The Global
Occupational
Health Network
ISSUE No. 5
SUMMER 2003
Dear GOHNET members and future members,
This is a special issue written to inform you about the ILO/WHO Joint
Committee on Occupational Health, as well as some ongoing activities.
The Committee first met in 1950 and will meet again from 2-5 December
in Geneva at the ILO headquarters office.
At the WHO 89th Session of the Executive Board in 1992, Dr Nakajima,
then Director-General of WHO, underlined the fact that ‘over the years,
WHO has given insufficient attention to the diseases affecting the entire
spectrum of the working population‘– from working children, to
adolescents, adults and the working elderly’.
In 1995, the ILO/WHO Joint Committee on Occupational Health met
and developed a consensus statement on occupational health. It reads as
follows: ‘The main focus in occupational health is on three different
objectives: (i) the maintenance and promotion of workers’ health and
working capacity; (II) the improvement of working environment and work
to become conducive to safety and health; and (iii) the development of
work organization and working cultures is intended in this context to mean
a reflection of the essential value systems adopted by the undertaking
concerned. Such a culture is reflected in practice in the managerial systems,
personnel policy, principles for participation, training policies and quality
management of the undertaking’.
The Committee found, that with respect to the areas for specific urgent
collaboration identified at the 11 th and prior session, there had been little
real progress achieved in many countries. Accordingly, the Committee
requested more specific reporting directly addressing the identified urgent
areas of collaboration at its subsequent meetings. Then, international
collaboration, co-operation and co-ordination were stressed as the keys to
success in occupational health, and this has not changed to this day. It was
mentioned that intensified areas of co-operation should be identified and
that the basic principle of the ILO/WHO collaboration should be a
‘common goal and complementary strategy’.
The agenda of the next Joint Committee meeting foresees the development
of joint work plans and co-ordination of strategies at global level between
ILO and WHO; discussions about occupational management systems and
the complementary roles of Ministries of Health and Labour. Selected
topics include the African Joint Effort, silicosis, national OHS profiles and
control banding.
In this Newsletter, you will find a selection of articles about related activities
in priority areas. International collaboration is the major theme and
contributors have delivered concrete examples. In addition, we will present
the Occupational Health Programme at WHO Headquarters.
For general comments, questions and future contributions you may contact
the editor:
Evelyn Kortum-Margot (kortummargote@who.int)
Occupational & Environmental Health Programme
Department of Protection of the Human Environment
WHO/OMS
20 Avenue Appia; CH - 1211 Geneva 27
Fax: +41.22.791 13 83
GOHNET
GOHNET NEWSLETTER
The Occupational Health
Programme of WHO
Headquarters
Dr Gerry Eijkemans (eijkemansg@who.int)
Occupational Health Programme
WHO headquarters, Geneva, Switzerland
Background
Working conditions, for the majority of the three billion workers
worldwide, do not meet the minimum standards and guidelines
set by the World Health Organization and the International
Labour Organization (ILO) for occupational health, safety and
social protection. Throughout the world, poor occupational
health and safety leads to two million work-related deaths, 271
million injuries and 160 million occupational diseases per year1.
The majority of the world’s workforce does not have access to
occupational health services; only 10-15 % of the total global
workforce has access to some kind of occupational health services.
The main problem of the absence of occupational health services
is the continuous presence of hazards in the workplace, such as
noise, toxic chemicals, and dangerous machinery, leading to a
huge burden of death, disability and disease. Also, psychosocial
risk factors at work such as stress and violence have become a
major issue in developed countries and are of growing concern
in the developing countries and countries in transition. An
additional problem is the massive inclusion of children in the
workforce, completely unprotected.
1
ILO, 2002
IN THIS ISSUE:
The Occupational Health Programme of WHO Headquarters
1
An example of co-operation with the private sector
3
The ILO/WHO Global Programme on Elimination of Silicosis
3
The WHO/ILO Joint Effort on Occupational Health and Safety
in Africa
5
An example of successful pilot training courses in
South Africa on Airborne Dust
6
An example of a successful pilot training course
in Arusha on Pesticides
8
Control Banding – Practical Tools for Controlling
Exposure to Chemicals
9
The Compendium of Activities of the WHO Network
of Collaborating Centres in Occupational Health
10
The Editor’s Book Tips
10
WHO Contacts
11
GOHNET Member Application Form
12
T h e G l o b a l O c c u p a t i o n a l H e a l t h N e t w o r k
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The WHO Occupational Health Programme
The framework for WHO’s Occupational Health (OCH)
Programme is’The Global Strategy on Occupational Health for All,
which was approved by the World Health Assembly in 1996.
The main priority areas are: strengthening of international and
national policies for health at work; promotion of a healthy work
environment, healthy work practices, and health at work;
strengthening of occupational health services; establishment of
appropriate support services for occupational health;
development of occupational health standards based on scientific
risk assessment; development of human resources; establishment
of registration and data systems and information support and
strengthening of research.
Implementation of the strategy is a task of the OCH Programme
in the WHO Headquarters, the six WHO Regional Offices, and
the Network of over 70 WHO Collaborating Centres (CCs) in
Occupational Health. The network members support each other;
the synergy that is created is much larger than the sum of
individual centres and activities. The CCs are organized in 15
Task Forces to carry out a four-year Work Plan 2002-2005
consisting of at least 130 funded projects. The Work Plan is
periodically updated and the progress is under constant
evaluation. Projects focus on various priority areas in occupational
health and result in products, which range from documents
and brochures in different languages, to training courses for
occupational health personnel and/or students, to the
establishment of questionnaires, guidelines and increased
international collaboration and direct action at national and
regional level, improving the workplaces and reducing hazards.
One of the priorities of the WHO OCH Programme is to
strengthen collaboration with ILO to avoid duplication and to
supplement each other. The ILO-WHO Joint Committee on
Occupational Safety and Health, created in 1948, identified for
its 12th Session, to be held in December 2003 the main areas of
intensified joint activity. These include the joint programme
including the global elimination of silicosis; OSH Management
systems and promotion of training, education and competence
assurance. Important new areas of co-operation include the
African Joint Effort, Control Banding (practical tools for
controlling exposure to chemicals) and the development of
national profiles on occupational health.
the personnel of national and city health departments have been
cut, weakening public health programmes including occupational
health, and health services; there is a drastic shortage of highlevel or specialized professional expertise of all kinds in most
countries. This situation is deteriorating due to the HIV/AIDS
pandemic.
WHO’s strategic directions and activities
Within the framework of the Global Strategy, some of the
activities that the WHO, with its network of collaborating centres
is carrying out are:
■
Through the Regional Offices, countries are encouraged
to adopt national strategies for occupational health and
safety that set priorities and targets, such as reduction of
“high incidence” or “high severity” risks; effective
prevention of disease and injury; elimination of hazards at
the design stage, and improved capacity of business
operators and workers to manage occupational health and
safety
■
Building strategic alliances with partners in the countries
and regions (ministries of health, labour, mining, workers
and employer Organization, universities, Egos) and build
in-house (WHO) alliances with programmes such as Stop
TB, HIV/AIDS, injury prevention, gender, mental health,
child health and to mainstream, from different angles,
occupational health in the health agenda
■
Supporting the inclusion of occupational health on national
and regional development agendas and mobilizing resources
for occupational health with different partners (for example,
explore collaboration with corporate sector)
■
Promote (applied) research (e.g. global burden of
occupational disease, cost-effectiveness of health and safety
interventions in the workplace, hazardous child labour) and
facilitate the exchange of positive experiences on
occupational risk assessment and improving working
conditions
■
Facilitate training and capacity building on occupational
health, involving the collaborating centres and other
partners in the field
■
Support countries in improving data collection and
surveillance systems on occupational injuries and diseases
■
Support direct interventions to improve the safety of health
care workers, particularly protecting them from HIV/AIDS
at the workplace
Future challenges
Major traditional occupational health needs still prevail among
the global workforce. In addition, due to the rapid changes in
economic structures, technologies and demography, new
occupational health needs have appeared, while the traditional
problems such as silicosis, injuries, hearing loss and so on, are
far from being solved. From a public and occupational health
point of view, global competition increases health and safety risks.
Manufacturing firms everywhere face global competition, and
often argue that any additional expenditure on safety or
prevention for workers threatens their viability, instead of
recognizing the expenditure on occupational health as an
investment.
Most people, both in urban and rural areas, work in small-scale
enterprises and in the informal economy. So far, success to provide
those workers with adequate health and safety services, both
preventive and curative, has been limited. Also, in many countries
2
A concrete example of collaboration, and creation of synergies
between different partners and activities, is the WHO-ILO Joint
Effort on Occupational Health and Safety in Africa (AJE), also
in line with WHO’s renewed focus on regional and country
support (see article by the same author on the AJE in this
Newsletter).
The challenge to improve the health of workers worldwide is
great. However, there is a growing understanding and interest
amongst partners to regard occupational health as an essential
element for sustainable development and poverty reduction. The
necessity of synergy and co-ordinated action to make the
difference for the workers in the world is also understood
increasingly.
T h e G l o b a l O c c u p a t i o n a l H e a l t h N e t w o r k
An example of co-operation with the private
sector
Co-operation between the
Occupational Health Programme
and Winterthur Insurance
Company
Dr Gregory Goldstein (goldsteing@who.int)
Occupational Health Programme
WHO headquarters, Geneva, Switzerland
In 2003, WHO commenced a collaborative programme in
occupational health with the Swiss Insurance Company
Winterthur. Two principal foci of the programme are:
(a) Development of WHO guidance on the implementation
of workplace health promotion (WHP)
(b) Cost-effectiveness of interventions for work-related back
disorders as a model for addressing additional topics
(a) Development of WHO guidance on the implementation
of workplace health promotion (WHP)
WHO and collaborating partners will implement state-of-theart workplace health promotion (WHP) pilot projects in a
number of countries and regions with deficient occupational
health conditions. They will also undertake a comprehensive
evaluation of the projects.
The WHP projects will develop and implement processes of good
practice in management of occupational, lifestyle, social and
environmental determinants of health. This involves the
combined efforts of employers, employees and society to improve
the work organization and working environment, increase worker
participation in shaping the working environment, and
encourage personal development. WHP will increase
employability of workers, help workers and their families avoid
poverty, and support public health initiatives against major
diseases, such as musculoskeletal disorders, heart disease, AIDS
and cancer.
(b) Cost-effectiveness of interventions for work-related back
disorders as a model for addressing additional topics
This programme is a joint project by three WHO Collaborating
Centres in Occupational Health (University of Massachusetts
at Lowell in the United States, TNO Work and Employment in
The Netherlands, and the National Institute of Occupational
Health in India) and by the Institute of Public Health Engineers,
India. Funding for this project is provided by Winterthur of
Switzerland, and by WHO.
The goal is to extend the current WHO cost-effectiveness study
of low back pain interventions (which focuses on health benefits
alone) more comprehensively to address.
“net costs”. The costs include changes in productivity and cost
savings due to prevention of illness. The numerator in the costeffectiveness ratio should reflect net costs, defined as the gross
cost incurred in implementing the use of the intervention minus
any cost savings due to avoided costs of compensation and illness
and reduction in cost due to improved productivity and product
quality. The denominator would reflect effectiveness of the
intervention either in terms of the number of healthy years gained
or incidence reduction, as may seem appropriate.
The products include reports describing the literature reviews
and the net-costs economic analyses of interventions for low
back pain within the United States and Europe in selected
industries. A report describing data findings and data-gaps in
India on economic analyses on back pain interventions will be
prepared, and a framework for data collection in selected
industries in India will be developed and piloted. A small
international meeting in Delhi in July is planned to review the
progress of the project, to learn about the situation in India, to
firm up the data collection framework, and to plan for the use
of the framework in case studies.
Additionally, at the meeting, discussions will take place on the
future extension of the model to other workplace topics, and
particularly the application of the net-costs model to the problem
of silicosis. It is anticipated that in 2004, there may be an
extension of the project to extend the economic analyses in
developed countries, to carry out net-costs analyses with data
collected in India, to conduct case studies in additional
developing countries, to prepare scientific articles, and to generate
a user-friendly framework for collection of data in specific settings
to allow local analyses of the net-costs of interventions.
The ILO/WHO Global Programme
on Elimination of Silicosis
Dr Igor Fedotov (fedotov@ilo.org)
InFocus Programme Safework
International Labour Office (ILO), Geneva, Switzerland
The problem
Silicosis is a well-known fibrogenic lung disease. The occupational
origin of silicosis was recognized far back in ancient times. Despite
all efforts to prevent it, this incurable disease still afflicts millions
of workers engaged in hazardous dusty occupations in many
countries. With its potential to cause progressive and permanent
physical disability, silicosis continues to be one of the most
important occupational health problems in the world.
Possibility of elimination
Today, society possesses all the necessary means to combat this
preventable disease and there is no excuse for silicosis persistence
throughout the world. In the absence of effective specific
treatment of silicosis, the only approach towards the protection
of workers‘ health is the control of exposure to silica-containing
dusts. Experience gained by some countries has convincingly
demonstrated that it is possible to reduce significantly the
incidence rate of silicosis with well-organized prevention
programs (Australia, Belgium, Canada, Finland, France,
Germany, Japan, Switzerland, Sweden, United Kingdom, and
the United States). The success of the prevention of silicosis
evidently results from a range of effective and imperatively
preventive measures at different levels.
At the national level : laws and regulations and their enforcement;
adoption of occupational exposure limits and relevant technical
standards; governmental advisory services; an effective inspection;
a well-organized reporting system, and a national action
programme involving governmental institutions, industry and
trade unions
At the enterprise level : application of appropriate technologies to
T h e G l o b a l O c c u p a t i o n a l H e a l t h N e t w o r k
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avoid the formation of silica-containing dust; use of engineering
methods of dust control; compliance with prescribed exposure
limits and technical standards; surveillance of work environment
to assess effectiveness of preventive measures; surveillance of
workers‘ health to detect early development of silicosis; use of
personal protective equipment (as a temporary measure); health
education and training, and co-operation between the employers
and workers.
Technical knowledge, professional expertise, qualified personnel
trained in using appropriate technologies and methods of dust
control, and access to relevant information are needed for
everyday activities to prevent silicosis. Evaluation of technologies,
which are applied in various industrial processes where silica dusts
are present, and methods of dust control are necessary to assess
the efficiency of prevention. They are also the basis of
recommendations for effective measures and technical standards
for a wider use (transfer of technology). In addition, further
epidemiological studies and research are needed to learn more
about the trend of the disease to prevent it effectively.
The ILO/WHO Global Programme
Over the years, the ILO and WHO have paid special attention
to the prevention of silicosis in close collaboration with national
and international organizations, especially with NIOSH (USA)
and the International Commission on Occupational Health
(ICOH). Joint activities in developing countries aim at
prevention of occupational respiratory diseases specifically
targeting silicosis and other pneumoconioses.
A special training program designed to upgrade practical skills
of specialists using the ILO International Classification of
Radiographs of Pneumoconiosis has considerably contributed
to early diagnosis of silicosis in developing countries. The
Program brought together specialists from industrialized and
developing countries.
The ILO/WHO long-term action program to prevent
pneumoconioses has been successfully implemented over the
years. It received a new impetus at the 12th Session of the Joint
ILO/WHO Committee on Occupational Health in April 1995.
The Committee identified the global elimination of silicosis as a
priority area for action in occupational health, inviting countries
to place it high on their political agenda and requesting the ILO
and WHO to establish a joint program of co-operation to achieve
this goal. Later on, the Program received an international
recognition at the 9th International Conference on Occupational
Respiratory Diseases, which was jointly organized by the ILO
and the Government of Japan in Kyoto in October 1997. The
Conference concluded, that the implementation of this
important program should be widely supported throughout the
world.
Within the framework of this collaboration, every effort should
be made to promote the exchange of technical information and
expertise to attain the common goal of the global elimination of
silicosis.
Purpose of the Program
The purpose of the Programme is to offer countries a framework
for a broad international collaboration and to contribute to the
elimination of silicosis as an occupational health problem
worldwide.
The immediate objective of the ILO/WHO Global Programme
is to promote the development by countries of National
Programmes on Elimination of Silicosis and reduce significantly
the incidence rate of silicosis by the year 2015.
The development objective of the ILO/WHO Global Programme
is to establish wide international co-operation on global
elimination of silicosis and eliminate it as an occupational health
problem by the year 2030.
Means of action
The principal means of action of the Program are:
(i) to catalyse long-term efficient co-operation between
industrialized countries, developing countries and
international organizations;
(ii) to promote the establishment by countries of National
Programmes on Elimination of Silicosis accompanied by
National Action Plans;
(iii) to provide technical assistance to countries in developing
models of National Programmes and National Action Plans
on Elimination of Silicosis and support their
implementation.
Program development
With due attention paid to the local conditions, a National
Program on Elimination of Silicosis should comprise the
following main elements:
(i) socio-economic context of the problem of silicosis in the
country;
(ii) economic incentives for the prevention of silicosis;
(iii) identification of target groups of workers at risk;
(iv) definition of a prevention strategy;
(v) involvement of principal partners in the implementation
of the program;
(vi) tripartite consultation and co-operation;
(vii) institutional framework required for the program
implementation;
Definition of the Program
(viii) mechanism for monitoring and evaluation;
The ILO/WHO Global Program on Elimination of Silicosis is
an international technical co-operation program designed to assist
countries in their action to combat silicosis and eliminate it as
an occupational health problem worldwide.
(ix) national standards and link with international standards;
By establishing this Global Program, ILO and WHO have shaped
a policy perspective for their member States for a wide
international collaboration, which should be governed by a true
partnership between industrialized and industrializing countries.
4
(x) relationship with the protection of the general environment.
At the national level, the Program is considered as a national
consensus policy document for priority action in a specific area of
occupational health outlining the roles and responsibilities of
partners.
T h e G l o b a l O c c u p a t i o n a l H e a l t h N e t w o r k
The National Action Plan on Elimination of Silicosis can
accompany the National Program and be prepared as a more
detailed document in the form of a compilation of required
actions necessary to achieve targets set up by the National
Program. Among others, it should indicate actions to be taken
to mobilize resources, contributions in kind, exchange of
technical information and expertise, institutional framework and
co-operation, as well as the establishment of partnerships
necessary for the successful program implementation.
The ILO/WHO Global Program on Elimination of Silicosis is
targeting countries that are willing to join the Program and
request the establishment of national programs. It will be
gradually expanding to include an increasing number of
countries. Today, the national campaigns to eliminate silicosis
are gathering momentum in China, Vietnam, Thailand, India,
Indonesia, Lebanon, South Africa, Poland, Russia, Ukraine,
Brazil, Venezuela, Turkey, Mexico and the United States.
Concluding remarks
Despite many obstacles, the idea of global elimination of silicosis
is technically feasible. Positive experience gained by many
countries shows that it is possible to reduce significantly the
incidence rate of silicosis by using appropriate technologies and
methods of dust control. The use of these technologies and
methods has proved to be effective and economically affordable.
Assistance provided within the framework of the ILO/WHO
Global Program will contribute to the upgrading of national
capacities to prevent silicosis. Countries will need to ensure that
all necessary measures for the prevention of the disease be taken
at the national and enterprise levels. It is strongly believed, that
the goal of global elimination of silicosis is realistic and can be
achieved through a very broad international collaboration
supporting national action programs and multi-disciplinary
efforts of occupational safety and health professionals, as well as
those from all economic sectors concerned.
The WHO/ILO Joint Effort (AJE) on
Occupational Health and Safety in
Africa
Dr Gerry Eijkemans (eijkemansg@who.int)
Occupational Health Programme
WHO headquarters, Geneva, Switzerland
Background
The framework of co-operation between ILO and WHO is set
by the Joint ILO/WHO Committee in the field of occupational
health. It is within this context that the African Joint Effort was
born. A workshop in Africa (Pretoria, South Africa, October
2000) of interested national and international institutions on
strengthening occupational health in Africa, concluded that a
broad African initiative in Occupational Health and Safety
(OHS) with leadership from WHO and ILO was opportune,
because it had a huge dynamic potential for improving the health
of workers in the region. This initiative would be the liaison for
all partners, in- and outside Africa, to join efforts and streamline
and co-ordinate activities. It would also facilitate fundraising.
The first official consultation, to develop a framework for the
joint effort in occupational health, took place in the WHO
Regional Office, Harare in March 2001. Agreement was reached
on the name of the initiative:
WHO/ILO Joint Effort on Occupational Health and Safety in Africa
(AJE), and on the development objective: Improve conditions and
environment of work in Africa, thus reducing the burden of
occupational diseases and injuries, through intensified co-ordination
of occupational health and safety activities.
Furthermore, the meeting developed a framework for this joint
effort, as well as a work plan with activities in four areas:
1.
Human resource development focused on capacity building
2.
National policies, programmes and legislation
3.
Information, research and awareness raising
4.
Promotion of OHS to protect workers in particularly
hazardous occupations and vulnerable groups in the
informal sector (women and children).
Gradually, partners from in- and outside Africa, became involved
in concrete activities of the AJE, particularly in the field of
training, and information sharing. The AJE website was created
(www.sheafrica.info), an AJE newsletter is produced periodically,
and practical interventions are undertaken on groups especially
exposed to hazards. In the WHO Collaborating Centre Network,
a special Task Force (Task Force 2: Intensive partnership in Africa)
was created on collaboration in Africa. A network of over hundred
interested partners, institutions and individuals, exists at the
moment.
Two high-level meetings were held in Geneva in January and
March 2003, with the participation of Regional and Programme
Directors of WHO and ILO, who restated their strong political
commitment. The convenience of linking the AJE to the regional
integration processes was particularly highlighted during these
meetings. The AJE was considered by all parties to have a huge
potential for collaboration, touching on all important
development issues of the region, including poverty reduction,
sustainable development and the HIV/AIDS epidemic. In those
meetings it was also stressed that it was convenient to include
the Eastern-Mediterranean region in the AJE, thus ensuring a
Pan-African effort.
A meeting took place in Cairo in April 2003 between WHO
and ILO to discuss the next steps to be taken in the AJE. The
meeting decided on two issues:
1. Formalization of the Joint Effort : The Regional directors of
ILO and WHO will sign a letter of agreement defining the
objectives and areas of co-operation by end of August 2003.
After signing the letter of agreement, ILO and WHO will inform
countries of the existence of the AJE, through a joint official
communication. This communication will also be used to
identify strong possible areas of work and interest in collaboration
with constituents.
2. Formalization through an official launching : The abovementioned letter of agreement to the countries will be considered
as a launch. Furthermore, the organization of sub-regional
meetings (aimed at making the AJE known, show results, and
increase visibility) with international and national institutions
and donors in 2004 was discussed.
T h e G l o b a l O c c u p a t i o n a l H e a l t h N e t w o r k
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Proposed joint activities
Traditionally, the AJE has been mainly involved in horizontal
co-operation, supporting institutions, countries and sub-regions
to organize activities that go beyond the scope of a particular
country. This is, for example, how the website, the clearinghouse,
and the international training courses started. The work plan,
that was developed in 2001 in Harare, reflects this approach.
This work plan is in the process of being evaluated and updated.
However, based on the meetings with the regional and executive
directors, the convenience of opening the scope of the AJE to
particular joint country support became evident. It is in this
light that the Cairo meeting focused on developing this new,
vertical component of the AJE.
A preliminary selection of countries was made, based on specific
criteria (regional distribution, ongoing work of WHO and ILO,
established capacity in the countries). The selection of the
countries will be made public after discussion with the relevant
stakeholders. The first step in the country approach will be to
hold conceptual workshops with ILO/WHO experts with their
constituents and possible donors in all selected countries. The
exact content of the workshop will be determined according to
the development stage, priorities and opportunities in each of
the countries.
The objective of such national workshops will be to reach
consensus on the need and content of the national profiles, to
identify emerging elements for national policy and a plan of
action, to identify and decide on action in specific industrial
sectors where both organizations could have a joint impact , and
to define priority areas for the short- and long-term perspective.
The meeting agreed, that National Profiles were important for
the establishment of national policies on OHS and that they
could constitute the first activity on which to concentrate cooperation. WHO and ILO have started this work in some
countries.
For more information on the AJE, please consult
www.sheafrica.info or contact the author.
An example of successful pilot
training courses in South Africa
A Report on Pilot Courses on Hazard Prevention
and Control in the Work Environment: Airborne
Dust, in South Africa, 10-28 March 2003
Dr Sophia Kisting (skisting@cormack.uct.ac.za)
University of Cape Town, South Africa
Background
Under the umbrella of the WHO/ILO Joint Effort for OHS in
Africa, pilot airborne dust control courses were held in South
Africa. Facilitators came from the National Institute for Working
Life (NIWL), Sweden and the Finnish Institute for Occupational
Health (FIOH) to contribute to regional efforts for greater
control of airborne dust. Ing-Marie Andersson, Gunnar Rosen
and Lars-Erik Byström of the NIWL and Hannu Riipinen from
the FIOH facilitated the courses. In Cape Town the course was
6
jointly hosted by the Occupational and Environmental Health
Research Unit (OEHRU) at the University of Cape Town and
the Peninsula Technikon. In Johannesburg it was hosted by the
National Centre for Occupational Health (NCOH). The
OEHRU and the NCOH are in the process of becoming WHO
Collaborating Centres in Occupational Health.
Many countries in the Southern African region have a high
prevalence of preventable airborne dust related diseases. Historic
and economic factors, as well as differential control standards
globally, play an important role in the continued exposure of
workers and communities to airborne dust. These factors were
taken into consideration in the planning and co-ordination stages
of the courses.
Organisational Aspects
Sponsorship The NIWL and the FIOH sponsored the facilitators,
as well as the development and preparation of the course
materials. The University of Michigan, Fogarty International
Center, Southern African Programme in Environmental and
Occupational Health, covered the cost of ten participants. WHO
under the umbrella of the WHO/ILO Joint Effort for
Occupational Health in Africa, as well as the Occupational and
Environmental Health Research Unit (UCT), supported the
organization and co-ordination of the courses.
Course Activities
Workplace Visits : During the week of 10-14 March different
workplaces and industries in and around Cape Town were visited.
The facilitators incorporated the information gathered locally
into the course material. Members from these workplaces were
invited to participate in the workshops and their participation
in the discussions made an important contribution to the
practical orientation of the workshops.
Participants : There were 30 participants in the Cape Town course
(including 6 students) and 28 participants in Johannesburg. Eight
colleagues from SADC member states (other than South Africa)
participated. Their experience of airborne dust challenges
enriched the discussions. Industrial hygienists, trade unionists,
environmentalists, senior university/technikon lecturers and
researchers, labour inspectors, private occupational health
consultants, occupational health nurses and doctors and a few
occupational and environmental health students joined the
courses.
This integrated approach was deliberately encouraged and
ensured that participants involved in different aspects of airborne
dust control came together to share practical experiences and to
encourage a team approach at workplaces to prevent exposure
to airborne dust.
The Courses : The first two days of the courses were based on the
WHO Prevention and Control Exchange Programme (PACE)
document on airborne dust to be found at the following location:
http://www.who.int/peh/Occupational_health/dust/
dusttoc.htm. The third day covered the PIMEX Method http:/
/www.niwl.se/pimex/.
The facilitators are from countries which managed to have good
control of airborne dust and where the incidence of diseases such
as silicosis have been reduced to less than 5 per year. What the
facilitators stressed repeatedly was the central role played by
workers engaged in dusty industries in achieving these remarkable
T h e G l o b a l O c c u p a t i o n a l H e a l t h N e t w o r k
results in their countries. The important principle they imparted
was that the central focus of dust prevention should be the
informed participation of workers in dust control programmes.
Technical measures are important but constitute but one aspect
of a team approach to dust control programmes.
The teaching material included printouts of the power-point
slides used by the facilitators and video clips from different
workplaces. This worked well and encouraged participation.
There was good interaction and active participation in the small
group discussions, as well as in the feedback sessions.
The PIMEX Course : PIMEX is a method used to visualize
airborne pollutants as part of a strategy to control exposure. A
strategy for its use called Workplace Improvement Strategy by
PIMEX was presented during the course. There was much
enthusiasm about the possibilities of the immediacy of the
PIMEX method in dust control programmes.
Feedback from participants
The feedback on the course was enthusiastic and mostly positive
and participants indicated that they could use the course
information in different ways.
Concerns expressed by participants included…
…the required technology may not be readily available in
resource-poor countries; more information on the relationship
between exposure and diseases is needed; financial constraints
especially in the Public Sector are possible limitations to the use
of the PIMEX Method; dust measurement needs to be covered
in future courses.
Policy Implications: Government departments need credible
information on which to base decisions concerning risk
assessment and OHS. Procedures to arrive at conclusions are
expensive, time consuming, and exact details are required to make
informed decisions. It is foreseen that the PIMEX Method will
assist with risk assessment for airborne dust and facilitate the
process of arriving at informed decisions with regard to certain
policies.
SADC Member States: Participants from Botswana, Lesotho,
Malawi, Namibia, Swaziland and Zambia all indicated that the
information and course material obtained will be useful to
supplement their teaching at university, technikon and
inspectorate level. It will also be useful in institutions introducing
new teaching curricula.
Teaching and curriculum development: The development of OHS
training tools that transcend language and education barriers
presents an ongoing challenge to OHS personnel. The course
material and the PIMEX method provide powerful education
and training tools that can be used to teach workers from different
language backgrounds or different literacy levels.
The PIMEX Method is a most innovative means of raising
awareness. Immediate feedback and location to the source of
exposure makes it one of the most powerful methods to
demonstrate exposure and intervene effectively. It will be useful
in teaching especially in analysis of problems to incorporate in
design.
Trade Unions:
Southern African Trade Union Coordinating Committee
(SATUCC): The material will be of great help to strengthen
existing OHS teaching material. The inclusion of images from
Southern Africa is very important, as it helped participants to
experience the relevance of the situation with which they can
identify. It will be ensured that a dust lamp is used in future
workshops and be encouraged that a dust lamp is used on every
visit to workplaces.
National Union of Mineworkers (NUM): The participation of
Trade Unions in airborne dust control programmes is of
fundamental importance as it is our members who are getting
sick and we need to be part of the solution. This course has been
inspiring. We need to look at how many people are getting sick,
we need to assess which production processes are making them
sick and intervene effectively. The PIMEX method is a powerful
tool for shop floor reality and will be useful in the construction
industry.
Research
The PIMEX method and the course material are good tools for
lecturers and students to use as part of their research projects. In
the mining sector the course material will be useful for further
research and intervention for the elimination of silicosis. A
research project has been started and the course information has
already assisted with brainstorming and networking for the
research. Information gathered from the research will be used
for intervention purposes. Staff members at the bakery were in a
position to see first hand where they can improve on dust control
efforts. Course material will be extremely useful for Masters
courses and will be used for a planned copper and arsenic
intervention study.
Informal Sector
Course participants, who have done work in the informal sector,
consider the visualisation method to be a useful tool for teaching,
for awareness raising and for preventive purposes in the sector.
Given the absence of OHS laws and regulations in the informal
sector, the marked variation in the nature of exposures, with
women and children often the worst affected. The course
information will be very suitable for intervention purposes but
also to gather information to influence policies.
Public lectures
The facilitators gave public lectures both in Cape Town and
Johannesburg. They discussed the important steps their countries
(Finland and Sweden) used to work towards the elimination of
silicosis as an occupational disease. The information was a
significant addition to that already provided in the course work.
The history of the steps taken by Sweden and Finland to work
towards the elimination of silicosis is of significance for countries
such as South Africa where silicosis and associated tuberculosis
are not yet controlled.
It was of central importance to hear first hand how two other
countries started to make systematic progress year by year when
resources were focused on the control of dust to prevent exposure
and not only on the diagnosis and treatment of silicosis once it
had occurred.
Observations and reflections on the course
■
The airborne dust courses provide a beautiful example of
North-South and South-South collaboration, goodwill
T h e G l o b a l O c c u p a t i o n a l H e a l t h N e t w o r k
7
■
■
■
amongst participating individuals and co-operation among
diverse institutions.
The lack of adequate infrastructure in several countries and
unequal access to information and communication
resources between and within countries must be recognized
by OHS institutions as a challenge to be overcome in the
interest of better health and safety.
Workers need to be an integral part of the process of dust
control.
The facilitators provided a striking example of a lack of
competitiveness and great willingness to share information
and resources without these being linked to financial gain.
Recommendations
The training material used and refined during the pilot
courses be compiled into a training course shall be
disseminated more widely via WHO.
■ As part of building and strengthening Collaborating
Centres internationally, the NIWL, FIOH and the WHO
consider running the course in different regions to
strengthen preventive dust control measures globally. Based
on the experience of the current course, it is important for
the facilitators to do the initial training of trainers and help
to establish a core of teachers familiar with the enabling
methods under discussion.
■ There should be a follow-up course preceding the 2005
IOHA 6th International Conference, which will take place
in Pilanesberg National Park in South Africa. This
conference provides an ideal opportunity to consolidate
the pilot airborne dust course and provide participants and
others from Southern Africa with the opportunity to present
information on practical interventions undertaken, as well
as possible training in dust measurement techniques.
■ There will be ongoing support with regard to information
and advice for different institutions keen on implementing
the methods learnt during the course. There will also be
discussions in the different institutions about starting and
maintaining An Airborne Dust Control Network.
■
Conclusion
There is great value in international collaboration where
experience and knowledge is shared and where we learn from
the strengths and the challenges facing different countries in their
quest for a healthier and safer work environment. The experience
of the airborne dust courses indicate that the sharing of
information and experiences is increasingly taking place on the
basis of equality and in the spirit of addressing global problems
in an informed manner. It is foreseen that the networking, that
has started with the current courses, will be strengthened and
consolidated in the coming years.
An example of a successful pilot
training course in Arusha on
Pesticides
A Report on the Pesticide Training Course in
Arusha, 24– 29 March 2003
Dr Mohamed F. Jeebhay (mjeebhay@cormack.uct.ac.za)
Occupational and Environmental Health Research Unit
University of Cape Town, South Africa
The course was organised as part of the University of Michigan
Fogarty International Centre grant to develop capacity in
occupational and environmental health in Southern Africa. It
was hosted by the Tropical Pesticides Research Institute (TPRI),
and co-facilitated by Leslie London from the University of Cape
Town, and James Matee with the assistance of Vera Ngowi from
the TPRIj. WHO provided financial support.
The course was officiated by high level public servants including
a representative of the Minister of Agriculture and Food Security,
and closed by a representative of the Arusha Regional
Commissioner, indicating the level of importance accorded to
the course by local partners.
Participants : There were 15 participants, mainly from Tanzania,
including delegates from Sudan, Kenya, Mozambique and two
participants from South Africa. The spread of participants was
impressive, including a few medical graduates working in
occupational health, some inspectors/licensing officials,
university academics and agronomic researchers.
Course : After a general introduction on the first day, the course
themes were leading into health effects (day 2), exposure (day
3), surveillance (day 4) and policy issues (day 5). The Saturday
involved a field trip to a chemical factory and a flower farm.
The course was marked by a lot of press coverage. Although it
involved some financial outlay to cover the journalist’s costs,
this idea worked well, and should be borne in mind for future
courses in the region.
On the first day, some of the evaluations appeared to express
some reservations about the unstructured format of teaching
(they preferred handouts and formal teaching), but within a day
or two, all evaluations seemed to indicate great enjoyment and
appreciation of the teaching methodology, which included
intensive student participation.
The quality of the inputs was high. Those who had been asked
to teach on the course, had prepared their material well, and
clearly thought carefully about the audience. TPRI staff made a
considerable contribution to the teaching of course.
Nida Besbellin from WHO headquarter’s International
Programme for Chemical Safety (IPCS), was keen to see input
from the course organisers into a planned WHO Manual, and
then later, the development of the course into a CD package.
Evaluations and feedback: It was pointed to the fact that the course
covered too much material. Lack of time for discussion was
often cited in feedback. Future courses should be less ambitious
in the breadth of material covered, or have a more narrow focus.
However, feedback was almost uniformly positive. Participants
identified benefits from both the content and the format of
teaching and valued the opportunities to share experiences
8
T h e G l o b a l O c c u p a t i o n a l H e a l t h N e t w o r k
between countries. They particularly enjoyed practical sessions
(risk perception and communication; cholinesterase testing in
the laboratory), the critical appraisal exercise and valued the slide
presentation and discussion for being realistic.
Control Banding – Practical Tools
for Controlling Exposure to
Chemicals
Worth noting is the discussion on training and safe use, which
was described as a “revolutionary way of looking at pesticide
problems”. One participant reported that in the information
session “I learnt for the first time how to do a literature search
on the internet”. This should be kept in mind for future courses
in which more time should be spent on developing hard skills.
Carolyn Vickers (vickersc@who.int)
International Programme on Chemical Safety
WHO headquarters, Geneva, Switzerland
with Heather Jackson (heather.jackson@lyondell.com)
President of IOHA (International Occupational Hygiene Association)
and Occupational Hygienist
It was also mentioned that more training should be provided,
either as additional courses examining in-depth areas (such as
acute poisoning surveillance, pesticide toxicology, chronic health
effects, biological monitoring training, and so forth), or it should
continue to exist as a general course repeated yearly in SADC
countries.
Recommendations
●
One of the points to emerge in discussions on acute
poisoning was the need for training of health care providers
in the region in the diagnosis and management of pesticide
poisoning, both acute and chronic. Since the WHO/IPCS
representative was present, it was possible to get an informal
commitment to pursue strategies to obtain training of
trainers supported by WHO in the region with the aim to
improve awareness, monitoring and surveillance of
pesticide-related morbidity and mortality.
●
Research and description of the extent of the problem in
the region is desperately needed.
●
The participants should stay in contact and follow-up
information on the activities of Fogarty and other capacity
building initiatives should be made available.
●
●
●
●
The WHO/IPCS representative at the meeting, Nida
Besbellin, was particularly interested in setting up links with
African centres for surveillance activities for acute pesticide
poisoning. The course offered an opportunity to join
different initiatives – the Fogarty UoM programme in the
region, the SIDA Occupational Health Capacity Building
initiative, and the WHO surveillance project. It was
indicated that the CDC was also interested in setting up a
link for acute pesticide poisoning surveillance, particularly
in Tanzania.
Numerous participants expressed interest in training
towards further degrees – PhDs and Masters. Hence, the
Fogarty plan to get twinned supervision for higher degrees
locally would be in demand.
Two areas that emerged as needing extensive input were
the critical appraisal of articles, and use of the Internet to
support research. These are generic research skills, not
specific to pesticides, but are clearly critical to enhancing
key occupational health skills. Future courses should make
these integral elements of the training, or even focus
specifically on such skills, as major a theme.
The course allowed us to continue to build South - South
collaboration and to provide support for potential future
African - Central American links through the SIDA project.
Growth in the use of chemicals in small- and medium-size
enterprises (SMEs) and in emerging economies, where access to
people with the experience to assess and control exposure to
chemicals is limited, has led to the development of a new
approach to the control of chemicals, called Control Banding
(1). Control Banding uses information from suppliers of
chemicals. It takes users through a series of simple steps to choose
practical control solutions for airborne contaminants that should
reduce exposures to levels, which present no danger to health.
The information needed from suppliers is in the simple form of
‘Risk phrases’, also called ‘R phrases’. Such phrases are currently
required in the European Union, and with the implementation
of the Globally Harmonised System (GHS) for Classification
and Labelling, will appear on products sold worldwide.
The concept of Control Banding was developed by the UK
Health and Safety Executive (HSE) in its COSHH Essentials
package (2). COSHH stands for Control of Substances Hazardous
to Health. An internationalized version was developed by the
International Labour Organization (ILO) in conjunction with
the International Occupational Hygiene Association (IOHA),
and is called the ‘ILO Toolkit’.
R phrases are assigned to chemicals based on their health hazards,
for example, whether the chemical is a sensitiser or may cause
cancer. The user finds R phrases on the label or Material Safety
Data Sheet provided by the chemical supplier. Based on the R
phrases for a particular chemical, the Control Banding approach
then assigns a ‘hazard group’. The next step is to consider the
exposure potential in the workplace being assessed, for example,
the quantity used and whether the substance is a solid or a liquid.
Thus, the user is guided through a risk assessment and ultimately
the selection of workplace controls.
Control Banding uses three broad control approaches: general
ventilation; engineering control; and containment. However, it
is recognized, that in some cases specialist advice will be needed
and this is control option 4.
The user takes the hazard group, quantity and level of dustiness/
volatility and matches them to a control approach using a simple
table. The controls are described in control guidance sheets,
which comprise both general information and, for commonly
performed tasks, more specific advice. This approach allows
businesses without ready access to specialist advice to effectively
reduce the exposures of its employees to the chemicals used.
International Application – The ILO Toolkit
Under the auspices of the International Programme on Chemical
Safety (IPCS (comprising WHO/ILO/UNEP)), an international
technical group has been established to further develop the ILO
Toolkit and to facilitate its application globally. Partners in this
effort include: the ILO; World Health Organization (WHO);
T h e G l o b a l O c c u p a t i o n a l H e a l t h N e t w o r k
9
IOHA; the UK HSE; and the US National Institute of
Occupational Safety and Health (NIOSH). In addition, a
number of WHO Collaborating Centres in Occupational Health
in countries have committed to piloting the Toolkit, which
involves translation and refinement of control recommendations
based on local conditions.
The next steps for the technical group are to develop an
implementation strategy, which will include activities such as
training and translation into local languages. Further information
on Control Banding can be found on the ILO website: http://
www.ilo.org/public/english/protection/safework/ctrl_banding/
index.htm, the IOHA website www.ioha.com, and the UK HSE
site which includes an internet based version of the COSHH
Essentials www.coshh-essentials.org.uk . The IPCS website is at
http://www.who.int/pcs/.
Abbreviations
CCs = WHO Collaborating Centres
HSE = UK Health and Safety Executive
IOHA = International Occupational Hygiene Association
ICSCs = International Chemical Safety Cards. These cards
currently contain EU R phrases and consideration is being given
to the need to include the GHS phrases in future.
Task Force 3:
Task Force 4:
Task Force 5:
Task Force 6:
Task Force 7:
Task Force 8:
Task Force 9:
Task Force 10:
Task Force 11:
Task Force 12:
Task Force 13:
Task Force 14:
Task Force 15:
Child labour/adolescent workers
Elimination of silicosis
Health care workers
Health promotion activity
Psychosocial factors at work
Promotion of OSH in small enterprises and in
the informal sector
Prevention of musculoskeletal disorders
Preventive technology
Training programmes and modules
Internet resources and networks
National and local profiles and indicators
Economic evaluation of interventions
Global burden of disease
Details of individual projects under these headings can be found
on our website:
http://www.who.int/oeh/OCHweb/OCHweb/OSHpages/
CCWorkPlan/Compendium/Compendium_files.htm.
The Compendium will be printed in June and requests for copies
can be addressed to the editor.
References
1.
2.
Oldershaw PJ. Control Banding – A practical approach to
judging control methods for chemicals; Journal of Preventive
Medicine 2001;9(4):52-58
Compendium of
Activities of the WHO
Collaborating Centres
in Occupational Health
UK Health and Safety Executive. COSHH Essentials – Easy steps
to control chemicals.
Network of Collaborating Centres
Work Plan 2001-2005
15 Task Forces
Protection of the Human Environment
Occupational and Environmental
Health Programme
The Compendium of Activities of
the WHO Collaborating Centres in
Occupational Health
The Work Plan 2001-2005 of the Network of the WHO
Collaborating Centres in Occupational Health was developed
over the period 2000 - 2001, and was reviewed during the Fifth
Network Meeting in Chiangmai by the participating
Collaborating Centres in November 2001. The plan incorporates
the plans and commitments of the Occupational Health
Programme, the Regional offices and the WHO Collaborating
Centres in Occupational Health, for the implementation of the
Global Strategy on Occupational Health for All. The participating
Collaborating Centres expressed their willingness to contribute
to specific tasks contained in the Work Plan.
The centres formed themselves in 15 Task Forces, which allowed
a Task Force of Collaborating Centres to be created for each of
15 priority areas, to carry out the Work Plan. Projects focus on
various priority areas in occupational health, and will result in
products which range from documents and brochures to training
courses for occupational health personnel and/or students, from
translation of occupational health materials to the establishment
of questionnaires, guidelines and increased international
collaboration. The Task Forces cover, in between others, the
areas specifically discussed in this Newsletter.
The 15 Task Forces comprise the following areas:
Task Force 1: Guidelines
Task Force 2: Intensive partnership in Africa
10
June 2003
World Health Organization
www.who.int/oeh
Last, but not least…..
The Editor’s Book Tips
Collaborating Centres in Occupational Health have, in
collaboration with the Occupational Health Programme, already
produced booklets in the Protecting Workers’ Health series within
the Global Work Plan of the Network. To date, five booklets
with different foci have been published on
■
Preventing Health Risks from the Use of Pesticides in
Agriculture
■
Understanding and Performing Economic Assessments at
the Company Level
■
Work Organisation and Stress
■
Psychological Harassment at Work, and
■
Preventing Musculoskeletal Disorders in the Workplace.
For copies you can either contact the editor of this Newsletter or
consult our website (www.who.int/oeh) under the rubric WHO
OSH Documents.
All publications will be available electronically in French and
Spanish.
T h e G l o b a l O c c u p a t i o n a l H e a l t h N e t w o r k
CONTACTS
WHO headquarters
Regional Office for the Eastern Mediterranean
(EMRO)
(www.who.sci.eg)
Cairo, Egypt
Fax: (202) 670 24 92 or 670 24 94
e-mail: arnaouts@emro.who.int
(www.who.int/oeh/)
Department of Protection of the Human
Environment
Occupational and Environmental Health
Programme
Geneva, Switzerland
Fax: (41) 22 791 1383
e-mail: kortummargote@who.int
WHO
Regional
Advisers
Occupational Health:
Regional Office for Europe (EURO)
(www.who.dk)
Copenhagen, Denmark
Fax: (45) 39 17 18 18
in
Regional Office for Africa (AFRO)
(www.whoafr.org/ )
Brazzaville, Congo
Fax: (242) 81 14 09 or 81 19 39
e-mail: pulet@afro.who.int
Regional Office for the Americas (AMRO)
(www.paho.org/ )
Pan American Health Organization (PAHO)
Washington DC, USA
Fax: (202) 974 36 63
e-mail: tennassm@paho.org
Regional Office for South-East Asia (SEARO)
(www.whosea.org/)
New Delhi, India
Fax: (91) 11 332 79 72
e-mail: caussyd@whosea.org
Regional Office for the Western Pacific (WPRO)
(www.wpro.who.int/)
Manila, Philippines
Fax: (63) 2 521 10 36 or 2 526 02 79
e-mail: ogawah@wpro.who.int
Editor: E Kortum-Margot
Design: J-C Fattier
© World Health Organization 2003
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T h e G l o b a l O c c u p a t i o n a l H e a l t h N e t w o r k