Report to the Minister of Labour

Transcription

1 Report to the Minister of Labour T I M D R I S C O L L E V A N D R Y S O N A N N E - M A R I E F E Y E R P H I L I P P A G A N D E R S E L W Y N M c C R A C K E N N E I L P E A R C E M A R K W A G S T A F F E

2 AUTHORS Tim Driscoll ELMATOM Pty Ltd, Riverview, NSW Evan Dryson Occupational Medical Specialists Ltd, Auckland; and Centre for Public Health Research, Massey University Anne-Marie Feyer Director, Health Advisory Practice, PricewaterhouseCoopers, Sydney; and Adjunct Principal Research Fellow, Department of Preventive and Social Medicine, University of Otago Philippa Gander Sleep/Wake Research Centre, Massey University Selwyn McCracken Injury Prevention Research Unit, University of Otago Neil Pearce Centre for Public Health Research, Massey University NOHSAC Telephone: (04) Fax: (04) Website: Postal address: P O Box 3705, Wellington ACKNOWLEDGEMENTS This work was funded by NOHSAC with assistance from the Accident Compensation Corporation and the Department of Labour. Neil Pearce s involvement was partly funded by a programme grant from the Health Research Council of New Zealand (HRC 02/159) ISBN This document is available on NOHSAC s website It can be freely quoted, copied and circulated with appropriate acknowledgement. The suggested citation is: Driscoll T, Dryson E, Feyer A-M, Gander P, McCracken S, Pearce N, Wagstaffe M. Review of Schedule 2 of the Injury Prevention Rehabilitation and Compensation Act 2001 (IPRC Act). NOHSAC: Wellington, 2005 Mark Wagstaffe National Occupational Health and Safety Advisory Committee (NOHSAC) Secretariat

3 Table of Contents List of Tables 3 Abbreviations 3 Executive Summary 5 1. Introduction Background Project aims Outline of the structure of the report 9 2. Methods Introduction Discussions with relevant parties International approaches Issues related to Schedule Schedule How Schedule 2 operates Comparison of Schedule 2 to the current ILO List and Annex Criteria for inclusion in Schedule 2 25 Strong causal link between the disorder and occupational exposure 25 Clear diagnostic criteria 25 The disorder comprises a considerable proportion of the cases of that disorder in the overall population or in an identifiable subset of the population Structure and content of Schedule 2 27 Focus on specific disorders 27 Focus on specific exposures 27 Exposure circumstances 28 The inclusion of a catch-all category Summary of issues related to Schedule Evidence Introduction Occupationally-related attributable fractions Sufficient exposure Disorders recommended for inclusion in Schedule 2 36 Infectious disease 36 Malignancy 38 Mental or neuropsychiatric disorders 39 Disorders of the nervous system 39 Vascular disorders 40 Respiratory disorders (non-malignant) 40 Hepatic disorders 41 Disorders of the genitourinary system 41 Non-cancerous skin disorders 42 Musculoskeletal disorders 42 Vibration disorders 43 Noise-induced hearing loss 43 Acute chemical poisoning/toxicity 43 Reproductive risks 44 Multiple chemical sensitivity 44 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 3

4 5.5 Disorders not recommended for inclusion in the Schedule 44 Infectious disease 44 Malignancy 44 Chemotherapeutic agents 46 Mental or neuropsychiatric disorders 46 Disorders of the nervous system 47 Vascular disorders 47 Respiratory disorders (non-malignant) 47 Hepatic disorders 47 Disorders of the genitourinary system 47 Non-cancerous skin disorders 47 Musculoskeletal disorders 48 Vibration disorders 48 Noise-induced hearing loss 48 Chemical poisoning/toxicity 49 Reproductive risks 49 Multiple chemical sensitivity Recommendations Recommended format and content of Schedule Disorders not recommended for inclusion in Schedule 2 55 Comparison of recommended revised Schedule 2 to current ILO Annex and its possible amendments References Appendices 59 Appendix 1 ILO Schedule 42 and related schedules Appendix 2 ILO Schedule 42 and related schedules Appendix 3 ILO Schedule 42 and related schedules 1934 and Appendix 4 Section 30 of the Injury Prevention, Rehabilitation, and Compensation Act Appendix 5 Comparison of Annex to ILO Recommendation 1941 to recommended revised version of Schedule 2 64 Appendix 6 Comparison of possible additions to Annex to ILO Recommendation 1941 to recommended revised version of Schedule R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

5 List of Tables Table 3.1 References to equivalent of Schedule 2 in selected countries 14 Table 4.1 Schedule 2 of the Injury Prevention, Rehabilitation, and Compensation Act Table 4.2 Comparison of 2002 version of ILO List of Occupational Diseases and the New Zealand Schedule 2 of the IPRC Act 20 Table 4.3 List of occupational diseases, as per Annex to ILO Recommendation Table 4.4 Table 5.1 List of occupational diseases being considered for inclusion in the Annex to ILO Recommendation Estimated occupational attributable fractions and resultant estimated annual burden of work-related disease mortality in New Zealand 1 34 Table 5.2 Estimated annual burden of work-related disease incidence in New Zealand 35 Table 6.1 Recommended format and content of Schedule 2 52 Table 6.2 Disorders recommended not to be included in Schedule 2, with justification against set criteria 55 Abbreviations ACC ACGIH AF IARC Accident Compensation Corporation American Conference of Government Industrial Hygienists Attributable fraction International Agency for Research on Cancer IPRC Act Injury Prevention, Rehabilitation, and Compensation Act 2001 TLV Threshold limit value R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 5

6 6 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

7 Executive Summary BAC KGROUND Schedule 2 of the Injury Prevention, Rehabilitation, and Compensation Act 2001 (IPRC Act) provides a list of occupational disorders and exposures. Claims made for disorders and exposures contained within Schedule 2 of the Act are able to be considered more quickly than other claims because the connection between the disorder and an occupational exposure is automatically accepted. In 2004, the National Occupational Health and Safety Advisory Committee (NOHSAC) released a report that described the burden of occupational disease and injury in New Zealand. Comparison of the report s findings with the New Zealand Schedule 2, which contains a list of formally recognised diseases and toxic substances, showed that Schedule 2 does not include many disorders for which there is strong evidence of connection to occupational exposures. In 2005, based on the results of the NOHSAC report and other relevant research, the Ministerial Advisory Panel on Work-related Gradual Process Disease and Infection reported concerns that Schedule 2 was too restrictive, particularly in regard to work-related gradual process disease and infection. In May 2005, the Honourable Ruth Dyson, Associate Minister for Labour and Minister for the ACC, requested NOHSAC to assist in a review of Schedule 2. This assistance was to involve a review of the NOHSAC report to inform the review of Schedule 2, and specifically to identify and document: the disorders where the causal link between exposure and development of the disorder is well established; and the prevalence of such disorders/diseases in the community (including work and non-work causative factors). This report provides the result of the requested review. The overall aim of the project was to provide background information and recommendations to support a review of Schedule 2 of the IPRC Act. METHODS Much of the factual information in this report is drawn directly from the NOHSAC report The burden of occupational disease and injury in New Zealand 1. Other information is based on published literature and relevant information from government reports, online sources and other appropriate sources. No new investigations were undertaken to obtain information on exposure or risk. RESULT S The International Labour Organization s List of Occupational Diseases (the ILO List) is documented in ILO Convention 42 (Workmen s Compensation (Occupational Diseases) Convention (Revised), 1934). This has been revised several times since it was first released, with further additions being considered in A number of countries have their own equivalent of Schedule 2, almost always based heavily on the ILO List. In most cases, the schedule contains a mixture of specific and non-specific disorders. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 7

8 Schedule 2 of the IPRC Act is comprised of a list of diseases linked to specific occupational exposures. The Schedule appears to be based on the International Labour Organization s List of Occupational Diseases. New Zealand is a signatory to ILO Convention 42, but has not ratified any of the later amendments to the Convention. The current version of Schedule 2 does not include many of the categories listed in the ILO List, which in turn does not include many disorders that can definitely arise due to occupational exposures. For inclusion in Schedule 2, it is desirable that: there is strong evidence of a causal link between the occupational exposure and the disorder; there are clear and repeatable criteria for diagnosing the disorder; and the disorder comprises a considerable proportion of the cases of that disorder in the overall population or an identifiable subset of the population. The structure of Schedule 2 is best based on a combination of specific disorder-exposure combinations, unless the number of potential exposures linked to a particular disorder, or the number of disorders linked to a particular exposure, make it impractical to list them all. Using these criteria, and scientific evidence from the published literature, the known and potential occupational disorders and exposures are considered. The disorders and exposures are grouped into those that should and should not be included in a revised version of Schedule 2, and reasons for the recommendations are presented. Finally, the recommended format and content of the revised form of Schedule 2, as well as the disorders not recommended for inclusion, are presented. 8 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

9 SECTION ONE INTRODUCTION 1 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 9

10 1.1 BAC KGROUND Schedule 2 of the Injury Prevention, Rehabilitation, and Compensation Act 2001 (IPRC Act) provides a list of occupational disorders and exposures. Claims made for disorders and exposures contained within Schedule 2 are able to be considered more quickly than other claims because the connection between the disorder and an occupational exposure is very clear and accepted internationally be medical experts. In 2004, the National Occupational Health and Safety Advisory Committee (NOHSAC) 1 released a report that described the burden of occupational disease and injury in New Zealand. The report made a detailed analysis of the evidence concerning work-related disorders in New Zealand. The analysis considered the likely causative occupational exposures, the strength of evidence regarding the connection between occupational exposures and the risk of developing the disorders, and the prevalence of exposure in the New Zealand workforce. The report also contained an estimate of the number of fatal and non-fatal occurrences of work-related disease and injury that occur in New Zealand each year i. The report highlighted that the official number of occurrences of fatal and non-fatal work-related disease and injury in New Zealand significantly underestimates the true number. It also showed that there are a large number of disorders for which there is good evidence of a strong connection to work-related exposures. Comparison of the report s findings with the New Zealand Schedule 2, which contains a list of formally recognised diseases and toxic substances, showed that Schedule 2 does not include many disorders for which there is strong evidence of connection to occupational exposures. In 2005, based on the results of the NOHSAC report and other relevant research, the Ministerial Advisory Panel on Work-related Gradual Process Disease and Infection reported concerns that Schedule 2 was too restrictive, particularly in regard to work-related gradual process disease and infection. Therefore, in May 2005, the Honourable Ruth Dyson, Associate Minister for Labour and Minister for the ACC, requested NOHSAC to assist in a review of Schedule 2 This assistance was to involve a review of the NOHSAC report to inform the review of Schedule 2, and specifically to identify and document: the disorders where the causal link between exposure and development of the disorder is well established; and the prevalence of such disorders/diseases in the community (including work and non-work causative factors). This report provides the result of the requested review PROJECT AIMS The overall aim of the project was to provide background information and recommendations to support a review of Schedule 2 of the IPRC Act. i NOHSAC is responsible for providing independent advice to the Minister of Labour on occupational health and safety issues in New Zealand. NOHSAC plays a key role in providing an independent assessment to the Minister on the major occupational health and safety issues for the New Zealand workforce, of advising on the measures that would deliver the greatest benefit for the prevention of occupational injury and disease, and in developing an evidence-based approach to occupational health and safety issues. 10 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

11 1. 3 OUTLINE OF THE S TRUCTURE O F THE REPORT The report has six main sections. Section 1 provides an introduction to the project. Section 2 describes the methodology used. Section 3 summarises the international approach to identifying work-related diseases and establishing a list of formally recognised work-related disorders. Section 4 considers issues relevant to Schedule 2 and the development of a revised Schedule. Section 5 contains the main information regarding potential work-related disorders and the strength of evidence concerning their possible connection to work-related exposures. It also discusses the appropriateness of each disorder for inclusion in the revised Schedule 2. Section 6 contains the formal recommendations for the revised Schedule 2, and is followed by a list of the references and the appendices. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 11

12 12 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

13 SECTION T WO METHODS 2 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 13

14 2.1 INTRODUCTION Much of the information in this report is drawn directly from the NOHSAC report The burden of occupational disease and injury in New Zealand 1. That report was prepared by the authors of the current report, along with Dr Andrea Mannetje. Other information presented in this report is based on published literature and other relevant information from government reports, online sources and other appropriate sources. No new investigations were undertaken to obtain information on exposure or risk. Estimates of the population attributable fraction (AF) come for the NOHSAC Burden report, which in turn came from two major reports into the burden of work-related ill health in Finland 2 and in the United States DISCUSSIONS WITH RELEVANT PARTIES Drafts of the report were reviewed by members of NOHSAC and a small number of other relevant parties. The authors in particular would like to thank Dr Kevin Morris, of the Accident Compensation Corporation, for his considered comments on the draft of this report. All comments were taken into account in developing this report, but they have not formally endorsed the final version of the report, and the contents may or may not totally reflect their views on various matters it considers. Widespread consultation was not undertaken, as this is planned for a later phase of the overall review process. 14 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

15 SECTION THREE APPROACHES 3 I N T E R N A T I O N A L R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 15

16 Summary The International Labour Organization s List of Occupational Diseases (the ILO List) is documented in ILO Convention 42 (Workmen s Compensation (Occupational Diseases) Convention (Revised), 1934). This has been revised several times since it was first released, with further additions being considered in A number of countries have their own equivalent of Schedule 2, almost always based heavily on the ILO List. In most cases, the schedule contains a mixture of specific and non-specific disorders. The International Labour Organization s List of Occupational Diseases (the ILO List) is documented in ILO Convention 42 (Workmen s Compensation (Occupational Diseases) Convention (Revised), 1934) (Appendix 2). This was a revised version of the original list that was documented in ILO Convention 18 (Workmen s Compensation (Occupational Diseases) Convention, 1925) (Appendix 1). Convention 42 has itself been revised twice, in 1964 (ILO Convention 121 (Employment Injury Benefits Convention, 1964)) and in 1980 (Employment Injury Benefits Convention, 1964 [Schedule I amended in 1980] (No. 121)) (Appendix 3). A more comprehensive list is included as an Annex to ILO Recommendation 194, released in 2002 (see Table 4.3). Further additions to this more comprehensive list were to be considered at an ILO meeting late in 2005 (see Table 4.4). A number of countries have their own equivalent of Schedule 2, almost always based heavily on the ILO List. In most cases, the schedule contains a mixture of specific and non-specific disorders. Exposures are only specified in some of the lists, or parts of some of the lists, although exposures are implied for those conditions with a direct causal connection to only one exposure. Many examples are available and can be accessed via the internet, as shown in Table 3.1. TA B L E 3. 1 References to equivalent of Schedule 2 in selected countries Hong Kong Ireland Ontario, Canada South Africa United Kingdom R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

17 SECTION FOUR SCHEDULE 2 4 I S S U E S R E L A T E D T O R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 17

18 Summary Schedule 2 of the IPRC Act is comprised of a list of diseases linked to specific occupational exposures. The Schedule appears to be based on the International Labour Organization s List of Occupational Diseases. Claims for compensation for a specific work-related disorder are handled differently, depending on whether or not the disorder is listed under Schedule 2. Investigating whether a particular claim meets all three criteria listed under the IPRC Act can be very costly in terms of time and resources. For disorders and exposures listed under Schedule 2, the process is much more streamlined. If the presence of the disorder is verified, the second and third criteria are accepted as being satisfied. Therefore, it only has to be determined that, on the balance of probabilities, the causative exposure occurred as a result of work activities. The current version of Schedule 2 does not include many of the categories listed in the ILO List. Even the ILO List does not include many disorders that can definitely arise due to occupational exposures. A more comprehensive list is included as an Annex to ILO Recommendation 194, released in Further additions to this more comprehensive list were to be considered at an ILO meeting late in New Zealand is a signatory to ILO Convention 42, but has not ratified any of the later amendments to the Convention. The disorders listed in the ILO Annex and its possible additions form a good starting point for establishing a comprehensive list of occupational disorders that should be included in Schedule 2. However, they should not be adopted without modification because they do not necessarily meet the appropriate criteria or format for a revised Schedule 2. For inclusion in Schedule 2, it is desirable that there is strong evidence of a causal link between the occupational exposure and the disorder, that there are clear and repeatable criteria for diagnosing the disorder, and that the disorder comprises a considerable proportion of the cases of that disorder in the overall population or an identifiable subset of the population. The structure of Schedule 2 is best based on a combination of specific disorder-exposure combinations, unless the number of potential exposures linked to a particular disorder, or the number of disorders linked to a particular exposure, make it impractical to list them all. 18 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

19 4.1 SC HEDULE 2 Schedule 2 of the IPRC Act is comprised of a list of diseases linked to specific occupational exposures. It is referenced in Section 30 of the Act (see Appendix 4). The Schedule appears to be based on the International Labour Organization s List of Occupational Diseases (the ILO List), described earlier. The current version of Schedule 2 is shown in Table 4.1. The Schedule is required because there are a wide range of disorders that could be the subject of a work-related compensation claim. For some disorders, there is good scientific evidence that specific occupational exposures can increase the risk of developing particular disorders. When the symptoms develop soon after exposure, the connection to work may be very clear. This is usually the case for acute poisoning, for example. However, for many exposures, the disorder may not become apparent for weeks, months or years after the causative exposure. In addition, for a given disorder, there is usually no difference in the symptoms, signs or investigation results regardless of whether the disorder arose due to occupational exposures or non-occupational exposures. This can make establishment of a connection to work very difficult, even when such a connection is truly present. Schedule 2 is designed to provide a list of disorders for which there is very good evidence of a causal connection to one or more workplace exposures. Disorders listed on the Schedule are accepted as arising from work, provided that the claimant has experienced the relevant exposure in the course of work. Potentially work-related disorders may not be listed on the Schedule for two main reasons. For many, the level of scientific evidence of a causal connection to work is insufficient to allow a connection to work to be automatically accepted. For others, the proportion of cases due to work is so low that it is likely that, in any individual, even if they are a worker with relevant work exposures, the disorder arose as a result of non-work exposures HOW SC HEDULE 2 OPERATES Claims for compensation for a specific work-related disorder are handled differently, depending on whether or not the disorder is listed under Schedule 2. If the disorder is not listed under Schedule 2, the claim is considered under a three-part assessment process, as described in Section 30(2) of the Act. To be successful, the claim must satisfy all three of the following criteria: The person s employment task or employment environment has a particular property or characteristic (that is, a causative agent) that caused, or contributed to the cause of, the physical injury ii. The property or characteristic is not found to any material extent in the claimant s non-work activities or environment. The risk of sustaining this form of personal injury is significantly greater for people who do this particular type of employment task, or work in that environment, than for people who do not. ii Presumably injury in this case includes any disorder, regardless of whether it is usually described as an injury or a disease. This is explained in more detail in Sections 20(2) and Section 26 of the Act. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 19

20 TA B L E 4. 1 Schedule 2 of the Injury Prevention, Rehabilitation, and Compensation Act 2001 iii N O. D E S C R I P T I O N 1. Pneumoconioses caused by sclerogenic mineral dust (silicosis, anthraco-silicosis, asbestosis) and silico-tuberculosis, provided that silicosis is an essential factor in causing the resultant incapacity or death. 2. Lung cancer or mesothelioma diagnosed as caused by asbestos. 3. Diseases of a type generally accepted by the medical profession as caused by beryllium or its toxic compounds. 4. Diseases of a type generally accepted by the medical profession as caused by phosphorus or its toxic compounds. 5. Diseases of a type generally accepted by the medical profession as caused by chrome or its toxic compounds. 6. Diseases of a type generally accepted by the medical profession as caused by manganese or its toxic compounds. 7. Diseases of a type generally accepted by the medical profession as caused by arsenic or its toxic compounds. 8. Diseases of a type generally accepted by the medical profession as caused by mercury or its toxic compounds. 9. Diseases of a type generally accepted by the medical profession as caused by lead or its toxic compounds. 10. Diseases of a type generally accepted by the medical profession as caused by carbon bisulphide. 11. Diseases of a type generally accepted by the medical profession as caused by the toxic halogen derivatives of hydrocarbons of the aliphatic series. 12. Diseases of a type generally accepted by the medical profession as caused by benzene or its toxic homologues. 13. Diseases of a type generally accepted by the medical profession as caused by nitro- and amido-toxic derivatives of benzene or its homologues. 14. Diseases of a type generally accepted by the medical profession as caused by ionising radiations. 15. Primary epitheliomatous cancer of the skin diagnosed as caused by tar, pitch, bitumen, mineral oil, anthracene, or the compounds, products, or residues of these substances. 16. Anthrax infection. 17. Leptospirosis diagnosed as caused by working with animals or their carcasses. iii From the Injury Prevention, Rehabilitation, and Compensation Act See Accessed August R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

21 Investigating whether a particular claim meets all three criteria can sometimes be very costly in terms of time and resources iv. For disorders and exposures listed under Schedule 2, the process is much more streamlined. If the presence of the disorder is verified, the second and third criteria are accepted as being satisfied. Therefore, it only has to be determined that, on the balance of probabilities, the causative exposure occurred as a result of work activities. The connection between such an exposure and the disorder does not need to be established by the claimant. For example, suppose a claim is made for leukaemia (one of the causes of which is known to be benzene). This is implicitly covered by the Schedule ( Diseases of a type generally accepted by the medical profession as caused by benzene or its toxic homologues ). Therefore, if the claimant can prove that their occupational duties involved non-trivial exposure to benzene, then the claim would be automatically accepted. Section 60 of the IPRC Act is also relevant to the application of Schedule 2. This section states: The Corporation may decline a claim that a personal injury is a work-related personal injury of a kind described in section 30(3) only if the Corporation establishes that: a) the person is not suffering from a personal injury of a kind described in Schedule 2; or b) the person s personal injury has a cause other than his or her employment COMPARISON OF SC HEDULE 2 TO THE CURRENT ILO LIST AND ANNEX As mentioned earlier, Schedule 2 has its origins in the ILO List of Classified Diseases originally presented in Convention 42, and since updated. New Zealand is a signatory to ILO Convention 42, but has not ratified any of the later amendments to the Convention. A comparison of the latest ILO List and Schedule 2 is shown in Table 4.2. Table 4.2 shows that many of the categories listed in the ILO List are not included in the current version of Schedule 2. Even the ILO List does not include many disorders that can definitely arise due to occupational exposures. A more comprehensive list is included as an Annex to ILO Recommendation 194, released in This is shown in Table 4.3. ILO Recommendation 194 recommended that countries include as many of the disorders in the Annex as possible in their list of diseases that should be the basis for compensation (the equivalent of Schedule 2). Further additions to this more comprehensive list were to be considered at an ILO meeting late in Disorders being considered for inclusion are shown in Table 4.4. iv Note that the ACC has a legislated maximum time of nine months within which it must issue a decision on a claim for personal injury caused by work-related gradual process, disease or infection. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 21

22 TA B L E 4. 2 Comparison of 2002 version of ILO List of Occupational Diseases and the New Zealand Schedule 2 of the IPRC Act I L O C O N V E N T I O N 121 ( A M E N D E D ) N Z S C H E D U L E 2 N O D E S C R I P T I O N N O D E S C R I P T I O N 1 Pneumoconioses caused by sclerogenic mineral dust risk (silicosis, anthraco-silicosis, asbestosis) and silico-tuberculosis, provided that silicosis is an essential factor in causing the resultant incapacity or death. 2 Bronchopulmonary diseases caused by hard-metal dust. 3 Bronchopulmonary diseases caused by cotton dust (byssinosis), or flax, hemp or sisal dust. 4 Occupational asthma caused by sensitising agents or irritants both recognised in this regard and inherent in the work process. 5 Extrinsic allergic alveolitis and its sequalae caused by the inhalation of organic dusts, as prescribed by national legislation. 6 Diseases caused by beryllium or its toxic compounds. 7 Diseases caused by cadmium or its toxic compounds. 8 Diseases caused by phosphorus or its toxic compounds. 9 Diseases caused by chromium or its toxic compounds. 10 Diseases caused by manganese or its toxic compounds. 11 Diseases caused by arsenic or its toxic compounds. 12 Diseases caused by mercury or its toxic compounds. 13 Diseases caused by lead or its toxic compounds. 14 Diseases caused by fluorine or its toxic compounds. 15 Diseases caused by carbon disulphide. 16 Diseases caused by the toxic halogen derivatives of aliphatic or aromatic hydrocarbons. 1 Pneumoconioses caused by sclerogenic mineral dust (silicosis, anthraco-silicosis, asbestosis) and silicotuberculosis, provided that silicosis is an essential factor in causing the resultant incapacity or death. 3 Diseases of a type generally accepted by the medical profession as caused by beryllium or its toxic compounds. 4 Diseases of a type generally accepted by the medical profession as caused by phosphorus or its toxic compounds. 5 Diseases of a type generally accepted by the medical profession as caused by chrome or its toxic compounds. 6 Diseases of a type generally accepted by the medical profession as caused by manganese or its toxic compounds. 7 Diseases of a type generally accepted by the medical profession as caused by arsenic or its toxic compounds. 8 Diseases of a type generally accepted by the medical profession as caused by mercury or its toxic compounds. 9 Diseases of a type generally accepted by the medical profession as caused by lead or its toxic compounds. 10 Diseases of a type generally accepted by the medical profession as caused by carbon bisulphide. 11 Diseases of a type generally accepted by the medical profession as caused by the toxic halogen derivatives of hydrocarbons of the aliphatic series. 2 2 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

23 TA B L E 4. 2 C O N T I N U E D I L O C O N V E N T I O N 121 ( A M E N D E D ) N Z S C H E D U L E 2 N O D E S C R I P T I O N N O D E S C R I P T I O N 17 Diseases caused by benzene or its toxic homologues. 18 Diseases caused by toxic nitro- and amino- derivatives of benzene or its homologues. 19 Diseases caused by nitroglycerin or other nitric acid esters. 20 Diseases caused by alcohols, glycols or ketones. 21 Diseases caused by asphyxiants: carbon monoxide, hydrogen cyanide or its toxic derivatives, hydrogen sulphide. 22 Hearing impairment caused by noise. 23 Diseases caused by vibration (disorders of muscles, tendons, bones, joints, peripheral blood vessels or peripheral nerves). 24 Diseases caused by work in compressed air. 25 Diseases caused by ionising radiations all work involving exposure to the action of ionising radiations. 26 Skin diseases caused by physical, chemical or biological agents not included under other items. 27 Primary epitheliomatous cancer of the skin caused by tar, pitch, bitumen, mineral oil, anthracene, or the compounds, products or residues of these substances. 28 Lung cancer or mesotheliomas caused by asbestos. 29 Infectious or parasitic diseases contracted in an occupation where there is a particular risk of contamination: (a) Health or laboratory work. (b) Veterinary work. (c) Work handling animals, animal carcasses, parts of such carcasses, or merchandise which may have been contaminated by animals, animal carcasses, or parts of such carcasses. (d) Other work carrying a particular risk of contamination. 12 Diseases of a type generally accepted by the medical profession as caused by benzene or its toxic homologues. 13 Diseases of a type generally accepted by the medical profession as caused by nitro- and amido-toxic derivatives of benzene or its homologues. 14 Diseases of a type generally accepted by the medical profession as caused by ionising radiations. 15 Primary epitheliomatous cancer of the skin diagnosed as caused by tar, pitch, bitumen, mineral oil, anthracene, or the compounds, products, or residues of these substances. 2 Lung cancer or mesothelioma diagnosed as caused by asbestos. 16 Anthrax infection. 17 Leptospirosis diagnosed as caused by working with animals or their carcasses. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 2 3

24 TA B L E 4. 3 List of occupational diseases, as per Annex to ILO Recommendation 194 v T Y P E O F D I S E A S E 1. Diseases caused by agents 1.1. Diseases caused by chemical agents Diseases caused by beryllium or its toxic compounds Diseases caused by cadmium or its toxic compounds Diseases caused by phosphorus or its toxic compounds Diseases caused by chromium or its toxic compounds Diseases caused by manganese or its toxic compounds Diseases caused by arsenic or its toxic compounds Diseases caused by mercury or its toxic compounds Diseases caused by lead or its toxic compounds Diseases caused by fluorine or its toxic compounds Diseases caused by carbon disulphide Diseases caused by the toxic halogen derivatives of aliphatic or aromatic hydrocarbons Diseases caused by benzene or its toxic homologues Diseases caused by toxic nitro- and amino-derivatives of benzene or its homologues Diseases caused by nitroglycerine or other nitric acid esters Diseases caused by alcohols, glycols or ketones Diseases caused by asphyxiants: carbon monoxide, hydrogen cyanide or its toxic derivatives, hydrogen sulphide Diseases caused by acrylonitrile Diseases caused by oxides of nitrogen Diseases caused by vanadium or its toxic compounds Diseases caused by antimony or its toxic compounds Diseases caused by hexane Diseases of teeth caused by mineral acids Diseases caused by pharmaceutical agents Diseases caused by thallium or its compounds Diseases caused by osmium or its compounds Diseases caused by selenium or its compounds Diseases caused by copper or its compounds Diseases caused by tin or its compounds Diseases caused by zinc or its compounds Diseases caused by ozone, phosgene Diseases caused by irritants: benzoquinone and other corneal irritants Diseases caused by any other chemical agents not mentioned in the preceding items to , where a link between the exposure of a worker to these chemical agents and the diseases suffered is established 1.2. Diseases caused by physical agents Hearing impairment caused by noise Diseases caused by vibration (disorders of muscles, tendons, bones, joints, peripheral blood vessels or peripheral nerves) Diseases caused by work in compressed air Diseases caused by ionizing radiations Diseases caused by heat radiation Diseases caused by ultraviolet radiation Diseases caused by extreme temperature (e.g. sunstroke, frostbite) Diseases caused by any other physical agents not mentioned in the preceding items to 1.2.7, where a direct link between the exposure of a worker to these physical agents and the diseases suffered is established 2 4 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

25 TA B L E 4. 3 C O N T I N U E D 1.3. Diseases caused by biological agents Infectious or parasitic diseases contracted in an occupation where there is a particular risk of contamination 2. Diseases by target organ systems 2.1. Occupational respiratory diseases Pneumoconioses caused by sclerogenic mineral dust (silicosis, anthraco-silicosis, asbestosis) and silicotuberculosis, provided that silicosis is an essential factor in causing the resultant incapacity or death Bronchopulmonary diseases caused by hard-metal dust Bronchopulmonary diseases caused by cotton, flax, hemp or sisal dust (byssinosis) Occupational asthma caused by recognized sensitizing agents or irritants inherent to the work process Extrinsic allergic alveolitis caused by the inhalation of organic dusts, as prescribed by national legislation Siderosis Chronic obstructive pulmonary diseases Diseases of the lung caused by aluminium Upper airways disorders caused by recognized sensitizing agents or irritants inherent to the work process Any other respiratory disease not mentioned in the preceding items to 2.1.9, caused by an agent where a direct link between the exposure of a worker to this agent and the disease suffered is established 2.2. Occupational skin diseases Skin diseases caused by physical, chemical or biological agents not included under other items Occupational vitiligo 2.3. Occupational musculo-skeletal disorders Musculo-skeletal diseases caused by specific work activities or work environment where particular risk factors are present. Examples of such activities or environment include: (a) rapid or repetitive motion (b) forceful exertion (c) excessive mechanical force concentration (d) awkward or non-neutral postures (e) vibration Local or environmental cold may increase risk 3. Occupational cancer 3.1. Cancer caused by the following agents Asbestos Benzidine and its salts Bis chloromethyl ether (BCME) Chromium and chromium compounds Coal tars, coal tar pitches or soots Beta-naphthylamine Vinyl chloride Benzene or its toxic homologues Toxic nitro- and amino-derivatives of benzene or its homologues Ionizing radiations Tar, pitch, bitumen, mineral oil, anthracene, or the compounds, products or residues of these substances Coke oven emissions Compounds of nickel Wood dust Cancer caused by any other agents not mentioned in the preceding items to , where a direct link between the exposure of a worker to this agent and the cancer suffered is established 4. Other diseases 4.1. Miners nystagmus v From Recommendation concerning the List of Occupational Diseases and the recording and notification of occupational accidents and diseases. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 2 5

26 TA B L E 4. 4 List of occupational diseases being considered for inclusion in the Annex to ILO Recommendation 194 T Y P E O F D I S E A S E 1. Diseases caused by agents 1.1. Diseases caused by chemical agents Diseases caused by pesticides 1.2. Diseases caused by physical agents Acute diseases caused by electromagnetic fields 1.3. Diseases caused by biological agents Tetanus Brucellosis Tuberculosis Diseases caused by hepatitis B virus and hepatitis C virus 2. Diseases by target organ systems 2.1. Occupational respiratory diseases (No additional diseases proposed) 2.2. Occupational skin diseases (No additional diseases proposed) 2.3. Occupational musculo-skeletal disorders v1 Radial styloid tenosynovitis due to repetitive movements, forceful exertions and extreme postures of the wrist Chronic crepitant tenosynovitis of hand and wrist due to repetitive movements, forceful exertions and extreme postures of the wrist Olecranon bursitis due to prolonged pressure of the elbow region Prepatellar bursitis following extended periods of work in kneeling position Epicondylitis due to repetitive forceful work Meniscus lesions following extended periods of work in a kneeling or squatting position Carpal tunnel syndrome Any other musculoskeletal and nervous diseases not mentioned in the preceding newly-proposed items where a link between the work activities or work environment of a worker and the diseases suffered is thoroughly documented in the literature 2.4 Mental and behavioural diseases Post-traumatic stress disorder due to stressful event or situation Psychosomatic psychiatric syndromes causes by mobbing 3. Occupational cancer 3.1. Cancer caused by the following agents Arsenic and its compounds Beryllium and its compounds Cadmium and its compounds Erionite Ethylene oxides Silica Hepatitis B virus and hepatitis C virus 4. Other diseases (No additional diseases proposed) vi These disorders are proposed to replace the current more general wording used for R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

27 The disorders listed in Tables 4.3 and 4.4 form a good starting point for establishing a comprehensive list of occupational disorders that should be included in Schedule 2. However, they should not be adopted without modification, because they do not necessarily meet the appropriate criteria or format for a revised Schedule 2. These criteria are considered in the next section CRITERIA FOR INCLUSION IN SC HEDULE 2 STRONG CAUSAL LINK BET WEEN THE DISORDER AND OCCUPATIONAL EXPOSURE Since the aim of Schedule 2 is to bypass the need for a claimant to establish a connection between a work-related exposure and a resulting disorder, it is essential that there be a well established causal link between the disorder and one or more occupational exposures. A vast range of work-related exposures have been implicated in single studies as possibly resulting in ill health. However, many of these findings have not been repeated in other studies, or are only identified in studies with significant methodological flaws. For these, the evidence of a connection to work is weak. Inclusion of every disorder that has ever been linked to a work-related exposure would mean the acceptance of claims for a large number of conditions that are in fact not related to work or unlikely to be related to work. This would mean the Schedule would not be suited to its main purpose. For other disorders, there is strong scientific evidence in terms of several well-conducted studies identifying a meaningfully increased risk of developing the disorder in exposed persons compared to unexposed persons. These are the conditions that should be included in the Schedule. Therefore, one criterion for inclusion in the Schedule is that there should be strong scientific evidence of a connection between the disorder and one or more work-related exposures. CLEAR DIAGNOSTIC CRITERIA It is important that disorders included in Schedule 2 have clear diagnostic criteria. This will mean there should be little question as to whether or not the claimant really has the disorder that is the subject of the claim. For many of the potential disorders that could be included, the diagnostic criteria are straightforward. This is the case for virtually all malignancies and for most pneumoconioses, for example. The issue is less clear for asthma, as there are several definitions of occupational asthma, some more inclusive than others. Also, establishing the connection to work can be difficult, and might need to involve serial tests of lung function during a working week and during times away from work, as well as challenge tests. Some of the musculoskeletal disorders, such as those associated with upper limb pain, and chronic neuropsychiatric disorders associated with solvent exposure are examples of disorders where establishing the diagnosis can be even more problematic. In many cases, there is lack of agreement as to what constitutes the disorder and on what basis it should be diagnosed. Associated with these criteria is the need for each claim to have an accurate diagnosis. For some conditions, such as occupational asthma, the direct connection to occupation will be intrinsic to the diagnosis. In many such cases, this is likely to mean that the diagnosis needs to be made or confirmed by an occupational physician or a medical R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 2 7

28 practitioner with considerable experience in occupational medicine. For other conditions, such as bladder cancer or lung cancer, the diagnosis must still be accurate, but the connection to work in the individual patient must then be established on the basis of the exposure history of the person. THE DISORDER C OMPRISES A C ONSIDERABLE PROPORTION OF THE C A SES OF THAT D ISORDER IN THE OVERALL POPUL ATION OR IN AN IDENTIFIABLE SUBSET OF THE POPUL ATION In theory, Schedule 2 should contain a list of every work-related disorder and its associated exposure. Unfortunately, most work-related disorders can also be caused by non-work exposures. Including every possible work-related disorder, no matter how common or what proportion of all occurrences of the disorder are related to work, would make Schedule 2 unwieldy and of little practical use. A response might be to only list disorders that are primarily caused by exposures that occur through work. However, such an approach has important and undesirable implications. For example, the most common cause of lung cancer in the community is smoking. Lung cancer is also known to be caused by exposure to asbestos, and the most common circumstance in which asbestos exposure occurs is through work. If lung cancer is excluded from consideration because the primary cause is non-occupational, many people whose cancer is actually caused by occupational exposure to asbestos will find it much more difficult to receive compensation for their illness. On the other hand, many people who are occupationally exposed to asbestos also smoke, making it difficult to decide what the most likely causative exposure was. Actually establishing the causative exposure is impossible, as lung cancer caused by asbestos exposure has the same morphological appearance as lung cancer caused by smoking. So, in the end, this has to be decided on the basis of probability. (Complicating the issue in this example is the fact that asbestos and smoking potentiate the harmful effect that each has. This means that a smoker who is also exposed to asbestos has a higher risk of developing lung cancer than would be expected on the basis of the increased risk expected from each individual exposure alone. Separating the different contributions from asbestos and smoking in such a situation is impossible.) Similarly, it has been reliably estimated that at least 10% to 15% of asthma in adults in industrialised countries is due to occupational exposures. This means that the other 85% to 90% of asthma cases are not due to occupational causes. Asthma is a common disease in the New Zealand community. Deciding not to include asthma on Schedule 2 simply because most cases are not occupational in causation would potentially exclude a large number of cases that genuinely arose as a result of occupational exposures. In applying this criterion, it is important to bear in mind that the proportion of cases of a particular disorder that are due to work will vary considerably between groups within the general population. A disorder that at a general population level is overwhelmingly non-occupational in origin might be primarily of occupational origin in certain sub-groups where workers commonly have exposures that increase the risk of developing the disorder. Therefore, a disorder that is usually due to non-occupational factors, but commonly due to occupation in workers with a specific exposure, could reasonably be included in the Schedule if it is directly linked to that exposure. For example, cases of tuberculosis would usually not be caused by occupational exposures, but tuberculosis in a healthcare worker is much more likely to be due to exposure to the causative organism as a result of work activities. So, tuberculosis in general would not be included in the Schedule, but tuberculosis in healthcare workers might be. The final content of Schedule 2 must, therefore, be a balance between a restrictive approach, which will mean some workers with genuinely work-related illness will find it difficult to receive compensation, and a more inclusive approach, which runs the risk of some people receiving compensation for a disorder that is, in fact, not due to their occupation. 2 8 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

29 4. 5 STRUCTURE AND CONTENT OF SC HEDULE 2 FOCUS ON SPECIFIC DISORDERS The current version of Schedule 2, and the ILO List of Diseases and Annex to the List of Diseases, are a mixture of specific and non-specific disorders. An example of a specific disorder is Lung cancer or mesothelioma diagnosed as caused by asbestos. It is usually straightforward to diagnose a person as having mesothelioma, and asbestos is virtually the only know cause of mesothelioma. It is also usually straightforward to diagnose a person as having lung cancer, although it is not possible to unequivocally establish whether or not an individual case of lung cancer arose as a result of asbestos exposure (or any other exposure). Most of the other disorders listed in the Schedule are non-specific. For example, Diseases of a type generally accepted by the medical profession as caused by chrome or its toxic compounds. Chromium and related compounds are associated with lung cancer, dermatitis, skin ulcers, perforation of the nasal septum, respiratory tract irritation, and chronic renal failure 4. All of these disorders can be caused by exposures other than chromium. So, it is not useful for Schedule 2 to include, for example, all cases of dermatitis. Instead, the focus should be on dermatitis caused by exposure to chromium or its compounds. Therefore, the Schedule is probably better structured primarily around the disorder, with qualifications as to what exposures should be considered as causal, rather than being structured around a particular exposure. So, Diseases of a type generally accepted by the medical profession as caused by chrome or its toxic compounds would be better along the lines of Lung cancer associated with occupational exposure to: asbestos, chromium, coke oven emissions..., Chronic renal failure associated with occupational exposure to: lead, cadmium, chromium, copper..., and so on. The Annex to the latest ILO List of Diseases adopts this approach in some situations. For example, Occupational asthma caused by recognized sensitizing agents or irritants inherent to the work process focuses on the disorder (asthma) and identifies the need that the causative exposure occurs in relation to work. (Note that even this entry is not perfect. The word occupational is redundant, because asthma caused by recognised sensitising agents or irritants inherent to the work process is, by definition, occupational asthma!) In general, the Schedule should identify specific disorders in relation to one or more specific exposures. Some variation in this approach is required when the exposure can be clearly related to work but there are many individual disorders and types of organ dysfunction that have been shown to be related to the exposure. In that situation, the specific exposure should be included, accompanied by a general reference to the many disorders that might be related to it. This is the approach recommended for most cases of acute or chronic poisoning. FOCUS ON SPECIFIC EXPOSURES Asthma illustrates a related issue, in that there are probably hundreds of occupational exposures that could potentially cause asthma. So, it would not be practical to explicitly include them all in the Schedule. This would also be the case for dermatitis. In contrast, it might be well be feasible and appropriate to include in the list specific exposures that have been associated with a particular form of cancer. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 2 9

30 For some disorders, connection to an occupation or task, rather than exposure to a specific agent, may be necessary. This is the case in two situations. Firstly, there may be very good evidence that work in a particular occupation increases the risk of developing a specific disorder, but the specific agent has not been identified. An example of this is Hodgkin s lymphoma associated with woodworking. Secondly, for most infections related to occupation, the infection is inextricably linked to exposure to a single agent the infective organism. That is, there is a clear one-to-one relationship between the disorder and an exposure. This differs from virtually all other disorders, in which the disorder may have many causes. For infections, it makes more sense to identify the occupational circumstances in which exposure to the infective organism can be expected to occur, rather than to simply identify the infective organism, because identifying the infective organism doesn t add any extra information. For example, leptospirosis is more usefully linked to dairy farming and abattoir work than to exposure to Leptospira, the causative exposure. In general, the Schedule should identify specific exposures in relation to a specific disorder. Some variation in this approach is required when the disorder can be clearly related to work but there are so many individual exposure types that have been shown to cause the disorder. In that situation, the specific disorder should be included, accompanied by a general reference to the many exposures that might cause it. In addition, for infections, the relevant exposure circumstances (usually summarised by the occupation) should be used. EXPOSURE CIRCUMSTANCES The International Agency for Research on Cancer (IARC) lists fourteen exposure circumstances that are classified as definitely increasing the risk of cancer and that are clearly (or occasionally) directly related to work. These include aluminium production, boot and shoe manufacture and repair, and occupational exposure as a painter. Typically, a number of types of cancer have been associated with each exposure circumstance, with the strength of evidence varying for different cancer types. Presumably, these exposure circumstances are consistently associated with an increased risk of cancer because they involve exposure to one or more specific carcinogens. In some instances, this exposure (or exposures) is known or strongly suspected. In other cases, the relevant exposure or exposures are not clear. These exposure circumstances do not lend themselves well to inclusion in Schedule 2. A single IARC exposure circumstance covers a range of different tasks and different exposures, only some of which may be carcinogenic. Therefore, many of the people included in the exposure circumstance will actually not have been exposed to whatever the causative exposure (or exposures) was. As long as the relevant exposure is included in the Schedule, it is not necessary (and in fact may be undesirable) to include the exposure circumstance as well. The only problem will arise if the exposure circumstance includes an exposure that is not included in the Schedule. This is only likely to occur when the causative exposure is not well characterised. In that instance, it is not desirable to include the exposure circumstance, because it is not clear what the true problem exposure is, and it is too difficult to establish that a worker has been exposed to a truly causative exposure. Therefore, the exposure circumstances identified as being carcinogenic have not been included in Schedule 2. The only exception to this is involuntary smoking (described in this report as exposure to environmental tobacco smoke ), which has been included because the exposure circumstance is directly linked to only one exposure (tobacco smoke). 3 0 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

31 THE INCLUSION OF A CATC H- ALL CATEGORY For the majority of disorders, most of the cases will arise from non-occupational exposure circumstances, but occupationally-related cases will arise sporadically. For example, a New Zealand government worker might go to a tropical country for a brief work project and contract malaria. It is not feasible to include every specific infection that might conceivably arise due to occupational exposure circumstances. Similar situations arise with disorders of all organ systems, such as heart failure, kidney disease, neurological disorders and haematological disorders. Therefore, these either need to be dealt with by including a catch-all provision in the Schedule, or by accepting that such rare cases need to be dealt with through the compensation mechanisms that do not involve referral to Schedule 2. The latest version of the ILO List does include some catch-all categories, but this does not seem to be consistent with the intention of Schedule 2. It is therefore recommended that catch-all categories not be used in Schedule 2, and that is the basis on which the recommendations in Chapters 5 and 6 are made SUMMARY OF ISSUES REL ATED TO SC HEDULE 2 In summary, for inclusion in Schedule 2, it is desirable that: there is strong evidence of a causal link between the occupational exposure and the disorder; there are clear and repeatable criteria for diagnosing the disorder; and the disorder comprises a considerable proportion of the cases of that disorder in the overall population or in an identifiable subset of the population. The structure of Schedule 2 is best based on a combination of specific disorder-exposure combinations, unless the number of potential exposures linked to a particular disorder, or the number of disorders linked to a particular exposure, make it impractical to list them all. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 31

32 3 2 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

33 SECTION FIVE EVIDENCE 5 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 3 3

34 Summary Using the criteria developed in Chapter 4, and scientific evidence from the published literature, this chapter examines specific known and potential occupational disorders and exposures. Most of the information on which this is based comes from the NOHSAC publication, The burden of occupational disease and injury in New Zealand supplemented by other information where appropriate. The section considers which disorders and exposures should and should not be included in a revised version of Schedule 2, and presents reasons for the recommendations. 5.1 INTRODUCTION Using the criteria developed in Chapter 4, and scientific evidence from the published literature, this chapter examines specific known and potential occupational disorders and exposures. Most of the information on which this is based comes from the NOHSAC publication, The burden of occupational disease and injury in New Zealand 1, supplemented by other information where appropriate. The section considers which disorders and exposures should and should not be included in a revised version of Schedule 2, and presents reasons for the recommendations OCCUPATIONALLY- REL ATED ATTRIBUTABLE FRACTIONS The third criterion mentioned in the previous chapter addressed whether the disorder in question comprised a considerable proportion of the cases of that disorder in the overall population or in an identifiable subset of the population. Disorders that did not meet this criterion would usually not be suitable for inclusion in the Schedule. One guide regarding this factor is the population attributable fraction, commonly also known as the attributable fraction (AF). The AF is the proportion of cases of a particular disorder that is due to the exposure in question. So, for the current report, the AF is the proportion of cases of the disorder that is due to the occupational exposure or exposures of interest. For example, if the AF for asthma is 15%, this means that approximately 15% of all cases of asthma in the community are due to occupational exposures. There are no New Zealand-based occupational AFs available. Instead, this report uses AFs taken from two recent major reports into the burden of work-related ill health in Finland 2 and in the United States 3, as reported in the NOHSAC Burden report. The AF is dependent on the relative risk of developing the disorder (the risk in a group with the exposure, divided by the risk in a group without the exposure) and the prevalence of the exposure in the community of interest. The relative risk will probably be similar in different communities, but the prevalence of exposure may vary. Therefore, AFs developed for one country will not necessarily be directly applicable to another, although they are likely to be similar in countries with a similar level of industrialisation and development. 3 4 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

35 For the same reason, community-based AFs will not necessarily be directly applicable to sub-groups within the community because the exposure prevalence can vary between different groups. This is of particular importance in an occupational setting, where persons working in a specific occupation may have a much higher prevalence of exposure than the general community. So, an AF of, say, 14% for bladder cancer in the general community may in fact be much higher in workers with occupational exposure to substances known to increase the risk of developing bladder cancer. In other words, a bladder cancer diagnosed in a worker with known exposure to a bladder carcinogen is much more likely to be due to an occupational exposure than a bladder cancer diagnosed in someone who has always been a clerical worker. Another issue to consider is that AFs may be based on relative risks derived from studying fatal cases or from studying incident cases. In many situations, the relative risk will be the same for fatal and incident cases, but this will not necessarily be so. However, in general, mortality AFs and incident AFs are used interchangeably. The presence of an AF for a disorder does not necessarily mean that the evidence for a causal connection to work is strong enough for the disorder to be included in the Schedule. Similarly, the reliability of the diagnostic criteria might be too low to allow the disorder to be included even if the AF is high. Attributable fractions therefore provide information as to which disorders are proportionately common enough to be candidates for inclusion in the Schedule, but can only be used as a guide. A disorder with a moderately high AF is likely to be a good candidate for inclusion, providing it meets the other criteria. However, a disorder with a low community-based AF could also still be proportionately common enough in certain occupational groups to be a candidate for inclusion. The available AFs for the disorders considered in this chapter are shown in Table 5.1. The table also shows the estimated annual number of New Zealand deaths due to occupation for each disorder. These estimates also come from the Burden document, and were determined by applying the attributable fractions to population data on the number of all New Zealand deaths for each disorder 5. Estimates of AF are not available for some disorders, because one or both of the required relative risk or exposure prevalence estimates are not available. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 3 5

36 TA B L E 5. 1 Estimated occupational attributable fractions and resultant estimated annual burden of work-related disease mortality in New Zealand vii D I S O R D E R AT T R I B U TA B L E F R AC T I O N D E AT H S M A L E F E M A L E Malignant neoplasms Oral cavity Pharynx Oesophagus Stomach Colon Rectum, rectosigmoid junction and anus Liver, specified as primary Gallbladder Pancreas Nasal cavities, middle ear and accessory Larynx Trachea bronchus and lung Pleura including mesothelioma Bone and articular cartilage Melanoma of skin Other malignant neoplasm of skin Female breast Cervix uteri Uterus Ovary and other uterine adnexa Prostate Bladder Kidney and other unspecified urinary Brain Hodgkin s disease Non-Hodgkin s lymphoma Leukaemia Total cancer cases (425) Mental disorders Senile and pre-senile organic psychotic disorders <34 Nervous system disorders Alzheimer s disease Parkinson s disease Diseases of circulatory system Ischaemic heart disease Cerebrovascular disease Diseases of respiratory system Pneumonia Chronic obstructive pulmonary disease (COPD) Asthma Asbestosis Pneumoconiosis due to other inorganic dust Total respiratory cases (201) Diseases of digestive and genitourinary system Ulcer of stomach and duodenum Nephritis, nephritic syndrome and nephrosis vii Adapted from Table 5.1 in The burden of occupational disease and injury in New Zealand R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

37 Table 5.1 presents the number of deaths from various diseases based on AFs. There is no equivalent information on disease incidence based on AFs, as the population-level data on the number of incident cases of each disorder are not available, except for malignancies. Therefore, for disorders that are rarely fatal (such as most of the musculoskeletal disorders), there may not be any available estimates (fatal or non-fatal) of burden based on AFs. Instead, a guide to the number of incident cases can be obtained from using information from a variety of sources. Table 5.2 provides information on the annual number of incident cases of work-related disease in New Zealand. The information is based on estimates contained in the Burden report. Most of the estimates are based on Accident and Compensation Corporation (ACC) data on accepted claims for 2001/2002. For pneumoconioses, chronic respiratory disease and mental disorders, there was no appropriate available information from the ACC, so other data sources were used. The estimates for these disease categories were obtained by applying Finnish age-sex-disease-specific incidence rates of occupational disease from 1993 to New Zealand population data for For malignancies, the ACC recorded only four accepted claims for 2001/2002. This is clearly a major underestimate. Another estimate of cancer incidence is possible, as population level cancer incidence data are available for New Zealand (from the National Cancer Registry) 6. The estimate in the table of the number of incident cancer cases was obtained by applying the AFs shown in Table 5.1 to cancer incidence data for New Zealand for No estimates could be obtained for coronary heart disease, infectious disease and asthma, as the ACC did not have claims recorded for these disorders and the available Finnish rates did not include these disorders. TA B L E 5. 2 Estimated annual burden of work-related disease incidence in New Zealand viii D I S E A S E i x N U M B E R O F C A S E S Disease of the eye 316 Diseases of digestive system 1,098 Pneumoconiosis x 269 Chronic respiratory disease x 1,564 Musculoskeletal 10,413 Cancer xi 773 Mental disorders x 166 Poisoning 223 Skin disorders 1,792 Diseases of ear/mastoid process 3,354 Other diseases 341 Coronary heart disease xii n.a. Infectious disease xii n.a. Asthma xii n.a. viii Adapted from Table 5.3 in The burden of occupational disease and injury in New Zealand 1. ix Based on ACC accepted claims for work-related disease in 2001/2002, unless otherwise stated 7. x xi xii Based on Swedish rates of occupational disease. No information on this disease was available from the ACC. Based on AFs applied to New Zealand cancer incidence data for Only includes persons aged 30 years or more. The number of cancer cases recorded by the ACC for the same period was four. There was no information available from the ACC or other sources for these disease groups. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 37

38 5. 3 SUFFICIENT EXPOSURE As mentioned earlier, because most occupational disorders can also be caused by non-occupational exposures, the final content of Schedule 2 must be a balance between a restrictive approach and a more inclusive approach. The final decision on which disorders to include on the Schedule is therefore based partly on the relative likelihood of a worker being exposed to the required occupational exposure circumstances. For this reason, the revised Schedule is recommended to include an explicit identification that there must be sufficient exposure to the identified exposures. Sufficient exposure in this context means exposure of sufficient duration and intensity that, based on current evidence, it is more likely than not to have contributed to the development of the condition. Relevant non-occupational exposures would not alter this. For example, persons with sufficient occupational exposure to an agent that is known to cause COPD should not be precluded from being covered by Schedule 2 just because they smoke (even though smoking is also known to increase the risk of developing COPD) DISORDERS RECOMMENDED FOR INCLUSION IN SC HEDULE 2 This section discusses the disorders that are recommended for inclusion in the revised Schedule. Basic information about each disorder and the relevant occupational exposures is presented, followed by justification of why the disorder is recommended for inclusion in the revised Schedule. INFECTIOUS DISEASE There are some infections that are likely to usually or commonly result from work-related exposures. These are good candidates for inclusion in the Schedule, because it is likely that any individual case would have arisen due to work-related exposures. Leptospirosis is an example of this sort of infection. For other infections, the majority of cases will occur not in relation to occupational exposure, which means the infection is not appropriate to include for workers in general. However, for some specific working groups, most cases of the infection in question will be due to occupational exposure, so the infection in that work group could be reasonably included in the Schedule. Tuberculosis in healthcare workers and Hepatitis A in sewer workers are good examples of this sort of infection. For the majority of infective organisms, most of the cases of infection will arise from non-occupational exposure circumstances, but occupationally-related cases will arise sporadically. In keeping with the approach developed in Chapter 4, such potential sporadic infective disorders are not recommended for inclusion in the Schedule. Tuberculosis Tuberculosis is an infection caused by Mycobacterium bacilli (usually Mycobacterium tuberculae). It can affect many organs, but respiratory tuberculosis is the most common form of the disease. Healthcare workers are the occupational group at highest risk of developing tuberculosis from a work-related exposure. Clinical laboratory workers, funeral parlour staff, farmers and veterinarians are probably also at increased risk. Silicosis predisposes the worker to developing pulmonary tuberculosis. 3 8 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

39 Brucellosis Brucellosis is a zoonotic infection caused by the Brucella abortus bacteria. The main occupational sources of infection are reproductive tract tissues of cattle, accidental exposures to Brucella vaccine, and exposure to the organism in laboratories. Occupations such as veterinarian, farmer and abattoir worker are likely to be most at risk. Leptospirosis Leptospirosis is a zoonotic infection caused by a range of small organisms called Leptospira. The main occupational source of infection is the urine of infected animals. Farming, especially dairy farming, and abattoir work, are the most common exposure circumstances, but other occupations such as forestry worker, hunter, veterinarian, plumber and transport operator are at increased risk. Legionellosis Legionellosis (also known as Legionnaire s disease) is a disease caused by infection with the Legionella bacteria. The source of Legionella infection in an occupational context is usually water aerosol from pooled warm water, such as occurs in association with air-conditioning cooling towers, but dust (such as potting mix) has also been documented as a source. Legionellosis has been clearly associated with a range of occupations, including air-conditioning maintenance workers, healthcare personnel, ship repair workers, gardeners, construction workers, sewerage workers, automotive plant workers, and miners. Viral hepatitis Viral hepatitis is an infection of the liver caused by one of a wide range of viruses. Hepatitis A is a concern in a few selected occupations, but, in an occupational context, hepatitis B (HBV) and hepatitis C (HCV) are the most important. The main routes of exposure are percutaneous (puncturing the skin) through needle stick injuries, and across mucous membranes or damaged skin, through contact with contaminated body fluids. Any occupation that increases the risk of such exposure increases the risk of contracting HBV or HCV through occupational exposures. Therefore, a wide range of occupations are at increased risk of exposure to HBV and HCV, in particular healthcare workers, embalmers, persons who handle body substances, clinical laboratory staff, workers in long-term correctional facilities, police, members of the armed forces and emergency services workers. The risk of exposure to HBV in the New Zealand workforce is higher than in many other developed countries because of the high prevalence of HBV in the general New Zealand population. HIV/AIDS HIV/AIDS is an acquired disorder of the immune system caused by the human immunodeficiency virus (HIV). There have not been many confirmed cases of occupationally acquired HIV, but any occupation at risk of needle stick injury or other parenteral exposure to body fluids is potentially at increased risk of developing HIV/AIDS from workplace exposures. Healthcare workers are probably most at risk. Others likely to be at increased risk include sex workers, embalmers, clinical laboratory staff, police, correction officers and security guards. Since the vast majority of HIV cases are non-occupational in origin, it is recommended that HIV not be included in Schedule 2 for all the above-mentioned occupations. However, the particular increased risk in healthcare workers justifies the inclusion of HIV/AIDS in healthcare workers in Schedule 2. Other infections There are a number of other infections that workers can develop as a result of occupational exposures. For example, New Zealand publications have identified work-related cases of anthrax, orf, giardiasis, Streptococcus suis type 2, Campylobacter pyloridis, and Corynebacterium lymphadenitis. Only those likely to be primarily of occupational origin are recommended for inclusion in the Schedule. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 3 9

40 MALIGNANCY Liver cancer Liver cancer (hepatocellular carcinoma) is a primary malignant disease of the liver (it excludes metastases to the liver from primary cancers elsewhere in the body.). Known causes of hepatocellular carcinoma are hepatitis B and C infection, dietary aflatoxin B1 and cirrhosis (with alcohol being the main cause). Occupational exposures known to be strongly associated with liver cancer are vinyl chloride monomer and hepatitis B and C infection. Occupations at high risk of exposure to hepatitis B and C infection (or high alcohol intake) therefore have increased risk of developing liver cancer. Sino-nasal carcinoma Sino-nasal carcinoma is a malignant disease of the lining tissues of the nose and upper airways. Exposure to wood dust has been consistently implicated as an occupational cause of sino-nasal cancer. In addition, exposure to leather dust, and work with welding, flame cutting and soldering have also been associated with an increased risk. Naso-pharyngeal carcinoma Nasopharyngeal carcinoma is a malignant disease of the nasopharynx (and so has some overlap with sino-nasal carcinoma). Formaldehyde has recently been designated by IARC as a cause of naso-pharyngeal cancer, but not of sino-nasal carcinoma. Larynx Laryngeal cancer is a malignant disease of the larynx. Smoking and alcohol are strongly associated with increased risk of laryngeal cancer. Many occupational exposures have been associated with an increased risk of laryngeal cancer. The strongest evidence is for sulphuric acid mists, asbestos and organic solvents. Lung and bronchus Lung cancer is a malignant disease of the respiratory tree and gas exchange areas of the lung. Smoking is the main external factor associated with the development of lung cancer. The main occupational exposures associated with lung cancer are asbestos, arsenic, beryllium, cadmium, chromium VI, diesel fumes, nickel, radon, silica, soots, coke oven emissions, bis (chloro-methyl) ether and environmental tobacco smoke. All but diesel fumes have been listed by IARC as definite human carcinogens causing lung cancer. Work in aluminium production, coal gasification, coke production and iron and steel founding have all been associated with an increased risk of lung cancer, presumably as a result of one or more of the above individual exposures. All these exposures are appropriate for inclusion in the Schedule, with the possible exception of environmental tobacco smoke. Many workers in the hospitality industry will have had exposure to environmental tobacco smoke, but the number of exposed workers and the intensity of exposure are likely to decrease considerably in the next five to ten years. The low intensity of exposure means that the associated increased risk of lung cancer is likely to be low. On balance, it is recommended that environmental tobacco smoke be included as an exposure in Schedule 2 for lung cancer. Skin (non-melanoma) Skin cancer is a malignant disease of the cells making up the skin. (Melanoma is considered in a separate section.) The only occupational exposures strongly implicated as increasing the risk of skin cancer are exposure to arsenic, polycyclic hydrocarbons (such as from coal tar products) and sunlight. 8 Mesothelioma Malignant mesothelioma is a malignant disease of the inside lining of the chest wall (pleura), pericardium and abdomen (peritoneum). Asbestos accounts for nearly all cases of malignant mesothelioma, and the vast majority of this asbestos exposure occurs in an occupational context. Erionite also causes malignant mesothelioma, but exposure in New Zealand is very unlikely. 4 0 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

41 Bladder cancer Bladder cancer is a malignant disease of urothelial tissue lining the urinary tract. Occupational exposures strongly implicated as causing bladder cancer are aromatic amines and poly-cyclic aromatic hydrocarbons (including in aluminium production, coal gasification and coke production). Other exposures associated with an increased risk for bladder cancer are paints, dyes, chlorinated hydrocarbons, and other solvents, metals and industrial oils/ cutting fluids. Lymphoma Lymphoma is a malignant disease of a subset of white blood cells. Lymphoma has two main forms Hodgkin s lymphoma and Non-Hodgkin s lymphoma. Wood dust in wood workers is the occupation most strongly linked to Hodgkin s lymphoma, but the precise causative exposures are not known. Phenoxyherbicides, chlorophenols and halogenated hydrocarbon solvents have been found to be associated with a markedly increased risk of lymphoma in some studies, although not all studies have found such an increased risk. The effect of phenoxyherbicides is probably due to contamination with 2,3,7,8-tetrachlorodibenzodioxin (TCDD), commonly known as dioxin. Leukaemia Leukaemia is a malignant disease of a subset of white blood cells. It has various forms, with the most relevant in occupational terms probably being acute lymphatic leukaemia (ALL) and acute myelocytic leukaemia (AML). Occupational exposures strongly implicated as causing leukaemia are ionising radiation, benzene and ethylene oxide. Soft tissue sarcoma Soft tissue sarcoma is a malignant disease of the muscle and related tissues. Dioxin has been strongly implicated as a probable cause of soft tissue sarcoma, although there remains some inconsistency in the findings in the literature. MENTAL OR NEUROPSYC HIATRIC DISORDERS None recommended. DISORDERS OF THE NERVOUS S YS TEM Parkinson s disease Parkinson s disease (and Parkinsonism) is a neurodegenerative disease of the central nervous system associated with damage to the substantia nigra. Most cases of Parkinson s disease do not have a known cause. The only known causative occupational exposure is manganese, although pesticides have been strongly implicated. Peripheral neuropathy Peripheral neuropathy describes a group of disorders characterised by temporary or permanent damage to nerves outside the central nervous system. There are many non-occupational causes of peripheral neuropathy, but also many peripheral neurotoxins (substances that result in damage to nerves) in the occupational environment. These include metals such as lead, mercury and arsenic; organic solvents such as n-hexane, carbon disulphide and trichloroethylene; pesticides such as organophosphates; and other substances such as acrylamide. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 41

42 Chronic solvent-induced toxic encephalopathy Chronic solvent-induced toxic encephalopathy (or chronic solvent neurotoxicity) is a disorder of the nervous system arising from exposure to certain organic solvents, particularly styrene, toluene, xylene, trichloroethylene, tetrachloroethylene, methylene chloride, and white spirit. Causative occupational exposures occur in processes that require the use of organic solvents. The major difficulties with this disorder in terms of inclusion in the Schedule are establishing the diagnosis (as the clinical changes may be subtle) and excluding non-occupational causes, as there are many non-occupational causes of cognitive dysfunction, with alcohol being one of the most important. On balance, the disorder is considered suitable for inclusion in the Schedule. VASCUL AR DISORDERS None recommended. RESPIRATORY DISORDERS ( N ON- MALIGNANT) Asthma Occupational asthma is a disorder characterised by bronchial hyper-responsiveness or variable airflow limitation related to workplace exposures. Whether only immunologically-mediated asthma should be considered to be occupational asthma, or whether asthma arising as result of workplace exposure to irritants, or exacerbation of pre-existing asthma by workplace irritants, should also be considered in the definition, is still the subject of debate. However, the broader definition seems to currently be more widely accepted. Occupational asthma is probably the most common work-related respiratory disorder in industrialised countries. Many hundreds of occupational agents, including some inorganic and organic dusts, have been associated with occupational asthma. Biological agents include grains, flours, plants and gums, fur, feathers and other animal parts, insects and fungi, drugs and enzymes, and various types of wood. Chemical agents include chlorofluorocarbons, alcohols, metals and their salts, isocyanates and welding fumes. The large number of occupational agents that have been shown to cause occupational asthma, and the likely future discovery of other such agents, means that listing the agents in Schedule 2 is impractical, but occupational asthma should be included. Chronic obstructive pulmonary disease Chronic obstructive lung disease (COPD) (also known as chronic airflow limitation) is a lung disease characterised by a widespread reduction in the diameter of the airways that cannot be reversed by treatment. Chronic bronchitis is a related disorder characterised by bronchial mucous hyper-secretion. There is a significant overlap between the two disorders, and they are considered together here. Tobacco smoking is the most important risk factor for the development of COPD and bronchitis, but many work-related exposures have been demonstrated to cause COPD. The causative agents of COPD include dust and fumes, with dusts showing a more consistent relationship than fumes. Relevant dusts include coal, silica, cotton dust and grain dust. Persons who develop COPD, who do not smoke and who are occupationally exposed to one of the implicated exposures can reasonably be assumed to have developed the COPD because of their occupation. However, the situation is very different for smokers. The overwhelming contribution of smoking to the development of COPD 4 2 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

43 makes it very difficult to assign an occupational attribution in persons who smoke, regardless of the occupational exposures that they may have. Nevertheless, on balance, it seems fairer to include on the Schedule COPD associated with the relevant exposures, regardless of whether or not the claimant smoked, than to exclude smokers from this part of the Schedule. Pneumoconioses Pneumoconioses are fibrotic lung diseases caused only by occupational exposure to specific mineral dusts. The most important of these pneumoconioses are silicosis, asbestosis and coal workers pneumoconiosis. Silicosis is caused by exposure to silica, asbestosis by exposure to asbestos and coal workers pneumoconiosis by exposure to coal. There are numerous other pneumoconioses of relevance to specific industries and occupations. Cases of these are rare, but they can still be included in the Schedule because those cases that do occur are almost certainly due to occupational exposures. Extrinsic allergic alveolitis Extrinsic allergic alveolitis (also known as hypersensitivity pneumonitis) is an immune-mediated disease of the alveoli (gas-exchange spaces in the lung). The disorder results from the body s immune response to repeated contact with small animal or vegetable dust particles. Mouldy hay, straw, grain or feathers are the typical causative exposures. There are a wide variety of occupational exposures associated with the development of extrinsic allergic alveolitis. However, the symptoms can vary, making the diagnosis difficult to establish in some cases. Byssinosis Byssinosis is an asthma-like condition associated with occupational exposure to cotton, hemp, flax or sisal dust. HEPATIC DISORDERS There are a variety of liver disorders that may be related to occupation. These include acute hepatitis (inflammation of liver cells), chronic active hepatitis, and hepatic cirrhosis. Cirrhosis is a disorder of the liver involving damage to liver cells, resulting in irreversible fibrosis. Acute hepatitis in an occupational setting is most commonly due to exposure to certain hazardous substances (particularly organic solvents) and to HBV and HCV. Chronic active hepatitis is due to exposure to HBV and HCV, which has been considered earlier. The strongest connection between occupational exposures and hepatic cirrhosis is to HBV and HCV, which have been considered earlier. Given that cirrhosis is also strongly associated with excessive alcohol intake, a common problem in the general community, it can be difficult to separate probable occupational cases from probable non-occupational cases. Therefore, it is recommended that cirrhosis only be included in the Schedule for persons with known occupational exposure to HBV or HCV. DISORDERS OF THE GENITOURINARY S YS TEM Chronic renal failure is a disorder of the kidney characterised by permanent damage to the filtration tissues. In the occupational setting, the nephritic syndrome is probably the most important type of chronic renal failure. The strongest connection between occupational exposures and chronic renal failure is with metals such as lead, cadmium, chromium, copper and mercury, including via welding fumes. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 4 3

44 N ON- C ANCEROUS SKIN DISORDERS Irritant and allergic contact dermatitis The main non-malignant skin diseases in an occupational context are irritant and allergic contact dermatitis. These disorders are a very common cause of ill health related to occupation. The hands are the predominant area affected. The main risk factor for irritant contact dermatitis is wet work, and work that involves exposure to a combination of different chemicals, especially cutting fluids and solvents. High risk exposures for allergic contact dermatitis include rubber chemicals, rubber latex, nickel, chromate and epoxy resin. As with occupational asthma, the large number of occupational agents that have been shown to cause occupational dermatitis means that listing the agents in Schedule 2 is impractical. Vitiligo Vitiligo is an uncommon skin disease in which the pigment-producing cells in the skin, mucous membranes and eye are affected, causing loss of pigment and seen as white patches on the skin or other affected areas. Most cases are non-occupational in origin, but there are several specific occupational exposures (para-tertiarybutylphenol, para-tertiary-butylcatechol, para-amylphenol, hydroquinone or the monobenzyl or monobutyl ether of hydroquinone) directly linked to the development of vitiligo (which is then known as occupational vitiligo). MUSCULOSKELETAL DISORDERS Upper limb disorders There is a range of upper limb musculoskeletal disorders associated with work. Some have clear clinical and pathological diagnostic criteria. These include rotator cuff syndrome, lateral epicondylitis, medial epicondylitis, ulnar nerve entrapment, radial nerve entrapment, tendonitis in the hand and fingers, Raynaud s phenomenon (peripheral neuropathy related to upper limb vibration, also known as vibration white finger), De Quervain s tenosynovitis and carpal tunnel syndrome. In addition, there are many cases of upper limb pain without associated objective signs. These cases have been given many labels, including repetitive strain injury, occupational overuse syndrome and non-specific musculoskeletal disorder of the upper limb. Usage in New Zealand ACC review and appeal cases has favoured the term regional pain syndrome. A wide range of occupations, tasks and workplace organisational and psychosocial factors have been associated with one or more of these upper limb disorders and syndromes. These include the use of hand tools; working with raised arms; vibration; the combination of repetition, force and posture; and low job control, low social support, perceived monotonous work and other causes of job strain. Some particular upper limb disorders have been associated with specific workplace postures or exposures. Identifying a particular person as having an occupationally-related upper limb disorder is complicated by several factors. There is a lack of agreement concerning diagnostic criteria for many disorders; a lack of agreement over the likely causative exposures, both in general and in specific cases; and many non-occupational exposures that can result in the disorders. All these factors need to be taken into account when making a final decision on which disorders should be included in the revised Schedule. Those to be included should have agreed diagnostic criteria and known occupational exposures. Workplace organisational factors are too difficult to define and measure to allow these to be included in the Schedule as one of the causative exposures. 4 4 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

45 Bursitis Bursitis is inflammation of a bursa, a small sac designed to decrease friction between muscles, tendons, bones and skin during movement. There are many bursae in the body. Any form of repetitive motion or persistent physical pressure can cause bursitis. Most bursae can become inflamed in the course of work when these exposures are involved, but the two most common involve the elbow (olecranon bursitis) and the knee (pre-patellar bursitis and infra-patellar bursitis). A direct connection to work should be demonstrable in most occupational cases involving the elbow or knee because of the close association with repetitive motion or persistent physical pressure. Occupational bursitis involving other bursae is possible, but likely to be much less common and harder to directly and confidently connect to occupational factors. VIBRATION DISORDERS Vibration has been associated with lower back pain and several upper limb pain disorders, including secondary Raynaud s phenomenon (vibration white finger), carpal tunnel syndrome and scleroderma. The strongest relationship is with secondary Raynaud s phenomenon, and this is the only disorder primarily due to vibration that is recommended to be included in the Schedule. Common causes of increased levels of hand-transmitted vibration are hammer drills, hand-held portable grinders and jigsaws. Other vibration-related diseases are too hard to consistently diagnose, or too commonly associated with non-occupational exposures, to include in the Schedule. N OISE- INDUCED HEARING LOSS Noise-induced hearing loss is a permanent, degenerative disorder of the inner ear characterised by loss of auditory acuity, particularly in the high frequency range. This particularly affects voice recognition. The cause of noiseinduced hearing loss is loud noise. This occurs in many occupational contexts. Persistent or intermittent exposure to noise above 85dB(A) is generally considered excessive and likely to lead to noise-induced hearing loss. ACUTE C HEMICAL POISONING/ TOXICIT Y Work-related acute and chronic poisoning covers a range of disorders characterised by systemic abnormalities of metabolic processes due to contact with one or more industrial chemicals. The abnormalities may affect any body system, but most commonly affect the respiratory, nervous or cardiovascular systems. The chronic problems are largely covered by other disorders considered for the Schedule. This proposed entry in the Schedule focuses on acute or short-term chemical-related problems and the exposures leading to them, as well as systemic problems arising from exposure to metals. There are a wide range of workplace chemicals that can cause abnormalities in metabolic processes. It is virtually impossible to ensure that every possible hazardous substance is explicitly included. The revised ILO List specifies a number of them in the section Diseases caused by chemical agents. Many (but not all) of these are also included in the current version of Schedule 2. The proposed approach for the revised Schedule is to include all the hazardous substances in the current ILO List and Schedule 2, with the addition of pesticides and related compounds and formaldehyde, and the explicit inclusion of toluene, xylene and methylene chloride. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 4 5

46 REPRODUCTIVE RISKS None recommended. MULTIPLE C HEMICAL SENSITIVIT Y Not recommended DISORDERS NOT RECOMMENDED FOR INCLUSION IN THE SC HEDULE This section discusses potential occupational disorders that are NOT recommended for inclusion in the revised Schedule. Basic information about each disorder and the relevant occupational exposures is presented, followed by justification as to why the disorder is not recommended for inclusion. It should be noted that exclusion of a disorder/exposure from Schedule 2 does NOT imply that it should not be compensated. Any such condition can still be considered under the three-part assessment process described by the IPRC Act. INFECTIOUS DISEASE Pneumococcal disease Pneumococcal disease is a common community infection. It usually causes respiratory tract infection, mainly pneumonia in adults, but may also cause severe, widespread infection. The risk of pneumococcal disease is increased by exposure to tobacco smoke, including environmental tobacco smoke. Occupations involving significant exposure to environmental tobacco smoke, such as bar worker and restaurant worker, have an increased risk of developing pneumococcal disease. However, pneumococcal disease is very common in the community, and the increased risk due to occupation is probably relatively small. This means the inclusion of pneumococcal disease in Schedule 2 would be likely to result in a large number of claims, the majority of which would probably not be related to occupation. Therefore, it is not recommended for inclusion in Schedule 2. MALIGNANCY Oral cavity cancer Oral cavity cancer is malignant disease of the mouth, tongue and salivary glands. Smoking and alcohol are both strongly associated with an increased risk of oral cavity cancer. There are no occupational exposures that have been strongly and consistently implicated as causes of oral cavity cancer. Oesophageal cancer Oesophageal cancer is a malignant disease of the oesophagus. Smoking, obesity and gastro-oesophageal reflux are strongly associated with increased risk of oesophageal cancer. There are no occupational exposures that have been strongly and consistently implicated as causes of oesophageal cancer. Colon cancer Colon cancer is a malignant disease of the large bowel (excluding the rectum). The main risk factors for colon cancer are associated with diet, alcohol intake and other personal factors. The only occupational factor consistently associated with increased colon cancer is low physical activity, but this exposure is too hard to define, and the 4 6 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

47 non-occupational causes likely to be so predominant, that the disorder is not recommended for inclusion in the Schedule. Rectal cancer Rectal carcinoma is a malignant disease of the rectum, which is at the end of the large bowel. There are no clear risk factors for rectal carcinoma, and no occupational exposures that have been strongly and consistently implicated as causes of rectal carcinoma. Gall bladder cancer Gall bladder cancer is a malignant disease of the gall bladder. There are no clear external risk factors associated with gall bladder cancer. There are no occupational exposures that have been strongly and consistently implicated as causes of gall bladder cancer. Pancreatic cancer Pancreatic cancer is a malignant disease of the pancreas. Smoking is the main external risk factor for pancreatic cancer. There are no occupational exposures that have been strongly and consistently implicated as causes of pancreatic cancer. Bone Bone cancer is a rare primary malignant disease of bone. There is little firm evidence of occupational causes of bone cancer. Skin (melanoma) Melanoma is a malignant disease of the melanin-containing cells of the skin. The only occupational exposure strongly implicated as increasing the risk of malignant melanoma is sunlight. However, the relationship is not straightforward, as there is evidence that occupations that provide chronic sunlight exposure may provide protection from melanoma 9. This makes melanoma an unsuitable disorder to be included at the moment in the revised Schedule. Female breast cancer Breast cancer is a malignant disease of the breast tissues. The main external causes of breast cancer appear to be ionising radiation, oral contraceptives and dietary factors. There are no occupational exposures that have been strongly and consistently implicated as causes of breast cancer. Cervical cancer Cervical cancer is a malignant disease of the uterine cervix. The main external risk factors associated with cervical cancer are infection with the human papilloma virus (HPV), cigarette smoking and possibly use of the oral contraceptive. There are no occupational exposures that have been strongly and consistently implicated as causes of cervical cancer. Uterine cancer Uterine cancer is a malignant disease of the uterus. The main external risk factors associated with endometrial cancer are oestrogen replacement therapy, obesity and dietary factors. There are no occupational exposures that have been strongly and consistently implicated as causes of endometrial cancer. Ovarian cancer Ovarian cancer is a malignant disease of the ovaries. There are no important external risk factors associated with ovarian cancer. There are also no occupational exposures that have been strongly and consistently implicated as causes of ovarian cancer. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 47

48 Prostate cancer Prostate cancer is a malignant disease of the prostate. There are no occupational exposures that have been strongly and consistently implicated as causes of prostate cancer. An association with pesticides, and occupations involved in pesticide exposure (such as pesticide applicators and farming) is suggested by published studies, but this evidence is not strong enough to allow the disorder to be included in the Schedule. Testicular cancer Testicular cancer is a malignant disease of the testes. No occupational exposures have been strongly implicated as causing testicular cancer. Renal cancer Renal carcinoma is a malignant disease of the kidney. There are no definite occupational causes of renal cell carcinoma. Brain cancer Brain cancer is a malignant disease of central nervous system tissues in and around the brain. It has various forms, with gliomas and meningiomas the types most commonly associated with occupational exposures. There are no occupational exposures that have been strongly and consistently implicated as causes of malignant brain tumours. Myeloma Myeloma is a malignant disease of a subset of white blood cells. No specific occupational exposures have been consistently and strongly implicated as causing myeloma. C HEMOTHERAPEUTIC AGENTS Fifteen chemotherapeutic agents are listed by IARC as definite human carcinogens. It is likely that more will be added in time, as new agents are developed and tested. Although occupational exposure to these agents is possible, either during manufacture or use, the risk is likely to be low. Another complicating factor is that often the agents are associated with an increased risk of a range of different cancers, with evidence of varying strength for each agent and each cancer type, and predominantly little direct evidence of increased risk in an occupational setting. This makes it difficult to fit these exposures into the structure of Schedule 2. MENTAL OR NEUROPSYC HIATRIC DISORDERS Stress-related psychological disorders related to work can result when the demands of the workplace (known as job strain ) place undue psychological strain on the worker. Anxiety, depression and related psychological disorders can result from this occupational strain. Job strain is also sometimes described as workplace stress, but stress is also used to describe the psychological disorder that might arise from excessive job strain, so job strain is the preferable term. Many characteristics of the working environment have been associated with stressrelated disorders. These include heavy workload, leadership/management style, professional conflict, excessive emotional demands of the job, and lack of job security. Virtually any occupation can have associated stress issues at some stage, and personal factors also play an important role in determining whether a particular factor or factors gives rise to symptoms of stress-related disorders in an individual worker. The ubiquitous nature of stress 4 8 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

49 in the general community, and the difficulty establishing what contribution work exposures may have had on the development of any stress-related disorders, makes stress-related psychological disorders unsuitable for inclusion in the Schedule. DISORDERS OF THE NERVOUS S YS TEM Dementia Dementia is a progressive, degenerative disease of the brain. The two main types are Alzheimer s disease and vascular dementia. No occupational exposures have been strongly associated with the development of dementia. VASCUL AR DISORDERS Ischaemic heart disease Ischaemic heart disease is a disorder characterised by partial or complete blockage of arteries taking blood to the muscle of the heart. The most important known risk factors for ischaemic heart disease are all likely to be largely non-occupational in origin smoking, high blood pressure, high cholesterol and diabetes. The connection between occupational exposures and ischaemic heart disease is controversial. The clearest evidence is probably for carbon disulphide and nitroglycerin, both of which are now rare workplace exposures, and carbon monoxide. There is now good, but not compelling, evidence for an association with low job control (possibly exacerbated by high job demands), and environmental tobacco smoke. The overwhelming contribution from non-occupational causes in most cases, and the difficulty in identifying and measuring potentially relevant occupational exposures in individual cases, means that ischaemic heart disease (and related cardiovascular disorders such as hypertension) is unsuitable for inclusion in the Schedule. RESPIRATORY DISORDERS ( N ON- MALIGNANT) Specific disorders recommended as in Section 5.4. HEPATIC DISORDERS Specific disorders recommended as in Section 5.4. DISORDERS OF THE GENITOURINARY S YS TEM Specific disorders recommended as in Section 5.4. N ON- C ANCEROUS SKIN DISORDERS Specific disorders recommended as in Section 5.4. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 4 9

50 MUSCULOSKELETAL DISORDERS Upper limb disorders Upper limb disorders are discussed in detail in Section 5.4. Only those disorders with agreed diagnostic criteria and known occupational exposures should be included in the Schedule. Occupational overuse syndrome is not recommended for inclusion in the Schedule because of difficulties establishing the diagnosis. There can also be difficulty identifying the causative exposure. Low back pain Low back pain is one of the most common musculoskeletal disorders related to work. Chronic low back pain, in particular, is a major cause of work-related disability and cost. It is also a major cause of disability and cost in the general community. Like many other work-related musculoskeletal disorders, the connection between symptoms, disability and demonstrable pathology is often not clear or requires very focused investigation. A wide range of occupations, work tasks, workplace factors and psychological factors have been associated with low back pain, with heavy lifting the task most commonly associated, but there is debate regarding the validity of much of the evidence. Therefore, this disorder is not suitable for inclusion in the Schedule. Osteoarthritis Osteoarthritis is a chronic degenerative disorder of joints characterised by damage to, and loss of, articular cartilage. It is very common in the general community, and there are many non-occupational causes. Heavy physical loading probably predisposes to the development of osteoarthritis in an occupational context, with recurrent kneeling or squatting being a particular problem, but there are no occupational exposures which have been conclusively found to be associated with the development of osteoarthritis. Scleroderma Scleroderma, also known as progressive systemic sclerosis, is a rare autoimmune disorder involving the connective tissue and damage to microvessels. A variety of occupational exposures have been linked to scleroderma, with the evidence strongest, but not definite, for silica. VIBRATION DISORDERS Vibration has been associated with lower back pain and several upper limb pain disorders, including secondary Raynaud s phenomenon (vibration white finger), carpal tunnel syndrome and scleroderma. Only secondary Raynaud s phenomenon vibration associated with vibration should be included in the Schedule. Other diseases specific to vibration exposure are too hard to consistently diagnose, or too commonly associated with non-occupational exposures, to be included. N OISE- INDUCED HEARING LOSS Recommended for inclusion, as in Section R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

51 ACUTE C HEMICAL POISONING/ TOXICIT Y Specific disorders recommended as in Section 5.4. REPRODUCTIVE RISKS Reproductive disorders cover problems with fertility and congenital abnormalities. Both males and females can be affected. Reproductive disorders have a wide range of causes, and in the majority of cases the cause may never be known. The application of diagnostic criteria for many reproductive disorders can also be difficult. Occupational exposures and occupations that have been strongly implicated in adversely affecting reproduction in both males and females are lead, mercury, multiple chemical and pesticide exposures, organic solvents (particularly carbon disulphide and 2-bromopropane), and ionising radiation. Other exposures implicated as being of concern specifically to females include ethylene glycol, toluene and shift work. Exposures implicated as being of concern specifically to males include the pesticides 1,2-dibromo-3-chloro-propane (DBCP), carbaryl and 2,4-dichloro phenoxy acetic acid (2-4 D); chromium; heat; microwave radiation; ethylene dibromide; and styrene. Reproductive disorders are so common in the general community, and so difficult to consistently diagnose, that in any individual case it is usually very difficult to determine the extent of the problem and to determine if an occupational exposure has made a meaningful contribution to the problem. Therefore, these disorders are not suitable for inclusion in the Schedule. MULTIPLE C HEMICAL SENSITIVIT Y Multiple chemical sensitivity is a syndrome characterised by an abnormal, multi-organ sensitivity following chemical exposures. There is lack of agreement as to what the underlying pathological mechanisms are and whether multiple chemical sensitivity should be viewed as a separate clinical entity. There are diagnostic criteria that are generally accepted, but difficult to apply. There are no occupational exposures clearly related to the development of multiple chemical sensitivity. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 51

52 5 2 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

53 SECTION SIX RECOMMENDATIONS 6 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 5 3

54 Summary This chapter presents the recommended format and content of the revised form of Schedule 2, as well as the disorders not recommended for inclusion. 6.1 RECOMMENDED FORMAT AND CONTENT OF SC HEDULE 2 Table 6.1 shows the recommended format and content of the revised form of Schedule 2. These are based on the considerations presented in Chapters 4 and 5. TA B L E 6. 1 Recommended format and content of Schedule 2 D I S O R D E R E X P O S U R E O R O C C U PAT I O N ( S U F F I C I E N T O C C U PAT I O N A L E X P O S U R E R E Q U I R E D ) Infectious disease Anthrax Brucellosis Hepatitis A Hepatitis B and C HIV/AIDS (and AIDS-related illnesses) Legionellosis Leptospirosis Orf Streptococcus suis Tuberculosis Relevant occupations involving work with animals or animal carcasses (such as animal handler, pelt handler, abattoir worker, meat inspector) Relevant occupations involving work with animals or animal carcasses (such as veterinarian, farmer or farm worker, abattoir worker, laboratory worker) Relevant occupations involving contact with human waste (such as sewerage worker, plumber) Relevant occupations involving contact with human bodily secretions (such as healthcare worker, embalmer, person who handles body substances, clinical laboratory staff, worker in long-term correctional facilities, police, member of the armed forces, emergency services worker) Relevant occupations involving contact with human bodily secretions in situations where HIV prevalence is likely to be significantly higher than the general community (such as healthcare worker, sex worker) Relevant occupations known to involve an increased risk of exposure to Legionella species than in the general community (such as air-conditioning maintenance worker, healthcare personnel, ship repair worker, gardener, construction worker, sewerage worker, automotive plant worker, miner) Relevant occupations involving work with animals or animal carcasses (such as farmer or farm worker, abattoir worker, forestry worker, hunter, veterinarian, livestock transport operator) or work with animal or human waste (such as plumber) Relevant occupations involving work with sheep or sheep carcasses (such as sheep farmer or farm worker, goat farmer or farm worker, abattoir worker, meat inspector) Relevant occupations involving work with pigs or pig carcasses (such as pig farmer or farm worker, pork butcher, pig breeder, abattoir worker) Relevant occupations involving contact with persons or animals in situations where tuberculosis prevalence is likely to be significantly higher than the general community (such as healthcare worker, clinical laboratory worker, funeral parlour staff, farmer, veterinarian), or person with silicosis 5 4 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

55 TA B L E 6. 1 C O N T I N U E D D I S O R D E R E X P O S U R E O R O C C U PAT I O N ( S U F F I C I E N T O C C U PAT I O N A L E X P O S U R E R E Q U I R E D ) Malignancy Liver cancer Sino-nasal carcinoma Naso-pharyngeal carcinoma Larynx Lung and bronchus Skin (non-melanoma) Mesothelioma Bladder cancer Hodgkin s lymphoma Non-Hodgkin s lymphoma Leukaemia Soft tissue sarcoma Disorders of the nervous system Parkinson s disease Peripheral neuropathy Chronic solvent-induced toxic encephalopathy Respiratory disorders (non-malignant) Asthma xiii Byssinosis Extrinsic allergic alveolitis Chronic obstructive pulmonary disease Silicosis Asbestosis Coal workers pneumoconiosis Other pneumoconiosis Hepatic disorders Chronic active hepatitis Hepatic cirrhosis Chronic renal failure Non-cancerous skin disorder Contact dermatitis (irritant and allergic) Vinyl chloride monomer, persons with known HBV or HCV related to occupation Wood dust Formaldehyde Sulphuric acid mists, asbestos, organic solvents Asbestos, arsenic, beryllium, bis (chloromethyl) ether (and chloromethyl methyl ether), cadmium, chromium VI, coke oven emissions, diesel fumes, environmental tobacco smoke, nickel, radon, silica, soot Arsenic, polycyclic hydrocarbons (such as from tar, pitch, bitumen, mineral oil, shale oil, anthracene, or other compounds, products, or residues of these substances); outdoor occupations Asbestos, erionite, talc containing asbestiform fibres 2-naphthylamine, benzidine, 4-Aminobiphenyl, N,N-Bis(2-chloroethyl)-2- naphthylamine, other aromatic amines, poly-cyclic aromatic hydrocarbons Wood dust Phenoxyherbicides, chlorophenols, halogenated hydrocarbon solvents, dioxin Ionising radiation, benzene, ethylene oxide Dioxin Manganese Metals such as lead, mercury and arsenic; organic solvents such as n-hexane, carbon disulphide and trichloroethylene; pesticides such as organophophates; acrylamide Organic solvents, particularly styrene, toluene, xylene, trichloroethylene, tetrachloroethylene, methylene chloride, white spirit Sensitising agents or irritants both recognised in this regard and inherent in the work process xiv Cotton, flax, hemp, sisal dust Damp material of biological origin, such as mouldy hay, straw, grain and feathers Coal, silica, cotton or grain dust Silica Asbestos Coal Exposures known to occasionally cause pneumoconiosis, such as beryllium, tin, iron oxide, barium, aluminimum, cobalt, tungsten xiv Persons with known HBV or HCV related to occupation Persons with known HBV or HCV related to occupation Metals such as lead, cadmium, chromium, copper and mercury, including via welding fumes Sensitising agents or irritants both recognised in this regard and inherent in the work process xiv R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 5 5

56 TA B L E 6. 1 C O N T I N U E D D I S O R D E R E X P O S U R E O R O C C U PAT I O N ( S U F F I C I E N T O C C U PAT I O N A L E X P O S U R E R E Q U I R E D ) Occupational vitiligo Musculoskeletal disorders Rotator cuff syndrome Lateral epicondylitis Medial epicondylitis Ulnar nerve entrapment Radial nerve entrapment Tendonitis in the hand and fingers Raynaud s phenomenon De Quervain s tenosynovitis Carpal tunnel syndrome Bursitis (at the elbow or knee) Noise-induced hearing loss Acute poisoning/toxicity (includes acute damage to the heart, lungs, liver, kidney, nervous system and blood) Para-tertiary-butylphenol; para-tertiary-butylcatechol; para-amylphenol; hydroquinone or the monobenzyl or monobutyl ether of hydroquinone Repeated and/or sustained shoulder postures at greater than 60 0 flexion or abduction Forceful and repetitive work involving wrist dorsiflexion, flexion, supination, and/or pronation, or that exceeds ACGIH Hand TLV Forceful and repetitive work involving wrist dorsiflexion, flexion, supination, and/or pronation, or that exceeds ACGIH Hand TLV Use of hand tools; working with raised arms; the combination of repetition, force and posture Use of hand tools; working with raised arms; the combination of repetition, force and posture Work involving highly repetitious, forceful hand/wrist exertions, or that exceeds ACGIH Hand TLV Vibration, hammer drills, hand-held portable grinders and jigsaws Use of hand tools; working with raised arms; the combination of repetition, force and posture Highly repetitive work, forceful work, and/or work involving exposure to vibration, or work that exceeds ACGIH Hand TLV Prolonged external friction or pressure or repetitive motion at or about the elbow or the knee Sufficient exposure to persistent or intermittent noise above 85db(a) Acrylonitrile; alcohols; antimony; arsenic; benzene; beryllium; cadmium; carbon disulphide; chromium; copper; fluorine; alcohol, glycols or ketones; hexane; lead; manganese; mercury; mineral acids; nitroglycerine (or other nitric acid esters); osmium; oxides of nitrogen; ozone; pesticides, herbicides and related compounds; pharmaceutical agents; phosgene; phosphorus; selenium; styrene; thallium; tin; toluene; vanadium; zinc; chemical asphyxiants (carbon monoxide, hydrogen cyanide, hydrogen sulphide, methylene chloride); irritants (benzoquinone and other corneal irritants); toxic halogen derivatives of aliphatic or aromatic hydrocarbons; toxic nitro- and amino-derivatives of benzene xiv xiii Whether only immunologically-mediated asthma should be considered to be occupational asthma, or whether asthma arising as result of workplace exposure to irritants, or exacerbation of pre-existing asthma by workplace irritants, should also be considered in the definition, is still the subject of debate. However, the broader definition seems to currently be more widely accepted. xiv The large number of occupational agents that have been shown to cause these disorders means that listing every relevant agent in connection with these disorders in Schedule 2 is impractical. 5 6 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

57 6. 2 DISORDERS NOT RECOMMENDED FOR INCLUSION IN SC HEDULE 2 Table 6.2 shows the disorders not recommended for inclusion in the revised form of Schedule 2, based on the consideration presented in Chapters 4 and 5. The exclusion of a disorder/exposure from Schedule 2 does NOT imply that it should not be compensated. Any such condition can still be considered under the three-part assessment process described by the IPRC Act. TA B L E 6. 2 Disorders recommended not to be included in Schedule 2, with justification against set criteria D I S O R D E R C R I T E R I A N O T M E T BY D I S O R D E R x v Infectious disease Pneumococcal disease Criteria 1 and 3 Malignancy Oral cavity cancer Criteria 1 and 3 Oesophageal cancer Criteria 1 and 3 Colon cancer Criteria 1 and 3 Rectal cancer Criteria 1 and 3 Gall bladder cancer Criteria 1 and 3 Pancreatic cancer Criteria 1 and 3 Bone Criteria 1 and 3 Skin (melanoma) Criterion 1 Female breast cancer Criteria 1 and 3 Cervical cancer Criteria 1 and 3 Uterine cancer Criteria 1 and 3 Ovarian cancer Criteria 1 and 3 Prostate cancer Criteria 1 and 3 Testicular cancer Criteria 1 and 3 Renal cancer Criteria 1 and 3 Brain cancer Criteria 1 and 3 Myeloma Criteria 1 and 3 Chemotherapeutic agents Criterion 1 Stress-related psychological disease Criteria 1, 2 and 3 Disorders of the nervous system Dementia Criteria 1 and 3 Vascular disorders Ischaemic heart disease Criteria 1 and 3 Musculoskeletal disorders Occupational overuse syndrome Criteria 1 and 2 Low back pain Criteria 2 and 3 Osteoarthritis Criteria 1 and 3 Scleroderma Criteria 1 and 3 Vibration disorders (except Raynaud s) Criteria 1, 2 and 3 Reproductive risks Criteria 2 and 3 Multiple chemical sensitivity Criteria 1, 2 and 3 xv The criteria are as follows 1) There is strong evidence of a causal link between the occupational exposure and the disorder. 2) There are clear and repeatable criteria for diagnosing the disorder. 3) The disorder comprises a considerable proportion of the cases of that disorder in the overall population or in an identifiable subset of the population. R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 57

58 Comparison of recommended revised Schedule 2 to current ILO Annex and its possible amendments The recommended revised Schedule 2 is much more comprehensive than the current Schedule. It includes most, but not all, of the entries in the ILO Annex and the additions currently being considered to the Annex. A comparison between the recommended revised Schedule 2 and the ILO Annex and its possible amendments is shown in Appendix 6. Disorders in the Annex and its possible amendments that are not included in the recommended revised Schedule have been excluded for one or more of the fact that it is too difficult to reasonably exclude non-occupational factors; there is insufficient evidence of a causal connection to work; there is no catch-all category included in the revised Schedule; or the disorder is actually an injury rather than a disease. 5 8 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

59 SECTION SEVEN REFERENCES 7 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 5 9

60 1. Driscoll T, Mannetje A, Dryson E, Feyer A-M, Gander P, McCracken, S, Pearce N, Wagstaffe M, The burden of occupational disease and injury in New Zealand. Technical Report. NOHSAC: Wellington Nurminen M and Karjalainen A, Epidemiologic estimate of the proportion of fatalities related to occupational factors in Finland. Scandinavian Journal of Work, Environment and Health, : Steenland K, Burnett C, Lalich N, et al, Dying for work: the magnitude of US mortality from selected causes of death associated with occupation. American Journal of Industrial Medicine, : Agency for Toxic Substances and Disease Registry, ToxFAQs for chromium. 2001: Atlanta, ATSDR. Accessed September, New Zealand Health Information Service, Mortality and demographic data , NZHIS, Ministry of Health: Wellington New Zealand Health Information Service, Cancer. New registrations and deaths , NZHIS, Ministry of Health: Wellington Statistics New Zealand, Injury statistics 2001/2002: work-related injuries. 2003, Statistics New Zealand Te Tari Tatau: Wellington. 8. Gawkrodger D, Occupational skin cancers. Occupational Medicine, (7): Gandini S, Sera F, Cattaruzza M, et al, Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. European Journal of Cancer, (1): R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

61 SECTION EIGHT APPENDICES 8 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 61

62 APPENDIX 1 ILO SC HEDULE 42 AND REL ATED SC HEDULES 1925 XVI S C H E D U L E I List of Occupational Diseases Documented in ILO Convention 18 (Workmen s Compensation (Occupational Diseases) Convention, 1925) L I S T O F D I S E A S E S A N D T OX I C S U B S TA N C E S Poisoning by lead, its alloys or compounds and their sequelae. Poisoning by mercury, its amalgams and compounds and their sequelae. Anthrax infection. L I S T O F C O R R E S P O N D I N G I N D U S T R I E S A N D P R O C E S S E S Handling of ore containing lead, including fine shot in zinc factories. Casting of old zinc and lead in ingots. Manufacture of articles made of cast lead or of lead alloys. Employment in the polygraphic industries. Manufacture of lead compounds. Manufacture and repair of electric accumulators. Preparation and use of enamels containing lead. Polishing by means of lead files or putty powder with a lead content. All painting operations involving the preparation and manipulation of coating substances, cements or colouring substances containing lead pigments. Handling of mercury ore. Manufacture of mercury compounds. Manufacture of measuring and laboratory apparatus. Preparation of raw material for the hatmaking industry. Hot gilding. Use of mercury pumps in the manufacture of incandescent lamps. Manufacture of fulminate of mercury primers. Work in connection with animals infected with anthrax. Handling of animals carcasses or parts of such carcasses including hides, hoofs and horns. Loading and unloading or transport of merchandise. xvi From Accessed August R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

63 APPENDIX 2 ILO SC HEDULE 42 AND REL ATED SC HEDULES xvii S C H E D U L E I List of Occupational Diseases Documented in ILO Convention 42 (Workmen s Compensation (Occupational Diseases) Convention (Revised), 1934) L I S T O F D I S E A S E S A N D T OX I C S U B S TA N C E S L I S T O F C O R R E S P O N D I N G I N D U S T R I E S A N D P R O C E S S E S Poisoning by lead, its alloys or Handling of ore containing lead, including fine shot in zinc factories. compounds and their sequelae. Casting of old zinc and lead in ingots. Manufacture of articles made of cast lead or of lead alloys. Employment in the polygraphic industries. Manufacture of lead compounds. Manufacture and repair of electric accumulators. Preparation and use of enamels containing lead. Polishing by means of lead files or putty powder with a lead content. All painting operations involving the preparation and manipulation of coating substances, cements or colouring substances containing lead pigments. Poisoning by mercury, its amalgams Handling of mercury ore. and compounds and their sequelae. Manufacture of mercury compounds. Manufacture of measuring and laboratory apparatus. Preparation of raw material for the hatmaking industry. Hot gilding. Use of mercury pumps in the manufacture of incandescent lamps. Manufacture of fulminate of mercury primers. Anthrax infection. Work in connection with animals infected with anthrax. Handling of animals carcasses or parts of such carcasses including hides, hoofs and horns. Loading and unloading or transport of merchandise. Silicosis with or without pulmonary Industries or processes recognised by national law or regulations as involving tuberculosis, provided that silicosis is exposure to the risk of silicosis. an essential factor in causing the resultant incapacity or death. Phosphorous poisoning by Any process involving the production, liberation or utilisation of phosphorous phosphorous or its compounds, or its compounds. and its sequelae. Arsenic poisoning by arsenic or its Any process involving the production, liberation or utilisation of arsenic compounds, and its sequelae. or its compounds. Poisoning by benzene or its Any process involving the production, liberation or utilisation of bezene or its homologues, their nitro- and homologues, or their nitro- or amido-derivatives. amido-derivatives, and its sequelae. Poisoning by the halogen derivatives Any process involving the production, liberation or utilisation of halogen of hydrocarbons of the aliphatic series. derivatives of hydrocarbons of the aliphatic series designated by nationals laws or regulations. Pathological manifestations due to: Any process involving exposure to the action of radium, radioactive substances, a) radium and other radioactive or X-rays. substances; b) X-rays. Primary epitheliomatous cancer of Any process involving the handling or use of tar, pitch, bitumen, mineral oil, the skin. paraffin, or the compounds, products or residues of these substances. xvii From Accessed August R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 6 3

64 APPENDIX 3 ILO SC HEDULE 42 AND REL ATED SC HEDULES 1934 AND 1980 S C H E D U L E I List of Occupational Diseases xviii E M P L OY M E N T I N J U RY B E N E F I T S C O N V E N T I O N, [ S C H E D U L E I A M E N D E D I N ] ( N O. 121 ) A R T I C L E Pneumoconioses caused by sclerogenic mineral dust risk (silicosis, anthraco-silicosis, asbestosis) and silico-tuberculosis, provided that silicosis is an essential factor in causing the resultant incapacity or death. 2. Bronchopulmonary diseases caused by hard-metal dust. 3. Bronchopulmonary diseases caused by cotton dust (byssinosis), or flax, hemp or sisal dust. 4. Occupational asthma caused by sensitising agents or irritants both recognised in this regard and inherent in the work process. 5. Extrinsic allergic alveolitis and its sequalae caused by the inhalation of organic dusts, as prescribed by national legislation. 6. Diseases caused by beryllium or its toxic compounds. 7. Diseases caused by cadmium or its toxic compounds. 8. Diseases caused by phosphorus or its toxic compounds. 9. Diseases caused by chromium or its toxic compounds. 10. Diseases caused by manganese or its toxic compounds. 11. Diseases caused by arsenic or its toxic compounds. 12. Diseases caused by mercury or its toxic compounds. 13. Diseases caused by lead or its toxic compounds. 14. Diseases caused by fluorine or its toxic compounds. 15. Diseases caused by carbon disulphide. 16. Diseases caused by the toxic halogen derivatives of aliphatic or aromatic hydrocarbons. 17. Diseases caused by benzene or its toxic homologues. 18. Diseases caused by toxic nitro- and amino- derivatives of benzene or its homologues. 19. Diseases caused by nitroglycerin or other nitric acid esters. 20. Diseases caused by alcohols, glycols or ketones. 21. Diseases caused by asphyxiants: carbon monoxide, hydrogen cyanide or its toxic derivatives, hydrogen sulphide. 22. Hearing impairment caused by noise. 23. Diseases caused by vibration (disorders of muscles, tendons, bones, joints, peripheral blood vessels or peripheral nerves). 24. Diseases caused by work in compressed air. 25. Diseases caused by ionising radiations all work involving exposure to the action of ionising radiations. 26. Skin diseases caused by physical, chemical or biological agents not included under other items. 27. Primary epitheliomatous cancer of the skin caused by tar, pitch, bitumen, mineral oil, anthracene, or the compounds, products or residues of these substances. 28. Lung cancer or mesotheliomas caused by asbestos. 29. Infectious or parasitic diseases contracted in an occupation where there is a particular risk of contamination: (a) Health or laboratory work. (b) Veterinary work. (c) Work handling animals; animal carcasses, parts of such carcasses, or merchandise which may have been contaminated by animals, animal carcasses, or parts of such carcasses. (d) Other work carrying a particular risk of contamination. xviii All work involving exposure to the risk concerned is included unless otherwise specified. 6 4 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

65 APPENDIX 4 SECTION 30 OF THE INJURY PREVENTION, REHABILITATION, AND COMPENSATION ACT 2001 xix 30. Personal injury caused by work-related gradual process, disease, or infection (1) Personal injury caused by a work-related gradual process, disease, or infection means personal injury (a) suffered by a person; and (b) caused by a gradual process, disease, or infection; and (c) caused in the circumstances described in subsection (2). (2) The circumstances are (a) the person (i) performs an employment task that has a particular property or characteristic; or (ii) is employed in an environment that has a particular property or characteristic; and (b) the particular property or characteristic (i) causes, or contributes to the cause of, the personal injury; and (ii) is not found to any material extent in the non-employment activities or environment of the person; and (iii) may or may not be present throughout the whole of the person s employment; and (c) the risk of suffering the personal injury (i) is significantly greater for persons who perform the employment task than for persons who do not perform it; or (ii) is significantly greater for persons who are employed in that type of environment than for persons who are not. (3) Personal injury caused by a work-related gradual process, disease, or infection includes personal injury that is of a type described in Schedule 2 that is suffered by a person who is or has been in employment involving exposure to agents, dusts, compounds, substances, radiation, or things (as the case may be) described in that schedule in relation to that type of personal injury. (4) Personal injury of a type described in subsection (3) does not require an assessment of causation under subsection (1)(b) or (c). [(4A) This Act covers personal injury caused by a work-related gradual process, disease, or infection only if (a) the exposure to the gradual process, disease, or infection actually occurred in New Zealand; or (b) the person concerned was ordinarily resident in New Zealand when the exposure actually occurred.] (5) Personal injury caused by a work-related gradual process, disease, or infection does not include (a) personal injury related to non-physical stress; or (b) any degree of deafness for which compensation has been paid under the Workers Compensation Act (6) Subsection (7) applies if, before 1 April 1974, the person (a) performed an employment task that had a particular property or characteristic; or (b) was employed in an environment that had a particular property or characteristic. (7) The circumstances referred to in subsection (6) do not prevent the person s personal injury from being personal injury caused by a work-related gradual process, disease, or infection, but he or she does not have cover for it if section 24 or section 361 applies to him or her. xix From Injury Prevention, Rehabilitation, and Compensation Act See Accessed August R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 6 5

66 APPENDIX 5 COMPARISON OF ANNEX TO ILO RECOMMENDATION 1941 TO RECOMMENDED REVISED VERSION OF SC HEDULE 2 A N N E X T O I L O R E C O M M E N DAT I O N 19 4 R E C O M M E N D E D R E V I S E D S C H E D U L E 2 N O. T Y P E O F D I S E A S E T Y P E O F D I S O R D E R 1. Diseases caused by agents 1.1. Diseases caused by chemical agents Diseases caused by beryllium or its toxic compounds Included for specific disorders Diseases caused by cadmium or its toxic compounds Included for specific disorders Diseases caused by phosphorus or its toxic compounds Included only in acute poisoning/toxicity Diseases caused by chromium or its toxic compounds Included for specific disorders Diseases caused by manganese or its toxic compounds Included for specific disorders Diseases caused by arsenic or its toxic compounds Included for specific disorders Diseases caused by mercury or its toxic compounds Included for specific disorders Diseases caused by lead or its toxic compounds Included for specific disorders Diseases caused by fluorine or its toxic compounds Included only in acute poisoning/toxicity Diseases caused by carbon disulphide Included for specific disorders Diseases caused by the toxic halogen derivatives of aliphatic or aromatic hydrocarbons Included only in acute poisoning/toxicity Diseases caused by benzene or its toxic homologues Included for specific disorders Diseases caused by toxic nitro- and amino-derivatives of benzene or its homologues Included only in acute poisoning/toxicity Diseases caused by nitroglycerine or other nitric acid esters Included only in acute poisoning/toxicity Diseases caused by alcohols, glycols or ketones Included only in acute poisoning/toxicity Diseases caused by asphyxiants: carbon monoxide, hydrogen cyanide or its toxic derivatives, Included only in acute poisoning/toxicity hydrogen sulphide Diseases caused by acrylonitrile Included only in acute poisoning/toxicity Diseases caused by oxides of nitrogen Included only in acute poisoning/toxicity Diseases caused by vanadium or its toxic compounds Included only in acute poisoning/toxicity Diseases caused by antimony or its toxic compounds Included only in acute poisoning/toxicity Diseases caused by hexane Included for specific disorders Diseases of teeth caused by mineral acids Included only in acute poisoning/toxicity Diseases caused by pharmaceutical agents Included only in acute poisoning/toxicity Diseases caused by thallium or its compounds Included only in acute poisoning/toxicity 6 6 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

67 A P P E N D I X 5 C O N T I N U E D A N N E X T O I L O R E C O M M E N DAT I O N 19 4 R E C O M M E N D E D R E V I S E D S C H E D U L E 2 N O. T Y P E O F D I S E A S E T Y P E O F D I S O R D E R Diseases caused by osmium or its compounds Included only in acute poisoning/toxicity Diseases caused by selenium or its compounds Included only in acute poisoning/toxicity Diseases caused by copper or its compounds Included for specific disorders Diseases caused by tin or its compounds Included only in acute poisoning/toxicity Diseases caused by zinc or its compounds Included only in acute poisoning/toxicity Diseases caused by ozone, phosgene Included only in acute poisoning/toxicity Diseases caused by irritants: benzoquinone and other corneal irritants Included only in acute poisoning/toxicity Diseases caused by any other chemical agents not mentioned in the preceding items to , No catch-all category included in the Schedule where a link between the exposure of a worker to these chemical agents and the diseases suffered is established 1.2. Diseases caused by physical agents Hearing impairment caused by noise Included Diseases caused by vibration (disorders of muscles, tendons, bones, joints, peripheral blood Revised schedule specifies only Raynaud s disease vessels or peripheral nerves) Diseases caused by work in compressed air Classified as an injury Diseases caused by ionizing radiations Specific malignancies related to ionising radiation included; other disorders related to ionising radiation classified as injuries Diseases caused by heat radiation Classified as an injury Diseases caused by ultraviolet radiation Classified as an injury Diseases caused by extreme temperature (e.g. sunstroke, frostbite) Classified as an injury Diseases caused by any other physical agents not mentioned in the preceding items No catch-all category included in the Schedule to 1.2.7, where a direct link between the exposure of a worker to these physical agents and the diseases suffered is established 1.3. Diseases caused by biological agents Infectious or parasitic diseases contracted in an occupation where there is a particular risk Revised Schedule specifies particular infectious diseases of contamination R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 67

68 A P P E N D I X 5 C O N T I N U E D A N N E X T O I L O R E C O M M E N DAT I O N 19 4 R E C O M M E N D E D R E V I S E D S C H E D U L E 2 N O. T Y P E O F D I S E A S E T Y P E O F D I S O R D E R 2. Diseases by target organ systems 2.1. Occupational respiratory diseases Pneumoconioses caused by sclerogenic mineral dust (silicosis, anthraco-silicosis, asbestosis) Included and silicotuberculosis, provided that silicosis is an essential factor in causing the resultant incapacity or death Bronchopulmonary diseases caused by hard-metal dust Included with pneumoconioses Bronchopulmonary diseases caused by cotton, flax, hemp or sisal dust (byssinosis) Included Occupational asthma caused by recognized sensitizing agents or irritants inherent to the Included work process Extrinsic allergic alveolitis caused by the inhalation of organic dusts, as prescribed by Included national legislation Siderosis Included Chronic obstructive pulmonary diseases Included in connection to specific exposures Diseases of the lung caused by aluminium Included in connection to pneumoconiosis and asthma Upper airways disorders caused by recognized sensitizing agents or irritants inherent to the Not included work process Any other respiratory disease not mentioned in the preceding items to 2.1.9, No catch-all category included in the Schedule caused by an agent where a direct link between the exposure of a worker to this agent and the disease suffered is established 2.2. Occupational skin diseases Skin diseases caused by physical, chemical or biological agents not included under other items Included Occupational vitiligo Included 2.3. Occupational musculo-skeletal disorders Musculo-skeletal diseases caused by specific work activities or work environment where Specific disorders included, connected to some of these exposures particular risk factors are present. Examples of such activities or environment include: (a) rapid or repetitive motion Included (b) forceful exertion Included 6 8 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

69 A P P E N D I X 5 C O N T I N U E D A N N E X T O I L O R E C O M M E N DAT I O N 19 4 R E C O M M E N D E D R E V I S E D S C H E D U L E 2 N O. T Y P E O F D I S E A S E T Y P E O F D I S O R D E R (c) excessive mechanical force concentration Not included (d) awkward or non-neutral postures Included (e) vibration Not included Local or environmental cold may increase risk Not included 3. Occupational cancer 3.1. Cancer caused by the following agents Specific cancer types included with specified exposures Asbestos Included for specific cancers Benzidine and its salts Included for specific cancers Bis chloromethyl ether (BCME) Included for specific cancers Chromium and chromium compounds Included for specific cancers Coal tars, coal tar pitches or soots Included for specific cancers Beta-naphthylamine Included for specific cancers Vinyl chloride Included for specific cancers Benzene or its toxic homologues Included for specific cancers Toxic nitro- and amino-derivatives of benzene or its homologues Included for specific cancers Ionizing radiations Included for specific cancers Tar, pitch, bitumen, mineral oil, anthracene, or the compounds, products or residues Included for specific cancers of these substances Coke oven emissions Included for specific cancers Compounds of nickel Included for specific cancers Wood dust Included for specific cancers Cancer caused by any other agents not mentioned in the preceding items to , No catch-all category included in the Schedule where a direct link between the exposure of a worker to this agent and the cancer suffered is established 4. Other diseases 4.1. Miners nystagmus Not included because it is such a rare disorder in the New Zealand workforce R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T ) 6 9

70 APPENDIX 6 C OMPARISON OF POSSIBLE ADDITIONS TO ANNEX TO ILO RECOMMENDAT ION 1941 TO RECOMMENDED REVISED VERSION OF SC HEDULE 2 P O S S I B L E A D D I T I O N T O A N N E X T O I L O R E C O M M E N DAT I O N 19 4 R E C O M M E N D E D R E V I S E D S C H E D U L E 2 N O. T Y P E O F D I S E A S E T Y P E O F D I S O R D E R 1. Diseases caused by chemical agents 1.1. Diseases caused by chemical agents Diseases caused by pesticides 1.2. Diseases caused by physical agents Acute diseases caused by electromagnetic fields 1.3. Diseases caused by biological agents Tetanus Brucellosis Tuberculosis Diseases caused by hepatitis B virus and hepatitis C virus 2. Diseases by target organ systems 2.1. Occupational respiratory diseases (No additional diseases proposed) 2.2. Occupational skin diseases (No additional diseases proposed) 2.3. Occupational musculo-skeletal disorders Radial styloid tenosynovitis due to repetitive movements, forceful exertions and extreme postures of the wrist Chronic crepitant tenosynovitisof hand and wrist due to repetitive movements, forceful exertions and extreme postures of the wrist Olecranon bursitis due to prolonged pressure of the elbow region Prepatellar bursitis following extended periods of work in kneeling position Epicondylitis due to repetitive forceful work Meniscus lesions following extended periods of work in a kneeling or squatting position Carpal tunnel syndrome Any other musculoskeletal and nervous diseases not mentioned in the preceding newly-proposed items where a link between the work activities or work environment of a worker and the diseases suffered is thoroughly documented in the literature 2.4 Mental and behavioural diseases Post-traumatic stress disorder due to stressful event or situation Psychosomatic psychiatric syndromes causes by mobbing 3. Occupational cancer 3.1. Cancer caused by the following agents Arsenic and its compounds Beryllium and its compounds Cadmium and its compounds Erionite Ethylene oxides Silica Hepatitis B virus and hepatitis C virus 4. Other diseases (No additional diseases proposed) Included Not included insufficient evidence Included Included Included Included for specific disorders Included Included Included Included Included Not included too difficult to reasonably exclude non-occupational factors Included No catch-all category included in the Schedule Not included too difficult to reasonably exclude non-occupational factors Not included too difficult to reasonably exclude non-occupational factors Included Included Included Included, although exposure is very unlikely in New Zealand Included Included Included 7 0 R E V I E W O F S C H E D U L E 2 O F T H E I N J U RY P R E V E N T I O N, R E H A B I L I TAT I O N, A N D C O M P E N SAT I O N AC T ( I P RC AC T )

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