title: Occupational health services now and in the future: the need for a paradigm shift.
abstract: OBJECTIVE
  Occupational health services (OHS) evolved in response to the needs of hazardous industries and on the premise that work was harmful. In the developed world, most of these industries have disappeared, and classical occupational diseases are uncommon.
  
  
  METHODS
  The evidence now is that most work is safe and safe work is good for health. Access to OHS is inconsistent, and there is no continuity of care for workers who move to another employer or leave work because of ill health.
  
  
  METHODS
  OHS therefore care for survivor populations and generally those in large enterprises who need OHS the least. From a societal viewpoint, OHS are not fit for purpose. They have not adapted to the evolving small business and more informal work sector. The health impact of long-term worklessness is large and the workless need access to the competencies of OHS.
  
  
  CONCLUSIONS
  In the future, OHS should develop to meet the needs of the working-age population and to maximize the functional capacity.
authors.affiliation: Healthy Working Lives Group, Public Health and Health Policy Section, University of Glasgow, Glasgow, Scotland. ewan.macdonald@glasgow.ac.uk
authors.forename: Ewan B
authors.initials: EB
authors.lastname: Macdonald
authors.forename: Kaveh A
authors.initials: KA
authors.lastname: Sanati
mesh_terms: D005544:Forecasting; D006297:Health Services Accessibility; D006801:Humans; D016272:Occupational Health; D009786:Occupational Health Services / Q000639:trends*; D058012:Small Business; D014478:Unemployment; D014937:Work; D014938:Work Capacity Evaluation