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Under-recognition & under-reporting

of Work Related Ill-health: 2 

One response to this question is to decompose it into relevant sections, and then expand on various sub-sections. Some points are listed hereunder, but there may be others which you may wish to add, as well as providing detail and further examples for the points already listed: 

The Natural History and Causation of the Disease 

  • Some diseases such as lung cancer are more commonly caused by non-occupational factors such as tobacco smoking, and these non-occupational factors might be incriminated by doctors or patients even where work had an important part in causing the illness 
  • Some occupational diseases may follow exposure after a long interval e.g. mesothelioma may occur even 40 years after asbestos exposure. 
  • Knowledge, Skills and Attitude of the Worker. 

  • Workers may be be unaware of the links between work and health or 
  • may fear the consequences of reporting their suspicions 
  • or simply it might not be perceived as being worthwhile to pursue compensation, say under Social Security legislation, because of a threshold of disability (beyond simple causation) which must be certified before entitlement to financial benefits, or for other reasons. 
  • Knowledge, Skills and Attitude of the Employer. 

  • Employers may be be unaware of the links between work and health or 
  • may fear the consequences of reporting their suspicions 
  • Knowledge, Skills and Attitude of the Doctor or other Health Care Professionals. 

  • A substantial proportion of medical history taking in hospital wards or general practices in relation to Occupation and Health is grossly inadequate
  • Many doctors might not have the knowledge to permit them to associate ill-health with possible occupational exposures 
  • Doctors may thus lack the skills and/or time to investigate, report or otherwise act on their suspicions, or those of their patients. 
  • Governmental, and other Societal Factors. 

  • Registration of Death in the UK only requires notification of the last full time job. 
  • There is no automatic linkage in the UK between Health Services information about individuals and their employment ('National Insurance') information. 
  • Other factors... 
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    In an attempt to get better measures of work related ill-health, there have been a number of initiatives e.g. some of the disease categories, such as occupational asthma and dermatitis, have been the subject of intensive surveys with diagnoses made by relevant specialists. One such project was the SWORD scheme (Surveillance of Work Related and Occupational Lung Disease). These studies have tended to show a fair agreement between the medically diagnosed incidence and the self-reported prevalence of these conditions, and in some situations suggest that self-reporting may under-estimate some categories of ill-health caused by work.

    The most comprehensive of voluntary medically certified reporting schemes for measuring the incidence of work related ill health is The Health and Occupation Research Network - THOR (which incorporates SWORD, EPIDERM and other schemes).