[ 1 5 8]
Enviro nme ntal Manage me nt and He alth
8 / 5 [1997] 1 5 8 –1 6 1
© MCB Unive rsity Pre ss [ISSN 0956-6163]
Education and training in occupational and
environmental health
Wai-On Phoon
Pro fe sso r o f Oc c upatio nal He alth, Unive rsity o f Sydne y, Pymble , NSW, Australia
Posits that in the last decade or so, there has been a very great increase of training courses in occupational and environmental health, not only in developing countries but in developed ones as well. However, training for occupa-tional health nurses and education in general environ-mental and occupational health for schoolteachers and school students, and students in engineering and business management, still leave much to be desired.
Com p a r ed w it h t h e sit u a t ion in 1985, w h en t h e fi r s t ed it ion of ou r su r vey of eigh t cou n -t r ies in As ia w a s p u blis h ed , m u ch p r ogr es s h a s b een m a d e. It wou ld b e of in t er es t t o r ev iew s om e of t h e p r ogr es s in t h os e eigh t cou n t r ies or t er r it or ies.
In H on g Kon g, w h ich is n ow p a r t of Ch in a , t r a in in g in t h e b a sic cou r s e for p h y sicia n s n ow occu p ies 10-30 h ou r s. T h er e a r e n ow sp ecia lis t Dip lom a s in Occu p a t ion a l Med i-cin e, N u r s in g a n d H ygien e w h ich d id n ot exis t in 1985.
In In d on es ia , m a n y m or e in for m a l cou r s es t h a n b efor e h ave b een con d u ct ed for d oct or s, h ygien is t s a n d n u r s es. Som e su ch cou r ses w er e con d u ct ed in colla b or a t ion w it h t h e De p a r t m en t of Occu p a t ion a l H ea lt h , M in is t r y of La b ou r, Sin ga p or e, a n d t h e N a t ion a l In s t it u it e of Occu p a it ion a l H ea lit h a n d Sa feit y, Au s -t r a lia . A s p ecia l cou r se in Occu p a -t ion a l Med i-cin e for In d on esia n d oct or s h a s b een p la n n ed for la t e 1997 in Syd n ey.
In Kor ea , h ou r s of t r a in in g for m ed ica l st u d en t s in occu p a t ion a l h ea lt h h ave in cr ea s ed t r em en d ou sly t o n ea r ly 100 h ou r s or m or e fr om t h e six t o t en h ou r s a d eca d e ea r lier. Sp ecia l cer t ifi ca t es for d oct or s, n u r s es a n d en v ir on m en t a l m on it or in g a n d sa fet y n ow exis t .
In M a lay sia , a n ew cou r se lea d in g t o t h e Ma st er of P u blic H ea lt h (in Occu p a t ion a l H ea lt h ) h a s b een est a blis h ed . T h er e a r e a lso sh or t cou r s es for d oct or s, n u r s es a n d sa fet y officer s.
In t h e P h ilip p in es, a M a s t er in Occu p a -t ion a l H ea l-t h Cou r s e h a s b een es -t a blis h ed a n d a ls o cou r ses lea d in g t o s p ecia l cer t ifi -ca t es in t h a t su b ject for d oct or s, n u r s es a n d sa fet y officer s.
In Sin ga p or e, yea r ly Design a t ed F a ct or y Doct or s ’ Cou r ses h ave b een h eld sin ce 1985 for gen er a l p r a ct it ion er s w h o con d u ct st a t u -t or y m ed ica l exa m in a -t ion s for wor k er s exp os ed t o sp ecifi c h a za r d s u n d er t h e F a ct o-r ies (M ed ica l E xa m in a t ion s) Re gu la t ion s, 1985, w h ich h ave b een a m en d ed w it h effect fr om Feb r u a r y 1997. T h e ob ject ives of t h e r e gu la t ion s a r e t o en s u r e t h a t wor k er s em p loyed in cer t a in h a za r d ou s occu p a t ion s a r e fi t t o r em a in a t su ch wor k a n d t o d et ect sign s a n d s y m p t om s of over exp os u r e ea r ly. T h is is d on e t h r ou gh sp ecifi c p r e-em p loy m en t
a n d p er iod ic m ed ica l exa m in a t ion s con d u ct ed by Design a t ed F a ct or y Doct or s (DF Ds )[1]. Cu r r en t ly, t h er e a r e a b ou t 67,000 wor k er s fr om a p p r oxim a t ely 1,500 est a blish -m en t s u n d er goin g su ch exa -m in a t ion s ever y yea r. T h e M a s t er of Scien ce (Occu p a t ion a l M ed icin e) Cou r se, est a blish ed in 1973, h a s ch a n ged it s n a m e t o Ma s t er of Med icin e (Occu p a t ion a l Med icin e), a n d con t in u es t o a t t r a ct m a n y st u d en t s fr om ot h er p a r t s of Asia a n d Afr ica a s h it h er t o.
In Sr i La n k a , 45 h ou r s of in s t r u ct ion in Occu p a t ion a l H ea lt h a r e n ow given in t h e M a st er of Com m u n it y M ed icin e Cou r se.
In T h a ila n d , t h er e is n ow a M a s t er of Sci-en ce Cou r s e in Occu p a t ion a l H ea lt h a n d Sa fet y a s w ell a s Cer t ifi ca t e Cou r s es in Occu -p a t ion a l Med icin e, Occu -p a t ion a l H ea lt h N u r sin g, a n d Sa fet y.
As ca n b e seen fr om Ta ble I, t h e ot h er cou n -t r ies in -t h e As ia -P a cifi c r e gion h ave a lso p r ogr es sed r a p id ly in ed u ca t ion a n d t r a in in g in occu p a t ion a l h ea lt h .
Au s t r a lia cou ld p er h a p s s er ve a s a n exa m -p le t o illu st r a t e som e of t h e -p r ogr es s m a d e. T h er e w er e a p p r oxim a t ely 30 p ost gr a d u a t e Dip lom a a n d Ma st er s’ p r ogr a m m es in 1994 in t h a t su b ject . To en su r e t h a t t h er e is sim ila r -it y of cu r r icu la t h e N a t ion a l In st -it u t e of Occu p a t ion a l H ea lt h a n d Sa fet y, Wor k sa fe Au st r a lia , a Fed er a l Gover n m en t a gen cy, p r e p a r ed a n d p u blish ed a d ocu m en t en t it led Gu id elin es for T er tia r y E d u ca tion Cou rses in Occu p a tion a l H ea lth a n d S a fety in A u stra lia in 1994[2]. T h is d ocu m en t w a s p r e p a r ed in con ju n ct ion w it h a b r oa d sect ion of ed u ca t or s in t h e su b ject a n d m a n y v iew s w er e
ca n va s sed . H ow ever, t h e a m ou n t of t r a in in g in occu p a t ion a l h ea lt h for m ed ica l s t u d en t s a n d b a sic n u r ses r em a in s in a d eq u a t e. T h e Un iver sit y of Syd n ey is fa ir ly t y p ica l of Au st r a lia a s a w h ole w ist h r e ga r d st o m ed ica l sst u -d en t s ’ t r a in in g. In it s t r a -d it ion a l six-yea r cu r r icu lu m , t h er e a r e on ly t wo lect u r es in t h e s econ d yea r in Toxic H a za r d s, follow ed by fi ve lect u r es in t h e fou r t h yea r :
• Lect u r e 1. In t r od u ct ion a n d h is t or y t a k in g • Lect u r e 2. Ch em ica l h a za r d s: b iologica l
m on it or in g
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Table I
Curre nt pro ble ms ide ntifie d thro ugh re spo nse s to que stio nnaire s
Part of other Training manager/
Country Basic physicians Other basic personnel PG courses PG courses CM E workers Others
Australia
S. Australia 2 0 hours PH/ Nurses “ minor” Grad Diploma/ MPH Doc tors/ Nurses/ Hygienists Available Physic ians’ training
Victoria Dip/ Masters Doc tors Safety Institute
W. Australia Grad Dip Available Employers and “ Very limited”
OHS/ MSc Trade Unions
Burma 3 hours PH/ Nurses/ Minor for Available M Med Sc (PH Doc tors/ Nurses/
engineers and Trop Med) Health Asst
China 8 0 -9 0 hours PH PH Master/ Dr Available Available Managers/
sc hools
8 hours management students
Med sc hool
Honk Kong 1 0 -3 0 hours Nurses/ PH Dip OH Annual Conferenc e For Manual Handling/ Dip OM 1
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2day ×9 months
of HK College of Comm Chemic als Dip for Nurses 1
⁄ 2day ×
Med, etc . 9 months
Dip Oc c Hyg 1 ⁄ 2day × 9 months
India “ Minor” PH minor DIH 9 months- Ind Med Assoc Cert Indust Health
2 years 3 0 hours/ Nurses 3 months
Dip Ind Safety 2 weeks Nat Safety
9 months Counc il
Indonesia “ Minor” PH minor Masters Drs/ nurses/ safety offic ers
Japan 1 0 -2 0 hours Nurses/ PH minor Dr Med Sc Master/ Dr med Sc Undergrad and Short Courses Japan Industrial Health
Assoc iation and Japan Med Assoc iation run many c ourses
Korea 9 6 -2 5 6 hours Nurses/ PH minor Dr and Masters OH Physic ians/ Nurses 2 4 hours Available Cert for Drs/ Nurses/
every other year, etc . Environ Safety Courses –
3 4 hours
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Table I
Part of other Training manager/
Country Basic physicians Other basic personnel PG courses PG courses CM E workers Others
M alaysia 2 0 hours MPH MPH Drs 7 2 hours/ Nurses/
Safety Personnel
New Z ealand 1 0 hours PH “ minor” DOH MPH No No Dip OHS for Safety
Philippines 1 0 -2 0 hours Nurses minor Master OH Nat Conferenc e Seminars No Cert for Drs 6 0 -7 2 hours
Cert for Nurses 5 0 -6 0 hours Training for Safety
Singapore 2 2 hours Nurses/ minor eng M Med OM/ Cert OHS M Med (PH) Drs/ Nurses/ Safety Available Designated Fac tory Drs
Comm Members/ Hygienists 4 months part-time
Safety Offic ers 1 year Engineers/ Arc hitec ts/ Management Courses
Sri Lanka 6 -8 hours PH personnel 4 5 hours in MSc 5 -6 days Drs/ PHIs Available
Community Med
Thailand “ Minor” PH/ Nurses “ minor” MSc OHS MSc Env Health Cert Oc Med for Drs
6 weeks
Nurses 1 year/ Cert Safety for Safety Offic ers 1 8 0 hours
Vietnam 6 0 0 hours Nurses/ PH/ Masters/ Dr For Drs/ Nurses/ Drs/ Nurses/ Safety
[ 1 6 1] Wai-On Pho o n
Educ atio n and training in o c c upatio nal and e nviro nme ntal he alth
Enviro nme ntal Manage me nt and He alth
8 / 5 [1 9 9 7 ] 1 5 8 –1 6 1
• Lect u r e 4. Law, r eh a b ilit a t ion , in t er ven -t ion s a n d con -t r ol
• Ses s ion 5. Ca se p r esen t a t ion s.
• In t e gr a t ed Tea ch in g Sess ion 1. Occu p a -t ion a l p u lm on a r y d is ea s es.
• In t e gr a t ed Tea ch in g Sess ion 2.
Mu s cu los k elet a l d isor d er s in occu p a t ion a l m ed icin e.
T h er e a r e n o la b or a t or y d em on s t r a t ion s, wor k sit e v isit s or clin ica l sess ion s w h er e p a t ien t s a r e s een .
Con t in u in g a n d in for m a l ed u ca t ion a ct iv it ies for it h e gen er a l p u blic h ave a ls o p r olifer -a t ed in Au s t r -a li-a . Sin ce 1987 N IOH S h -a s r u n sh or t on e- t o t h r ee-d ay cou r s es in d iffer en t p a r t s of Au s t r a lia . T h ese cou r s es a d d r es s a w id e r a n ge of su b ject s, s u ch a s a s b est os -r ela t ed d isea ses, H IV a n d h e p a t it is in h ea lt h ca r e wor k er s, m a n u a l lift in g, office er gon om ics, m a n a gem en t of ch em ica l h a za r d s, p r ob -lem s of s h ift wor k , a n d in d oor a ir q u a lit y.
T r a in in g cou r s es for em p loyer s, m a n a ger s a n d wor k er s h ave a ls o in cr ea sed s ign ifi ca n t ly. E ver y yea r N IOH S p r ov id es gr a n t s t o t h e p ea k em p loyer a n d t r a d e u n ion b od ies for t h is p u r p ose. Am on g t h e m a n y s u ch cou r ses a r e t h r ee-d ay cou r s es for s u p er v isor s a n d wor k er r e p r es en t a t ives t o wor k s it e occu p a -t ion a l h ea l-t h a n d s a fe-t y (OH S) com m i-t -t ees. In Au s t r a lia , a n y en t er p r ise w it h 20 or m or e wor k er s is r eq u ir ed t o set u p s u ch a com m it -t ee.
Con t in u ed m ed ica l ed u ca t ion (CME ) is p r ob a bly goin g t o b e obliga t or y for a ll d oct or s soon er or la t er. At p r esen t , CME p r ogr a m m es a r e op t ion a l, bu t a s u b st a n t ia l p r op or t ion of occu p a t ion a l p h y sicia n s d o p a r t icip a t e. Sev er a l b od ies, in clu d in g t h e F a cu lt y of Occu p a -t ion a l M ed icin e, -t h e Socie-t y of Occu p a -t ion a l Med icin e, a n d u n iver s it ies a ll d eliver CME p r ogr a m m es.
Doct or a l p r ogr a m m es, s u ch a s for t h e Doc-t or of P h ilos op h y De gr ee, a r e a lso ava ila ble for r es ea r ch in t o occu p a t ion a l h ea lt h s u b ject s in m ost of t h e 30 or s o u n iver s it ies in Au s -t r a lia .
Mos t of t h e ot h er cou n t r ies s u r veyed h ave a lso m a d e good p r ogr es s in occu p a t ion a l h ea lt h ed u ca t ion a n d t r a in in g. J a p a n , t h e lea d in g econ om ic p ow er in t h e Asia -P a cifi c, h a s r ecen t ly est a blish ed p r ofes sion a l ed u ca -t ion for occu p a -t ion a l m ed icin e for
p h y s icia n s. H it h er t o, on ly r es ea r ch t r a in in g, su ch a s for t h e Doct or of Med ica l Scien ce De gr ee, w a s ava ila ble.
Wit h s om e exce p t ion s, h ow ever, ed u ca t ion a n d t r a in in g for n u r s es a n d sa fet y p er s on n el leave m u ch t o b e d esir ed . T h er e is, in gen er a l, a p a u cit y of cou r ses for s u ch p er s on n el.
H ow ever, a t t h e XIII Wor ld Con gr ess on Occu -p a t ion a l Sa fet y a n d H ea lt h , h eld in N ew Delh i in 1993, a n u m b er of p r esen t a t ion s d escr ib ed n ew d evelop m en t s in s a fet y t r a in in g. For exa m p le, a t h r ee-sem es t er p os t gr a d u a t e d e gr ee cou r se is offer ed by t h e Re gion a l E n gi-n eer igi-n g Colle ge, Tir u ch ir a p a lli. It is t h e ogi-n ly cou r se a t u n iver sit y level in In d ia . H ow ever, d ip lom a level cou r ses for scien ce gr a d u a t es a r e offer ed by t h e r e gion a l la b ou r in st it u t e in ea ch st a t e[3].
H ow ever, t h e t r em en d ou s a dva n ces in occu -p a t ion a l h ea lt h ed u ca t ion in t h is r e gion a r e exem p lifi ed by t h e h old in g of t h e 3r d In t er n a -t ion a l Con fer en ce on E d u ca -t ion a n d T r a in in g a t t h e Un iver sit y of Occu p a t ion a l a n d E n v i-r on m en t a l H ea lt h in J a p a n in 1991. Ap p i-r oxi-m a t ely 250 p a r t icip a n t s ca oxi-m e fr ooxi-m over 30 cou n t r ies t o d is cu ss a ll a sp ect s of ed u ca t ion a n d t r a in in g in occu p a t ion a l h ea lt h [4].
In en v ir on m en t a l h ea lt h , a la n d m a r k wor k -sh op w a s h eld for t h e Asia -P a cifi c r e gion in 1995 in Melb ou r n e, Au st r a lia . T h e Un it ed N a t ion s E n v ir on m en t P r ogr a m m e – N E TTLAP – h eld a t r a in in g a n d r esou r ces d evelop -m en t wor k sh op in b a sic ch e-m ica ls a n d h a z-a r d ou s w z-a s t e m z-a n z-a gem en t . A st r ik in g fez-a t u r e of t h e wor k sh op w a s t h e m u lt i-d is cip lin a r y com p osit ion of t h e k ey sp ea k er s. T h ey ca m e fr om en v ir on m en t a l en gin eer in g, socia l scen ces, occu p a t ion a l h ygiscen e, t oxicology, scen v i-r on m en t a l m a n a gem en t , ed u ca t ion a l sci-en ces, a n d occu p a t ion a l h ea lt h . If it a ch ieved n ot h in g else, a t lea st t h e wor k s h op b r ou gh t m a n y k ey ed u ca t or s in d iffer en t a sp ect s of en v ir on m en t a l h ea lt h fr om m a n y Asia -P a cifi c cou n t r ies t oget h er for t h e sh a r in g of p r ob -lem s a n d p os sible solu t ion s[5].
References
1 P h oon , W.O., “T h e d esign a t ed fa ct or y d oct or s ’ cou r s e in Sin ga p or e”, Pr oceed in gs of X I A sia n
Con feren ce on Occu p a tion a l H ea lth , Ma n ila ,
1985, p p. 97-100.
2 P h oon , W.O., “In for m a t ion , ed u ca t ion , a n d t r a in in g s t r a t e gies in occu p a t ion a l h ea lt h a n d s a fet y ”, in “F r om r esea r ch t o p r even t ion ”,
Pr oceed in gs of 58th A n n iv ersa r y of Fin n ish In stitu te of H ea lth Celeb ra tion s, 1995, p p. 186-92
3 M oh a m m ed , K.P., “Sa fet y ed u ca t ion in In d ia ”,
A b stra cts, X III World Con g ress on Occu p a tion a l S a fety a n d H ea lth , N ew Delh i, 1993, p. 131.
4 Un iver s it y of Occu p a t ion a l a n d E n v ir on m en -t a l H ea l-t h , Pr oceed in gs of 3rd In -ter n a -tion a l
Con feren ce in Occu p a tion a l H ea lth , J a p a n , 1991.
5 Un it ed N a t ion s – N E TTLAP, Pr oceed in gs of th e
Work sh op on E n v ir on m en ta l T er tia r y a n d T ra in in g in T ox ic Ch em ica ls a n d H a z a rd ou s Wa ste M a n a gem en t, Melb ou r n e, Au st r a lia ,
