Rodríguez Jareño Mari Cruz, De Montserrat I Nonó Jaume
Departamento de Ciencias Médicas, Facultad de Medicina, Universitat de Girona, Girona, Spain.
Arch Prev Riesgos Labor. 2017;20(2):80-101. doi: 10.12961/aprl.2017.20.2.02.
In Spain, the limited preventive usefulness of health surveillance is determined by the indiscriminate use of nonspecific "generic" health examinations aimed at producing a "fitness for work list", presumably allowing companies to comply with health and safety regulations. This study aimed to produce a technical interpretation of the Spanish Prevention of Risks at Work Act and propose a new conceptual framework to favour greater preventive usefulness of health surveillance within the current regulatory framework.
Using qualitative techniques of content analysis, the text of the Law was studied, the key concepts that impeded the fulfilment of the preventive objectives of health surveillance were identified, and a technical interpretation adjusted to regulations was made in order to propose a new conceptual framework RESULTS: This conceptual framework would include: clearly differentiating health surveillance from health examinations (one of its instruments) and from fitness for work evaluations (an independent concept in itself); restricting mandatory health surveillance to situations in which it is "imperative" to carry it out because of the existence of a substantial risk to workers or third parties, including potentially vulnerable workers; and communicating the results of health surveillance through preventive recommendations to the company, reserving fitness for duty certificates -always based on clear, pre-established and justified criteria in relation to risk- for mandatory surveillance.
The proposed new conceptual framework falls within the scope of the Spanish Prevention of Risks at Work Act, and its implementation could contribute to improving the preventive usefulness of health surveillance without the need to reform the legislation.
在西班牙，健康监测的预防作用有限，这是由不加区分地使用非特定的“通用”健康检查所决定的，这些检查旨在生成一份“适合工作清单”，大概是为了让公司遵守健康与安全法规。本研究旨在对西班牙《工作风险预防法》进行技术解读，并提出一个新的概念框架，以在当前监管框架内提高健康监测的预防作用。
运用内容分析的定性技术，研究该法律文本，确定阻碍实现健康监测预防目标的关键概念，并进行符合法规的技术解读，以提出一个新的概念框架。结果：这个概念框架将包括：明确区分健康监测与健康检查（其工具之一）以及与工作适应性评估（其本身是一个独立概念）；将强制性健康监测限制在因存在对工人或第三方的重大风险（包括潜在弱势工人）而“必须”进行的情况下；通过向公司提出预防性建议来传达健康监测结果，将工作胜任证书（始终基于与风险相关的明确、预先确定且合理的标准）保留用于强制性监测。
提议的新概念框架属于西班牙《工作风险预防法》的范畴，其实施有助于在无需改革立法的情况下提高健康监测的预防作用。
