Moving knowledge of global burden into preventive action.

BACKGROUND: Estimation of the global burden of disease and injury due to selected occupational factors is a topic of interest to policy makers, governments, and international bodies. The World Health Organization (WHO) has implemented a Comparative Risk Assessment (CRA) to estimate risk to exposed populations. METHODS: Estimates of the risk factor-burden relationships by age, sex, and WHO subregion were generated. Risk measurements (relative risks and mortality rates) for the health outcomes were determined primarily from studies published in peer review journals. The resulting burden was described as the attributable fraction of disease or injury, using both mortality and disability-adjusted life years (DALYs). RESULTS: The papers in this issue include discussions of worldwide mortality and morbidity from lung cancer, leukemia, and malignant mesothelioma arising from occupational exposures; mortality and morbidity from asthma, COPD, and pneumoconiosis; the global burden of low back pain; exposure to contaminated sharps injuries among health care workers; noise-induced hearing loss; and occupational injuries. Three papers focus on economic issues: estimation of net-costs for prevention of occupational low back pain; cost effectiveness of occupational health interventions; and the cost effectiveness of interventions in the prevention of silicosis. CONCLUSIONS: The magnitude of the occupational health burden in the world is overwhelming, and the causes and mechanisms are multiple and complex. Commitment from all stakeholders is imperative to translate economic progress into sustainable human development and well-being.

Developing regional workplace health and hazard surveillance in the Americas

An objective of the World Health Program at the Pan American Health Organization (PAHO) is to strengthen surveillance in worker's health in the Region of the Americas in order to implement prevention and control strategies. To date, four phases of projects have been organized to develop multinational workplace health and hazard surveillance in the Region. Phase 1 was a workshop held in 1999 in Washington, D. C. for the purpose of developing a methodology for identifying and prioritizing the top three occupational sentinel health events to be incorporated into the surveillance systems in the Region. Three surveillance protocols were developed, one each for fatal occupational injuries, pesticide poisoning, and low back pain, which were identified in the workshop as the most important occupational health problems. Phase 2 comprised projects to disseminate the findings and recommendations of the Washington Workshop, including publications, pilot projects, software development, electronic communication, and meetings. Phase 3 was a sub-regional meeting in 2000 in Rosario, Argentina, to follow up on the progress in carrying out the recommendations of the Washington workshop and to create a Virtual Regional Center for Latin America that would coordinate the efforts of member countries. Currently phase 4 includes a number of projects to achieve objectives of this Center, such as pilot projects, capacity building, editing a compact disk, analyzing legal systems and intervention strategies, software training, and developing an internet course on surveillance. By documenting the joint efforts made to initiate and develop Regional multinational surveillance of occupational injuries and diseases in the Americas, this paper aims to provide experience and guidance for others wishing to initiate and develop regional multinational surveillance for other diseases or in other regions (AU)