Role of trade unions in workplace health promotion.

Since the 19th century, workers have organized in trade unions and parties to strengthen their efforts at improving workplace health and safety, job conditions, working hours, wages, job contracts, and social security. Cooperation between workers and their organizations and professionals has been instrumental in improving regulation and legislation affecting workers' health. The authors give examples of participatory research in occupational health in Denmark and Finland. The social context of workplace health promotion, particularly the role of unions and workers' safety representatives, is described in an international feasibility study. Health promotion is rife with fundamental political, socioeconomic, philosophical, ethical, gender- and ethnicity-related, psychological, and biological problems. Analysis of power and context is crucial, focusing on political systems nationally, regionally, and globally. The authors advocate defending and supporting workers and their trade unions and strengthening their influence on workplace health promotion. In the face of rapid capitalist globalization, unions represent a barricade in defense of workers' health and safety. Health promoters and related professionals are encouraged to support trade unions in their efforts to promote health for workers and other less privileged groups.     

Workers' perceptions, knowledge and responses regarding occupational health and safety: a report on a Canadian study

This paper presents data from interviews with 492 rank and file workers. It examines aspects of workers' perceptions, knowledge and actions regarding workplace hazards and views these as indicators of the potential strength of labour in improving occupational health and safety. Respondents had a strong consciousness of ways in which their work might damage their health and they or their fellow workers had experienced half of the symptoms they mentioned. However, they lacked information on the results of environmental and medical monitoring, their core legal rights and the more effective strategies for reducing hazards. Few respondents sought information and few were persistent in dealing with their worries about hazards. Knowledge of their rights under the current occupational health and safety legislation was linked with taking such actions. It is suggested that workers' pursuit of their health and safety concerns might be facilitated if they had better access to information about their legal rights and mechanisms for dealing with hazards in the workplace.     

Perspectives for workplace health promotion in Latin America and the Caribbean

The Latin American and Caribbean region is witnessing the emergence of discussion on workplace health promotion (WHP). The authors propose WHP as an equitable collective action targeting primarily work hazards and their determinants. It has its economic-political "macro" level and a downstream "micro" level. On the macro level, neoliberalism, privatization, and deregulation threaten equitable health and labor issues. Effective labor and health legislation and a fair degree of social redistribution of resources support WHP. Micro-scale WHP is important for contextual reasons and social diffusion, and can literally save lives. Worker involvement, free association of workers, public health affiliation, the precautionary principle, sensitization and training, employer responsibility for healthy working conditions, coalitions between workers and health professionals, and preference for reduction of direct work hazards over modification of personal lifestyles are basic tenets of WHP.     

Perspectives for Workplace Health Promotion in Latin America and the Caribbean

Abstract

The Latin American and Caribbean region is witnessing the emergence of discussion on workplace health promotion (WHP). The authors propose WHP as an equitable collective action targeting primarily work hazards and their determinants. It has its economic-political “macro” level and a downstream “micro” level. On the macro level, neoliberalism, privatization, and deregulation threaten equitable health and labor issues. Effective labor and health legislation and a fair degree of social redistribution of resources support WHP. Micro-scale WHP is important for contextual reasons and social diffusion, and can literally save lives. Worker involvement, free association of workers, public health affiliation, the precautionary principle, sensitization and training, employer responsibility for healthy working conditions, coalitions between workers and health professionals, and preference for reduction of direct work hazards over modification of personal lifestyles are basic tenets of WHP.     

Community-based survey of maquiladora workers in Tijuana and Tecate, Mexico

Responses to a survey of 177 maquiladora workers by specially trained peers suggest that transnational corporations operating the plants are ignoring Mexican regulations regarding hazard communication, training, health and safety committees, and uncontrolled hazards in the workplace. The "global standard" for workplace health and safety, often claimed by transnationals, should be made a reality.     

Occupational health services to assist workers' health promotion based on a participatory training program of staff members for public health centers

Work-related health problems among employees of small-scale enterprises and un-employed workers are still serious in Japan. Occupational health services related to their working conditions and environment are limited and more provison needs to be made. Our participatory training program is aimed at allowing staff members of public health centers to provide occupational health services and assist workers' health promotion. In this program, participants examine occupational risk factors affecting workers' health problems with ergonomic check-lists and discuss potential improvements in the workplace. Participants experience practical visits to small-scale enterprises in their communities and the resultant occupational health services are discussed and evaluated at the final step in this program. The essential feature of successful case was that the public health center had coordinated community resources and occupational health services with ergonomic check-lists accepted by small-scale enterprises. This participatory training program is effective from the viewpoint of evaluating occupational risk factors affecting workers' health problems and proposing improvements in the workplace. In order to optimally provide occupational health services for the employees of small-scale enterprises and un-employed workers, the community resources including health facilities and the parties concerned must be organized and utilized effectively.     

The management of occupational health by NHS Trusts in the north of England

This paper reports the findings of an audit of the management of occupational health arrangements in 36 NHS Trusts in the Northern and Yorkshire region of England. A questionnaire was designed based on a national NHS occupational health standard to obtain data on eight categories of occupational health activity: health and safety; pre-employment assessments; Infection Control; health surveillance; sickness absence; ill-health retirement; health promotion and record storage. The management arrangements for occupational health were varied. Assessments of workplace hazards, prevention of HIV-positive workers from performing exposure-prone invasive procedures and the assessment of pregnant workers were identified as issues for further consideration. Provision of competent and effective occupational health services will assist in the management of sickness absence and in the protection and promotion of health of staff. It will also contribute to the health and safety of patients.     

Gendered bodies: recruitment,management and occupational health in northern Thailand's electronics factories

This paper explores workers' experiences and understandings of occupational health hazards in the electronics industries of northern Thailand. Women form the bulk of the lower-level workforce as operators responsible for assembling the parts that make up microchip components. Drawing data from 16 months of research in workers' dormitories, formal and informal interviews and questionnaire surveys, in this paper I explore how gender relations are central to the organization and experience of work in these industries. I identify "work process" health hazards resulting from the physical working environment, and "workplace" health hazards relating to the organizational and social pressures of the working environment. Musculoskeletal pain, eye strain, chemical exposure, stress, improper use of safety equipment and accidents all impact upon women workers' health. Additionally, risk behaviors such as amphetamine and alcohol use, and unprotected sex, are associated with the social context of factory work.     

Assessment of feasibility of workplace health promotion

BACKGROUND: A simple empirically based method for assessment of the feasibility of workplace health promotion programs is described, focusing on cancer hazards (lifestyles, workplace hazards, deficient early detection). The basic components of feasibility are addressed: extent of hazards; needs of employees for hazard reduction and acceptability of WHP; and social context. METHODS: The procedure consists of six modules: guidelines on feasibility assessment; employee questionnaire; interview checklists for probing attitudes of management and partners (social context); data form; debriefing; and assessment of feasibility. Pretesting was completed in 16 workplace communities representing industry, construction, transport, telecommunications, health care, lodging and catering, teaching, and municipality jobs in five countries; a total of 1,085 subjects completed the employee questionnaire on health hazards, needs, and acceptability. RESULTS: The method demonstrated its utility in obtaining and summarizing the necessary data. Feasibility was assessed for the 16 test communities. CONCLUSION: The procedure can be customized; it has a high degree of face validity or understandability, and it is applicable in a wide variety of settings.     

Improvement in the occupational health program in a Finnish construction company by means of systematic workplace investigation of job load and hazard analysis

The aim of the present study was to improve an occupational health program by means of systematic workplace investigations. The 8-month study was done at three building sites of one construction firm. The method for workplace investigations was a simple job hazard analysis of chemical hazards, physical hazards, physical work load, mental stress, and risk of injury, each factor being rated on a three-point scale. Information was gathered by observations, interviews, and a worker questionnaire. Occupational health and safety personnel and worker representatives dealt with problems cooperatively. Together they assessed occupational loads and hazards, whereafter the occupational health and safety personnel devised an occupational health care program and proposed preventive measures. The workplace investigation method proved to function well. It improved the occupational health care program, produced an overall analysis of occupational hazards, and dramatically increased the number and quality of proposed preventive measures. The new method was evaluated to be clearly superior to previous practices and was implemented at moderate cost. The study showed that attention to issues of environmental and occupational health can effectively prevent health impairment even in difficult setting such as construction work. More research is needed for effective utilization of information accumulated by systematic workplace investigations.     

The inverse hazard law: blood pressure, sexual harassment, racial discrimination, workplace abuse and occupational exposures in US low-income black, white and Latino workers

Research on societal determinants of health suggests the existence of an "inverse hazard law," which we define as: "The accumulation of health hazards tends to vary inversely with the power and resources of the populations affected." Yet, little empirical research has systematically investigated this topic, including in relation to workplace exposures. We accordingly designed the United for Health study (Greater Boston Area, Massachusetts, 2003-2004) to investigate the joint distribution and health implications of workplace occupational hazards (dust, fumes, chemical, noise, ergonomic strain) and social hazards (racial discrimination, sexual harassment, workplace abuse). Focusing on blood pressure as our health outcome, we found that among the 1202 low-income multi-racial/ethnic working class participants in our cohort - of whom 40% lived below the US poverty line - 79% reported exposure to at least one social hazard and 82% to at least one high-exposure occupational hazard. Only sexual harassment, the least common social hazard, was associated with elevated systolic blood pressure (SBP) among the women workers. By contrast, no statistically significant associations were detectable between the other additional highly prevalent social and occupational hazards and SBP; we did, however, find suggestive evidence of an association between SBP and response to unfair treatment, implying that in a context of high exposure, differential susceptibility to the exposure matters. These results interestingly contrast to our prior findings for this same cohort, in which we found associations between self-reported experiences of racial discrimination and two other health outcomes: psychological distress and cigarette smoking. Likely explanations for these contrasting findings include: (a) the differential etiologic periods and pathways involving somatic health, mental health, and health behaviors, and (b) the high prevalence of adverse exposures, limiting the ability to detect significant associations. As clarified by the "inverse hazard law," to understand health inequities, research is needed that contrasts exposures and health status population-wide, not just among those most inequitably exposed.     

Development and process evaluation of the participatory and action-oriented empowerment model facilitated by occupational health nurses for workplace health promotion in small and medium-sized enterprises

The objective of this study is to develop an available empowerment model for workplace health promotion (WHP) in small and medium-sized enterprises (SMEs) and to evaluate its applicability and feasibility. Semi-structured interviews with employers and workers in SMEs were conducted to assess their actual requirements for support. The structure of our new empowerment model was discussed and established through several rounds of focus group meetings with occupational safety and health researchers and practitioners on the basis of results of our interviews. We developed a new participatory and action-oriented empowerment model based on needs for support of employers and workers in SMEs. This new model consists of three originally developed tools: an action checklist, an information guidebook, and a book of good practices. As the facilitators, occupational health nurses (OHNs) from health insurance associations were trained to empower employers and workers using these tools. Approximately 80 SMEs (with less than 300 employees) were invited to participate in the model project. With these tools and continued empowerment by OHNs, employers and workers were able to smoothly work on WHP. This newly developed participatory and action-oriented empowerment model that was facilitated by trained OHNs appears to be both applicable and feasible for WHP in SMEs in Japan.     

Work Place Health Promotion

This article deals with the question of whether and how much workplace health promotion measures have infiltrated the working world and which factors determined the results of health promotion programs for the enterprises. To answer this question we conducted a longitudinal study (measuring times: 1997 and 2003) in 150 enterprises in Hessen and Thueringen of the service sector and metal branch. A standardized questionnaire was used to collect the data. One of the results was that the high level of occupational safety and health (OSH) obtained was greatly appreciated by the enterprises interviewed. Many of the enterprises (82.7%) were able to implement at least one workplace health promotion (WHP) measure, mostly assessments of occupational health risks and behavior-oriented offers. The portion of businesses with a very good to sufficient level of workplace health promotion increased clearly from 16.0% in 1997 to 27.4% in 2003. Half of the enterprises interviewed confirmed the need for information and consultation in questions about occupational safety and health issues and workplace health promotion. They expected support particularly from the institutions for statutory occupational accident insurance, health insurance companies, public institutions for labor protection and safety engineering, as well as from the advisory boards of the trade unions. These institutions definitely need to address the consultation requests from the enterprises, as the lack of information and contact persons was one of the reasons why workplace health promotion measures could not be implemented.This study was commissioned by the Hans Boeckler Foundation and the SMBG and translated by Evelyn Jäck     

某包装物厂职业病危害控制效果评价

目的探讨某厂塑料编织袋和塑料包装容器生产装置的职业病危害因素控制效果,确保作业人员的生产安全和身体健康。方法通过职业卫生现场调查、职业卫生检测等方法收集数据和资料,并结合职业病防护设施、个人职业病防护水平和定量分级结果,对试运行期间的作业人员的职业病危害因素接触水平及职业健康影响进行评价。结果本项目存在的职业病危害因素中化学物质有丁醇、二甲苯、甲苯、乙苯、邻苯二甲酸二丁酯、乙酸乙酯、乙酸丁酯、一氧化碳、甲醛;粉尘有聚乙烯粉尘、聚丙烯粉尘;物理因素为噪声,共计12种。检测结果表明,部分工种甲苯、聚乙烯粉尘超过国家卫生标准。对其防护设施进行改造后,各工种接触甲苯、聚乙烯粉尘的浓度均符合标准要求。结论本项目职业病防护设施改造前职业病危害严重,对职业病防护设施进行改造后,作业场所作业人员接触职业病危害因素的浓（强）度均符合国家卫生标准。     

The inverse hazard law: Blood pressure,sexual harassment,racial discrimination,workplace abuse and occupational exposures in US low-income black,white and Latino workers

Research on societal determinants of health suggests the existence of an “inverse hazard law,” which we define as: “The accumulation of health hazards tends to vary inversely with the power and resources of the populations affected.” Yet, little empirical research has systematically investigated this topic, including in relation to workplace exposures. We accordingly designed the United for Health study (Greater Boston Area, Massachusetts, 2003–2004) to investigate the joint distribution and health implications of workplace occupational hazards (dust, fumes, chemical, noise, ergonomic strain) and social hazards (racial discrimination, sexual harassment, workplace abuse). Focusing on blood pressure as our health outcome, we found that among the 1202 low-income multi-racial/ethnic working class participants in our cohort – of whom 40% lived below the US poverty line – 79% reported exposure to at least one social hazard and 82% to at least one high-exposure occupational hazard. Only sexual harassment, the least common social hazard, was associated with elevated systolic blood pressure (SBP) among the women workers. By contrast, no statistically significant associations were detectable between the other additional highly prevalent social and occupational hazards and SBP; we did, however, find suggestive evidence of an association between SBP and response to unfair treatment, implying that in a context of high exposure, differential susceptibility to the exposure matters. These results interestingly contrast to our prior findings for this same cohort, in which we found associations between self-reported experiences of racial discrimination and two other health outcomes: psychological distress and cigarette smoking. Likely explanations for these contrasting findings include: (a) the differential etiologic periods and pathways involving somatic health, mental health, and health behaviors, and (b) the high prevalence of adverse exposures, limiting the ability to detect significant associations. As clarified by the “inverse hazard law,” to understand health inequities, research is needed that contrasts exposures and health status population-wide, not just among those most inequitably exposed.     

Leaving it up to the workers: sociological perspective on the management of health and safety in small workplaces.

Small workplaces present particular challenges for the promotion of occupational health and safety. However, little is known about the social organization of work in such settings and how it relates to matters of health and safety. The research on which this article is based relates patterns of occupational health behavior to the nature of social relationships within the workplace. From a qualitative analysis of interviews with 53 small business owners, the author describes the most common approach to managing workplace health and safety: leaving it up to the workers. This posture is explained in terms of the owners' perception of risk, particularly their understanding of workplace hazards, and their assessment of the social costs of ignoring or addressing such issues. Owners tended to discount or normalize health hazards, and to believe that management intervention in employee health behavior was paternalistic and inconsistent with prevailing patterns of labor relations and norms respecting individual autonomy. Many owners understood health and safety not as a bureaucratic function of management but as a personal moral enterprise in which they did not have legitimate authority. The conceptualization of the owners' responses in terms of "social rationality" has implications for addressing problems of health and safety in small workplaces.     

黄石市3家企业职工职业卫生服务认知现状调查

摘要:目的　了解企业职工对职业卫生服务的认知状况,并分析影响职工职业卫生服务认知的因素。方法　采用系统抽样选择湖北省黄石市3家企业的90名职工为调查对象,并以问卷调查了解职工对职业卫生服务的认知情况;采用EpiData 3.1建立数据库,运用SPSS18.0软件对数据资料进行描述,并以χ2检验作统计分析。结果　约75%的职工知晓工作中所接触的职业性危害因素,只有50%的职工知晓职业性危害因素的检测浓度,且仅有33.0%的职工在工作企业接受过职业卫生相关知识培训;月收入、户籍状况和企业及工会对职工进行职业卫生服务的宣传力度是影响职工职业卫生服务认知率的主要因素;随着月收入的增加,职工对应签订劳动合同、缴纳保险金及进行职业健康监护的知晓率也随之增高。结论　企业应当定期对职工进行职业性危害因素浓度监测和作业人员的职业健康检查,发现问题、及时整改;同时应针对不同层次的企业职工开展多元化的职业卫生健康宣传和教育工作,加强企业的监管力度,以保障职工对职业有害因素的知情权,提高工人职业卫生服务认知总体水平。     

Developing an action-based health and safety training project in southern China

A project brought together international footwear manufacturers, labor rights groups, local contract factories, and occupational health professionals to strengthen factory health and safety programs in southern China. Steps involved in the two-year project, including needs assessment, interviews and focus groups with workers and supervisors; design and development of a participatory workshop; development of plant-wide health and safety committees in three footwear factories; and evaluation project impact, are discussed. The project significantly increased occupational safety and health knowledge, and hazards in the factories were identified and corrected. Successes and challenges faced by three functioning worker-management health and safety committees are discussed. Key elements to create effective programs with meaningful participation by workers include: 1) developing clear guidelines that enable multi-stakeholder groups to collaborate; 2) obtaining top-level management support; 3) building workers' knowledge and capacity to fully participate; 4) involving local labor rights groups and occupational professionals in support and technical assistance; and 5) connecting project goals to larger issues within a country and the global economy.     

城市外来农民工的健康状况与政策建议

分析当前城市外来农民工的年龄结构、受教育程度、职业、收入、流动情况等人口社会学特征 ,探讨该人群的传染病发病与流行、生产事故与职业危害、生殖健康以及心理健康、社会适应等总体健康状况 ,并从健全社会保障制度、体现卫生服务的公平性、关心弱势集体的健康状况、加强健康教育和健康促进等角度提出改善农民工的健康状况、提高该人群健康水平的政策建议。     

加快建立我国职业卫生的协调与合作机制

本文围绕着保障工作场所的职业安全卫生,阐明了我国的职业卫生工作所涉及的责任相关方及其责任。包括责任主体用人单位和劳动者,政府监管管理部门,职业卫生技术服务支撑体系,研究和技术支持体系,社会相关方（劳动者和用人单位的体表,行业协会、学会等）,从国家级和企业级两个层面提出我国应加快建立的职业病防治工作的协调与合作机制,包括多部门协调机制、三方协调机制和社会对话,职业卫生专项集体合同的协商,中小企业联合委员会,职业卫生信息共享等,以期推动我国职业卫生协调与合作机制的建立与发展。