Despite the seriousness of disasters such as the Buncefield fire in 2005, less than 1% of accidental hazardous exposures to chemicals occur at chemical plant or “major hazard” industrial facilities, according to the extraordinary conclusions of a review of chemical incidents in England and Wales during 2006/07, recently published by the Health Protection Agency (HPA)1. In fact, the single most common location for incidents involving chemicals are domestic premises, following accidents involving, for example, mercury thermometers, carbon monoxide or poisonous household products.
The HPA’s Chemical Hazards and Poisons Division (CHaPD) provides 24-hour specialist advice on the health implications of chemical incidents to health protection units around the country and to other agencies, such as the NHS and emergency services. For the purposes of the review, CHaPD analysed 1,015 chemical incidents occurring in 2006/07, noting a 5% year-on-year increase in reported incidents over the period. Fires were the most common cause of chemical incidents, accounting for 28% of the total for the period. Chemical spills made up 14% of the total, and leaks accounted for another 14%. Releases of vapours and gases (including carbon monoxide gas) accounted for 15% of the total.
Despite the significance of accidents in domestic premises, the bulk of chemical incidents occur in workplaces: the next most common locations being industrial, commercial, transport and healthcare premises, according to the HPA review.
The categories of chemicals most frequently involved were: products of combustion (588 incidents) “other organics” (274 incidents) “other inorganics” (258 incidents) and metals (115 incidents). Mercury featured in approximately half of incidents involving metals. In 11% of reported incidents, the identity of the substance causing ill effects could not be determined.
The surveillance review was published during the HPA’s annual international chemical and environmental hazards conference, held in Manchester in May2, which included an occupational health session for the first time.
Occupational health session
A theme of the session was the potential benefits for workers, employers and society as a whole of better integration of occupational and public health activity.
Professor Tar-Ching Aw, professor of occupational medicine at the Faculty of Medicine and Health Sciences in the United Arab Emirates, formerly at the University of Kent in Canterbury, used the example of secondary, or “para-occupational” exposures to hazardous substances to illustrate the point. Occupational exposures to chemicals and other substances can affect workers’ families and others with whom they come into contact: mesothelioma from long-term contact with asbestos fibres on work clothing being the classic example. Such secondary effects have been associated with lead, arsenic, beryllium, polychlorinated biphenyls and pesticides but can be prevented by simple measures, such as the provision of showers and clothes-changing facilities, Aw noted.
The second occupational health speaker was Dr Dil Sen, head of the HSE’s corporate medical unit, the small Bootle‑based unit of occupational physicians that is all that remains of the Employment Medical Advisory Service.
Sen acknowledged that the purely occupational diseases that EMAS had been concerned with in the past had been eclipsed in terms of importance by non‑life‑threatening complaints such as musculoskeletal disorders and “stress”. He said that management of these complaints – which often have no underlying pathology but are strongly influenced by biopsychosocial factors – and explaining them to sufferers, were not only a key challenge for occupational physicians but also require co-operation with those working in general practice and public health.
Rehabilitation of those suffering from non-incapacitating conditions, such as the partially disabled, were the key new goals in occupational health, said Sen. The evidence base – that “good” work is healthy while worklessness causes physical and mental ill health – was now established.
Commercial occupational health providers also needed to act more responsibly, Sen argued, broadening the scope of their services, for example by using the workplace as a venue for health promotion initiatives and reaching out to the local community. He commented that occupational health professionals generally needed to “come down from their ivory tower and work with other healthcare and medical colleagues in the widest sense” in order to publicise the work they do and raise the profile of occupational health in society. The whole medical community in the UK should have a common goal of preventing ill health, keeping people in work wherever possible and getting people back to suitable work after a period of ill health.
Radon in homes
Although primarily concerned with the public health matters such as chemicals in the environment and the management of chemical emergencies – including chemical terrorist attacks – the Manchester conference also covered non-chemical public health risks.
Underlining the fact that some of the most significant contemporary health hazards occur in the home, a significant session concerned exposure to naturally occurring radon gas in domestic premises, which is a serious concern in certain parts of the country.
The HPA announced that it was recommending to government that UK Building Regulations should be changed so as to require that all new property incorporates the basic measures necessary to reduce internal radon levels. The conference heard that, although smoking is by far the greatest risk factor for lung cancer, causing more than 30,000 cases each year in the UK, radon is the second most common cause, resulting in up to an estimated 2,000 lung cancer cases per year.