Working with substances hazardous to healt Introduction

This leaflet describes how to control hazardous substances at work so that they do not cause ill health. It will help you understand what you need to do to comply  with the Control of Substances Hazardous to Health (COSHH) Regulations 2002 (as amended) which apply to the way you work with these substances. If you run a small business or are self-employed, you need this information to  make sure you are protecting your employees. If you run a medium-sized or large  business, where decisions about controlling hazardous substances are more complex, you will also need professional advice. The leaflet will also be useful for trade union and employee health and safety representatives.

Why do I need to read this leaflet?

Every year, thousands of workers are made ill by hazardous substances, contracting lung disease such as asthma, cancer and skin disease such as dermatitis. These diseases cost many millions of pounds each year to:

■ industry, to replace the trained worker;

■ society, in disability allowances and medicines; and

■ individuals, who may lose their jobs.

You, as the employer, are responsible for taking effective measures to control  exposure and protect health. These measures can also improve production or cut  waste.

Looking after your business Your aim in running your business is to make a profit. You know what you do, and  how you are doing it. You know what ‘processes’ and ‘tasks’ are involved. You  know the short cuts. Ensuring your workers remain healthy may also lead to healthy profits.

Which substances are harmful?

■ Dusty or fume-laden air can cause lung diseases, eg in welders, quarry workers or woodworkers.

■ Metalworking fluids can grow bacteria and fungi which cause dermatitis and asthma.

■ Flowers, bulbs, fruit and vegetables can cause dermatitis.

■ Wet working, eg catering and cleaning, can cause dermatitis.

■ Benzene in crude oil can cause leukaemia.

Many other products or substances used at work can be harmful, such as paint, ink, glue, lubricant, detergent and beauty products.Ill health caused by these substances used at work is preventable. Many substances can harm health but, used properly, they almost never do. Find out the dangers in your business – ask your supplier, your trade association, and check for your trade on HSE’s website: www.hse.gov.uk. Substances can also have dangerous properties. They may be flammable, for example solvent-based products may give off flammable vapour. Clouds of dust from everyday materials, such as wood dust or flour, can explode if ignited. This leaflet does not deal with flammability or explosion hazards (see ‘Find out more’).

Look at each substance Which substances are involved? In what way are they harmful? You can find out by:

■ checking information that came with the product, eg a safety data sheet;

■ asking the supplier, sales representative and your trade association;

■ looking in the trade press for health and safety information;

■ checking on the Internet, eg HSE’s website pages for your trade. Think about the task If the substance is harmful, how might workers be exposed?

■ Breathing in gases, fumes, mist or dust?

■ Contact with the skin?

■ Swallowing?

■ Contact with the eyes?

■ Skin puncture?

Bear these in mind when you look at the tasks.

Exposure by breathing in

Once breathed in, some substances can attack the nose, throat or lungs while others get into the body through the lungs and harm other parts of the body, eg the liver.

Exposure by skin contact Some substances damage skin, while others pass through it and damage other parts of the body. Skin gets contaminated:

■ by direct contact with the substance, eg if you touch it or dip your hands in it;

■ by splashing;

■ by substances landing on the skin, eg airborne dust;

■ by contact with contaminated surfaces – this includes contact with  contamination inside protective gloves. 

Exposure by swallowing People transfer chemicals from their hands to their mouths by eating, smoking etc without it washing first. Texas Essential Knowledge and Skills for Health Education  Subchapter A. Elementary

In health education, students acquire the health information and skills necessary to become  healthy adults and learn about behaviors in which they should and should not participate. To  achieve that goal, students will understand the following: students should first seek guidance  in the area of health from their parents; personal behaviors can increase or reduce health  risks throughout the lifespan; health is influenced by a variety of factors; students can recognize and utilize health information and products; and personal/interpersonal skills are needed to promote individual, family, and community health. Kindergarten students are taught basic factors that contribute to health literacy. Students learn about their bodies and the behaviors necessary to protect them and keep them healthy. Students also understand how to seek help from parents and other trusted adults.

Healthcare industry

This section provides background information on the size, geographic distribution, employment, and economic condition of the healthcare industry.  Facilities described within the document are also described in terms of their North American Industry Classification System (NAICS) codes.  The NAICS, which was developed jointly by the United States, Canada, and Mexico to provide new comparability in statistics about business activity across North America, has replaced the U.S. Standard Industrial Classification (SIC) system, under which Health Services is designated 80. Facilities in the healthcare industry are identified under NAICS code 62.

Note that, while there are benefits to the NAICS codes for organizing categories of business, there are disadvantages in the case of the healthcare sector. For the most part, healthcare organizations, whether large or small, in-patient or outpatient, have some level of complexity to their operations and functions.  Even small multi-service hospitals have complex service offerings, and generate a large variety of waste.  Therefore, the NAICS code information presented below is supplemented with a more robust picture of the rapidly changing healthcare universe.

Introduction, Background, and Scope of the Notebook

The healthcare and social assistance industry (NAICS code 62) comprises many subsectors including ambulatory healthcare services, hospitals, nursing and residential care facilities, and social assistance. This Notebook focuses primarily on the activities performed at hospitals. However, many of these activities can be performed by others in the healthcare  industry, and as such, this notebook applies to those providers as well. 

The specific subsectors covered in this industry document are: CNAICS 621. Ambulatory Healthcare Services. The following types of facilities are covered under this NAICS code: 

• 1.     Physicians’ offices,
• 2.     Dentists’ offices,
• 3.     Other health practitioners’ offices,
• 4.     Outpatient care centers,
• 5.     Medical and diagnostic laboratories,
• 6.     Home healthcare services, and
• 7.     Other ambulatory healthcare services.

These entities may be free standing and perhaps privately owned or may  be part of a hospital or health system.  Currently, most hospitals (NAICS  622) also offer ambulatory healthcare services.  For some facilities, these services represent as much as 60-70 percent of hospital business.  Much of this change has been driven by adjustments in healthcare finance and reimbursement, advances in technology, and new and effective pharmaceuticals, that eliminate the need for inpatient and invasive care services. Also of note is the growing emergence of complementary healthcare services that are also ambulatory in nature.  These include chiropractic care, massage, acupuncture, and acupressure. C NAICS 622. Hospitals. The following types of facilities are covered under this NAICS code:

1.     General medical and surgical hospitals,

2.     Psychiatric and substance abuse hospitals, and

3.     Specialty (except psychiatric and substance abuse) hospitals.

This category potentially includes many types of hospitals such as academic medical center/university-based/teaching hospitals, community hospitals, speciality hospitals (i.e., orthopedic or pediatric), and tertiary care facilities that are qualified to handle major trauma cases (i.e., burns and catastrophic accidents). There are also distinctions between public and private hospitals, hospitals that are part of a healthcare system (i.e., organizations such as Kaiser Permanente),  Veterans Administration hospitals, and other types of facilities. Hospitals and healthcare systems are continually changing their service offerings, and responding to various internal and external forces including reimbursement issues, advances in technology, and shifts in the populations they serve. CNAICS 623. Nursing and Residential Care Facilities. The following types of facilities are covered under this NAICS code:

1.     Nursing care and assisted living facilities,

2.     Residential mental retardation/health and substance abuse facilities,

3.     Community care facilities for the elderly, and

4.     Other residential care facilities.

Nursing care and residential care facilities offer nonacute care to individuals, either those suffering from a chronic condition (e.g., dementia, developmental delay, multiple sclerosis, Parkinson’s disease, autism), aging, or mental health problems.

As population demographics in the United States shift and demand for care services and facilities increases, more and more facilities offering some component of the above services will arise.

The veterinary services industry (NAICS 541940) also performs many activities similar to the healthcare industry.  Veterinary facilities may find some of the information in this

Notebook relevant and useful. C NAICS 541940. Veterinary Services. This industry includes establishments of licensed veterinary practitioners primarily in the practice of veterinary medicine, dentistry, or surgery for animals, and establishments providing testing services for licensed veterinary practitioners.

Health Inequalities: What Do We Know About the Health Status of Canadians?

Section 3 examines significant inequalities in the health status of Canadians. Whether it is measured using self-reports of overall health status, infant mortality rates, chronic conditions, activity limitations/disability status or the Health Utility Index, health status is worse for those with lower incomes. Cut another way, the health status of groups that are particularly vulnerable to poverty (e.g. lone mothers, Aboriginal persons, Atlantic Canadians) is consistently worse than that of the general population. Evidence shows that countries with less inequality and/or less poverty than Canada have better health outcomes and fewer health inequalities.

Examples presented in this section illustrate clearly that patterns of inequality in health status correlate very closely with patterns of inequality in SES. That is, groups with the lowest SES are also the groups most likely to have poor health status. While this evidence is certainly very suggestive, such informal evidence does not prove that there is causal link between poverty and health.

Does Poverty Cause Poor Health?

Sections 4, 5, and 6 of the report examine more formal, generally multivariate analyses that attempt to establish that poverty causes poor health. Studies of this type can be divided into those with a micro or individual orientation (i.e. personal direct experience of poverty is associated with personal health status) and those with a macro or populationorientation (i.e. living in a society with a more unequal distribution of income is associated with worse population health outcomes).

The key finding from the individual/micro-level research is that there is a very clear and very robust relationship between individual income and individual health. That is, poverty leads to lower health status. Additional findings include: 

•  While increases in income are associated with increases in health status across the  full income spectrum, the gains are largest for those at the bottom of the incomedistribution scale.

•  Longer-term measures of income have larger health associations. 

•  Long-duration poverty has larger associations with health than occasional episodes  of poverty. 

•  While both income level and changes in income level are important, the former is  more important. 

•  Negative ìshocksî to income have bigger consequences than positive shocks. 

•  For children, spells with low SES in the early years are most important in terms of impact on health. At the population/macro-level, a flurry of research has tested the hypothesis that societies with more inequality have worse health outcomes. Explanations for this phenomenon vary: 

•  The absolute income hypothesis suggests that health status increases with the level of personal income but at a decreasing rate, so that countries with more equally distributed incomes will be observed to have higher average levels of health.

•  The relative position (or psycho-social) hypothesis emphasizes individual position within a social hierarchy, independent of standard of living, as the key to understanding the link between socio-economic inequality and health. 

•  The neo-materialist hypothesis argues that high levels of income inequality are simply one manifestation of underlying historical, cultural, political and economic processes that simultaneously generate inequalities, for example, in social infrastructure (e.g. medical, transportation, educational, housing, parks and recreational systems). From this perspective, inequalities in health derive from inequalities in all of the above aspects of the material environment.

The Right to Health

As human beings, our health and the health of those we care about is a  matter of daily concern. Regardless of our age, gender, socio-economic  or ethnic background, we consider our health to be our most basic and  essential asset. Ill health, on the other hand, can keep us from going to  school or to work, from attending to our family responsibilities or from  participating fully in the activities of our community. By the same token,  we are willing to make many sacrifices if only that would guarantee us  and our families a longer and healthier life. In short, when we talk about  well-being, health is often what we have in mind. 

The right to health is a fundamental part of our human rights and of our  understanding of a life in dignity. The right to the enjoyment of the highest  attainable standard of physical and mental health, to give it its full name,  is not new. Internationally, it was first articulated in the 1946 Constitution of the World Health Organization (WHO), whose preamble defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The preamble further states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an adequate standard of living (art. 25). The right to health was again recognized as a human right in the 1966 International Covenant on Economic, Social and Cultural Rights. Since then, other international human rights treaties have recognized or referred to the right to health or to elements of it, such as the right to medical care. The right to health is relevant to all States: every State has ratified at least one international human rights treaty recognizing the right to health. Moreover, States have committed themselves to protecting this right through international declarations, domestic legislation and policies, and at international conferences. In recent years, increasing attention has been paid to the right to the highest attainable standard of health, for instance by human rights treatymonitoring bodies, by WHO and by the Commission on Human Rights (now replaced by the Human Rights Council), which in 2002 created the mandate of Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health. These initiatives have helped clarify the nature of the right to health and how it can be achieved.

This fact sheet aims to shed light on the right to health in international human rights law as it currently stands, amidst the plethora of initiatives and proposals as to what the right to health may or should be. Consequently, it does not purport to provide an exhaustive list of relevant issues or to identify specific standards in relation to them.The fact sheet starts by explaining what the right to health is and illustrating its implications for specific individuals and groups, and then elaborates upon States' obligations with respect to the right. It ends with an overview of national, regional and international accountability and monitoring mechanisms.