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- Original Article Occupational health risk assessment, exposure monitoring, and medical surveillance in the UK, EU, and US: a comparative analysis and implications for occupational disease prevention in Korea
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Sangjun Choi1,2
, Kyong-Hui Lee3, Kyung Ehi Zoh4, Dong-Hee Koh5, Won Kim6, Kwonchul Ha7, Dong-Uk Park8,* -
Annals of Occupational and Environmental Medicine 2026;38:e18.
DOI: https://doi.org/10.35371/aoem.2026.38.e18
Published online: June 15, 2026
1Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Korea
2Catholic Institute for Public Health and Healthcare Management, Seoul, Korea
3US Army 65th Medical Brigade, Department of Public Health, Camp Casey, Dongducheon, Korea
4Department of Environmental Health, Graduate School of Public Health, Seoul National University, Seoul, Korea
5Department of Occupational Environmental Medicine, Severance Hospital, Yonsei University, Seoul, Korea
6Wonjin Institute for Occupational and Environmental Health, Seoul, Korea
7Occupational Safety & Health Research Institute, Changwon National University, Changwon, Korea
8Department of Environmental Health, Korea National Open University, Seoul, Korea
- *Corresponding author: Dong-Uk Park Department of Environmental Health, Korea National Open University, 86 Daehak-ro, Jongno-gu, Seoul 03087, Korea E-mail: pdw545@gmail.com
- Sangjun Choi and Kyong-Hui Lee contributed equally to this work.
• Received: March 18, 2026 • Revised: June 10, 2026 • Accepted: June 11, 2026
© 2026 Korean Society of Occupational & Environmental Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
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Background Although most countries maintain occupational safety and health (OSH) legislation to prevent occupational diseases, the legal codification and integration of occupational health risk assessment (HRA), exposure monitoring, and medical surveillance vary substantially across jurisdictions; therefore, this study compared the legal frameworks of Korea, the United Kingdom (UK), the European Union (EU), and the United States (US) to examine the linkage among these elements, assess whether they support estimation of individual cumulative past exposure, and derive implications for improving occupational disease prevention in Korea.
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Methods This qualitative comparative legal analysis examined employer obligations related to quantitative exposure monitoring, HRA, and medical surveillance under the OSH systems of the UK, the EU, the US, and Korea. Primary statutes and subordinate regulations were systematically reviewed to assess how these elements are mandated, linked, and supported by record-keeping provisions enabling cumulative exposure estimation.
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Results The UK and the EU explicitly require HRA as a regulatory starting point and link exposure monitoring and medical surveillance to the outcomes of risk assessment, with targeted hazard-based provisions for intrinsically high-risk agents. The US adopts a hybrid approach, imposing mandatory monitoring and medical surveillance for high-hazard substances under 29 Code of Federal Regulations 1910 Subpart Z while relying on general statutory duties elsewhere. Korea applies broad list-based requirements for exposure monitoring and medical surveillance that are largely independent of HRA outcomes and do not include legally mandated variables necessary for systematic cumulative exposure estimation. In contrast, the UK, the EU, and partially the US provide legal mechanisms, including long-term record-keeping provisions, that enable reconstruction of individual cumulative occupational exposure.
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Conclusions Strengthening the integration of HRA, exposure monitoring, and medical surveillance—together with improved record-keeping structures that support cumulative exposure reconstruction—may contribute to more effective occupational disease prevention and long-term medical surveillance in Korea.
BACKGROUND
Occupational safety and health (OSH) legislation is founded on the principle that employers must provide a workplace free from risks of injury or disease to workers engaged in economic activity, which constitutes the core justification for state intervention. Almost all countries maintain OSH legislation to prevent worker injuries and work-related diseases. The scope, structure, and stringency of employer obligations vary substantially across jurisdictions among countries. A common legal rationale underlying these systems is that occupational accident and health risks arise from economic activities organized and controlled by employers; therefore, the state intervenes to impose minimum duties requiring employers to provide work and workplaces that do not expose workers to serious accident and health risks. Across OSH systems, this principle assigns employers primary responsibility for preventing recognized hazards that may cause injury or disease to workers.
Across major OSH systems, core legal instruments for occupational disease prevention typically include occupational health risk assessment (HRA), quantitative exposure monitoring or measurement (exposure monitoring) and health examinations or health surveillance (medical surveillance). For the prevention of occupational diseases, occupational HRA, exposure monitoring, and medical surveillance should be closely linked, as they are intended to evaluate exposure levels, support exposure reduction, estimate individual cumulative exposure, and detect early adverse health effects. However, the extent to which these elements are legally mandated, and the manner in which they are connected within regulatory frameworks, differ markedly across countries. Comparative research has shown that such differences reflect broader regulatory traditions and governance styles. Rothstein et al. (2019)1 demonstrated that European Union (EU) OSH systems vary in how explicitly they balance risk, prevention, and economic considerations, with distinct national regulatory approaches emerging within the EU. Morillas et al. (2013)2 compared occupational health and safety management practices in Sweden and Spain following implementation of the EU Framework Directive, highlighting how institutional context shapes the practical operation of risk-assessment-based regulation.
Despite this growing body of literature, few studies have systematically compared—within a single analytical framework—employer obligations for quantitative exposure monitoring, HRA, and medical surveillance among countries, particularly in relation to occupational disease prevention. Moreover, the degree to which these elements are legally linked—and whether their institutional design supports prioritization, proportionality, and long-term disease surveillance—remains insufficiently examined.
The objectives of this study are (1) to compare employer obligations related to exposure monitoring, including quantitative measurement, HRA, and medical surveillance; (2) to examine how exposure monitoring, HRA, and medical surveillance are legally linked; (3) to assess whether existing legal and record-keeping frameworks enable estimation of individual workers’ cumulative past exposure; and (4) to propose key policy and regulatory improvements for preventing occupational health risks in Korea. The comparative analysis focused on the United Kingdom (UK), EU, and the United States (US) which have established and stable OSH legal systems.
METHODS
This study employs a qualitative comparative legal analysis to examine the OSH regulatory frameworks of Korea, the UK, the EU and the US. These jurisdictions were purposively selected to represent diverse legal and regulatory approaches to occupational disease prevention. The analysis was conducted through a structured review of primary statutory and regulatory texts in each jurisdiction, focusing specifically on employer obligations regarding exposure monitoring, HRA, and medical surveillance. By systematically comparing these core regulatory components, this study identifies and evaluates the distinct legal characteristics and requirements across the four jurisdictions.
For the UK, the principal legislation reviewed included the Health and Safety at Work etc. Act 1974 (HSWA)3 and the Control of Substances Hazardous to Health (COSHH) Regulations.4 For the US, the study examined the Occupational Safety and Health Act (OSHAct)5 and relevant provisions of 29 Code of Federal Regulations (CFR) Part 19106, including standards related to hazard assessment, exposure limits, and substance-specific requirements. For the EU, the review covered the Framework Directive 89/391/EEC7 and related directives governing chemical agents and carcinogens, including Directive 98/24/EC8 and Directive 2004/37/EC9. For Korea, the OSH Act and its subordinate regulations were reviewed (English version available).10,11
The comparative analysis focused on the following aspects: (1) whether exposure monitoring, including quantitative measurement, is explicitly mandated by law; (2) whether HRA is required as a legal starting point or embedded as an operational function within the regulatory framework; (3) whether there are legal mechanisms to estimate individual cumulative exposure for the prevention of occupational diseases, including requirements to record and manage exposure histories specific to individual workers, such as the duration of their employment in relevant tasks and their job change history, within workplace monitoring or risk assessment processes; (4) whether medical surveillance is mandated, and how these are linked to exposure monitoring or HRA; and (5) the structural relationships among these elements within each legal hierarchy (primary statutes versus subordinate regulations). In addition, peer-reviewed journal articles addressing comparative OSH regulatory models and risk-based regulatory approaches were reviewed to contextualize the legal findings and to identify existing analytical frameworks relevant to occupational disease prevention.
This study focused on comparing the legal framework and regulatory principles governing occupational HRA, exposure monitoring, and medical surveillance in the EU, the UK, and the US. Accordingly, the analysis did not extend to differences in the scope, methods, or level of practical implementation across jurisdictions. For the EU in particular, the analysis was confined to the common legal framework and regulatory principles established by the relevant directives, rather than differences in implementation or enforcement at a national level among individual member states.
Ethical approval and informed consent were not required for this study because it did not involve human participants or animals.
RESULTS
Most countries share a common overarching objective of protecting workers’ safety and health, while adopting different legal hierarchies to implement this goal (Table 1). Substantial differences among countries were found in how national legal systems define the scope of HRA and mandate exposure monitoring and medical surveillance. OSH legislation of the UK COSHH and EU Directives explicitly mandate HRA as a general employer obligation, and exposure monitoring and medical surveillance are legally linked to the outcomes of that assessment (Directive 89/391/EEC, Articles 6 and 9).7 The EU and the UK generally require employers to determine exposure monitoring and medical surveillance based on risk assessment outcomes, with limited hazard-based exceptions for intrinsically high-risk agents such as chemicals8 and Carcinogens, Mutagens, and Reproductive toxins (CMR) in the EU9 (Tables 2 and 3) and lead (The Control of Lead at Work Regulations 2002)12 or asbestos (Control of Asbestos Regulations 2012)13 or ionizing radiation (Ionizing Radiations Regulations 2017)14 in the UK. While the UK and EU rely primarily on risk-based or substance-specific approaches, Korea applies broad, list-based mandatory requirements, and the US adopts a hybrid model combining general statutory duties with substance-specific mandatory standards (Table 4). Unlike the UK, EU, and Korea, the US OSHAct does not explicitly mandate HRA as a legal obligation.
The UK4 and the EU8 maintain record-keeping requirements that capture exposure level, duration, and changes in job or task assignments, thereby enabling reconstruction of cumulative occupational exposure over a worker’s employment, particularly for high-risk substances (Table 4). Under the UK COSHH Regulations, HRA records must document key findings, such as exposure duration, type and level, as well as the determinants of high exposure, together with relevant medical surveillance information. Additionally, exposure monitoring and medical surveillance records must be kept for at least 40 years so that long-term occupational disease risks can be evaluated. The US15, 16 enables cumulative exposure levels primarily through long-term retention of exposure and medical records for substances regulated under 29 CFR 1910 Subpart Z. While Korea’s exposure monitoring and medical surveillance records lack the legally mandated variables necessary for the systematic estimation of cumulative exposure, existing records typically include only limited information, such as measured concentration, exposure time, and work process. The UK and EU require long-term retention of exposure monitoring and medical surveillance records (generally about 40 years) with worker access rights, while the US mandates at least 30 years of retention and guarantees worker access. By contrast, Korea typically requires 5 years of record retention (30 years for CMR) and does not clearly ensure workers’ access to their individual exposure records (Table 4). Our comparative review of legal provisions governing HRA, exposure monitoring, and medical surveillance in the EU, the UK, and the US, several policy improvements can be proposed for the Korean OSH system (Table 5).
DISCUSSION
Despite the fact that all OSH systems are intended to prevent work-related diseases, there are substantial differences in the legal codification of HRA, its historical and regulatory background, and its functional use in guiding exposure monitoring and medical surveillance across different countries (Table 1). In the UK, the EU, and Korea, HRA is explicitly established as a core employer obligation under primary legislation or binding regulations (Table 2).3,7,10 This reflects a preventive regulatory philosophy, in which the systematic identification and evaluation of risks serve as the legal gateway to exposure control, exposure monitoring, and medical surveillance. In contrast, the US does not mandate HRA as a formal legal requirement. Instead, employer responsibility is functionally defined through enforceable hazard control duties and post-hoc accountability.5 This is shaped by the historical priority of rapid and enforceable intervention during periods of severe industrial harm. The Korean approach diverges from both of these by placing reliance on lists of hazardous agents that are administratively predefined. In this context, exposure monitoring and medical surveillance are mandated with a high degree of rigidity, irrespective of the outcomes of HRA. The measurement of working environments may overlap conceptually and operationally with HRA, as both aim to identify and manage workplace health hazards. However, under the current legal framework, the two are not explicitly or systematically linked in a way that makes measurement a formal consequence of risk assessment.
With the exception of Korea, all systems examined in this study maintain legal record-keeping provisions that allow estimation of individual workers’ cumulative exposure to hazardous agents, thereby enabling HRA beyond point-in-time measurements (Table 4). These record-keeping structures enable framework-based systems to reconstruct cumulative occupational exposure over the course of a worker’s employment and to evaluate long-term occupational disease risks beyond point-in-time exposure monitoring, particularly for high-risk substances. The US enables cumulative exposure assessment primarily through the long-term retention of exposure and medical records for substances regulated under 29 CFR 1910 Subpart Z.16 By contrast, the absence of legally mandated variables for cumulative exposure estimation in the Korean OSH framework restricts the reconstruction of long-term exposure histories relevant to occupational disease risk. These structural differences suggest that framework-based systems (UK and EU) prioritize flexibility and proportionality by linking legal obligations to assessed risk, whereas Korea emphasizes administrative completeness through comprehensive predefined lists. The US model occupies an intermediate position, concentrating legally enforceable monitoring and medical surveillance on a limited number of high-hazard substances while relying on general duties for other risks.
The health risks associated with risk-based regulation highlight that while risk-based approaches can enhance proportionality and resource allocation, they may also create blind spots when exposure information is incomplete or poorly integrated, underscoring the need for robust documentation and cumulative exposure tracking in regulatory design.17 Likewise, effective occupational disease prevention requires systematic integration of exposure monitoring, risk evaluation, and medical surveillance over time,18 suggesting that Korea’s framework would benefit from strengthening the linkage between HRA, measurement records, and long-term health monitoring. Indeed, well-documented and managed risk assessment outcomes may provide useful information on workers’ current and cumulative exposure characteristics, including exposure duration, job history, and changes in tasks, which can help determine whether targeted preventive health surveillance is appropriate. The RNV3P (Réseau National de Vigilance et de Prévention des Pathologies Professionnelles, National Network for the Vigilance and Prevention of Occupational Diseases) network in France illustrates how standardized recording and coding of occupational exposure information can be systematically linked to programmed medical surveillance to detect emerging disease-exposure associations.19
This study suggests several policy implications based on a review of the major legal frameworks for occupational disease prevention in the UK, the EU, the US, and Korea. International practices indicate that mandatory regulatory requirements, such as exposure monitoring and medical surveillance, often target substances with high intrinsic hazards, including CMR, or agents associated with substantial cumulative exposure risks. Conversely, other hazardous substances are usually managed through risk-based decision-making reflecting actual exposure conditions and levels (Tables 2 and 3). This allows regulatory resources to focus on substances with the greatest potential health impact. In the UK, EU, and US, the existence of structured record-keeping systems with extended retention periods and worker access rights facilitates the reconstruction of cumulative occupational exposure and occupational disease surveillance. Conversely, in Korea, the adoption of shorter retention periods and more circumscribed access rights has the potential to impose limitations on these functions (Table 4).
In view of these findings, it is recommended that several improvements be considered for the Korean OSH framework (Table 5). Firstly, it is argued that HRA could function more effectively as an integrative starting point that links exposure monitoring and health examinations, rather than operating as a parallel or isolated procedure. Secondly, legal provisions may be considered to ensure that HRA records contain the information necessary to estimate individual cumulative exposure, including variables such as employment duration, job and task changes, and time-varying exposure intensity. The provision of such information has the potential to serve as a valuable exposure indicator in the context of medical surveillance. This can assist in the prevention of both reversible and irreversible diseases associated with specific hazardous agents. Furthermore, it can facilitate the estimation of past exposure levels in instances where workers develop suspected work-related diseases and individual causation needs to be assessed. The primary objective of HRA is to identify workplace hazards, evaluate exposure, and establish appropriate control measures; the estimation of cumulative exposure may provide additional information for health risk evaluation and long-term health surveillance, but is not the principal purpose of HRA. Thirdly, there is potential for the coordination of exposure monitoring records and medical surveillance, with the objective of informing the interpretation of medical surveillance outcomes by exposure histories, and providing feedback for the updating of HRA and preventive measures by medical surveillance findings. Finally, such integration, in conjunction with sufficiently long retention periods and worker access to exposure monitoring and medical surveillance records, would facilitate the more systematic use of these data to reconstruct individual exposure histories and to assess job-related risks for chronic diseases, including cancer, in the context of occupational disease prevention and long-term medical surveillance. The structure and operation of OSH legislation may be influenced by broader legal traditions and institutional contexts. These include differences in legal systems, industrial structure, labor relations, and administrative capacity. However, the present study focused on comparing legal frameworks and regulatory principles, so these contextual factors were not examined in detail. The analysis concentrated chiefly on a comparison of legal provisions rather than an evaluation of the practical implementation of these systems. Consequently, the findings should not be interpreted as establishing a single regulatory “gold standard.” Instead, the study compares how different jurisdictions structure legal obligations and recommendations to protect worker health under their respective institutional contexts.
This study is not without its limitations. The analysis concentrated chiefly on a comparison of legal provisions rather than an evaluation of the practical implementation of these systems. Consequently, the findings should not be interpreted as establishing a single regulatory “gold standard.” Instead, the study compares how different jurisdictions structure legal obligations and recommendations to protect worker health under their respective institutional contexts. It is evident that both risk-assessment-based and list-based regulatory approaches possess distinct strengths and limitations. Risk-based systems, such as those in operation in the UK and EU, permit flexible and proportionate management in accordance with actual exposure conditions. However, the effectiveness of these systems may be contingent upon the competence of the employer and the quality of implementation. In contrast, Korea's list-based system provides a standardized minimum level of protection through mandatory quantitative measurement of designated hazardous agents and facilitates hazard identification based on established risks. In comparison with other countries, Korea also maintains a relatively broad list of designated hazardous agents. Therefore, further refinement of the list, particularly towards intrinsically high-risk substances such as CMR, may be considered. On the whole, neither approach can be said to be inherently superior, but rather both reflect different regulatory strategies that have been shaped by institutional and policy contexts. Nevertheless, the results may provide useful references for identifying inefficient elements in the current Korean systems of HRA, exposure monitoring, and medical surveillance, and for considering potential revisions to relevant legal provisions.
CONCLUSIONS
This study demonstrates that, although all jurisdictions aim to prevent occupational disease, substantial differences exist in the legal structuring and interconnection of HRA, exposure monitoring, and medical surveillance. The UK and the EU both operate framework-based systems that link regulatory obligations to assessed risk, in which general duties and specific regulations together require the assessment and control of occupational disease risks. In contrast, the US relies on substance-specific mandatory standards for high-hazard agents. Conversely, Korea's predominantly list-based approach has the potential to restrict the integrative function of HRA and the reconstruction of cumulative occupational exposure. The enhancement of legal linkages among HRA, exposure monitoring, and medical surveillance, in conjunction with the refinement of record-keeping structures, has the potential to contribute to the enhancement of the effectiveness of occupational disease prevention and long-term medical surveillance in Korea.
Abbreviations
CFR
Code of Federal Regulations
CMR
Carcinogens, Mutagens, and Reproductive toxins
COSHH
Control of Substances Hazardous to Health
EU
European Union
HRA
health risk assessment
HSWA
Health and Safety at Work etc. Act
ISHA
Industrial Safety and Health Act
MHSWR
Management of Health and Safety at Work Regulations
OSH
occupational safety and health
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Competing interests
The authors declare that they have no competing interests.
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Author contributions
Conceptualization: Park DU. Data curation, scrub data, and maintain research data: Park DU, Choi S, Lee KH, Zoh KE, Koh DH, Kim W, Ha K. Methodology/formal analysis/validation, development or design of methodology; formal techniques to analyze or synthesize study data, verification, whether as a part of the activity or separate, of the overall replication/reproducibility of results/experiments and other research outputs: Park DU, Choi S, Lee KH. Writing - original draft: Park DU. Writing - review & editing: Choi S, Lee KH, Zoh KE, Koh DH, Kim W, Ha K.
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Acknowledgments
We acknowledge the assistance of artificial intelligence tool (ChatGPT 5.2) for English language editing and literature search during the preparation of this manuscript. The authors reviewed and take full responsibility for the final content of the manuscript.
NOTES
Table 1.
Summary of occupational safety and health legal frameworks (primary and secondary legislation) for the prevention of occupational diseases by country
| Country | Legislation | Legal purposes | Official URL |
|---|---|---|---|
| Korea | ISHA of 1981 | To protect workers’ life and health by preventing industrial accidents | https://www.law.go.kr/LSW/lsInfoP.do?lsId=001766 |
| Enforcement Decree & Enforcement Rules of the ISHA | To implement specific measures for occupational health protection, including hazard control, HRA, workplace exposure monitoring, and medical surveillance | https://www.law.go.kr | |
| UK | HSWA 1974 | To secure the health, safety, and welfare of workers and protect others from risks arising from work activities | https://www.legislation.gov.uk/ukpga/1974/37 |
| MHSWR 1999 | To operationalize the general duties set out in the HSWA | https://www.legislation.gov.uk/uksi/1999/3242/contents | |
| COSHH Regulations 2002 | To protect workers’ health from hazardous substances through HRA, exposure control, monitoring, and medical surveillance | https://www.legislation.gov.uk/uksi/2002/2677 | |
| EU | Framework Directive 89/391/EEC | To introduce general principles for the prevention and protection of workers’ safety and health | https://eur-lex.europa.eu/eli/dir/1989/391/oj |
| Chemical Agents Directive 98/24/EC | To protect workers from health risks related to chemical agents, including mandatory HRA and preventive measures | https://eur-lex.europa.eu/eli/dir/1998/24/oj | |
| Carcinogens and Mutagens Directive 2004/37/EC | To provide enhanced protection of workers’ health from carcinogenic and mutagenic substances | https://eur-lex.europa.eu/eli/dir/2004/37/oj | |
| US | OSHAct of 1970 | To assure safe and healthful working conditions for workers | https://www.osha.gov/laws-regs/oshact/completeoshact |
| OSHAct Standards (29 CFR Part 1910: General Industry) | To establish exposure limits, monitoring requirements, and health protection measures for chemical and physical hazards | https://www.osha.gov/laws-regs/regulations/standardnumber/1910 |
Table 2.
Comparison of the legal linkage among occupational HRA, exposure monitoring, and medical surveillance by country
Table 3.
Comparison of risk-based and list-based regulatory approaches to exposure monitoring and medical surveillance
Table 4.
Comparison of record-keeping provisions enabling cumulative exposure assessment
| Country | HRA and exposure monitoring for estimating cumulative exposure levels | Overall capacity for cumulative exposure assessment | Legal requirements for exposure monitoring and medical surveillance records, including retention periods | Key legal provisions |
|---|---|---|---|---|
| Korea | Working environment measurement records typically capture point-in-time concentrations without documenting employment duration, job or task changes, or time-varying exposure intensity, thereby limiting reconstruction of individual cumulative exposure. | Low–Moderate (records exist but lack required variables and integration for cumulative assessment) | Typically 5 years; 30 years for records related to CMR and high-hazard chemicals exposures. Medical surveillance records are neither integrated with cumulative exposure assessment nor accessible to workers. | Industrial Safety and Health Act (English): https://elaw.klri.re.kr/eng_mobile/viewer.do?hseq=63609&key=40&type=part |
| UK | During HRA, employment duration, exposure intensity and frequency, and medical examination findings are evaluated, allowing reconstruction of cumulative exposure across job transitions and employment periods. | High (explicit personal exposure records with long retention enable cumulative assessment) | At least 40 years. Medical surveillance required where risk persists; records retained and linked to exposure information and accessible to workers. | COSHH Regs. 6, 10, 11 |
| EU | Records document the nature, level, and duration and are updated with changing work conditions, enabling reconstruction of time-varying cumulative exposure. | High (risk-based documentation supports cumulative exposure estimation, especially for CMR) | Typically 40 years after end of exposure. Mandatory medical surveillance for CMR; results used for follow-up and accessible to workers. | Framework Directive 89/391/EEC Arts. 6, 9; Chemical Agents Directive 98/24/EC Art. 4; CM Directive 2004/37/EC Arts. 3, 14 |
| US | Exposure and medical records under substance-specific standards capturing exposure levels, dates, job classifications, and monitoring result, enabling reconstruction of cumulative exposure | Moderate–High (strong for covered substances; limited outside Subpart Z) | At least 30 years. Medical surveillance records retained and accessible to workers. | OSHA Record Access Standard §1910.1020 Access to employee exposure and medical records; 29 CFR 1910 Subpart Z |
Table 5.
Key policy implications for improving the Korean Occupational Health System based on international comparison
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XML DownloadOccupational health risk assessment, exposure monitoring, and medical surveillance in the UK, EU, and US: a comparative analysis and implications for occupational disease prevention in Korea
Occupational health risk assessment, exposure monitoring, and medical surveillance in the UK, EU, and US: a comparative analysis and implications for occupational disease prevention in Korea
| Country | Legislation | Legal purposes | Official URL |
|---|---|---|---|
| Korea | ISHA of 1981 | To protect workers’ life and health by preventing industrial accidents | |
| Enforcement Decree & Enforcement Rules of the ISHA | To implement specific measures for occupational health protection, including hazard control, HRA, workplace exposure monitoring, and medical surveillance | ||
| UK | HSWA 1974 | To secure the health, safety, and welfare of workers and protect others from risks arising from work activities | |
| MHSWR 1999 | To operationalize the general duties set out in the HSWA | ||
| COSHH Regulations 2002 | To protect workers’ health from hazardous substances through HRA, exposure control, monitoring, and medical surveillance | ||
| EU | Framework Directive 89/391/EEC | To introduce general principles for the prevention and protection of workers’ safety and health | |
| Chemical Agents Directive 98/24/EC | To protect workers from health risks related to chemical agents, including mandatory HRA and preventive measures | ||
| Carcinogens and Mutagens Directive 2004/37/EC | To provide enhanced protection of workers’ health from carcinogenic and mutagenic substances | ||
| US | OSHAct of 1970 | To assure safe and healthful working conditions for workers | |
| OSHAct Standards (29 CFR Part 1910: General Industry) | To establish exposure limits, monitoring requirements, and health protection measures for chemical and physical hazards |
| Country | Key summary | Legal basis |
|---|---|---|
| Korea | HRA, workplace exposure monitoring, and medical surveillance are regulated as parallel obligations, with limited explicit legal linkage that allows HRA results to guide or feed back into monitoring and surveillance. Legal provisions do not systematically require recording or retaining key variables needed to reconstruct individual cumulative exposure. | ISHA Art. 36, Art. 125, Art. 130; Enforcement Rules Art. 37, Art. 186 & Annex 21, Art. 201 & Annex 22 |
| UK | HRA functions (regulation 6) as the starting point for determining the need for exposure monitoring (regulation 10) and medical surveillance (regulation 11). Long-term retention of exposure records enables estimation of individual cumulative exposure. | COSHH Reg. 6, Reg. 10, Reg. 11 |
| EU | HRA explicitly requires consideration of the level, type, and duration of exposure, providing a legal basis for cumulative exposure assessment. For carcinogens and mutagens, record-keeping and medical surveillance are strengthened and structurally linked to risk assessment. | Directive 98/24/EC Art. 4; Directive 2004/37/EC Art. 14, 15 |
| US | The OSHAct establishes a general duty of protection, while practical linkage is implemented through substance-specific mandatory standards. For a limited number of high-hazard substances such as lead and benzene, exposure monitoring and medical surveillance are jointly mandated with long-term retention of exposure records. | OSHAct Sec. 5(a); CFR Title 29, Part 1910 Subpart Z (Toxic and Hazardous Substances); 1910.1000~1096 |
| Country | Occupational health risk-based system as primary model | Mandatory exposure monitoring/medical surveillance based on high hazard | Scope of hazard-based mandatory agents |
|---|---|---|---|
| Korea | Yes. HRA, measurement and medical surveillance are mandated independent of HRA outcomes. | Yes. Working environment measurement and medical surveillance legally required for designated hazardous agents. | Mandatory hazard list-based coverage (Approximately 200 of designated hazardous agents with OELs). |
| UK | Yes. Risk assessment mandated under HSWA and COSHH; monitoring and medical surveillance determined by assessment results. | Yes. Separate regulations for high-hazard agents (e.g., Lead at Work Regulations, Asbestos Regulations, Ionizing Radiation Regulations). | Narrow, substance-specific exceptions (lead, asbestos, radiation) |
| EU | Yes. Explicit legal duty for employer risk assessment under Framework Directive 89/391/EEC; measurement and medical surveillance linked to assessment outcomes. | Yes. Strengthened obligations for CMR under Directive 2004/37/EC. | Limited to intrinsically high-hazard categories (e.g., CMR). General systems remain health risk-based. |
| US | No explicit statutory risk assessment mandate; hazard control framed under General Duty Clause. | Yes. Substance-specific mandatory standards under 29 CFR 1910 Subpart Z (e.g., §1910.1001–§1910.1096). | Partially. Hybrid system combining general duty and hazard-specific standards. Approximately 35 high-hazard agents regulated individually under Subpart Z. |
| Country | HRA and exposure monitoring for estimating cumulative exposure levels | Overall capacity for cumulative exposure assessment | Legal requirements for exposure monitoring and medical surveillance records, including retention periods | Key legal provisions |
|---|---|---|---|---|
| Korea | Working environment measurement records typically capture point-in-time concentrations without documenting employment duration, job or task changes, or time-varying exposure intensity, thereby limiting reconstruction of individual cumulative exposure. | Low–Moderate (records exist but lack required variables and integration for cumulative assessment) | Typically 5 years; 30 years for records related to CMR and high-hazard chemicals exposures. Medical surveillance records are neither integrated with cumulative exposure assessment nor accessible to workers. | Industrial Safety and Health Act (English): |
| UK | During HRA, employment duration, exposure intensity and frequency, and medical examination findings are evaluated, allowing reconstruction of cumulative exposure across job transitions and employment periods. | High (explicit personal exposure records with long retention enable cumulative assessment) | At least 40 years. Medical surveillance required where risk persists; records retained and linked to exposure information and accessible to workers. | COSHH Regs. 6, 10, 11 |
| EU | Records document the nature, level, and duration and are updated with changing work conditions, enabling reconstruction of time-varying cumulative exposure. | High (risk-based documentation supports cumulative exposure estimation, especially for CMR) | Typically 40 years after end of exposure. Mandatory medical surveillance for CMR; results used for follow-up and accessible to workers. | Framework Directive 89/391/EEC Arts. 6, 9; Chemical Agents Directive 98/24/EC Art. 4; CM Directive 2004/37/EC Arts. 3, 14 |
| US | Exposure and medical records under substance-specific standards capturing exposure levels, dates, job classifications, and monitoring result, enabling reconstruction of cumulative exposure | Moderate–High (strong for covered substances; limited outside Subpart Z) | At least 30 years. Medical surveillance records retained and accessible to workers. | OSHA Record Access Standard §1910.1020 Access to employee exposure and medical records; 29 CFR 1910 Subpart Z |
| Domain | International practice (EU·UK·US) | Policy implication derived from this study |
|---|---|---|
| Linkage between risk assessment and measurement/medical surveillance | HRA serves as the basis for determining when measurement and medical surveillance are required. | Strengthen legal linkage so that risk assessment guides measurement and health examination decisions |
| Scope of mandatory measurement and medical surveillance | Mandatory requirements limited to high-hazard agents (e.g., CMR). | Restrict mandatory requirements to intrinsically high-hazard substances and apply risk-based management to others |
| The documentation of the exposure conditions for the estimation of individual cumulative exposure | Exposure level, duration, and task conditions determine regulatory intensity. | Mandate recording of employment duration, job/task changes, and time-varying exposure intensity |
| Integration of exposure monitoring and medical surveillance data | Exposure records and medical surveillance inform each other iteratively. | Integrate exposure monitoring and medical surveillance records to estimate individual cumulative exposure and support the prevention of occupational diseases |
| Retention periods for exposure records and reconstruction of cumulative exposure | Exposure monitoring and medical surveillance records are retained long-term (typically 30–40 years), and workers have legal access to their own exposure and health records. | Ensure long-term retention of exposure monitoring and medical surveillance records, particularly for CMR and other high-hazard substance exposures (e.g., >30 years), to facilitate cumulative exposure reconstruction and occupational disease surveillance |
Table 1. Summary of occupational safety and health legal frameworks (primary and secondary legislation) for the prevention of occupational diseases by country
ISHA: Industrial Safety and Health Act; HRA: Health risk assessment; HSWA: Health and Safety at Work etc. Act; MHSWR: Management of Health and Safety at Work Regulations; COSHH: Control of Substances Hazardous to Health; OSHAct: Occupational Safety and Health Act; CFR: Code of Federal Regulations.
Table 2. Comparison of the legal linkage among occupational HRA, exposure monitoring, and medical surveillance by country
HRA: Health risk assessment; ISHA: Industrial Safety and Health Act; COSHH: Control of Substances Hazardous to Health; OSHAct: Occupational Safety and Health Act; CFR: Code of Federal Regulations.
Table 3. Comparison of risk-based and list-based regulatory approaches to exposure monitoring and medical surveillance
HRA: Occupational Health risk assessment; OEL: occupational exposure limit; HSWA: Health and Safety at Work etc. Act; COSHH: Control of Substances Hazardous to Health; CMR: Carcinogens, Mutagens, and Reproductive toxins; CFR: Code of Federal Regulations.
Table 4. Comparison of record-keeping provisions enabling cumulative exposure assessment
HRA: Health risk assessment; CMR: Carcinogens, Mutagens, and Reproductive toxins; COSHH: Control of Substances Hazardous to Health; OSHA: Occupational Safety and Health; CFR: Code of Federal Regulations.
Table 5. Key policy implications for improving the Korean Occupational Health System based on international comparison
HRA: Health risk assessment; CMR: Carcinogens, Mutagens, and Reproductive toxins; CFR: Code of Federal Regulations.
