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Module 4

Occupational Medicine

Exercise 1

WHO Global Plan of Action on Workers’ Health 2008-2017

Name and Surname of the Participant: Dante Mejia

Country: Peru
Future challenges for Occupational Health Physicians
Some of the challenges Occupational Health Physicians (OHP) are facing or going to face in
the next future in Peru are:
Continuous update of Technology
Globalization, which takes place also in Peru, is closely related to the expansion of
technology, which brings new risks that OHP have never studied even in post-graduate
studies, leading them to take extra courses.
Continuous change of products (like chemicals) in the work process
The substitution with less hazardous substances which many Peruvian OHP do not know
about their disease cycle, making more complicated to understand related diseases.1
The growing incidence of mental health diseases and Noncommunicable diseases
(NCD)
Work-related mental illnesses, such as stress and burnout, are increasing.2 Much of these
diseases are not taught appropriately in pre-grade school in Peru. NCD number is growing
due to demographic and diet trends of the Peruvian workforce, which is related to an
epidemiological transition of Peruvian mortality during the last 20 or 30 years.
The prevention and less evident diagnosis of both groups of illnesses, along with their
complicated comorbidity 3 relationship with occupational health diseases are and will be
widespread problems for Peruvian OHP.
The maintenance of the traditional Medical school
Education in Peruvian Medical schools stimulate OHP to perform more secondary
prevention or reactive activities (diagnosis, treatment of occupational diseases) than
primary prevention, such as health promotion, prevention and multidisciplinary work.
The number of OHP is small for the growing demand
There are few OHP due to the little government incentive and poor marketing of this
specialization in Peruvian Medical Schools, making a lack of OHP shortly4 in Peru.
The increasing number of competences required
Considering OHP as the ones with the broader and transversal knowledge of other OSH
disciplines,1 core competences and required skills are demanded in OHP competences.
Some of them are not taught efficiently in Peruvian Medical School such as Management,
and Epidemiology or not taught at all such as soft skills, leading them to take additional
courses sometimes after post-graduate studies.
Little Research as well as not extensive
In countries like Peru, where the Medical–industrial complex sponsors most of the medical
research, investigation in the field of occupational medicine is becoming less frequent,
giving less evidence for OHP to prevent or address professional diseases which some of
them are endemic in some geographical places in Peru like Leishmaniasis or Carrion’s
disease.
The changes in OSH Legislation 1
Peru has changed its OSH legislation to reduce the working time of OHP in companies (see
RM N° 571-2014/MINSA), making more difficult to achieve their objectives in the
management of OSH due to a shorter time.

The main types of emerging diseases that OHP will have to be ready to face.
Psychosocial diseases
The increasing psychosocial load in companies,4 along with the high and chronic impact on
quality of life in workers.
Diseases related to Sedentary Behavior in the Workplace
In developing countries like Peru, there is a rapidly increasing number of NCD with a high
burden of disease expressed in DALY (Disability-Adjusted Life Year) related to a sedentary
life such as cardiovascular diseases.5
Diseases related to environmental changes
Solar UV radiation is higher in countries near the equator, or with high altitude like Peru,
Outdoor workers (like informal street vendors) are exposed to this hazard, leading to an
increase of skin diseases such as dermatological cancer.6
Diseases by emerging or increasing virulence of biological agents
Zika and Multidrug-resistant Tuberculosis (MDR-TB) will endanger in some specific
categories of workers such as the case in Peruvian health workers.7

Conclusion
Main challenges Peruvian OSH will face in the future in Peru are:
1. The adequate management of diseases of complex origin that may involve NCD and
occupational health diseases, as well as the correct primary prevention in diseases
that are growing in the working population according to their individual and
environmental characteristics.
2. The short number of OHP with the competences that are required in this field to carry
an accurate OSH Management.
3. Getting the right knowledge of diseases that could arise as a result of technological
changes in Peru.
References

1. Gastañaga, MC. (2012). Salud Ocupacional: Historia Y Retos Del Futuro


[Occupational Health: History and Challenges of the Future]. Rev Peru Med Exp
Salud Publica, 29(2), 177-178. Retrieved from
http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1726-
46342012000200001&lng=es&tlng=es.

2. World Health Organization (2007). Global Plan of Action on Workers’ Health 2008-
2017. [Adobe Reader XI Version]. Retrieved from
http://www.who.int/occupational_health/WHO_health_assembly_en_web.pdf

3. Candiotti, C; Francia, J. (2018). Estado de avance de la salud de los trabajadores en


Perú [Current status on the progress of workers’ health in Peru]. Acta Med Peru.
2018;35(1), 3-5. Retrieved from
http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1728-
59172018000100001&lng=es&tlng=es.

4. Loeppke, R., et al. (2017). Global Trends in Occupational Medicine: Results of the
International Occupational. J Occup Environ Med., 59(3), e13-e16. DOI:
10.1097/JOM.0000000000000974.

5. Ministry of Health of Peru. (2014). Carga de Enfermedad en el Perú [The Burden of


Disease in Peru] [Adobe Reader XI Version]. Retrieved from
http://www.dge.gob.pe/portal/docs/tools/Cargaenfermedad2012.pdf

6. Sordo, C.; Gutiérrez, C. (2013). Cáncer de piel y radiación solar: experiencia peruana
en la prevención y detección temprana del cáncer de piel y melanoma [Skin cancer
and solar radiation: Peruvian experience in the prevention and early detection of
melanoma and skin cancer]. Revista Peruana de Medicina Experimental y Salud
Publica, 30(1), 113-117. Retrieved from
http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1726-
46342013000100021&lng=es&tlng=es.

7. Soto-Cabezas, M., Chávez-Pachas, A., Arrasco-Alegre, J., & Yagui-Moscoso, M.


(2016). Tuberculosis en trabajadores de salud en el Perú 2013-2015 [Tuberculosis in
health workers in Peru 2013.2015]. Revista Peruana De Medicina Experimental Y
Salud Pública, 33(4), 607-615. DOI http://dx.doi.org/10.17843/rpmesp.2016.334.2542