According to the Belgian law, occupational medicine has to help protect employees' health and promote employment for everyone who is capable to carrying out a job. This takes place on the one hand by the surveillance of working conditions, and on the other by medical surveillance.
The surveillance of working conditions enables risks to be detected and to eliminate or reduce them as much as possible. To this end the occupational health physician works together with other disciplines. Medical surveillance extends to the detecting and preventing of health problems.
Both with regard to medical surveillance and the surveillance of working conditions, the occupational health physician fulfils an almost exclusively advisory role. It is almost always the employer who decides what will be the consequences of the advice given by the occupational health physician.
This advice may relate to improving the collective working conditions, to adapting the work to certain individual requirements and to the medical fitness of employees.
In Belgium all employees have access to and the right to occupational health service assistance either through an internal or and external prevention service. Each employer must, as soon as he has taken on an employee, ensure that the employee may benefit from occupational medical surveillance (means).
In order for the 'adviser on prevention & occupational medicine' (as he is described in the new Law on the Welfare of Employees in the Performance of their Work) to be able to carry out his task completely independently - both technically and morally - he has a statute that protects him against arbitrary dismissal.
Medical surveillance, which is compulsory for certain groups of employees who are exposed to specific risks, consists of a pre-employment examination and also periodic examinations. All these examinations must be carried out by the occupational health physician, not by another doctor.
In the pre-employment examination, the occupational health physician seeks to determine the extent to which the (potential) employee may be at risk of suffering adverse effects to his or her health in carrying out the job in question. Traditionally he bases his assessment both on the previous history of the health of the person concerned and also on his current state of health. This means that the occupational health physician looks for clinically evident signs that might indicate a greater susceptibility to certain risk factors (such as results in a blood test or in functional tests of organs, existing hypersensitivity to certain substances, other symptoms of illness, etc.).
As mentioned earlier, as regards the prevention of health problems in the workplace, the occupational health physician only acts in an advisory capacity. Precisely because of this, in taking decisions regarding the medical fitness of the employee - in his interest - he is obliged to take into consideration the real situation in the company, and not the ideal situation.
Occupational health physicians are subject to precisely the same ethical considerations as other doctors. In addition, the legislator has established separate, extremely strict rules in order to guarantee the confidentiality of personal medical data.
The occupational health physician cannot reveal any of an individual's medical information to the employer. He submits his decisions using a form drawn up for this purpose and required by law. The form indicates whether the worker is fit, unfit or fit to perform the work only under certain conditions. In the latter case, the physician proposes specific adaptation measures in order to employ the individual or keep him at work in spite of his problems. If the worker is ill, the physician will authorise sick leave. The length of the sick leave will nonetheless be determined by the worker's family doctor.
Carrying out a certain occupation can lead to diseases that are the result of external exposure. Some examples of occupational diseases are lung disorders in miners due to exposure to silicium dioxide; occupational deafness in metalworkers due to exposure to noise; asbestosis, lung cancer and mesothelioma due to exposure to asbestos; cancer of the bladder due to exposure to benzidine; skin disorders in employees who come into contact with cement or certain chemicals; certain forms of blood cancer in employees who come into contact with benzene or ionising radiation; kidney disorders from working with cadmium; asthma through contact with animals in a laboratory and infectious diseases such as hepatitis-B in doctors, nurses and other people working in hospitals.
The term occupation-related illnesses is a collective name for all kinds of disorders and complaints that can also be caused or influenced by the occupation. Typical examples of this are back pain and stress syndrome. This latter can, in addition to mental symptoms such as sleeplessness, also be accompanied by physical symptoms such as gastro-intestinal complaints, chronic headache, raised or lowered blood pressure, heart rhythm disturbances, etc.
A number of years after industrial medical surveillance was regulated by law in Belgium (1968), the term occupation-related illness was used mainly to focus attention on the need to take preventive measures for these illnesses in the workplace as well.
Here, prevention means the taking of measures to limit health risks. In this area the difference between occupational diseases and occupation-related illnesses is less relevant. In terms of prevention, after all, full attention must be given to all possible effects on health. The most obvious preventive measure is that of reducing exposure, because the greater the exposure, the greater is the risk of health being damaged.
In many cases occupational diseases can be prevented by appropriate preventive measures. These might include, for example, a ban on the use of certain substances such as asbestos and benzidine. This ban could be lifted only in very exceptional, and strictly controlled, circumstances. For other substances, such as benzene - a component of crude oil - a ban might apply for many possible industrial applications. In an oil refinery, where benzene is inevitably present, the emphasis would be on strict hygiene measures intended to reduce exposure as much as possible.
Without doubt a great deal of human suffering has been prevented with the aid of detailed legislation, the general industrial medical service provision (which is strongly oriented towards advising on preventive hygiene measures in the workplace), a watchful health and safety inspectorate and a strong system of social concertation.
But in Belgium as well in certain areas a high price has been paid due to poor prevention. An example of this is provided by the many health problems that had been caused due to inadequate protection against dust in mining.