Veglia Amanda, Pahwa Manisha, Demers Paul A
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada.
Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada.
Saf Health Work. 2017 Mar;8(1):29-35. doi: 10.1016/j.shaw.2016.07.001. Epub 2016 Aug 4.
Despite our knowledge of the causes of cancer, millions of workers are involuntarily exposed to a wide range of known and suspected carcinogens in the workplace. To address this issue from a policy perspective, we developed a policy framework based on a prospective health policy analysis. Use of the framework was demonstrated for developing policies to prevent cancers associated with diesel engine exhaust (DEE), asbestos, and shift work, three occupational carcinogens with global reach and large cancer impact.
An environmental scan of existing prospective health policy analyses was conducted to select and describe our framework parameters. These parameters were augmented by considerations unique to occupational cancer. Policy-related resources, predominantly from Canada, were used to demonstrate how the framework can be applied to cancers associated with DEE, asbestos, and shift work.
The parameters of the framework were: problem statement, context, jurisdictional evidence, primary prevention policy options, and key policy players and their attributes. Applying the framework to the three selected carcinogens illustrated multiple avenues for primary prevention, including establishing an occupational exposure limit for DEE, banning asbestos, and improving shift schedules. The framework emphasized the need for leadership by employers and government.
To our knowledge, this is the first proposal for a comprehensive policy framework dedicated to the primary prevention of occupational cancer. The framework can be adapted and applied by key policy players in Canada and other countries as a guide of what parameters to consider when developing policies to protect workers' health.
尽管我们了解癌症的成因，但仍有数百万工人在工作场所非自愿地接触到多种已知和疑似致癌物。为了从政策角度解决这一问题，我们基于前瞻性健康政策分析制定了一个政策框架。该框架的应用体现在为预防与柴油发动机尾气（DEE）、石棉和轮班工作相关的癌症制定政策方面，这三种职业致癌物在全球范围内存在且对癌症有重大影响。
对现有的前瞻性健康政策分析进行环境扫描，以选择和描述我们的框架参数。这些参数因职业癌症的独特考虑因素而得到扩充。主要来自加拿大的与政策相关的资源被用于展示该框架如何应用于与DEE、石棉和轮班工作相关的癌症。
该框架的参数为：问题陈述、背景、管辖证据、一级预防政策选项以及关键政策参与者及其属性。将该框架应用于三种选定的致癌物，展示了一级预防的多种途径，包括为DEE设定职业接触限值、禁止使用石棉以及改善轮班安排。该框架强调了雇主和政府发挥领导作用的必要性。
据我们所知，这是首个致力于职业癌症一级预防的全面政策框架提案。加拿大和其他国家的关键政策参与者可以对该框架进行调整和应用，作为制定保护工人健康政策时应考虑哪些参数的指南。
