Occupational Disease: Cancer of the Philippine Business Sector

I. What is Occupational Disease?

Occupational diseases in the Philippines are so common that common workers no longer know the difference between work-related diseases and hereditary or pre-existing illnesses. This awareness shortcoming results to the deprivation of rights which are all supported by Philippine law, and specifically, the labor code and Presidential Decree 626.

The term occupational disease refers to any ailment caused, developed or resulted from work and by the work environment itself. The disease may originate directly from the nature of work, the risks encompassing the job, the environment that comes with the work or any factor brought about by the duties.

Manual laborers almost always experience muscle sprains due to their job description. Encoders are always at high risk of developing Carpal tunnel syndrome (CTS) due to the repetitive positioning of the hands on keyboard. Chemical engineers who frequently rove chemical plantations are always exposed to toxic chemicals that may cause lifetime respiratory and organ problems. Street sweepers whose duty is practically to work with dirt, garbage and pollutions may develop diseases associated with their job description, like leptospirosis during rainy season and skin cancer from prolonged exposure to the sun and pollutants during hot dry season.

Occupational diseases are not to be confused with occupational injuries. The former term results to long-term health conditions that may interfere with the performance of responsibilities, if not totally impede one from working, while the latter is used to describe short-term injuries obtained from work-related factors that may minimally, if not totally, affect the performance of tasks and responsibilities of the worker.

Unlike injuries, occupational diseases are grounds for claiming early retirement benefits in the form of disability compensation arising from the need for long-term or permanent medical support, or temporary or permanent disability of the claimant. With all the medical reasons entitled to corresponding compensation into consideration, the fact remains that occupational injuries are still plausible to aggravation, leading to occupational diseases in the long run.

Common and rare diseases, whether medically classified as hereditary, genetic, environmental, incidental, etc., can be considered as work-related. Thus, all occupational diseases fall under other medical categories as well.

Primary ailments are not always occupational in nature and occupational diseases are not always primary ailments. Howbeit, complications of non-work-related sicknesses forming new ailments due to work-related factors can be declared occupational diseases as well. Such cases are still subject to contest by and large, principally and legally speaking.

All compensations for work-related ailments, injuries and deaths in the Philippines are upheld by the Employee’s Compensation Commission (ECC). Appeal on the body’s decision is still possible through regular litigation process in the courts.

II. Identifying the List

Among the health conditions considered as work-related sicknesses, either as direct effect or as complication arising from occupational risks, respiratory conditions are the most prone to aggravation that may develop to more serious ailments.

The following are the recognized occupational and compensable diseases as universally accepted.

1. Cancer of the epithelial lining of the bladder
2. Cancer, epithellomatous or ulceration of the skin or of the corneal surface of the eye
3. Cataract
4. Deafness
5. Decompression sickness
6. Dermatitis
7. Infections
8. Ionizing radiation disease, inflammation, ulceration or malignant disease of skin or subcutaneous tissues of the bones or leukemia, or anemia of the aplastic type
9. Poisoning
10. Pneumoconiosis
11. Diseases caused by abnormalities in temperature and humidity
12. Vascular disturbance in the upper extremities
13. Viral Hepatitis
14. Poisoning by cadmium
15. Leukemia and lymphoma
16. Cancer of stomach and other lymphatic and blood forming vessels; nasal cavity and sinuses
17. Cancer of the lungs, liver and brain
18. Cardio-Vascular Diseases
19. Cerebro–Vascular Accidents
20. Malaria and Schistosomiasis
21. Pneumonia
22. Hernia
23. Bronchial Asthma
24. Osteoarthritis
25. Viral Encephalitis
26. Peptic ulcer
27. Pulmonary Tuberculosis
28. Essential Hypertension
29. Asbestosis

The given occupational diseases can still lead to other complications, which may or may not be recognized as work-related. This issue is subject to investigation and hearing as pleased by the appealing party.

III. Occupational Disease in International Perspective

The international community, especially the United States of America, doesn’t see the issue as a laughing matter. In fact, specializing research and regulating bodies have been established to cater to the cause and adhere to international standardizing guidelines in relation to occupational safety and health. These bodies commit to the improvement and more efficient management of Environment, Health and Safety within public and private organizations in a global scale.

A complaint of an ailing worker in the US against a company unwilling to render disability compensations and benefits can easily lead to a half-million law suit, and similar cases are not unusual in their justice system. The information dissemination on the rights of US citizens regarding occupational safety and health is incredibly high as there is an active propagation of labor laws as initiated both by the government and private sectors. Such issues also catch significant media attention which proves that safety and health matters at work are growing interests in their culture.

Do Filipinos act the same with such violation of their right?

IV. Knowing the Rights and Benefits

Stated in Chapter VI of the Labor Code are the declarations a patient can file, which are classified according to the status of the illness – temporary total disability, permanent total disability and permanent partial disability. Compensation benefits cover all disability categories under the Workmen’s Compensation Law (PD 626).

All Filipinos proven to be suffering from the backlash of working under hazardous and risky conditions are entitled to disability benefits unless disqualified under legally exempted circumstances.

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Disability benefit refers to the compensation package granted to an employee from private or public sector, including the dependents, to make up for the provider’s lost opportunity to continue working, temporarily or permanently, due to work-related injury, sickness or death. The disability benefit is given by the Social Security System (SSS) in the form of Disability Compensation or the Government Service Insurance System (GSIS) in the form of Employees Compensation (EC), whichever organization covers the employee’s membership. Depending on the claim’s category, an employee can avail either of the following mandatory benefits:

• cash income for disability or death
• medical assistance and related services for sickness or injury
• rehabilitation services in addition to monetary benefit for permanent disability

The enumerated privileges (as only members can avail) all fall under mandatory benefits as stipulated by the Philippine Constitution. However, another set of benefits or monetary compensation can be availed directly from the employer (right to a safe working environment) if it can be proven that there is negligence on occupational safety and health on the employer’s part. Conscious negligence or not, the employer is still accountable to the employee.

Whether privilege or right, a claimant can file only one claim, or all at the same time, if applicable.

V. Employment: Links and Probabilities

In the last couple of years, there is a significant increase in incidents of work-related illnesses in the country which prompted the Occupational Safety and Health Center (OSHC), a branch of the Department of Labor and Employment (DOLE) tasked to do continuous research and information dissemination on occupational safety and health, to recommend new entrees in the existing list of accepted occupational diseases. Occupational cancers such as lung cancer, bladder cancer, leukemia, liver cancer and three more related diseases lead the newly identified health cases to which qualified employees are protected against.

Chronic renal failure is also seen climbing the charts. In fact, it appeared in SSS’ record as the most frequent basis of disability claims, albeit not necessarily reflecting work environment origin.

The increased number of occupational health risks remains bothering, but the opposite in number is seen among successful compensation benefits awarded to availing employees.

According to the preliminary results of the January 2012 Current Labor Statistics (CLS) released by the Bureau of Labor and Employment Statistics (BLES), the Philippine labor force is still largely comprised of employment from the services sector which sums to almost 20 million people. This translates to more Filipinos with employers to back-up the upheld labor right mandated by the Amended Rules on Employees’ Compensation. However, this is only on legal basis and not on actuality.

The service sectors are teeming with minimum wage employees, and they are the most vulnerable to environmental, health and safety hazards. They are also the less benefited in pre- and post-employment periods.

The Philippines has more underemployed workers at 19.3% of the entirety than those employed who commensurate to their educational attainment. They both seemingly fail to maximize their rights to compensation for occupational diseases and injuries. In a country where majority in the underemployment statistics belongs to manual laborers, with only 41.2% reaching at least high school level, the concept of such right is widely unknown. As the agricultural sector predominantly represents the labor force at 43.4% in the underemployed category alone, while only 40.7% belongs to the services sector, it is deduced that most marginalized Filipinos do not even have employers to seek for when it comes to occupational diseases and the compensations and benefits that come with it.

Certainly, there is lack of awareness among workers whenever a violation of their right to avail compensation and benefits for acquired illnesses as possibly caused and developed by environmental and occupational factors is committed. But tracing the lack of knowledge on such cases, the lack of awareness has possibly arisen from the unidentified acceptable occupational diseases.

VI. Diseases: Occupational or Pre-existing?

In a report compiled by the National Statistical Coordination Board (NSCB) in 2009 and published in Philippine Industry Yearbook of Labor Statistics, work-related musculoskeletal diseases topped the list of occupational diseases in the Philippines. These are the lesser serious cases with include back and neck-shoulder pain, shoulder tendinitis and the infamous carpal tunnel syndrome, which is often developed from repetitive wrong posture of the hands while doing work in front of the computer.

Peptic ulcer and essential hypertensions follow next but may also be contested by employers as primary ailments or pre-existing conditions – illnesses that are either hereditary or possibly developed at an earlier time prior to employment.

However, the most widely accepted diseases in the row are occupational dermatitis and bronchial asthma. Occupational dermatitis is a type of contact dermatitis where the allergens are acquired from the work environment. For some workers exposed to similar risk, this may seem a normal skin reaction caused by a hard day’s work due to the lack of understanding of the chemicals and irritants regularly used in the workplace. Manual laborers from the construction, manufacturing and agricultural industries often experience such condition, but they stay unprotected most often than not, physically and legally.

Many victims consider the condition less dreadful that does not require exacting legal process for compensation. This is, of course, notwithstanding the cause.

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Bronchial asthma, a commonly reported occupational respiratory disease, is also often seen among Filipino workers, whether toiling on a menial job or office setting. Many studies relate it to environmental risks, most of them found in workplaces. Unfortunately, as it is the most prominent pre-existing condition as well (even medical insurance companies classify it as pre-existing), direct connection is not readily acceptable. Patients with bronchial asthma, whether authentically connected with past jobs or not, will have hard time proving the claim to the authorities.

  

VII. Occupational Disease vis-à-vis Economic Standing

Another fatal occupational disease worthy of attention is tuberculosis (TB), also the sixth leading cause of mortality among Filipinos. Surveys show that it frequently appears on retired factory workers, especially the ones from industries utilizing chemical in production and wood works. However, its most prominent link is to cigarette smoking, both active and passive. On this ground, proving origin from the workplace is highly contestable.

Despite the obscurity on the basis of identifying TB as common occupational disease in the Philippines, international data on the top causes of mortality collected by the World Health Organization (WHO) show it as a prevalent reason for death only among low- and medium- income countries. It does not appear in high-income countries. According to The World Bank, the Philippines is classified as a lower-middle-income country.

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TB is the seventh top killer disease among low-income countries. It is sixth in the Philippines, also a low-income economy. This shows that there is consistency among classified countries.

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As the income level of the countries moves up, the record of TB-related deaths also goes down.

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Among the high-income countries or first world countries, TB is not a top killer disease. These countries include the following:

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It is worth adding that the countries with less recorded TB-related deaths also have more teeth when it comes to Environment, Health and Safety (EHS) standardization as compared to the Philippines.

The economic standing of countries according to salary does not necessarily correlate with the type of disease, occupational or not. It is noticeable, though, that the countries having generally higher cases of TB mortality are the ones with more menial jobs on industries employing manual laborers.

In the Philippines alone, where many TB patients link their disease to work environment, there is an apparent trend in the social category of victims, significant majority belonging to wage earners.

On the other hand, the first world countries have fewer incidents, insufficient to place it on the top list. It can be deduced without finality that the type of work environment and nature of work in these countries affect the end result of their mortality rate in accordance to cause. Likewise, these richer countries have unquestionably better facilities, working conditions and better practices and standards of Occupational Safety and Health (OSH). Their guidelines are more likely seen as applied rules than theoretical, having more research and stricter guidelines on OSH regulation as mandated by laws.

  

VIII. Occupational Safety and Health (OSH) Standardization

There is an ongoing initiative by the World Health Organization (WHO) and the International Labour Organization (ILO) – two leading agencies advocating occupational safety and health standardization and monitoring at an international scale – to assist developing nations on OSH matters through projects like “Healthy Cities” (a project that aims to “establish healthy public policy at the local level through health promotion).

Based on the 2007 Factsheet released by the European Agency for Safety and Health at Work, the reference for this global action, developing countries allot lower budgets for OSH but spends relatively higher percentage of their GDPs on work-related illnesses – as much as 10% of the total GDPs while European nations under the strict mandate of the aforementioned agency only spends around 2.6% to 3.8%.

The agency sets the same standard for all member countries, making the advanced development, promotion and productivity in each member state at par with each other; thus, at par with international standards.

Using the data, it can be interpreted for European countries alone that the lower the OSH budget and policy regulation is, the higher the spending on avoidable circumstances like occupational diseases will be.

In the United States of America (USA), the Occupational Safety and Health Administration (OSHA) enforces all regulations and requirements as mandated by the federal law. It is the governing agency of the US Department of Labor in charge of certifying and inspecting companies. Unlike its counterpart in the Philippines (OSHC), the requirements set by OSHA are all for compliance to keep the operation going. The OSHC requirements, on the other hand, are for accreditation purposes only and not do not serve as prerequisites for permits.

The world’s most recognized certification for occupational health and safety management systems (OHSMS) is the OHSAS 18000 (Occupational Health and Safety Advisory Services), a British Standard pioneered by BSI Group (British Standard Institution). It is renowned as an equivalent to ISO 9001:2000 and ISO 14001:2004 – the highest certifying body for private or public organizations worldwide. These standards are prevalently used in Europe and North America to help with occupational health and safety performance and develop policy making methods.

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Passing one of the three aforementioned certifications is complicated enough. In spite of the difficulties in achieving these high standards, many international organizations still aim to implement all three to get the corresponding accreditations.

Despite global recognition and widespread application from western countries and first-world Asian countries (even including Malaysia), Philippine companies do not widely use these standards and in fact, do not allot budget as much as their foreign counterparts do.

The AFNOR Groupe of France and Standards Australia are the counterparts of the Occupational Safety and Health Center in the Philippines. Both agencies have the same strict regulations as that of the International Organizations for Standardization (ISO).

The countries with less numbers of deaths as a direct result, if not associated, of occupational diseases belong to the group with stricter and more regulated standards in OSH. More studies are also conducted by their designated agencies to conform and adopt improved policies and guidelines on occupational health and safety management.

IX. Disability Benefit Claims, Refusal and Dismissal

Like in any other claims, an investigation is imperative as stated in government and company policies. Oftentimes, the investigation reaches litigation through court hearing. This is the most difficult part – proving the claim and the liability of the employee and employer, respectively. Inauspiciously, it is safe to state that claimants who reach this stage are somehow luckier to have known such right exists. Hence, many Filipinos do not know the concept of company liabilities.

An employee who plans to file for compensation benefits due to the declaration of disability to the SSS or GSIS needs to prove the veracity of medical condition to qualify as occupational disease and be declared compensable. Contests from concerned companies are anticipated, but concomitant complaints can be redirected to the Employee’s Compensation Commission (ECC), which is the governing body in regulating employee benefits as part of the Liability Rule under the Handbook on Employee’s Compensation and State Insurance Fund, should the complaints be dismissed. Court proceedings come next if another dismissal happens at the level of the governing body.

Diseases, whether recognized as environmental/occupational or not, do not receive approval without much scrutiny to protect the rights of employers against extortion and abuse of employees seeking compensation. Certain qualifications and due process have been identified towards the resolve of cases to keep both parties equally treated. But why does the law allow refusal of claims and dismissal of subsequent cases?

Many listed occupational diseases have relatively high number of cases even outside the environmental and occupational setting. Carpal tunnel syndrome (CTS) is an example of an occupational disease that is very popular among office workers who spend hours in front of the computer. However, it cannot be associated with work right away as there are many ways of acquiring it even inside the home. Students are also susceptible to the disease.

For a disease to be quantified as work-related, it should be proven to have first existed on or after employment period. Pre-existing condition can be dismissed right away, especially if the condition has far association with the company industry or the nature of the job has low chance of producing such health problem.

It should not also be categorized as secondary ailment resulting from a pre-existing primary ailment. Secondary ailments, or practically quantified as complications, should be proven to have been exacerbated by the occupational disease per se to have merit. Unfortunately, a complication said to have started from a pre-existing primary ailment has weaker, but not essentially impossible, substance on the claim.

A good example of a workman’s compensation filed as claim to GSIS and subsequently, as an appeal to ECC and case to the Court of Appeals (CA), is the case GSIS vs. Valenciano. Valenciano was a Clerk II and eventually, a Senior Terminal Operations Officer at the Philippine Ports Authority (PPA). He filed a claim for compensation benefits with the GSIS after being diagnosed with coronary artery disease in 1984. Two years later, Diabetes Mellitus was discovered rendering him to be insulin resistant leading to increased arterial pressure. This condition gave him the risk of developing hypertension in 1988. A decade has passed and he was diagnosed with Pulmonary Tuberculosis II.

By 2002, he was suffering from diabetes mellitus, pneumonia, hypertension, pulmonary tuberculosis and cerebro-vascular disease (CVD).

The claim was denied by GSIS while the appeal was also dismissed by ECC on the ground that Valenciano’s primary ailment was not occupational disease; “neither was there any showing that his duties have increased the risk of contracting said ailments.” The ECC concluded that his “hypertension, pneumonia and pulmonary tuberculosis were mere complications of his primary ailment of diabetes mellitus, which is not an occupational disease; hence, not compensable.” CVD, albeit possibly an occupational disease, was likewise dismissed after the claimant “failed to show compliance with all the conditions for its compensability.”

However, the Court of Appeals (CA) reversed the decision, ruling that while hypertension, pneumonia and pulmonary tuberculosis were caused by diabetes mellitus, the development of the diseases didn’t occur without environmental and occupational factors, as deemed associated with Valenciano’s employment history.

Valenciano began smoking frequently at the age of 20 which has a strong association with the contracted diseases. His primary ailment is undisputedly conterminous to the presented complications. But whatever it is that the cause of the diseases are inclined to, occupational factors undoubtedly affected the end result of his health which became CA’s basis for the subsequent standing. Nonetheless, grey areas and point for disputes are available for the case.

For similar cases, modern scientific findings are leaning towards conclusions that certain types of sicknesses may evolve into something else due to external factors other than what originally caused the primary ailments. The inclusion of these scientifically plausible factors on the epidemiology and mutation of recognized occupational disease may improve the overall regulation of benefits for employees and add credibility to the existing list of considerable and recognized occupational diseases.

The traditional way of looking at health conditions and their causes are still prevalently applied in the Philippines, which make consideration for possible work-disease link narrower; hence, it is more inefficient.

  

X. Rights to Benefits: Ignorance or Oversight?

Among the most common occupational diseases, work-related musculoskeletal diseases consistently grab the top spot since 2003. It is noticeable that the number of occupational diseases also increased by 34.29% from the 2007 data – 47,235 to 71894 cases.  Environmental factors, although not necessarily occupational factors, affect the continual rise in cases, but other external factors, such as lifestyle and genetic, are to be considered. Nonetheless, the data signifies clearly that there is heightened problem in occupational diseases in general that demands full attention from the concerned government agencies, employers and employees.

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In the most-recent survey conducted by the Bureau of Labor and Employment Statistics (BLES) under DOLE, the most common occupational injuries in non-agricultural establishments are superficial injuries and open wounds with an average incidence rate of 50.8%. It took more than half of the cases of occupational injuries recorded in the Philippines, a significantly wide gap ahead of the second most common case which is dislocations, sprains and strains, collectively, at a lower percentage of 12.7%.

As the term implies, these superficial injuries tend to be overlooked by employees due to relatively non-serious effects to the health, also tendered with minimal to no medical attention at all. Thus, there is absolutely high chance of overlooking rights against these work-related injuries.

Condoned right is a condoned action and solution by the employer and employee alike. Big or small, serious or superficial, every case of occupational injury should be handled appropriately and in accordance to existing laws protecting the labor force. It can be deduced that non-serious injuries do not elicit much attention from concerned workers, enough to command legal benefits as identified by the ECC.

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Notwithstanding the obvious decrease in number of work-related injuries since 2003, the significantly high number of cases still infers lack of impressive occupational health and safety management systems in the country.

Many employers may have been doing their homework towards improvement of recorded incidence, but do employees actively do their part in bringing these cases to the attention of the authorities?

XI. Issues to Address

The main issues to be addressed on this employee welfare matter revolve around the fulfillment of the rights bestowed upon employees with work-related injuries and diseases and their encompassing backdrop in the Philippines, including clearly delineating the liability of both the employer and employee.

• What are the issues of work-related diseases and injuries at large in the Philippine set-up?
• What is the stand of the government on occupational diseases?
• Does the government give enough and efficient service on this matter?
• To what extent are occupational diseases covered by employers’ liability?
• Do employers act on claims in accordance to governing mandates and laws?
• Are employees with occupational diseases given sufficient attention, benefits and consideration?
• Do employees with occupational diseases know the appropriate actions, or at the least, their rights on their cases?