New global indicator for workers' health: mortality rate from diseases attributable to selected occupational risk factors.

Through sustainable development goals 3 and 8 and other policies, countries have committed to protect and promote workers' health by reducing the work-related burden of disease. To monitor progress on these commitments, indicators that capture the work-related burden of disease should be available for monitoring workers' health and sustainable development. The World Health Organization and the International Labour Organization estimate that only 363 283 (19%) of 1 879 890 work-related deaths globally in 2016 were due to injuries, whereas 1 516 607 (81%) deaths were due to diseases. Most monitoring systems focusing on workers' health or sustainable development, such as the global indicator framework for the sustainable development goals, include an indicator on the burden of occupational injuries. Few such systems, however, have an indicator on the burden of work-related diseases. To address this gap, we present a new global indicator: mortality rate from diseases attributable to selected occupational risk factors, by disease, risk factor, sex and age group. We outline the policy rationale of the indicator, describe its data sources and methods of calculation, and report and analyse the official indicator for 183 countries. We also provide examples of the use of the indicator in national workers' health monitoring systems and highlight the indicator's strengths and limitations. We conclude that integrating the new indicator into monitoring systems will provide more comprehensive and accurate surveillance of workers' health, and allow harmonization across global, regional and national monitoring systems. Inequalities in workers' health can be analysed and the evidence base can be improved towards more effective policy and systems on workers' health.

Par le biais des objectifs de développement durable 3 et 8 ainsi que d'autres mesures, plusieurs pays se sont engagés à protéger et promouvoir la santé des travailleurs en réduisant l'impact des maladies liées au travail. Mais pour évaluer leurs progrès en la matière, il convient de mettre en place des indicateurs estimant l'impact des maladies liées au travail afin de placer le développement durable et la santé des travailleurs sous surveillance. D'après l'Organisation mondiale de la Santé et l'Organisation internationale du Travail, seulement 363 283 (19%) des 1 879 890 décès liés au travail dans le monde en 2016 découlaient de blessures, tandis que 1 516 607 (81%) d'entre eux étaient causés par des maladies. La plupart des systèmes de surveillance qui s'intéressent à la santé des travailleurs ou au développement durable, comme le cadre mondial d'indicateurs pour les objectifs de développement durable, comportent un indicateur relatif à l'impact des accidents de travail. Cependant, rares sont ceux qui possèdent un indicateur concernant l'impact des maladies professionnelles. Pour combler cette lacune, nous dévoilons un nouvel indicateur mondial: le taux de mortalité dû aux maladies attribuables à certains facteurs de risque professionnels classé par maladie, facteur de risque, sexe et catégorie d'âge. Nous exposons le motif politique de l'indicateur, décrivons l'origine des données et les méthodes de calcul, et communiquons et analysons l'indicateur officiel pour 183 pays. Nous fournissons également des exemples de la façon dont l'indicateur peut être utilisé dans des systèmes nationaux de surveillance de la santé des travailleurs et soulignons ses forces et faiblesses. Nous concluons en affirmant que l'intégration de ce nouvel indicateur dans les systèmes de surveillance offrira un suivi plus complet et précis de la santé des travailleurs et ouvrira la voie à une harmonisation des systèmes mondiaux, nationaux et régionaux. Il est possible d'analyser les inégalités en matière de santé des travailleurs et d'en améliorer les bases factuelles afin d'établir des politiques et systèmes plus efficaces dans ce domaine.

A través de los objetivos de desarrollo sostenible 3 y 8 y de otras políticas, los países se han comprometido a proteger y promover la salud de los trabajadores reduciendo la carga de morbilidad relacionada con el trabajo. Para supervisar los avances en el cumplimiento de estos compromisos, debería disponerse de indicadores que reflejen la carga de morbilidad relacionada con el trabajo, a fin de controlar la salud de los trabajadores y el desarrollo sostenible. La Organización Mundial de la Salud y la Organización Internacional del Trabajo estiman que solo 363 283 (19%) de las 1 879 890 muertes relacionadas con el trabajo a nivel mundial en 2016 se debieron a lesiones, mientras que 1 516 607 (81%) muertes se debieron a enfermedades. La mayoría de los sistemas de vigilancia centrados en la salud de los trabajadores o el desarrollo sostenible, como el marco de indicadores mundiales para los objetivos de desarrollo sostenible, incluyen un indicador sobre la carga de las lesiones laborales. No obstante, pocos de estos sistemas cuentan con un indicador sobre la carga de las enfermedades relacionadas con el trabajo. Para subsanar esta carencia, presentamos un nuevo indicador mundial: la tasa de mortalidad por enfermedades atribuibles a factores de riesgo laborales seleccionados, por enfermedad, factor de riesgo, sexo y grupo de edad. Describimos la justificación política del indicador, describimos sus fuentes de datos y métodos de cálculo, e informamos y analizamos el indicador oficial para 183 países. También proporcionamos ejemplos del uso del indicador en los sistemas nacionales de vigilancia de la salud de los trabajadores y destacamos las ventajas y las limitaciones del indicador. Concluimos que la integración del nuevo indicador en los sistemas de vigilancia proporcionará una vigilancia más exhaustiva y precisa de la salud de los trabajadores, y permitirá la armonización entre los sistemas de vigilancia mundiales, regionales y nacionales. Se podrán analizar las desigualdades en la salud de los trabajadores y se podrá mejorar la base de evidencias para lograr políticas y sistemas más eficaces en materia de salud de los trabajadores.

Update of the WHO global air quality guidelines: Systematic reviews - An introduction.

This paper aims to serve as an introduction to the Special Issue in Environment International entitled "Update of the WHO Global Air Quality Guidelines: Systematic Reviews". The article has two main objectives. One is to provide the context to this Special Issue, related to (a) policy context, overall exposure to air pollution, and burden of disease attributable to air pollution, and the other is to describe (b) the WHO guideline development process, with special emphasis on the systematic reviews. In particular, this paper presents the systematic reviews and other supporting evidence that was used and discussed during the process and summarizes important methodological information about the approaches taken to conduct the systematic reviews. These approaches include the definition of population, exposure, comparator, outcomes and study design (PECOS) questions, the assessment of the risk of bias in individual studies and the assessment of the overall certainty of the evidence. In summary, the new WHO global air quality guidelines are informed by the best available scientific evidence covering a vast number of research papers published until September 2018, and appraised by experts and stakeholders in the field of air quality. However, research gaps remain and, therefore, further research is warranted.

Priorities for improving chemicals management in the WHO European Region-stakeholders' views.

BACKGROUND: Prevention of the impact of chemicals on human health and the environment is an increasing focus of public health polices and policy makers. The World Health Organization European Centre for Environment and Health wanted to know what were stakeholders' priorities for improving chemicals management and prevention. METHODS: Semi-structured interviews were undertaken with 18 diverse stakeholders to answer this question. The interview questionnaire was developed using current WHO chemical meeting reports, the Evidence Implementation Model for Public Health Systems and categories of the theory of diffusion. Stakeholder views were attained on three main questions within the questionnaire. (i) What priority actions should be undertaken to minimize the negative impact of chemicals? (ii) Who needs to be more involved and what roles should they have? (iii) How can science and knowledge on chemicals and health be translated into policies more effectively and what are the greatest barriers to overcome? RESULTS: Cross cutting issues, such as legislation strengthening and enforcement, further collection of information, capacity building, education and awareness raising were considered priorities. The responders had the same vision on roles and responsibilities of different stakeholders. The greatest barrier to adoption, implementation and enforcement of evidence-based policies reported was leadership and political commitment to chemical safety. CONCLUSIONS: Priorities raised differed depending on knowledge, professional background and type of stakeholder. Factors influencing priority identification at the national level include international and global context, availability of information, knowledge of the current situation and evidence-based good practice, and risks and priorities identified through national assessments.

Development of the WHO Environmental Noise Guidelines for the European Region: An Introduction.

Following the Parma Declaration on Environment and Health adopted at the Fifth Ministerial Conference (2010), the Ministers and representatives of Member States in the WHO European Region requested the World Health Organization (WHO) to develop updated guidelines on environmental noise, and called upon all stakeholders to reduce children's exposure to noise, including that from personal electronic devices. The WHO Environmental Noise Guidelines for the European Region will provide evidence-based policy guidance to Member States on protecting human health from noise originating from transportation (road traffic, railway and aircraft), wind turbine noise, and leisure noise in settings where people spend the majority of their time. Compared to previous WHO guidelines on noise, the most significant developments include: consideration of new evidence associating environmental noise exposure with health outcomes, such as annoyance, cardiovascular effects, obesity and metabolic effects (such as diabetes), cognitive impairment, sleep disturbance, hearing impairment and tinnitus, adverse birth outcomes, quality of life, mental health, and wellbeing; inclusion of new noise sources to reflect the current noise environment; and the use of a standardized framework (grading of recommendations, assessment, development, and evaluations: GRADE) to assess evidence and develop recommendations. The recommendations in the guidelines are underpinned by systematic reviews of evidence on several health outcomes related to environmental noise as well as evidence on interventions to reduce noise exposure and/or health outcomes. The overall body of evidence is published in this Special Issue.

Diagnosis, monitoring and prevention of exposure-related non-communicable diseases in the living and working environment: DiMoPEx-project is designed to determine the impacts of environmental exposure on human health.

The WHO has ranked environmental hazardous exposures in the living and working environment among the top risk factors for chronic disease mortality. Worldwide, about 40 million people die each year from noncommunicable diseases (NCDs) including cancer, diabetes, and chronic cardiovascular, neurological and lung diseases. The exposure to ambient pollution in the living and working environment is exacerbated by individual susceptibilities and lifestyle-driven factors to produce complex and complicated NCD etiologies. Research addressing the links between environmental exposure and disease prevalence is key for prevention of the pandemic increase in NCD morbidity and mortality. However, the long latency, the chronic course of some diseases and the necessity to address cumulative exposures over very long periods does mean that it is often difficult to identify causal environmental exposures. EU-funded COST Action DiMoPEx is developing new concepts for a better understanding of health-environment (including gene-environment) interactions in the etiology of NCDs. The overarching idea is to teach and train scientists and physicians to learn how to include efficient and valid exposure assessments in their research and in their clinical practice in current and future cooperative projects. DiMoPEx partners have identified some of the emerging research needs, which include the lack of evidence-based exposure data and the need for human-equivalent animal models mirroring human lifespan and low-dose cumulative exposures. Utilizing an interdisciplinary approach incorporating seven working groups, DiMoPEx will focus on aspects of air pollution with particulate matter including dust and fibers and on exposure to low doses of solvents and sensitizing agents. Biomarkers of early exposure and their associated effects as indicators of disease-derived information will be tested and standardized within individual projects. Risks arising from some NCDs, like pneumoconioses, cancers and allergies, are predictable and preventable. Consequently, preventative action could lead to decreasing disease morbidity and mortality for many of the NCDs that are of major public concern. DiMoPEx plans to catalyze and stimulate interaction of scientists with policy-makers in attacking these exposure-related diseases.

Towards estimating the burden of disease attributable to second-hand smoke exposure in Polish children.

OBJECTIVES: To estimate the burden of disease attributable to second-hand smoke (SHS) exposure in Polish children in terms of the number of deaths and disability adjusted life years (DALYs) due to lower respiratory infections (LRI), otitis media (OM), asthma, low birth weight (LBW) and sudden infant death syndrome (SIDS). MATERIALS AND METHODS: Estimates of SHS exposure in children and in pregnant women as well as information concerning maternal smoking were derived from a national survey, the Global Youth Tobacco Survey, and the Global Adult Tobacco Survey in Poland. Mortality data (LRI, OM, asthma, and SIDS), the number of cases (LBW), and population data were obtained from national statistics (year 2010), and DALYs came from the WHO (year 2004). The burden of disease due to SHS was calculated by multiplying the total burden of a specific health outcome (deaths or DALYs) by a population attributable fraction. RESULTS: Using two estimates of SHS exposure in children: 48% and 60%, at least 12 and 14 deaths from LRI in children aged up to 2 years were attributed to SHS, for the two exposure scenarios, respectively. The highest burden of DALYs was for asthma in children aged up to 15 years: 2412, and 2970 DALYs, for the two exposure scenarios, respectively. For LRI, 419 and 500 DALYs, and for OM, 61 and 77 DALYs were attributed to SHS, for the two exposure scenarios, respectively. Between 13% and 27% of SIDS cases and between 3% and 16% of the cases of LBW at term were attributed to SHS exposure. CONCLUSIONS: This study provides a conservative estimate of the public health impact of SHS exposure on Polish children. Lack of comprehensive, up to date health data concerning children, as well as lack of measures that would best reflect actual SHS exposure are major limitations of the study, likely to underestimate the burden of disease.

Regulatory factors of basal F(2)-isoprostane formation: population, age, gender and smoking habits in humans.

Oxidative stress is assumed to be the key underlying factor in the pathogenesis of many common diseases. This study describes the basal levels of 8-iso-PGF(2alpha ), a major F(2)-isoprostane and an in vivo oxidative stress biomarker in healthy subjects from three countries, namely Italy, Poland and Sweden, in relation to their smoking habits, age and gender. It studied urinary 8-iso-PGF(2alpha ) in 588 subjects from Sweden (n=220), Italy (n=203) and Poland (n=165). Polish subjects had the highest levels of F(2)-isoprostanes followed by the Swedish and Italians when adjusted for smoking, age, sex and creatinine and the inter-country differences were statistically significant. Smokers had significantly higher levels of 8-iso-PGF(2alpha ) compared to non-smokers in all countries and there was a moderate decrease with age. Women had only slightly lower 8-iso-PGF(2alpha ) than men. There is a difference in F(2)-isoprostane levels in vivo between countries. Smoking, age and gender affect isoprostane formation and should be taken into consideration in clinical studies of oxidative stress.

Urinary mercury and biomarkers of early renal dysfunction in environmentally and occupationally exposed adults: a three-country study.

We conducted a cross-sectional study in Sweden, Italy and Poland to assess environmental and occupational exposure to mercury from chloralkali (CA) plants and the potential association with biomarkers of early renal dysfunction. Questionnaire data and first-morning urine samples were collected from 757 eligible subjects. Urine samples were analysed for mercury corrected for creatinine (U-HgC), alpha-1-microglobulin (A1M), N-acetyl-beta-glucosaminidase (NAG) and albumin. Determinants of urinary mercury excretion were examined. Levels of kidney markers were compared in three U-HgC categories, and differences were tested taking age and other covariates into account. In the general population, the median U-HgC was higher in Italian (1.2 microg/gC) than in Polish (0.22 microg/gC) or Swedish (0.21 microg/gC) subjects, and no effect of living close to CA plants could be shown. Dental amalgam, chewing on amalgam, and fish consumption were positively associated with U-HgC. In subjects from the general population, no effects on the kidney markers could be detected, while in men, including workers occupationally exposed to mercury, U-HgC was positively associated with the kidney markers, especially with NAG, but to some extent also with A1M and albumin. Differences in urinary mercury and kidney markers in the general population between three studied countries could possibly be due to dietary factors, increased susceptibility to mercury at low selenium intake or co-exposure to other nephrotoxic metals.

Children's environmental health and the precautionary principle.

The concept of precaution has a long history in medicine and public health. The modern precautionary principle (PP), originating from environmental debates in Germany in the 1970s, has been included in many international agreements, such as the Treaty on European Union. PP is a public policy tool that justifies actions, which protect human health and the environment in face of uncertain risks. The outcome of the application of PP depends on the level, nature, and distribution of acceptable risks and on the availability of alternatives, and can range from taking no action to banning of substances or the activities of concern. Given the complex nature and uncertainty of environmental risks to children's health, a precautionary approach is warranted. Public health professionals and clinical practitioners could adopt such an approach within the wider context of considering the environment as a source of risks to children's health. Relevant knowledge and skills are needed to enable health care professionals to address these issues. New methodological and scientific approaches are necessary to make use of scattered, but potentially relevant clinical evidence in providing 'early warnings' of health hazards.

Environmental burden of disease due to lead in urban children from Silesia, Poland.

We performed environmental burden of disease (EBD) assessment of the neurotoxic effects of lead in the Polish urban children, in accordance with the WHO guidelines. The EBD assessment was based on the data on blood lead levels (BLL) of more than 8500 children from the lead biomonitoring programme conducted in the urban centre of the Upper Silesia Province, Poland between 1993 and 2000. In order to make the EBD assessment region specific, in the projections to years 2001 and 2005 we used 4% annual decrease in BLL, derived from the earlier analysis of the Silesian BLL data instead of the WHO proposed 7.8%. Mean BLL in the Silesian children projected for the year 2001 was higher (4.9 microg/dL) than the corresponding value for the WHO EurB region (3.9 microg/dL). The incidence rate of mild mental retardation (MMR) in the Silesian children was twice as high as in the EurB region for the year 2001, meaning more than two additional cases of MMR due to lead exposure per 1000 children aged 0-1 year, compared with 1 in 1000 children in the EurB region.

Urinary mercury in adults in Poland living near a chloralkali plant.

We conducted a study within the framework of the interdisciplinary European Mercury Emission from Chloralkali Plants (EMECAP) project to assess exposure to mercury (Hg) and the contribution of Hg emissions from a mercury cell chloralkali plant to urinary mercury (U-Hg) in adults living near the plant. We collected data from questionnaires and first morning urine samples from 75 subjects living near the Tarnow plant in Poland and 100 subjects living in a reference area. Median U-Hg was 0.32 mug/g creatinine (microg/gC) and 0.20 microg/gC, respectively. The median U-Hg was also higher in the amalgam-free subjects living near the plant (0.26 microg/gC) than in the reference group (0.18 microg/gC), but no such association was found in a multivariate analysis. There was a statistically significant positive association between U-Hg and number of teeth with amalgams, a negative association with age and a tendency towards higher U-Hg in female subjects. In the amalgam-free subjects there were statistically significant effects of female sex and fish consumption, and a negative association with age. The additional long-term average air Hg concentration from the plant, based on EMECAP environmental measurements and modelling, was estimated to be 1-3.5 ng/m(3) for the residential study area and should have a very small effect on U-Hg. The other Hg emission sources such as coal combustion facilities located nearby should be taken into account in assessing the overall impact of air Hg on U-Hg in this area.

Assessment of lead exposure and associated risk factors in urban children in Silesia, Poland.

A program of childhood lead poisoning prevention was conducted in six cities of Silesia, the most industrialized region of Poland. We analyzed records of 11,877 children aged 24-84 months, tested between 1993 and 1998, to assess children's exposure to lead and associations of blood lead levels (BLL) with season of sampling, questionnaire data, and environmental levels of lead. Air lead concentrations and lead fallout, as measured in the ambient air monitoring system, were below current Polish air quality standards and gradually decreased. The geometric mean (GM) BLL was 6.3 microg/dL (range from 0.6 to 48 microg/dL), and >13% of children had BLL > or =10 microg/dL. Mean BLL declined from 6.8 microg/dL in 1993-1994 to almost 5.5 microg/dL in 1998. GM BLL in spring and summer ('nonheating' season) months were 10% higher than BLL in children tested in fall and winter ('heating' season), although air lead concentrations were lower in nonheating and higher in the heating season. For both the heating and nonheating seasons, there was a significant increase in the mean BLL with increasing air lead concentrations. Poor housing (odds ratio (OR): 1.82; 95% CI: 1.4, 2.3), two or more siblings in the family (OR: 3.12; 95% CI: 2.6, 3.7), lack of recreational trips outside the region (OR: 1.66; 95% CI: 1.47, 1.89), and the time child spent outdoors were associated with elevated BLL. Variables found to affect BLL in the Silesian children should be used to propose criteria to improve identification of children at risk and to focus prevention activities more effectively.

Environmental lead exposure in Polish children: blood lead levels, major sources and principles of the lead poisoning prevention.

In Poland, children are exposed to lead from the combustion of leaded gasoline and industrial processes. Since the early 1990s, emission levels have declined, and a ban on leaded petrol is anticipated in 2005. Major industrial sources are located in Silesia Province and the copper mining centre (Legnica region). Concerns about, lead exposure in children date back to the 1980s; mean blood lead levels (BILL)reported in children living near lead smelters in Silesia exceeded 20microg/dl. in the 1990s, mean BLLs were decreasing, both in urban children and those living near lead industry. Lower than the CDC action level of 101microg/dl, they were however higher than mean values in children from the other countries, where leaded gasoline had already been banned. Childhood lead poisoning prevention requires a comprehensive approach, involving different sectors. Medical prevention focuses on the early detection of exposed child by the blood lead testing and individual case management. An increasing body of evidence, indicating adverse effects even below the current "safe" level of 101microg/dl, argues for intensification of the primary prevention, which requires legal, economic and technical measures. Public health efforts should contribute to the reduction and elimination of sources of exposure in child's environment and public education campaigns.