A global survey on occupational health services in selected international commission on occupational health (ICOH) member countries.

BACKGROUND: The United Nations General Assembly (UNGA), the International Labour Organization (ILO), the World Health Organization (WHO), the International Commission on Occupational Health (ICOH), and the European Union (EU) have encouraged countries to organize occupational health services (OHS) for all working people irrespective of the sector of economy, size of enterprise or mode of employment of the worker. The objective of this study was to survey the status of OHS in a sample of countries from all continents. METHODS: A questionnaire focusing on the main aspects of OHS was developed on the basis of ILO Convention No. 161 and several other questionnaire surveys used in various target groups of OHS. The questionnaire was sent to 58 key informants: ICOH National Secretaries. RESULTS: A total of 49 National Secretaries responded (response rate 84.5%), from countries that employ 70% of the total world labour force. The majority of the respondent countries, 67%, had drawn up an OHS policy and implement it with the help of national occupational safety and health (OSH) authorities, institutes of occupational health or respective bodies, universities, and professional associations. Multidisciplinary expert OHS resources were available in the majority (82%) of countries, but varied widely in quantitative terms. The average OHS coverage of workers was 24.8%, with wide variation between countries. In over two thirds (69%) of the countries, the content of services was mixed, consisting of preventive and curative services, and in 29% preventive only. OHS financing was organized according to a mixed model among 63% and by employers only among 33% of the respondents. CONCLUSIONS: The majority of countries have drawn up policies, strategies and programmes for OHS. The infrastructures and institutional and human resources for the implementation of strategies, however, remain insufficient in the majority of countries (implementation gap). Qualitatively, the content and multidisciplinary nature of OHS corresponds to international guidance, but the coverage, comprehensiveness and content of services remain largely incomplete due to a lack of infrastructure and shortage of multiprofessional human resources (capacity gap). The estimated coverage of services in the study group was low; only a quarter of the total employed population (coverage gap).

Asbestos: use, bans and disease burden in Europe.

OBJECTIVE: To analyse national data on asbestos use and related diseases in the European Region of the World Health Organization (WHO). METHODS: For each of the 53 countries, per capita asbestos use (kg/capita/year) and age-adjusted mortality rates (deaths/million persons/year) due to mesothelioma and asbestosis were calculated using the databases of the United States Geological Survey and WHO, respectively. Countries were further categorized by ban status: early-ban (ban adopted by 2000, n = 17), late-ban (ban adopted 2001-2013, n = 17), and no-ban (n = 19). FINDINGS: Between 1920-2012, the highest per capita asbestos use was found in the no-ban group. After 2000, early-ban and late-ban groups reduced their asbestos use levels to less than or equal to 0.1 kg/capita/year, respectively, while the no-ban group maintained a very high use at 2.2 kg/capita/year. Between 1994 and 2010, the European Region registered 106,180 deaths from mesothelioma and asbestosis, accounting for 60% of such deaths worldwide. In the early-ban and late-ban groups, 16/17 and 15/17 countries, respectively, reported mesothelioma data to WHO, while only 6/19 countries in the no-ban group reported such data. The age-adjusted mortality rates for mesothelioma for the early-ban, late-ban and no-ban groups were 9.4, 3.7 and 3.2 deaths/million persons/year, respectively. Asbestosis rates for the groups were 0.8, 0.9 and 1.5 deaths/million persons/year, respectively. CONCLUSION: Within the European Region, the early-ban countries reported most of the current asbestos-related deaths. However, this might shift to the no-ban countries, since the disease burden will likely increase in these countries due the heavy use of asbestos.

Does Workers' Compensation Status Affect Outcomes after Lumbar Spine Surgery? A Systematic Review and Meta-Analysis.

Low back pain (LBP) is currently the leading cause of disability worldwide and the most common reason for workers' compensation (WC) claims. Studies have demonstrated that receiving WC is associated with a negative prognosis following treatment for a vast range of health conditions. However, the impact of WC on outcomes after spine surgery is still controversial. The aim of this meta-analysis was to systematically review the literature and analyze the impact of compensation status on outcomes after lumbar spine surgery. A systematic search was performed on Medline, Scopus, CINAHL, EMBASE and CENTRAL databases. The review included studies of patients undergoing lumbar spine surgery in which compensation status was reported. Methodological quality was assessed through ROBINS-I and quality of evidence was estimated using the GRADE rating. A total of 26 studies with a total of 2668 patients were included in the analysis. WC patients had higher post-operative pain and disability, as well as lower satisfaction after surgery when compared to those without WC. Furthermore, WC patients demonstrated to have a delayed return to work. According to our results, compensation status is associated with poor outcomes after lumbar spine surgery. Contextualizing post-operative outcomes in clinical and work-related domains helps understand the multifactorial nature of the phenomenon.

Decent Work, ILO's Response to the Globalization of Working Life: Basic Concepts and Global Implementation with Special Reference to Occupational Health.

Twenty years ago, the International Labour Organization (ILO) launched a new strategy, the Decent Work Agenda, to ensure human-oriented development in the globalization of working life and to provide an effective response to the challenges of globalization. We searched for and analysed the origin of the Decent Work concept and identified the key principles in ILO policy documents, survey reports, and relevant United Nations' (UN) documents. We also analysed the implementation of the Decent Work Country Programmes (DWCPs) and examined the available external evaluation reports. Finally, we examined the objectives of the ILO Decent Work Agenda and the Decent Work targets in the UN 2030 Agenda for Sustainable Development in view of occupational health. In two thirds of the ILO's Member States, the Decent Work Agenda has been successfully introduced and so far fully or partly implemented in their DWCPs. The sustainability of the Decent Work approach was ensured through the UN 2030 Agenda, the ILO Global Commission Report on the Future of Work, and the ILO Centenary Declaration. However, objectives in line with the ILO Convention No. 161 on Occupational Health Services were not found in the DWCPs. Although successful in numerous aspects in terms of the achievement of the Decent Work objectives and the UN Sustainable Development Goals (SDGs), the Decent Work Agenda and the Decent Work Country Programmes need further development and inclusion of the necessary strategies, objectives, and actions for occupational health services, particularly in view of the high burden of work-related diseases and, for example, the present global pandemic. In many countries, national capabilities for participation and implementation of Decent Work Country Programmes need strengthening.

Reply to "Comment on Iavicoli et al. Ethics and Occupational Health in the Contemporary World of Work. Int. J. Environ. Res. Public Health 2018, 15, 1713".

The authors would like to extend their thanks for the fruitful comments and suggestions, which are useful for conducting deeper analyses of the ethical concerns related to occupational health. [...].

Ethics and Occupational Health in the Contemporary World of Work.

The last two decades have seen increasing attention to professional ethics in the field of occupational health in industrialized and developing countries, partly reflecting the changing world of work, demographic shifts and new technologies. These changes have led to the revisiting of traditional ethical principles and the emergence of ethical issues related to occupational health. This article looks at the problems raised by these ethical concerns and proposes some solutions. We revised the existing literature on the ethical conflict in occupational health in order to identifying drivers and barriers for correct professional ethics. The ethical choices are not only based on balanced risk and benefit assessment for various stakeholders, but there are a number of deontological aspects as well that go beyond the mere benefit domains. There is still no systematic approach for analysing the true extent of these issues and their solutions.

Assessing the protection of the nanomaterial workforce.

Responsible development of any technology, including nanotechnology, requires protecting workers, the first people to be exposed to the products of the technology. In the case of nanotechnology, this is difficult to achieve because in spite of early evidence raising health and safety concerns, there are uncertainties about hazards and risks. The global response to these concerns has been the issuance by authoritative agencies of precautionary guidance to strictly control exposures to engineered nanomaterials (ENMs). This commentary summarizes discussions at the "Symposium on the Health Protection of Nanomaterial Workers" held in Rome (25 and 26 February 2015). There scientists and practitioners from 11 countries took stock of what is known about hazards and risks resulting from exposure to ENMs, confirmed that uncertainties still exist, and deliberated on what it would take to conduct a global assessment of how well workers are being protected from potentially harmful exposures.

Risk of accidents and occupational diseases among the Finnish Defence Forces.

OBJECTIVES: Military activities are often considered more dangerous than civilian work, especially in crisis situations, but peacetime or even peacekeeping conditions have seldom been analyzed in this respect. According to the compensation statistics of the Finnish State Treasury, in 2001, 80% of injuries among military personnel were caused by accidents at work, 15% occurred during commuting to and from work, and 5% were attributable to occupational diseases. RESULTS: The compensated accident frequencies varied between 22 and 26 cases per 1 million work hours during the 1990s. During the past few years, the incidence rate has slightly declined. When accidents among military personnel were considered, most occurred during military exercises (57%), during other work (35%), or during work commuting (9%). One person died in an accident during a military exercise in 2001. On the basis of the data of this study, the hypothesis of a substantially higher risk during peacetime for military work, compared with civilian work, is not defensible. The accident rates in the calendar year 2000 were 25% higher for Finnish civilian work (32 cases per 1 million hours) than for the Finnish Defence Forces (22 cases per 1 million hours).

Smoking prevalence, smoking-related lung diseases, and national tobacco control legislation.

OBJECTIVES: To review statistics on smoking prevalence and to analyze whether the implementation of national tobacco control legislation had an association with the prevalence of smoking, and thereby, with the occurrence of smoking-related lung diseases. DESIGN: Smoking prevalence rates (from 1960 to 2000), lung cancer incidence rates (from 1980 to 2000), and respiratory disease mortality rates (from 1980 to 1998) were obtained from Finnish national surveys and registers. Regression models with 20-year lag times for disease occurrence were applied in the statistical analysis. RESULTS: Daily smoking prevalence among men decreased continuously from 58 to 28% in the period from 1960 to 2000. Between 1965 and 1971, male lung cancer incidence was still on the increase, but from 1971 it decreased from 80 to 32 per 100,000 men. The male respiratory disease mortality rate declined steeply during the study period. From 1960 to 1973, women's smoking prevalence increased from 12 to 20%. At the introduction of the tobacco control bill in 1975, the increase leveled off and female smoking prevalence slightly decreased, but then rose again after 1985 to remain at 20%. Lung cancer incidence among women increased throughout the study period, but the gradient of the curve lowered in the 1980s. CONCLUSIONS: National legislative actions were found to be associated with a change in smoking prevalence among women from a linear rise to a plateau. The results of the present study showed a very strong association between reduced smoking prevalence and the occurrence of lung cancer.

The opportunities and obstacles to collaboration between the developing and developed countries in the field of occupational health.

The 2.4 billion working people in the developing countries often have to endure employment conditions, which do not meet even basic occupational safety and health (OSH) standards. The lack of work safety, excessive work loads, and occupational physical, chemical and biological exposures result in occupational diseases, injuries and as many as 1.2 million fatalities each year. Furthermore, as little as 15% of workers in the developing countries have access to occupational health and safety services. Some collaboration between the industrialized and developing countries in the field of OSH has been practiced for 30 years but its volume has been modest compared to other sectors of development assistance. The lessons learned from 30 years of experience are that the most important OSH improving factors in developing countries include legal and policy instruments, national OSH programs, infrastructure for OSH implementation, and OSH services. The establishment of OSH expert human resources, centers serving as engines for research, training, as well as information and registration systems can also be considered as key factors in any such collaboration. A convincing government OSH policy, and close cooperation between social partners and the government are also critical factors that guarantee sustainable OSH programs in a developing country over a long-term basis.

Occupational health services in selected International Commission on Occupational Health (ICOH) member countries.

OBJECTIVES: International organizations have encouraged countries to organize occupational health services (OHS) for all working people. This study surveyed how that objective has been achieved in a sample of International Commission on Occupational Health (ICOH) member countries from all continents. METHOD: A structured questionnaire was sent to ICOH national secretaries in 61 countries. The survey focused on (i) policies and strategies; (ii) systems, institutions, and infrastructures; (iii) contents and activities; (iv) human and other resources; (v) financing; and (v) future priorities in the development of national OHS systems. RESULTS: Of 47 respondents, 70% had drawn up a policy and strategy for OHS and 79% had a national institute of occupational health or safety. The calculated coverage of workers was 19% among the respondent countries. Sixty percent of respondent countries used multiple channels for service provision and 70% provided mixed contents of OHS with preventive and curative services. Almost all (94%) reported availability of multidisciplinary experts, but not in sufficient numbers. OHS is financed through combined employer plus insurance financing in 62% of respondents and through employer financing only in 38%. The countries identified well the needs for future development of OHS. CONCLUSIONS: In spite of documented policies for OHS, only slightly over one third of the surveyed countries had organized OHS for more than 50% of workers. The vast majority of workers of the world are underserved due to four gaps in OHS: implementation, coverage, content, and capacity.

Finnish Institute of Occupational Health (FIOH): prevention and detection of asbestos-related diseases, 1987-2005.

BACKGROUND: Between 1987 and 1992, the Finnish Institute of Occupational Health (FIOH) initiated and implemented the Asbestos Program that aimed at reducing asbestos-related risks. It was a cooperative effort between government authorities, labor market organizations, and health care and labor protection personnel. METHODS: During the Program and its follow-up since 1993 several preventive actions were taken, and considerable new legislation and official instructions were issued. RESULTS: Approximately 200,000 people in Finland have been exposed to asbestos in their work. Through the cooperative efforts of government, labor, health care and worker protection programs, the import of asbestos was ceased in 1993 with a few exceptions. Almost all imports ceased in 2005 following European Union directives. Regulation of asbestos abatement companies has been greatly increased. The occupational exposure limit has been reduced from 2.0 fibers/cm(3) to the present 0.1 fibers/cm(3). Asbestos-related diseases are closely monitored and education of health care providers regarding the occupational source of these conditions is now emphasized. CONCLUSIONS: The success of the primary goal of the Program, a reduction in asbestos-related morbidity, will not be fully realized for many decades.