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Occupational disease – making the link between work and health – review (& ODRA response)

Update Oct 30:  Responding to the landscape review, the Occupational Disease Reform Alliance acknowledges the work done but regrets the resulting report “misses the point entirely” when it comes to problems with the WSIB’s occupational disease recognition system. See  “Another government report on occupational disease: more broken promises” (Hamilton Star, Oct. 27).

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Occupational disease is widely acknowledged to be under-recognized and under-reported. The challenges in linking workplace exposure to an occupational illness are many, especially when symptoms appear long after exposure. Released last week, the Occupational Disease Landscape Review by authors Dr Linn Holness and Janet Baker (MAP Centre for Urban Health Solutions) makes 41 recommendations to help address those challenges.

Launched in April 2022 by the Ministry of Labour and WSIB, the study focuses on many of the issues identified by Dr Paul Demers in his review (Jan. 9, 2020) on the work-relatedness of occupational cancer, including the need for rigorous data collection and surveillance, its utilization in prevention, and improved training of healthcare providers on recognition of occupational illness.

Recommendations to improve prevention and healthcare delivery

The Landscape Review proposes solutions to help workers navigate between the occupational health and safety system and the healthcare system, to recognize symptoms early and determine the work-relatedness, critical to treatment and assessing risk and needed prevention efforts for others in the workplace. Among key topics addressed:

  • Awareness, recognition and reporting of occupational disease
  • Workplace prevention training and medical screening for workers exposed to hazards
  • Quality occupational disease surveillance system to capture, track and analyze data
  • Cluster management and investigation
  • Simplify worker’s journey through the healthcare system (protection of worker rights, physician clinical support and capacity, standardized care approaches)
  • Physician education on occupational medicine in medical schools
  • Occupational history and information collection in the electronic medical record

What the report does not address

The scope of the review does not cover WSIB processes, or address individual occupational diseases. It is often the case that a worker seeks medical attention for a disease when it begins to interfere with their employment. At that stage, compensation for lost earnings and assistance with health care costs are a vital part of the treatment process and therefore timely recognition of occupational diseases by the WSIB is essential. While it is hoped that these recommendations will lead to increased awareness of the relationship of many diseases to the workplace by health care professionals, Ontario also needs to take steps to enable a timely recognition of work related illness and disease by the WSIB.

This was addressed in the submission of Injured Workers Community Legal Clinic on the WSIB’s Occupational Disease Framework. One of Chief Justice Meredith’s founding principles for the Ontario workers compensation system is that the right to compensation for occupational diseases is put on the same footing as to the right to compensation for accidents.

How well does Ontario’s workers compensation system recognize occupational disease? The Paul A. Demers 2020 report showed that Ontario is falling embarrassingly behind other jurisdictions. Ontario is significantly behind Germany, France, Denmark, Italy and Belgium with respect to the accepted claims rate. Germany, at the top, is at 15.1% per 100,000 insured workers. Ontario is at 2.9%. This meagre acceptance rate of occupational diseases is a WSIB crisis that requires further action.

Occupational Exposure Registry

In calling for a comprehensive provincial disease surveillance system, the authors of the OD Landscape Review highlight the need for agreement on its purpose, what data is required, and clear accountability. While referencing existing information sources, the review discusses gaps in current data collection and utilization, and urges the Ministry to commission an expert taskforce to review potential surveillance methodologies and establish an appropriate sustainable, trusted and adequately resourced occupational disease surveillance system.

In response, the Government has committed to creating an Occupational Exposure Registry (projected for 2025) in collaboration with the Ontario Cancer Research Centre and “also working with healthcare providers and industry associations to gather new data and catalogue past and current occupational exposures..”

The Ministry has also announced it will create an Occupational Illness Leadership Table of industry experts and worker advocates to guide implementation of report recommendations.

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