The second edition of the List of Work-Related Illnesses (LDRT), recently published, arrives in the midst of a kind of epidemic of underreporting of such cases in the country. The diagnosis is made by Márcia Bandini, professor at the Faculty of Medical Sciences (FCM) at Unicamp and one of the project's technical coordinators. According to the professor, the expectation is that the new list, more detailed than its first edition (from 1999), will allow the identification and notification of cases that have not been detected, and this in order to draw up a profile of workers' illnesses. Brazilians.
“The vast majority of injury notifications today relate to work accidents, not illnesses. Looking at the data, the proportion is almost three in every four cases”, says Bandini, who researches the centrality of work in people's health-illness process. “We want to know beforehand so we can prevent it”, adds the doctor. At the invitation of the Ministry of Health, she shared the technical coordination of the project with doctor Elizabeth Costa Dias, professor at the Federal University of Minas Gerais (UFMG), and doctor João Silvestre da Silva-Junior, professor at the University of São Paulo ( USP). In addition to carrying out research on the topic, the three professors work in assistance and surveillance discussions at the National Network for Comprehensive Occupational Health Care (Renast) and in debates on public policies related to the subject.
An instrument for clinical and epidemiological use, the LDRT allows us to look at both the individual and the collective, explains Bandini. The document works as a basis for professionals to find the relationship between a patient's diagnosis and their work history, allowing them to detect situations in which it is necessary to intervene in workplaces to prevent new cases. According to the teacher, the list also has a pedagogical function. “It is not a list for use only by doctors or health professionals, but also by unions, social movements, human resources professionals and even employers, because it is a guide. We want it to serve as a catalyst for surveillance, preferably not just focused on health services.”
The professor highlights the complexity of the process of preparing the document, interrupted with the arrival of Jair Bolsonaro as president and restarted a year later, in a leaner version. Its preparation involved an initial study with 240 lists from around the world, something necessary to reach the state of the art on work-related illnesses. The comparative analysis of data collected globally with the 1999 list and recent information on the Brazilian reality made it possible to update and expand the existing list of diagnoses. The new version was submitted to technical workshops – which included the participation of doctor Sergio Roberto de Lucca (also a professor at FCM) – and, before being made official, underwent consultations with specialists, professionals from the Unified Health System (SUS) and to the general population.
Covid-19
The doctor lists three main highlights of the current version of the list. The first concerns Covid-19, which arrived in Brazil months before the work was completed. “The first provisional measure for the pandemic had an article explicitly saying: Covid is not an occupational disease. This happened in April 2020. In May, the article was overturned by the Supreme [Federal Court]. As the list was already very advanced, after seeking evidence and consulting what the World Health Organization [WHO], the International Labor Organization [ILO] and countries around the world were doing, the final version of the LDRT ended up being published incorporating the Covid-19. But the next day it was revoked.”
Bandini considers the republication of the list now a possibility so that there is compensation for damages related to contamination by covid-19 in the workplace from October 2020, when the document would come into force if it had not been suspended. “A legal exception was created, which makes the list an instrument with legal validity since that period. It is important to remember that not every case of Covid-19 is work-related, but when it is, it needs to be recognized as such to do justice to those who have experienced it.or that and so that there is a line of care for those who work today. And it applies not only to those who died, but also to those who were hospitalized and who live with the consequences of the disease or hospitalization.”
Getting out of delay
Bandini chooses the recognition of psychosocial factors related to work and their inclusion in the document as the second highlight of the project, as it indicates the late progress on issues already discussed worldwide since 1980. “We are quite behind, including in relation to other countries in Latin America. The WHO has just published a document that discusses how organizations need to be prepared to deal with the issue. ILO Convention 190, of 2019, dealt with the elimination of violence and harassment [in the workplace]. Many places have already gone a step further and are developing or adopting assessment instruments to be able to address this, which is so subjective.”
Arranged on two fronts, called A and B, the list can be consulted starting from work to reach the diagnosis or vice versa, explains Bandini. It is not, therefore, a disease manual. Psychosocial factors – such as harassment, violence, interpersonal relationships and communication – are found in part A. In the other, mental disorders and the abusive use of psychoactive substances (including caffeine) are listed. “A lot of people commented about the coffee. It is not common to have a case of caffeine abuse, especially because the substance does not produce as exuberant dependence as cocaine or benzodiazepines, but it is possible. And, if it can happen, it needs to be on the list, because we have to stay alert. Even if it’s something rare.”
In the same section, the inclusion of suicide as a separate event is also mentioned as progress, signaling the importance of discussing such a delicate issue. According to Bandini, there is a tendency to “pathologize” the problem, as if every suicide was the product of a mental disorder that was not adequately treated. In this sense, its inclusion on the list sheds light on the issue and allows us to discuss the role of work throughout a process that may involve other factors and be triggered, for example, by despair. “Around 3,5% of people have suicidal ideation. We are not talking about something absent from our daily lives,” he says.
The death in 2017 of Luiz Carlos Cancellier de Olivo, then rector of the Federal University of Santa Catarina (UFSC), and the 60 suicides of former employees of the French company Télécom, between 2006 and 2009, are cited by the professor to remember that suffering Extreme psychic stress associated with the job can become a risk. “In the French case, a study showed that there was something in common, that the deaths had to do with the way those people were treated in the organization”, says Bandini.
Finally, the expansion of the space reserved for cancer cases is the third significant difference between the current list and the previous version, in the professor's opinion. In addition to the evolution of scientific studies, which made it possible to recognize a greater variety of diseases, Bandini highlights the contribution of the National Cancer Institute (Inca) to refine the classification of the different agents associated with each type of cancer. The new edition also includes cases of cancer potentially related to work, something absent from the 1999 document.
