Occupational Disease in Canada 加拿大职业病管理概况 E. Kevin Kelloway, Ph.D.柯乐威 教授 Canada Research Chair in Occupational Health Psychology 加拿大职业健康心理学研究主席兼圣玛丽大学职业健康与安全中心主任 Cover Page

Overview概况 OVERVIEW OF CANADA 加拿大概况 REGULATORY ENVIRONMENT 立法环境 DEFINITION 定义 COMPENSATION 赔偿 TREATMENT 治疗 PREVENTION 预防

The Land 国土 10 million square kilometers - second largest nation on Earth, after Russia 1000万平方公里—世界上第二大国仅次于俄罗斯 North to south 4,800 km - more than two thirds of its residents live within 300 km of its southern border with 12 states of the United States 南北跨度4800公里--三分之二多的人口居住在和美国12个州接壤的南部300公里以内的边界地带。

Yukon 育空地区 Nunavut 鲁拉乌特地区 Northwestern Territories 西北地区 Quebec 魁北克省 Newfoundland 纽芬兰省 Quebec 魁北克省 British Columbia 不列颠哥伦比亚省 Alberta 艾尔伯塔省 Saskatchewan 萨斯喀彻温省 Manitoba 曼尼托巴省 Prince Edward Island 爱德华王子岛省 Ontario 安大略省 New Brunswick 新布拉威克省 Nova Scotia 新斯科舍省

The People 国民 The Population 人 口 加拿大人口统计 Thousands 单位千 Canada persons (thousands) 2002 2003 2004 2005 2006 Canada 31,372.60 31,676.10 31,989.50 32,299.50 32,623.50 Newfoundland and Labrador纽芬兰省 519.4 518.4 517.2 514 509.7 Prince Edward Island爱德华王子岛省 136.9 137.3 137.9 138.2 138.5 Nova Scotia新斯科舍省 934.5 936.5 938 936.1 934.4 New Brunswick新布拉威克省 750.3 751.2 752.1 751.5 749.2 Quebec魁北克省 7,445.70 7,494.70 7,548.60 7,597.80 7,651.50 Ontario安大略省 12,102.00 12,262.60 12,416.70 12,558.70 12,687.00 Manitoba曼尼托巴省 1,155.60 1,161.90 1,170.50 1,174.10 1,177.80 Saskatchewan萨斯喀彻温省 995.9 994.7 994.9 990 985.4 Alberta艾尔伯塔 3,116.30 3,161.40 3,207.00 3,277.60 3,375.80 British Columbia卑诗省 4,115.40 4,155.40 4,203.30 4,257.80 4,310.50 Yukon Territory育空地区 30.1 30.6 30.9 31.1 31.2 Northwest Territories西北地区 41.5 42.2 42.8 42.6 41.9 Nunavut鲁拉乌特地区 28.7 29.2 29.6 30 30.8 Note: Population as of July 1. 2006

The People 国民 Canada’s Population is over 31.6 million people. 人口超过3160万 1.17 million people (4%) are Aboriginal Peoples: First Nations (60%), Métis (33%), Inuit (4%) and Other (3%) 117万（4%）为土著居民：-原住民（60%），米提人（法裔土著混血33%），因纽特人（4%） 6.2 million people (20%) are Immigrants. 620万（占人口20%）移民 Canada’s population growth (1997-2005) is attributable to: 加拿大的人口增长（1997-2005）主要来自于： 3 million births, 2 million deaths and over 2 million new immigrants. 出生人数300万，死亡人数200万，超过200万的新移民 Most Canadians live in urban settings - over 80% reside in towns and cities.大部分加拿大人居住在城市环境-80%的人居住在城镇和城市中

The Canadian Constitution加拿大宪法 Canada is a federation with three levels of government: federal, provincial and municipal加拿大是由三级政府组成的联邦体制：联邦、省、市 Under the Canadian Constitution, powers are divided between the federal and provincial governments 根据加拿大宪法，联邦和省级政府分权 Municipalities are not recognized in the Constitution except to the extent that they are the responsibility of provinces 宪法中对市级政府的管理范围没有明确，只提到该级政府由省级政府负责 There are about 4,000 municipal governments in Canada加拿大大约有4000个市政府

The Canadian Constitution 加拿大宪法 The federal government maintains the “peace, order and good government” of the whole country by making laws with respect to immigration, unemployment insurance, trade and commerce, national defence, native affairs, and criminal law. 联邦政府通过制定关于移民、失业保险、商贸、国防、少数民族事务和刑法等法律，来维持整个国家的“和平、秩序和良政”。 Provincial governments are empowered to control regional and local affairs including education, health, social services, property rights, administration of justice, local public works, and municipal institutions. 省级政府被授权管理地区和地方事务，包括：教育、卫生、社会服务、财产权、司法管理、地方公共设施和市级机构。 Some responsibilities are shared between the federal and provincial governments such as immigration, agriculture, and pensions. 在有些领域中，联邦和省政府共同承担责任，如移民、农业和养老金。 Municipal governments - strictly local matters市政府-仅限于管理当地事务

Economy 加拿大的经济 the eight - largest trading nation 世界第八大贸易国 Natural Resources : Iron Ore Nickel high-tech industrial society, Canada today closely Zinc Copper resembles the US 当今的加拿大是高新技术工业社会，和美国十分相似 Gold Lead Potash Silver advantages - natural resources, skilled labor force, and modern capital plant Fish Timber 经济优势：自然资源、高技能的劳工队伍和现代化的工厂 Wildlife Coal Petroleum Natural Gas Hydropower

Economy 经济

The workforce 劳动力结构 Industry 行业 Number 人数 Goods Producing 商品生产 3,708,300 Agriculture 农业 321,900 Natural Resources 自然资源 310,700 Utilities 基础设施 149,900 Construction 建筑 1,178,000 Manufacturing 制造业 1,756,800

The workforce劳动力结构 Industry 行业 Number 人数 Industry 行业 Number 人数 Services 服务业 13,086,400 Trade 贸易 2,632,100 Accommodation/ Food 酒店/食品 1,034,500 Transportation and warehousing 交通和仓储 819,900 Other 其他 785,500 Finance, insurance, real estate金融、保险和房地产 1,118,000 Public Admin 公共管理 923,800 Professional专业技术人员 1,196,900 Business services商业服务 639,000 Education教育 1,196,500 Health Care Social Services公共卫生服务 1,955,100

Occupational Injuries/diseases 职业伤害/职业病 Number of Workers Covered (000s) (1) 涉及到工人 Total Claims Reported 统计的申报 数字 Accepted Time-Loss Injuries Fatalities Total 受理的误工工伤 % Time-Loss Injuries 误工工伤比率 Total死亡数 % Fatalities 死亡率 1996 10 758.6 947 776 377 885 39.9 703 0.07 1997 10 986.7 962 134 379 851 39.5 833 0.09 1998 11 259.4 970 224 375 360 38.7 798 0.08 1999 11 548.4 996 617 379 450 38.1 835 2000 11 781.8 1 050 226 392 502 37.4 882 2001 11 983.9 1 021 524 373 216 36.5 919 2002 12 148.8 997 691 359 174 36.0 934 2003 12 729.0 980 436 348 715 35.6 963 0.10 2004 12 708.2 977 118 340 502 34.8 928 2005 13 052.2 994 886 337 930 34.0 1 097 0.11 Average 11 895.7 989 863 366 459 37.0 889

The Accident Pyramid 事故金字塔结构 For every one workplace death there are 34 injuries resulting in lost time, 900 minor injuries, 1,500 near misses, and 20,000 unsafe actions. 作业点每死亡1人的同时大约有 34人受伤误工 900人受轻伤 1500人侥幸脱险 和20,000人次违法安全规定操作

Cause of workplace fatality 作业点死亡原因统计 (2005) Exposure to harmful substances or environments – 512 deaths (asbestos is the single leading cause)接触有害物质或环境-512人（石棉是最主要的原因） Transportation accidents – 229 deaths交通事故-229人 Contact with objects and equipment – 142 deaths 接触物体及操作设备致死-142人 Falls – 77 deaths高坠或摔倒-77人 Bodily reaction and exertion – 30 deaths 身体反应及用力不当-30人 Fire or explosion – 19 deaths火灾或爆炸-19人 Assaults and violent acts – 21 deaths 施暴和其它攻击性暴力行为-21人 Other (events or exposures, unknown or simply not specified) – 67 deaths其他（事故或接触 ，情况不明或不具体）-67人死亡

Regulatory Environment 立法环境 HEALTH CARE医疗卫生 Canada has 1 Federal and 13 provincial and territorial governments 加拿大有1个联邦政府和13个省级和特区政府 Constitution says that [a] health care is a provincial/territorial responsibility and that [b] all Canadians have access to the same level of health care no matter where they live 宪法规定，医疗卫生由省级或特区政府管理，无论居住在哪个地方，所有加拿大人都享有同样水平的医疗卫生服务 Role of the Federal government is to provide funding, ensure equality and ensure compliance with the Canada Health Care Act 联邦政府的职责是提供资金，确保平等并且加拿大医疗保健（卫生）法得到执行

Regulatory Environment立法环境 Occupational Health and Safety 职业卫生与安全 Regulated mostly at the provincial level (over 80% of workers) 主要由省政府立法（涵盖超过80%的工人） Workers in some industries (e.g., banking, inter-provincial transportation) are federally regulated有些行业（如银行、省际交通）则属于联邦立法范围 Great deal of collaboration between provincial and federal agencies – so regulations are very similar (but not exactly the same) across jurisdictions省级和联邦机构之间进行了大量协作-所以各个管辖区的法规非常相似（但是并不完全相同）

Definition of Occupational Disease职业病的定义 Two main elements are present in the definition of an occupational disease: 职 业病的定义包括两个要素  the causal relationship between exposure in a specific working environment or work activity and a specific disease; and 某一疾病与接触某一工作环境或 从事某一工作存在的因果关系  the fact that the disease occurs among a group of exposed persons with a frequency above the average morbidity of the rest of the population. 接触特定 环境工作的人群患某一疾病频率高于其他人群

Classes of Occupational Disease (ILO)职业病的分类 1. Diseases caused by agents由不同因素导致的职业病 1.1 Diseases caused by chemical agents 化学因素导致的职业病 1.2 Diseases caused by physical agents 物理因素导致的职业病 1.3 Diseases caused by biological agents 生物因素导致的职业病 2. Diseases by target organ特定器官疾病 2.1 Occupational respiratory diseases职业呼吸道疾病 2.2 Occupational skin diseases职业皮肤病 2.3 Occupational musculoskeletal diseases职业骨骼疾病 3. Occupational cancer职业性癌症 4. Others其它

Some problematic characteristics存在的一些问题 Results from cumulative (chronic) rather than acute exposure 结果来自长期积累（慢性）而非急性接触 Delayed onset conditions推迟了发作因素 Not unique to occupational exposures 有些职业病不 仅限于职业接触引起

Compensation赔偿 Applied for (typically) after diagnosis 诊断后申请 Application likely to be successful if [a] employed in a known high risk occupation for specific condition; [b] documented exposure to hazard; and [c] clinical diagnosis/impairment 如具备以下条件申请可能成功：1.受雇于高危行业；2.有接触致危因素的条件；3.医疗诊断/损伤 Most WCBs recognize presumptive cases (firefighters and some cancers, coal miners and silicosis, construction workers and HAVS) 大多数工伤赔偿局接受以下推理的情况为职业病（消防员与一些癌症，煤矿工人与矽肺病，建筑工人与手臂振动综合症 Can extend into retirement 赔偿可以延续到退休以后

Treatment治疗 Occurs in the regular health care system在正规医疗卫生系统进行 Not tied to compensation but if pensionable, then award may include medical costs (e.g., drugs) not normally paid for in health care system与赔偿无关，如果可以领养老金，赔偿则会包括医疗卫生系统通常不会支付的医疗费用（如某些药品） Some specific occupational clinics in larger centres (e.g., occupational medicine, HAVS etc), by referral, additional costs paid for by insurer大中心的一些特定职业诊所（如职业药物、手臂振动综合症等）的转诊病人，额外费用由保险公司支付 Some specialized clinics (e.g., pain clinics) – by referral, additional costs paid by insurer一些特定门诊（如疼痛门诊）的转诊病人，额外费用由保险公司支付 Insurer may institute active return to work policies including treatment, job accomodation, ergonomic redesign etc保险公司会遵守相关规定，包括治疗、重新安排工作、根据人体工学重新设计等。

Prevention预防 Dealt with under the OHS legislation – no distinction made between occupational accidents and occupational disease针对职业卫生与安全立法-没有将职业事故和职业病加以区别 Since all occupational disease results from exposure to a hazard, prevention focuses on controlling the exposure:因所有职业病都由接触致危因素导致，预防的重点主要为控制接触 At the source – elimination, engineering and administrative controls源头上-消除、工程和管理控制 Along the path – elimination, engineering and administrative controls过程中- 消除、工程和管理控制 At the worker – personal protective equipment (PPE)工人-个人防护用品

Types of control控制类型 Engineering Controls工程控制 -MOST EFFECTIVE最有效 Process control – change how job is done 过程控制-改变工作方式 Isolation/enclosure of emission source隔离/关闭排放源 Ventilation通风 Administrative Controls 管理控制–CAN BE UNRELIABLE可能靠不住 Scheduling/job rotation/rest periods日程安排/工作轮换/休息时间 Work Practices工作实践 Emergency preparedness应急准备 Personal Hygiene个人卫生 Personal Protective Equipment (PPE) - CAN FAIL WITHOUT WARNING 个人防护用品-如果无警告可能无效

Public Health in Canada 加拿大的公共卫生 The role of the Public Health Agency of Canada is to: * Promote health; * Prevent and control chronic diseases and injuries; * Prevent and control infectious diseases; * Prepare for and respond to public health emergencies, and * Strengthen public health capacity in a manner consistent with a shared understanding of the determinants of health and of the common factors that maintain health or lead to disease and injury. NO SPECIFIC ROLE IN OCCUPATIONAL HEALTH AND SAFETY 加拿大的公共卫生机构的职责是： 促进健康； 预防和控制慢性病和伤害； 预防和控制传染病； 公共卫生紧急事件应急准备和处理； 注重决定卫生的因素，增强对医疗保健，常见致病及工伤因素的认识，以此加强加拿大的公共卫生能力； 政府并没有赋予卫生部门专门的职业卫生与安全的特别职能。

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