Sick because of work: when work doesn't pay and prevention fails

Every year 4,000 Dutch people die as a result of their work, a large proportion of these cases are due to hazardous substance exposure. This must change, which is why the government wants no one to die from poor working conditions by 2040. How can we prevent work-related illnesses due to exposures? And are such work-related illnesses adequately recognized and acknowledged? This was discussed in the lecture on work-related illness organized by De Nieuwe Utrechtse School, Van Hier Naar [...] and Exposome-NL.

The impact of your work environment on your health

A healthy work environment is important because a large proportion of your time is spent at work. Some occupations involve specific health risks. Workers exposed to asbestos or the mineral silica, found  in mining and glass production, are more likely to develop lung cancer for example "As an epidemiologist I research the links between exposures and diseases," says Dr. Susan Peters, associate professor at Utrecht University's Institute for Risk Assessment Sciences. Peters maps the exposome all environmental factors to which humans are exposed. "The exposome is difficult to measure, it varies over time and there is no method with which all the factors in your environment can be measured at once." Peters and colleagues are nonetheless rising to this challenge, and will employ innovative methods within the LEXCES partnership by for example mapping chemical exposure of workers at chemical companies. "Through this project we can identify who is exposed to certain substances and who may become ill," says Peters. Based on this information, the amount of exposure that leads to the development of illnesses can be examined, and permissible standards adjusted accordingly.

In welding training, the subject of 'safe welding' is an elective; that has to change

Prevention is better than cure

Simply adjusting the standard will not solve the problem. "Start with education," argues Dr. Jos Rooijackers, pulmonologist and chairman of Netherlands Expertise Centre for Occupational Respiratory Disorders (NKAL). According to Rooijackers not enough attention is given to learning to work safely. "The topic of 'safe welding' is optional in welding training; that has to change,". As a pulmonologist he encounters many patients who have developed lung conditions due to unhealthy working conditions, among whom is Henri Willems. Willems inhaled toxic welding gases for 14 years whilst working. "We wore masks that were intended for construction dust but they did not protect against inhaling welding gases," he indicates. When he cycled to the doctor with shortness of breath, he collapsed. His lung capacity had halved, and he was eventually diagnosed with non-asthmatic occupational asthma.

Justice and recognizing occupational diseases

"Fortunately I had a good occupational therapist who recognized the symptoms and they realized that it was work-related," Willems continues. However, due to a lack of consultation time and knowledge, occupational diseases are not always recognized by doctors. "Because these diseases do not appear until later in life, it is more difficult to recognize them as occupational diseases," says Peters. When an occupational disease is recognized by a doctor, legal proceedings can be initiated to obtain compensation from the employer. Since 2023 workers can also use the compensation for substance-related occupational diseases (TSB) for financial relief for some specific conditions. The list currently consists of three conditions, which will be expanded upon in time.

Mr. Marlou Overheul, PhD candidate at the Molegraaff Institute for Private Law, researches equity in compensation schemes for occupational diseases. "Claim settlements are complex and involve many legal obstacles," says Overheul. "The procedures are long and mentally taxing for the patient, with slim chances of them gaining the full amount of compensation." This was also evident in a recent case on impaired health following employee exposure to the carcinogen Chromium6. NOS reported that the court rejected the victims' claims due to a lack of evidence and medical records for each individual. There are also other situations in which patients fall between the cracks during settlements. "My occupational disease is not presently in the TSB settlement ," says Willems, who is still in litigation proceedings against his former employer. "Paying for medication, a stair-lift and other aids has all but wiped out my savings."

There is still much to be done to ensure that by 2040 no one becomes ill due to exposures at work,. Research into the work-related exposome must continue in order to help prevent work-related illness, and, where necessary, the amendment of permissible standards for exposure to hazardous substances. It is essential that this knowledge then reaches the workplace and that employers and employees learn to work safely. It is also important that physicians are trained to recognize occupational diseases only then can patients be treated appropriately.