Advancing worker health and safety in the developing world

OBJECTIVES: Working conditions in the developing world seldom meet the minimum standards required by international agencies. This article addresses some of the major obstacles to occupational and environmental health and suggests methods by which they can be overcome. METHODS: International agencies such as the World Health Organization (WHO) and the International Labor Organization (ILO) offer a number of programs that address the problem. RESULTS: The results of international efforts to date have been disappointing. There is a need for renewed efforts on the part of international agencies and the developed countries. CONCLUSIONS: Occupational health and safety can be advanced in the developing world with modest funding of innovative programs.     

The ratification status of ILO conventions related to occupational safety and health and its relationship with reported occupational fatality rates

The aim of this study was to assess the relationship between the ratification status of occupational safety and health (OSH)-related ILO conventions and reported occupational fatality rates of ILO member countries, while controlling for possible confounding factors. ILO member states were divided into 4 levels of income status, based on the gross national income per capita. Seventeen conventions designated as OSH-related were examined. Reported country occupational fatality rates were compared according to the ratification status of these 17 conventions and multiple regression analyses were conducted to assess the relationship between the fatality rates, ratification status, income level and length of ILO membership. Fatality rates were inversely and significantly related to income levels. In general, non-ratifying countries had higher work-related fatality rates than ratifying countries. A statistical model for identifying predictors of fatal injury rates showed that a larger number of conventions ratified was significantly associated with lower fatality rates. The fact that non-ratifying countries generally have higher fatality rates than ratifying ones supports the notion that all countries should promote ratification of ILO conventions aimed at improving OSH conditions.     

Occupational health in Yugoslavia

Occupational health in Yugoslavia was once well organized in accordance with WHO declarations and ILO conventions and recommendations. Since the 1990s, the system has been disrupted by destruction of the former Yugoslavia, wars, refugees, changes in the economy, and NATO bombardment. Economic trends, main industries, and employment and unemployment conditions in Yugoslavia are presented. The organization of occupational health services, their tasks, and prevailing problems are discussed. Occupational diseases and relevant research and educational opportunities are described. The authors conclude by suggesting approaches to improving worker's health in the future.     

Occupational Health in Yugoslavia

Abstract

Occupational health in Yugoslavia was once well organized in accordance with WHO declarations and ILO conventions and recommendations. Since the 1990s, the system has been disrupted by destruction of the former Yugoslavia, wars, refugees, changes in the economy, and NATO bombardment. Economic trends, main industries, and employment and unemployment conditions in Yugoslavia are presented. The organization of occupational health services, their tasks, and prevailing problems are discussed. Occupational diseases and relevant research and educational opportunities are described. The authors conclude by suggesting approaches to improving worker's health in the future.     

European initiatives and the occupational hygiene profession.

This paper summarizes the development of occupational hygiene in Europe where the recognition of this profession is still not adequate especially at the political and governmental level. The role of international organizations or associations such as the World Health Organization (WHO) and the International Occupational Hygiene Association (IOHA) is emphasized and illustrated by a few examples. Although not promoting the occupational hygiene profession as such, the European Community is playing a significant role in the development of this discipline by its active policy in the field of health and safety at work. The other relevant actors in this respect are the International Labour Office (ILO) and the dynamic and proficient national societies such as the Italian Association of Industrial Hygienists and the British Occupational Hygiene Society. A few of the most relevant challenges in the development of this indispensable discipline are finally presented. One of the highest priorities is training and education since a profession cannot evolve and continue to grow without fresh blood.     

World Trade Organization, ILO conventions, and workers' compensation

The World Trade Organization, the World Bank, and the International Monetary Fund can assist in the implementation of ILO Conventions relating to occupational safety and health in developing countries. Most countries that seek to trade globally receive permission to do so from the WTO. If the WTO required member countries to accept the core ILO Conventions relating to occupational safety and health and workers' compensation, it could accomplish something that has eluded international organizations for decades. International workers' compensation standards are seldom discussed, but may at this time be feasible. Acceptance of a minimum workers' compensation insurance system could be a requirement imposed on applicant nations by WTO member states.     

The asbestos cancer epidemic

The asbestos cancer epidemic may take as many as 10 million lives before asbestos is banned worldwide and exposures are brought to an end. In many developed countries, in the most affected age groups, mesothelioma may account for 1% of all deaths. In addition to mesotheliomas, 5-7% of all lung cancers can be attributed to occupational exposures to asbestos. The asbestos cancer epidemic would have been largely preventable if the World Health Organization (WHO) and the International Labor Organization (ILO) had responded early and responsibly. The WHO was late in recognizing the epidemic and failed to act decisively after it was well under way. The WHO and the ILO continue to fail to address the problem of asbestos mining, manufacturing, and use and world trade of a known human carcinogen. Part of the problem is that the WHO and the ILO have allowed organizations such as the International Commission on Occupational Health (ICOH) and other asbestos industry advocates to manipulate them and to distort scientific evidence. The global asbestos cancer epidemic is a story of monumental failure to protect the public health.     

Labour standards, safety and health, and risk assessment in the fishing sector

The International Labour Organization (ILO) has, since its founding, worked towards the improvement of the working conditions of all people through various means of action, including the adoption of international labour standards. This paper will briefly discuss ILO's standards concerning occupational safety and health, its specific standards concerning work on board fishing vessels, and its work to develop a new Convention and Recommendation on Work in the Fishing Sector. It will then cover the background and debate concerning the provisions in these proposed instruments that relate to improving occupational safety and health, with a special emphasis on proposed requirements and guidance concerning "risk assessment". Examples will be provided of how "risk assessment" has been used in ILO instruments, in regional (European Union) legislation concerning the fishing sector and in national laws, regulations and practice in this sector. The objective of the paper is to stimulate debate on how "risk assessment" of safety and health matters on fishing vessels could be promoted worldwide, taking into account differing levels of development and the considerable diversity of fishing operations.     

Codes of ethics (conduct)

Some international organizations and many societies of health and safety professionals have codes of ethics (conduct). The intent is to promote ethical behavior, though compliance is voluntary and enforcement is generally not possible. It is important that all occupational health and safety professionals adopt and live up to the same code. It also is important that the same code of conduct apply to industrializing countries just as it applies to developed countries. A new International Code of Conduct (Ethics) for Occupational Health and Safety Professionals, developed by 40 international health and safety professionals and set forth in this article, addresses professional obligations and responsibilities and introduces a higher standard of ethical conduct than formerly existed.     

Origins of the WHO Framework Convention on Tobacco Control

The World Health Organization (WHO) Framework Convention on Tobacco Control originated in 1993 with a decision by Ruth Roemer and Allyn Taylor to apply to tobacco control Taylor's idea that the WHO should utilize its constitutional authority to develop international conventions to advance global health. In 1995, Taylor and Ruth Roemer proposed various options to WHO, recommending the framework convention-protocol approach conceptualized by Taylor.Despite initial resistance by some WHO officials, this approach gained wide acceptance. In 1996, the World Health Assembly voted to proceed with its development. Negotiations by WHO member states led the World Health Assembly in May 2003 to adopt by consensus the WHO Framework Convention on Tobacco Control-the first international treaty adopted under WHO auspices. The treaty formally entered into force for state parties on February 27, 2005.     

Global Estimates of the Burden of Injury and Illness at Work in 2012

This article reviews the present indicators, trends, and recent solutions and strategies to tackle major global and country problems in safety and health at work. The article is based on the Yant Award Lecture of the American Industrial Hygiene Association (AIHA) at its 2013 Congress. We reviewed employment figures, mortality rates, occupational burden of disease and injuries, reported accidents, surveys on self-reported occupational illnesses and injuries, attributable fractions, national economic cost estimates of work-related injuries and ill health, and the most recent information on the problems from published papers, documents, and electronic data sources of international and regional organizations, in particular the International Labor Organization (ILO), World Health Organization (WHO), and European Union (EU), institutions, agencies, and public websites. We identified and analyzed successful solutions, programs, and strategies to reduce the work-related negative outcomes at various levels. Work-related illnesses that have a long latency period and are linked to ageing are clearly on the increase, while the number of occupational injuries has gone down in industrialized countries thanks to both better prevention and structural changes. We have estimated that globally there are 2.3 million deaths annually for reasons attributed to work. The biggest component is linked to work-related diseases, 2.0 million, and 0.3 million linked to occupational injuries. However, the division of these two factors varies depending on the level of development. In industrialized countries the share of deaths caused by occupational injuries and work-related communicable diseases is very low while non-communicable diseases are the overwhelming causes in those countries. Economic costs of work-related injury and illness vary between 1.8 and 6.0% of GDP in country estimates, the average being 4% according to the ILO. Singapore's economic costs were estimated to be equivalent to 3.2% of GDP based on a preliminary study. If economic losses would take into account involuntary early retirement then costs may be considerably higher, for example, in Finland up to 15% of GDP, while this estimate covers various disorders where work and working conditions may be just one factor of many or where work may aggravate the disease, injury, or disorders, such as traffic injuries, mental disorders, alcoholism, and genetically induced problems. Workplace health promotion, services, and safety and health management, however, may have a major preventive impact on those as well. Leadership and management at all levels, and engagement of workers are key issues in changing the workplace culture. Vision Zero is a useful concept and philosophy in gradually eliminating any harm at work. Legal and enforcement measures that themselves support companies and organizations need to be supplemented with economic justification and convincing arguments to reduce corner-cutting in risk management, and to avoid short- and long-term disabilities, premature retirement, and corporate closures due to mismanagement and poor and unsustainable work life. We consider that a new paradigm is needed where good work is not just considered a daily activity. We need to foster stable conditions and circumstances and sustainable work life where the objective is to maintain your health and work ability beyond the legal retirement age. We need safe and healthy work, for life.     

Addressing the tobacco epidemic in the Philippines: progress since ratification of the WHO FCTC

Tobacco use is the leading cause of preventable death, and is estimated to kill more than 5 million persons each year worldwide. Tobacco use and exposure to second-hand smoke pose a major public health problem in the Philippines. Effective tobacco control policies are enshrined in the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), a legally binding international treaty that was ratified by the Philippines in 2005. Since 2007, Bloomberg Philanthropies has supported the accelerated reduction of tobacco use in many countries, including the Philippines. Progress in the Philippines is discussed with particular emphasis on the period since ratification of the WHO FCTC, and with particular focus on the grants programme funded by the Bloomberg Initiative. Despite considerable progress, significant challenges are identified that must be addressed in future if the social, health and economic burden from the tobacco epidemic is to be alleviated.     

Occupational medicine in European countries and in Yugoslavia

A recent publication on occupational health services in European countries prepared by the World Health Organization is reviewed. On the basis of guidance by the international organizations, the overall objectives of occupational health services are embodied in principles which are implemented in various ways in the practical activities undertaken in each country. The functions of occupational health services, organizational models, coverage, personnel, support systems (industrial hygiene, ergonomics, psychology, clinical occupational medicine) as well as research, training and funding are discussed. Comparison is made with the actual situation and development of occupational health service in Croatia with special reference to the conclusions drawn at a round table discussion organized by the Association of Occupational Health of the Croatian Medical Society in Pazin, in April 1991.     

Occupational hygiene: where from and to?

Occupational Hygiene was born in the forties in the USA, from the need to focus on the causes of the occupational diseases from a scientific and technical point of view. In other words this is to understand how to detect, how to evaluate and how to control the chronic risks at the workplace. The discipline developed very well from that time up to the nineties thank to a strong commitment of dedicated people and professional societies supported by international organizations such as the ILO and the WHO. Nowadays the situation of Occupational Hygiene differs considerably between countries which can arbitrarily be categorized according to the "culture and tradition" they have in this field. The development of this science has decreased in the countries where it has been very well established. This is probably due to the fact that the field of Occupational Health has been enlarged very much in the last decade so that Occupational Hygiene has to struggle more than before to defend its ecological niche (specificity) in this vast domain. In some countries the discipline is mixed with safety or environmental protection or even with the quality management and there is no curricula for Occupational Hygiene only. In many countries it simply does not exist. What will be the future of Occupational Hygiene? It is not possible to answer this question but there are clear opportunities to show the importance of Occupational Hygiene such as the REACH regulation in Europe which full comply with the core competencies of this profession. Other opportunities such as the elaboration of simple tools to assess and control the occupational hazards (toolkits) may also lead to a decrease in the need of well educated professionals since these tools will not require a long training to be used. In conclusion, the future will depend on the way the actual occupational hygienists will work to become more visible and to be considered as essential partners to reach the main goal of Occupational Health which is to build up healthy workplaces, for healthy companies in a healthy economy. The Occupational Hygiene Societies at the national level and the IOHA (International Occupational Hygiene Association) at the international level, will have a key role to play in this future evolution.     

The present state and future prospects of occupational health in Bangladesh

Bangladesh is a relatively young and developing country. At the present time, like in most developing countries, a clear demarcation between occupational health care and general medical care is difficult to be recognized in Bangladesh. Occupational health is a fairly new field, as the country is undergoing industrialization and occupational health activities are operated by several ministries, such as Labour, Health, Industry and Transport. Legal foundations of the occupational health-care system based on British India and Pakistani era, were adopted and amended by the Government of Bangladesh after the liberation of the country in 1971. Most of the Labour laws have been rectified by the Government of Bangladesh according to the ILO Conventions. Reconsideration of the occupational health service system avoiding duplication for the 'occupational health' component in several ministries might be helpful to achieve the successful provision of an occupational health service in the developing Bangladesh.     

Global,regional and national burden of disease attributable to 19 selected occupational risk factors for 183 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

ObjectivesWe provide a brief introduction to the objectives, data, methods and results of the World Health Organization (WHO)/International Labor Organization (ILO) Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), which estimated the burden attributable to 19 selected occupational risk factors.MethodsThe WHO/ILO Joint Estimates were produced within the global Comparative Risk Assessment framework, which attributes the burden of one specific health outcome (ie, disease/injury) to a specific occupational risk factor. For 39 established occupational risk factor-health outcome pairs, estimates are produced using population attributable fractions (PAF) from recent burden of disease estimates. For two additional pairs, PAF are calculated from new databases of exposure and risk ratios produced in WHO/ILO systematic reviews. Attributable disease burdens were estimated by applying the PAF to total disease burdens.ResultsGlobally in 2016, it is estimated that 1.88 [95% uncertainty range (UR) 1.84–1.92] million deaths and 89.72 (95% UR 88.61–90.83) million disability-adjusted life years were attributable to the 19 selected occupational risk factors and their health outcomes. A disproportionately large work-related burden of disease is observed in the WHO African Region (for disability-adjusted life years), South-East Asia Region, and Western Pacific Region (for deaths), males and older age groups.ConclusionsThe WHO/ILO Joint Estimates can be used for global monitoring of exposure to occupational risk factors and work-related burden of disease and to identify, plan, cost, implement and evaluate policies, programs and actions to prevent exposure to occupational risk factors and their associated burden.     

FIOH-sponsored newsletter misrepresents asbestos hazards in Zimbabwe

The Finnish Institute of Occupational Health (FIOH) has received support from the World Health Organization (WHO) and the International Labor Office (ILO) to publish the African Newsletter on Occupational Health and Safety. The African Newsletter on Occupational Health and Safety should not be a medium for industry propaganda, or the source of misinformation among the workers of Africa. Instead, FIOH should provide the same level of scientific information in Africa that it does in Finland and other developed countries.     

The role of permissible limits for hazardous airborne substances in the working environment in the prevention of occupational disease

Recognized limits of permissible exposure to hazardous airborne substances adopted by different countries for industrial health protection may differ by a factor of 10. A Joint ILO/WHO Committee on Occupational Health in 1969 was unable to recommend a single set of values as international standards for more than a few toxic agents. The greatest differences are in the tolerance limits employed in the USA and in the USSR. The reasons for this substantial disagreement are discussed in this paper and are explained in terms of fundamental differences in the psychophysiological criteria employed to establish safe limits between the maintenance of good health and the development of a significant threat to the health. Some practical implications in the selection of permissible limits of exposure by developing countries are discussed in relation to living standards, endemic disease, climate, and geographical situation.     

Development of carcinogenicity classifications and evaluations: the case of formaldehyde

In this paper carcinogenicity classification and evaluations case of formaldehyde made by national and international agencies and organizations (such as European Union, International Agency for Research on Cancer, World Health Organization) both in occupational (such as American Conference of Government Industrial Hygienists, National Institute of Occupational Safety and Health and Occupational Health and Safety Administration) and non occupational environment (such as United States Environmental Protection Agency) are proposed. The differences in the database and consequently in the conclusion are described in a short historical review since formaldehyde was considered for the first time as regard as health effects.     

ILO／WHO全球消除矽肺的国际规划

矽肺能使工人致残，至今仍然是世界上最重要的职业卫生问题之一。由于缺乏有效特异的治疗矽肺的措施，保护工人健康的唯一办法是控制矽尘的接触。本文就所需要采取的措施．职业接触限值陈述了目前国际上的趋势，最后介绍了ILO／WHO全球消除矽肺的国际规划。只有通过广泛的国际合作，各学科专业的共同努力及各有关经济部门的参与和支持，ILO／WHO全球消除矽肺的国际规划才能在全球实现。