Department of Public Health and Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA.
Department of Physical Medicine and Rehabilitation, University of Miami, Miller School of Medicine, Miami, FL, USA.
Ann Work Expo Health. 2021 Mar 3;65(2):143-147. doi: 10.1093/annweh/wxaa066.
Increasing scientific evidence suggests that addressing complex, wide-ranging concerns among worker populations should include the integration of traditional occupational safety and health with often siloed worksite wellness programs. The Total Worker Health (TWH) approach developed by the National Institute for Occupational Safety and Health can support skin cancer prevention efforts by integrating organizational-level policies, programs, and practices that strategically merge both skin protection from work-related safety and health hazards with promotion of skin illness prevention efforts. In the firefighter workforce, epidemiologic studies suggest an increased risk of skin cancer despite the use of personal protective equipment during fire incident response. Mechanisms for dermal absorption of carcinogenic compounds such as polycyclic aromatic hydrocarbons have given insight into how these hazardous chemicals can enter the skin and increase cancer risk. Mitigation of carcinogenic exposures requires a TWH approach that merges skin protection and promotion, routine surveillance, skin health assessment, worksite-based interventions, and regular evaluation of program activities. In this commentary, an example of a TWH approach is provided from the Firefighter Cancer Initiative (FCI), a transdisciplinary initiative focused at addressing excess burden of cancer in the firefighter workforce. The FCI builds on the TWH approach through the following components: (i) organizational leadership commitment; (ii) elimination of workplace hazards and promotion of worker well-being; (iii) engagement of workers in program design and delivery; (iv) ensuring confidentiality and privacy in program participation; and (v) integrating systems effectively. Occupational hygienists have strong potential to play a crucial role beyond traditional risk assessment, exposure assessment, and health protection that further includes skin health promotion and integration of related programs into a TWH framework.
越来越多的科学证据表明，解决工人群体中复杂、广泛的问题应包括将传统职业安全与健康与通常孤立的工作场所健康计划相结合。国家职业安全与健康研究所开发的全面工人健康（TWH）方法可以通过整合组织层面的政策、计划和实践来支持皮肤癌预防工作，这些政策、计划和实践策略性地将工作相关安全和健康危害的皮肤保护与促进皮肤疾病预防工作结合起来。在消防员劳动力中，尽管在火灾事故应对中使用了个人防护设备，但流行病学研究表明皮肤癌的风险增加。多环芳烃等致癌化合物的皮肤吸收机制使人们深入了解这些危险化学品如何进入皮肤并增加癌症风险。减少致癌暴露需要采用 TWH 方法，将皮肤保护和促进、常规监测、皮肤健康评估、基于工作场所的干预措施以及定期评估计划活动结合起来。在这篇评论中，提供了一个全面工人健康方法的示例，该示例来自消防员癌症倡议（FCI），这是一个跨学科倡议，专注于解决消防员劳动力中癌症负担过重的问题。FCI 通过以下组成部分建立在 TWH 方法的基础上：（i）组织领导承诺；（ii）消除工作场所危害和促进工人福祉；（iii）让工人参与计划设计和实施；（iv）确保计划参与的保密性和隐私性；（v）有效整合系统。职业卫生学家除了传统的风险评估、暴露评估和健康保护之外，还有很大的潜力发挥关键作用，这进一步包括皮肤健康促进和将相关计划纳入 TWH 框架。
