Purpose of the review

An occupational disease (OD) is a health problem caused by an exposure to a workplace hazard. For the purpose of this review, ODs are diseases resulting from exposure to chemicals, physical agents (noise, vibration, radiation, extremes of temperature) or biological agents.

There are many occupational diseases, and some examples include:

  • occupational lung diseases such as asthma, silicosis, asbestosis
  • occupational skin disease such as irritant and allergic contact dermatitis
  • occupational cancers such as lung, skin and bladder cancers, mesothelioma
  • noise-induced hearing loss, hand-arm vibration syndrome
  • infectious diseases

There are also different ways to classify occupational disease: it may be based on the body system affected, the length of time before the onset of the disease or the type of exposure.

This report does not address individual occupational diseases.

For the purposes of this review, the categories provided by the WSIB (Appendix 1) were used. These are acute exposure and effects, chronic exposure and effects and long-latency illnesses.

Making the link between exposures at work and health symptoms is often missed. Yet these diseases not only have clinical impact but they can significantly interfere with work performance and quality of life, and in some cases, may cause death.

Recognizing symptoms early and determining the work-relatedness is critical to treatment and ongoing prevention efforts for others in the workplace.

Today in Ontario, a worker with work-related disease symptoms may have difficulty navigating between the two landscapes of the occupational health and safety system (OHS system) and the healthcare system (HC system). This may result in difficulties with timely diagnosis, treatment, and return-to-work planning. We know we can do better.

Focus of the review

The OD Landscape Review used a clinical lens to identify areas for improvement in both workplace prevention and healthcare delivery for the benefit of people working in Ontario. It also considered ways to strengthen the connections between the two systems for mutual benefit and improved impact.

Topics covered in the review included:

  • awareness, recognition and reporting of occupational disease
  • prevention: workplace prevention
  • prevention: workplace screening
  • disease surveillance
  • cluster management
  • clinical resources related to OD with a focus on healthcare (health human resources)
  • physician education and training
  • inclusion of occupation in the electronic medical record
  • timely adjudication and compensation (Worker health journey)

Topics out of scope for this review include:

  • funding of the prevention system
  • prevention mandate
  • reporting relationships and alignment with the system
  • WSIB processes related to occupational disease

We also acknowledge that there are aspects of the prevention of exposures that cause OD that are not part of this review.

Approach to the review

The OD Landscape Review report includes summary findings and recommendations by review topic. In addition, a visual storyboard was developed to conceptualize the current reality and opportunities.

The review steps included:

  1. A brief review by topic of:
    • Ontario legislative and regulatory requirements
    • relevant clinically based research in Ontario
    • prior reports commissioned by the government (or its agencies)
  2. Interviews with stakeholders and key informants from the occupational health and safety system and the healthcare system to review current practices and issues.
  3. A consultation phase to validate findings and identify solutions for system(s) improvement, including focus groups.
    • Three groupings representing a) labour unions and workers, b) employers and c) government-funded health and safety system partners participated. Each group met twice, once to discuss the current state and the second to discuss solutions. A listing of focus group members is included in Appendix 2. The focus group discussions were recorded, transcribed and themed independently by the Survey Research Unit at MAP Center for Urban Health Solutions, Unity Health Toronto.
  4. A final stage of report writing was informed by continued discussions considering how best to build on existing expertise, recognize work already underway, and consider feasibility. The following principles were developed to guide the report writing:
    • Give priority to forward looking prevention opportunities.
    • Apply an equity lens to ensure those workplaces most at risk receive more services.
    • Keep it simple, start with a shared focus, and measure progress and outcomes.
  5. Final recommendations were made for the short term and longer term, including proposed implementation guidance.