not only in manufacturing but also in services and they constitute a major concern of
occupational and environmental health. Extensive information is regularly published on toxic substances by World Health
Organization. Much of the interest of occupational health has been on detection, prevention and reduction of exposure to toxic
materials at the workplace, but more recently also on contamination of environment. The knowledge of sources and effects of toxins in
occupational settings is extensive. Factors such as duration and extent of exposure, age, gender, fitness and additional risk factors such
as smoking or alcohol abuse affect the toxicity of an agent. Environmental factors include temperature and air flow and physical and
chemical properties of the toxic agent. Examples of toxic substances and the history of control measures to eliminate or minimize their
effects illustrate the complexity of the problem.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




               Factors affecting an aerosol, s toxicity

Physical properties       Physical state (particles, mist or gas, solubility)
Chemical properties       Acidity, alkalinity, fibrogenicity, antigenicity
Individual susceptibility Immunology status (atopy,HLA type)
Modified from Morgan WRC et al, 1984.


Silica. Silicosis is one of the oldest known occupational diseases, affecting miners in particular. In ancient Greece and Rome it was
described as “fatal dust“. Silica occurs in minerals and rocks throughout the world as fee silica or combined in quartz, flint or
sandstone. Workers are exposed to inhalation of silica dust in mining, tunneling, stone cutting, quarrying, iron and steel works, brick
making, polishing of stone, glass, metal and many other industries.

Silicosis is a condition of massive fibrosis of the lungs caused by a prolonged inhalation of silica dust. It is classified as
pneumoconiosis, a general inflammatory fibrotic lung condition. Silicosis can progress from mild symptoms of shortness of breath to
radiological evidence of pulmonary consolidation and concomitant tuberculosis. Silica has not been proved to be carcinogenic. The
problem remains difficult to prevent and there is still a controversy as to legally enforceable standards and compensation for workers
with silicosis.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




      Sources of emissions of particulate matter

Sources                        % of the total emission

Industrial processes                 38
Stationary burning of fuels          25
Transport                            20
Other                                17
EPA, 1984.

Anthracosis (coal worker's pneumoconiosis) is a diffuse nodular deposition of dust in the lungs as a result of a long term exposure to
bituminous or anthracite coal dust in coal mining. In simple coal worker s pneumoconiosis, coal dust is widely distributed throughout
the lungs leading to the development of coal “macules“ around the bronchioles. Later on a mild dilatation known as focal dust
emphysema also occurs; however it does not extend to the alveoli and is not associated with airflow obstruction. However, each year
about 1- 2 % of miners with simple anthracosis go on to develop progressive massive fibrosis, which can sometimes develop after the
exposure has ceased, or it may progress without further exposure.

Simple anthracosis is not associated with respiratory symptoms. If present, the airway obstruction is due to either coincidental
emphysema from smoking, industrial bronchitis, or to a progressive massive fibrosis. The diagnosis depends on a history of suitable
exposure, usually at least 10 years underground, and the characteristic x-ray pattern of small rounded opacities.

Occupational Asthma. Numerous allergenic and non-allergenic materials in the occupational environment are recognized causes of a
reversible airway obstruction. Examples include castor bean, grain, proteolytic enzymes used in detergent manufacturing, beer-and
leathermaking industries, flax, formalin, epoxy resins and hemp. The list is continually growing.
TRAC 2002 – RO / 02 / B / F / PP / 141 061
Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




Dust suppression is essential in industries where known allergens or bronchoconstrictors have been identified. However elimination of
all instances of sensitization and clinical disease may not be possible. A highly susceptible individual must be removed from a setting
known to produce asthmatic symptoms.

Byssinosis. A condition known also as “cotton dust“ has been a common cause of chronic obstructive lung disease among the long –
term workers in textile industries in some developed countries. Byssinosis is seen almost entirely in workers who come into contact
with cotton trash (i.e. unprocessed, unpurified cotton). Evidence suggests that some material in the cotton bract leads to development
of bronchoconstriction. Chest tightness develops on the first day after returning to work following a weekend of vacation. Many
subjects who complain of chest tightness also demonstrate a drop in ventilatory capacity over the first week of shift.

The promulgation of new standards for the ventilation and filtration and machinery used has reduced its occurrence. Replacement of
old equipment with modern and automated machines gave an improved production speed, more effective use of the floor space,
reduced labor input, and a higher quality product, along with lower dust levels. Economic crisis in textile industry in Slovenia today is
opening questions as to its prospects in the future. The costs anticipated for the renovation is unattainable.

Asbestos. Asbestos related diseases as an occupational public health problem surpassed all the anticipations after the rapid increase of
the use of asbestos during World War In Slovenia it left a gruesome legacy in Anhovo with hundreds of workers affected. Inhalation
of asbestos dust over a period of years results in the development of a serious type of fibrosis of the lung. The first reports of an
association between asbestos and lung cancer began to appear in the 1930s. Later a synergistic relationship between asbestos exposure
and cigarette smoking was scientifically documented. Today exposure to asbestos is accepted as the cause of mesothelioma, a highly
malignant cancer of the chest or abdominal lining. The latency period may be 20 –30 years or more and the risk of the disease is
related to the extent of exposure.
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Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




Occupational diseases caused by asbestos

Asbestosis, diffuse interstitial lung fibrosis
Diseases of the pleura
Plaques in the parietal pleura
Diffuse thickening of the pleura
Benign pleural effusion
Lung cancer
Malignant mesothelioma of the pleura or the peritoneal lining
Slovenian regulation for asbestos, 1997.

The maximal concentrations of asbestos in the air have been given by a number of agencies. According to OSHA at present 1 fiber of
asbestos in ml3 for an 8 hours exposition should be the limit. In the future this limit should be reduced to 0,5 and 0,2 fibers in ml 3.

The exposure may occur in asbestos - cement production, shipyard workers, garage workers exposed to brake lining, plumbers, and
construction workers using asbestos - based products. In the 1990 there is still some concern that asbestos products manufactured in
developing countries are being imported to the developed countries. Asbestosis is preventable primarily by effective dust suppression
in the work environment. Further industrial hygiene advances are likely essentially to eliminate it. Scientific community has been
impressed by the results of a study in United States where a concomitant effect of asbestos and smoking have been identified as causes
of lung cancer.
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Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




Lung cancer hazard for smokers and nonsmokers exposed to asbestos fibers

Group                             Expected incidence/ 100 000 population
                           Exposure to 0,0004 fibers/ml 3 Exposure to 0,002 fibers 3ml

Men smokers                            19,2                            146
Women smokers                          10,5                            52,4
Men nonsmokers                         2,7                             13,2
Women nonsmokers                       1,4                             6,8
Mesothelioma (all groups )             15,6                            78
Natl Res Council (1984).

In 1999, the European Union effectively banned the use of asbestos products. There are still open questions as to what to do with
public buildings such as schools, hospitals, and apartment houses in which asbestos has been extensively used for the roof tiles and
other construction materials. In Slovenia asbestos was banned in 1996. To enable the transition from the asbestos to the nonasbestos
manufacturing a special fund has been approved by the legislative body in the budgets for 1997 and 1998 for the acquisition of new
technology and equipment. In the regulation as the asbestos are listed chrysotile, amosit, actinolit, anthophylit, crocidolit and tremolit.
All the products containing asbestos must be clearly marked that they can be dangerous.

Lead. Lead is used with thousands of applications because of its plasticity and softness. Lead poisoning has been a worker s hazard
since ancient times. Lead enters the body though inhalation and ingestion. It is causing intestinal colics, encephalopathy, delirium and
even coma in its acute form. Chronic forms of plumbism or lead poisoning can be seen as mental dullness, headache, memory loss,
neurological effects (wriest drop), anemia and a blue line on the gums.
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Source: UL
Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




Effect of different concentrations of lead in the blood on health

Effects on health                           ug/100 ml

Concentrations dangerous for the fetus              10 –15
Changes in the blood enzymes                        15 – 20
Lower IQ in children                                > 25
Anemia in adults                                    50
Anemia in children                                  40
Brain damages ( irreparable )                       100
Likar M, 1998.

Lead toxicity has been a traditional health problem of glaziers and potters: lead is used in the manufacturing process. We experienced
in Slovenia lead poisonings with traditionally prepared kitchen pottery in the northeastern region. Wines and rum stored in lead
containers or in pewter utensils were known to be associated with the “dry grips“ in the seventeenth and eighteenth centuries.

Lead toxicity and excess exposure in the workplace remain a problem in the most developed countries. The major toxic effects
induced by lead are hypertension, neuropathy, carcinogenesis, and reproductive damage for men and abortion for women. Studies
have revealed a widespread exposure above permissible limits in many countries. They include traditionally high exposure industries
such as primary and secondary lead smelting, battery and pigment manufacturers, brass/bronze foundries and in no less than 50 other
industries. In 1997 the CDC adopted a standard of <10 ug/dl, a level at which a negative effect of cognitive development is reported.
Despite major improvements 1,7 million children aged 1 – 5 years in the United States still have blood lead levels above 10 ug/dl.
Reduction in lead exposure has been achieved in United States by a combination of legislation and professional and social pressures
resulting in the adoption of lead – free gasoline, removal of lead from paints, and its substitution in many industrial practices.
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Awareness and active lobbying by public health minded groups has had a beneficial effect in reducing lead toxicity in the community
and workplace.


Vinyl chloride.

Vinyl chloride is a flammable gas with a faintly sweet odor. It is an important component of the chemical industry because of its
flame-retardant properties, low cost and many end product uses. It is also a carcinogen causing liver, brain and lung cancer, as well as
spontaneous abortion. Vinyl chlorides are dangerous primarily when inhaled or ingested. Vinyl chloride usage increased since the
1930s and more dramatically after the end of World War II until the 1970s. In the 1980s, polyvinyl chloride (PVC) was shown to be
associated with Raynaud's phenomenon and later with malignancies, including hemangiosarcoma of the liver. OSHA established the
carcinogenicity of PVC as a result of the review of all the evidence in 1974. Scientists concluded that that there was no safe level of
exposure to vinyl chlorides. OSHA adopted 1 part per million as the maximum possible dose. While the risk assessment issues are still
controversial, reduction of exposure to workplace carcinogens such as vinyl chloride is the accepted standard of modern occupational
health.

                       Standards for vinyl chloride

Agency            Location       Level                Observations

FDA               food         5 –50 PPM          Monomers in polymers in wrappings
OSHA        air in workplace    1 PPM             for an eight hours shift
EPA            inside air      10 PPM             Limitsemission in the environment
EPA               water         2 ug/l            from 1988 to all systems for drinking
                                                  water( 8 months in a year )
NIOSH      air in workplace       0               because of its carcinogenicity
Likar M, 1998.
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Despite an opposition of the industry to this reduction, full compliance was achieved in United States within 18 months by improving
ventilation, reducing leaks, modifying reactor designs and chemical pathways, and using greater automation of the process. Even more
effective was a major improvement in the production of PVC using less vinyl chloride. The costs to industry of reducing exposure
levels were less than 25 % of anticipated costs because of unanticipated innovations in the production process.

In Slovenia we have a claiming a “story of success“, producing seat covers for various car makes and types. They are exporting sat
covers to a number of countries. We hope seat covers containing vinyl chloride will not change the story of success to a tragedy.

Agent orange. Agent orange is a herbicide used widely by the US armed forces in Vietnam War to defoliate large areas of that
country. This agent includes dioxin and is carcinogenic. Dioxin is the most toxic substance man has ever produced. It can be compared
only to botulinum toxin. High levels of dioxin have been found in breast milk, adipose tissue in blood of the Vietnamese population.
Even though sampling has not been systematic, studies at the beginning of 1990s show that high levels of dioxinlike contaminants are
seen in blood samples of the Vietnamese population exposed to Agent Orange during the war. The explosion in Italian town of Sevese
in 1976 and dioxin in toxic wastes in Times Beach in the state of Missouri have been warning signals for the future. Additional studies
are necessary to establish the effects of dioxin such as increased cases of cancer or birth defects. However, court and compensation
decisions have been made in favor of veterans exposed to Agent Orange despite inconclusive epidemiological evidence of its ill
effects on health. In Slovenia it was discovered that a factory producing batteries and other electrical appliances has dumped a number
of its faulty products near a river in the southeaster part without proper precautions. The place was investigated but no dangerous
substances have been discovered.

Workplace violence. Violence is endemic in many societies today and affects many organizations and institutions. Violence has
become a major cause of fatal injuries in then workplace. Violence in the health setting has a long history, with the first documented
cases in the early 1850s when patients fatally assaulted psychiatrists in metal health facilities. Since then there have been many reports
of assaults, hostage taking, rapes robbery, and other violent acts in the health care and community settings. During the 1990s,
homicide became a leading occupational cause of death for females and the second leading cause, after motor vehicle crashes, for men
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Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES



in the United States.

Homicide at work has only recently been addressed as an occupational hazard, and research in this area is in its infancy. There are no
known universal standards to protect workers from work–related violence, and no policy has been created to protect workers. It is
becoming increasingly obvious that preventing violence in the workplace is essential. Management and workers organization as well
as health systems share responsibility. Prevention of drug, alcohol, and sexual abuse and harassment at work are vital to prevent
workplace violence
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9. Occupational health in clinical practice
The clinical physician should consider the patient's occupation and previous history. The inclusion of questions related to past
employment may be crucial in investigation of the disease. The health care provider should be aware of industries in the community
and their potential hazards. The clinician is particularly important because he or she may be the first to see index cases of toxicity.
This requires simple observations.

 Factors observation during walk through inspection of work sites

Marker                   Observations of conditions, safety arrangements, and effects on workers
                         health

Sensory observation      Eye irritation, poor lighting, noise levels, metalic taste in air, smell, visible
                         fumes, exhaust, temperature (heat/cold )
Safety devices           Use of hard helmets, welding masks, safety shoes and clothing ,ear,
                         eyes and face protectors, first aid facilities ,respirators
Storage                  Hazardous chemical substances closet, unlabelled bottles, containers
Toilets                  Cleanliness, fixtures ,soap, toilet paper, waste disposal tins
Worker hygiene           Changing place; showers ;lockers ;clothing change
Eating place             Separate tables; cleanliness; washup facilities
Worker's complaint       Headache, fatigue, dizziness, nausea, breatlessness, skin problems
Worker morale            Worker morale is reflected in turnover and absenteeism
Hazard control           Labeling ,process recording, periodic screening
Cleanliness              Removal of waste products, oil or chemicals on floors, tables
Vents, fans              Exhaust of fumes, odors,dust
Worker-management        Consultations and sharing responsibility to reduce hazards
cooperation
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Risk assessment. Identifying and quantifying occupational and environmental risks is difficult, but clinical and public health
observations, supplemented by epidemiological analysis, can identify toxic or carcinogenic factors that can be reduced or eliminated
by public health intervention. High levels of awareness from environmental or occupational exposures can help identify index cases.
Similarly, epidemiological small area analysis can identify populations at high risk for professional disease, giving localization for
further investigation.

Establishment of dose – response relationship requires well-conducted observational studies. In some cases preventable risks can
remain undetected but still sufficient to warrant compensation. A known case was febrile illness in veterans suffering effects attributed
to toxic exposures in the Gulf War in 1991. Regulatory and compensation decisions must often be made in the face of inconclusive
and contradictory conclusions. The topic remains one of the controversy and contradiction with cases providing precedents that affect
future court and regulatory decisions. The contribution of epidemiology to resolve such issues remains controversial.

Preventing disasters in the workplace

Disasters in a workplace are only noted if media become interested to expose some journalistic aspects. In fact even small accidents
without a notorious publicity can affect workers and the surrounding community. The major responsibility for prevention major
disasters is with management but the workers and society also have roles in the process. Prevention involves education of workers and
management, and constant monitoring. Government has the overall responsibility to provide legislative documents and enforce
standards, safe conditions of work, and control of toxic materials and ensure a fair compensation for injury or disease.
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Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
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 Markers and indicators of disaster management capabilities

Markers                                     Indicators

Administrative           Occupational health disaster plan, access to first aid, frequent disaster
                         drills, close supervision of subcontractors
Investigation            Thorough investigation of complains ,leaks and spills
Monitoring workers       Monitor worker injuries ,illnesses, toxic levels, use of safety measures
Technological            Fail- safe monitoring devices, real time monitoring ,minimal on site
                         storage ,automatic alarm/shutdown devices ,local         incineration/
                         neutralization
Transportation           Vehicle and containers standards ,driver training , fatigue, alcohol
                         and drug abuse, traffic offenses
Information              Worker information, right to know of workers and community,
                         community disaster plan
Richter et al, 1992.

The simple qualitative observations listed above can provide a useful picture of the disaster management capacity of a work site. The
principle of “good worksite practice” is a parallel to good manufacturing practices required by food and drug authority. It is based on
the concept that current standards of acceptable safety involve standards of facilities, staffing, and operational criteria.
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Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




10. Occupation and the new public health

Social class, often defined by occupation and education, is a key determinant of then health status. A population of unskilled workers
has higher rate of coronary heart disease, strokes, and cancer, and their children have much higher rates of mortality and morbidity
than the children of higher skilled workers, or business and professional persons do. The worker who has little say in determining his
or her activities may be subject to a higher stress on the job, especially if on the production line, and with lower wages. The main
factors responsible for an increasing vulnerability of men especially to a variety of life threatening conditions, including suicide,
alcoholism, violence, cardiovascular disease and others are known. The phenomenon of downsizing, or reducing the work force,
affects production workers but also reaches middle and upper management levels, so that the danger of losing a position at an age
when finding new employment is unlikely, may become a severe health hazard. Awareness and responsiveness to a variety of risks
associated with employment and occupation is part of health responsibility. Prevention may reduce in some situation occupational
diseases, screening for case finding and clinical management in others.
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Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




11. Summary

Environmental health and occupational health are increasingly important elements of the New public health along with concern for the
ecology of the world. The problems of this field have become more complex in the past several decades and some other global
ecological concerns emerged. Global warming has been noted, hazards associated with nuclear accidents after Chernobyl, and
numerous chemical disasters in all parts of the world. Some environmental issues have become massive such as desertification,
destruction of forests and new air pollution. The gap between developed and underdeveloped countries started to increase in spite of
tremendous and obvious improvements of life in some parts. Societal issues obtained new characteristics. The economic growth has
suddenly shown two faces, one of the satisfied consumerism and the other of extreme poverty and poor health. We are now living in a
world in which one billion people have a life expectancy of an average of eighty years and five billion are dying at an average age of
40 to 50. The poorer countries are in vain trying to cope with rapidly increasing number of populations and increasing expectations
for a better and longer life.

Is the prospect bleak? Are we experiencing the effects of Pandora's box being open suddenly and nobody has been prepared for the
consequences of the urbanization and industrialization to the environment? Important progress has been made in many fields such as
management of water, waste products, and toxic wastes, in air quality standards especially since 1970s. Workers safety and health have
improved over the past century in the industrial countries. But how these improvements have been achieved? It is obvious that some of
the gains are at the cost of moving hazardous materials and working conditions to newly industrializing or developing countries in the
global economy. Even a well-organized health sector is not capable of dealing with the problems of environment and occupational
health. The support of public opinion is not enough; it is requiring the cooperation of many levels of government 's agencies. The new
public health can unite the efforts of professionals and politicians as it is used to epidemiological provide the necessary information as
to the mortality, morbidity, or physiological change that may occur as a result of environmental damages. It can also be expected that
improvements of technology will contribute to provide standards for a cleaner, safer and more pleasant environment.

The New Public Health includes the health issues of the environment and occupational health, but widens the field to clinical services
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Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
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for the individuals and communities. For a society there are choices to be made in creating a less toxic and hazardous environment.
Choices between private and public transport, between jobs in industries with toxic emissions, or between producing energy from
traditional fuels, nuclear or other sources such as using windmills or local hydroelectric power stations. The price of industrialization
over the twenties century has reached unacceptable and insurmountable levels even for the most developed countries and more so for
the countries in development. The gross pollution will have to be reduced to prevent natural and man made disasters that may involve
conventional explosives or biological, chemical, and even nuclear methods of destruction. The investments in a healthier environment
have become a necessity, and attained in never before envisaged proportions.

The government of Republic of Slovenia has accepted recently a ten years plan to determine the environmental signals. The plan has
been divided into several chapters.
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Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
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The situation today and the changes in the environment

Water                                                               1997 – 2001
Air                                                                 1998 – 2001
Ozon and climatic changes                                           1992 – 2000
Soil                                                                1995 – 2000
Nature and biodiversity                                             1992 – 2000
Waste                                                               1995 – 2001
Integration of the policy and the protection of natural resources
Agriculture                                                         2001
The use of substances for the protection of vegetation              1992 – 2001
The use of mineral fertilizers                                      1900 – 2000
Power supply
The use of the final power                                          1990 – 1999
The production of electric power from renewable sources             1990 – 1999
Transport
The average age of the vehicles                                     1995 – 2000
The cargo and the freight transport                                 1995 – 2001
Health of the population
The quality of the drinking water                                   1999 – 2001
The quality of the recreational waters                              1996 – 2001
Financing the protection of natural resources
Environmental taxes and other sources                               1999 – 2001
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Title: SPECIFIC SOCIO-ECONOMIC AND PUBLIC HEALTH ASPECTS IN ZONES WITH HIGHLY POLLUTING AND HIGH ENERGY - INTENSIVE INDUSTRIAL
UNITS: PROFESSIONAL DISEASES




References

Environmental protection agency, 1987.
Hunter D.1969.The diseases of occupation .4th ed. London.
Likar M.1998.Vodnik po onesnaževalcih okolja. ZSIS.
Mc Innes G.2003.Europe's environment the third assessment. European Environment agency. Copenhagen 2003.
National research council.1984. Lead in the human environment. Washington, Acad Press.
Regulation for asbestos, Slovenia, 1997.
Richter ED et al. 1992. Recognition and use of sentinel markers in preventing industrial disasters. Prehospital and disaster medicine.
Tulchinsky TH and E Varavikova. 2000.The new public health. An introduction to the 21st century. Acad Press.
Vlada republike Slovenije.2003.Okolje v Sloveniji. Predlog poročila o stanju okolja 2002.
WHO report 1992? “0ur planet our health “.

				
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