Marco Maroni's memorial
lecture: Who takes care of
workers' health ? –
international strategies
Timo Leino, DMSc
Senior Expert on Occupational Health Services
19.10.2009
Understanding the problem
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2
Work-related morbidity
Work-related diseases
Public health
Occupational
diseases and
work injuries
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3
60% of disease burden in Europe is accounted by
seven risk factors measured by DALYs
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high blood pressure
tobacco
alcohol
high blood cholesterol
overweight
low fruit and vegetable intake
physical inactivity
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12.8%
12.3%
10.1%
8.7%
7.8%
4.4%
3.5%
Source: WHO
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Attributable fraction for work of some
common diseases
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asthma (male)
lung cancer
coronary heart disease
low back pain
total mortality
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29%
(Karjalainen 2001)
25-30% (Axelsson 2001)
5-10% (Leigh 1997)
50%
(NAS 2001)
6.7 % (Nurminen 2001)
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Health inequalities in some European
countries
Deaths/1 000 persons
Age-adjusted mortality (per 1000 persons) of men aged 30-59 by
socioeconomic group in 1991–95.
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Manual workers
7
Non-manual workers
6
5
4
3
2
1
0
Finland
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Sweden
Norway
Denmark
England/Wales
Italy/Torino
Source: Mackenbach J. et al.., Int J Epid 2003; 32:830-837
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Some present concerns
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social dialogue inadequate
variation and polarisation of health
access to service
access to info
non-coherence of actions in different sectors of society
costs and resources
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A model of health service access
Source: Tanahashi, T. (1978) "Health service coverage and its evaluation", Bulletin of the
World Health Organization, 56(2) : 295-303.
SERVICE DELIVERY GOAL
Process of service provision
Effectiveness Coverage
Target population who do not
contact services
Contact Coverage
Acceptability Coverage
Accessibility Coverage
Availability Coverage
TARGET POPULATION
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Current situation of OH services
• Awareness of occupational safety and health is low
• Coverage less than 15 % with wide variation (4-90%)
• SMEs and self-employed not covered or have very low
coverage
• Workers in agriculture and home industries, temporary
workers, unemployed, migrants and those in informal
economy usually do not have access to OH services
• Content of services does not match with the needs
• Expertice of service providers and quality of services
varies greatly
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Needs and demands
Clients
Demands
Needs
Supply - experts
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Where should be the focus?
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Working population or those in paid jobs?
Population
Non-active
population
Micro companies &
SMEs
Formal empl.
Informal
work
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Unemployed
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Primary prevention or treatment of
diseases?
Today
Very ill or
dependent
In the future?
Very ill or
dependent
Health in danger
OECD: 3%
of total
health
expenditure
goes to
prevention
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Health in danger
Healthy
Healthy
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Work ability or diagnosis of ODs?
Occupational health care is for
• maintenance and promotion of worker's health and
working capacity
• improvement of working conditions and work
• development of work organizations and working cultures
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Less fortunate or well-doers?
When the aim is to improve health of the whole population, the
greatest benefit is gained through advancing health of the less
fortunate groups.
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Health of population
25
20
15
10
5
0
1
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2 status 3(education,
4 income,
5 etc.) 6
Social
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Strategic approaches
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Occupational health and public health
systems
International strategies and collaboration
Societal support systems
Employability
Work ability
Health
OHS
system
Life PHC
style system
Habits
Labour relations
Work
Occupational hazards
and strains
Health behaviour
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Primary prevention
Population strategies
• broad
• target populations
• public health approach
• impact in all exposure
categories
• not optimal for prevention of
high risks
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High-risk strategies
• narrow, exact
• target individuals
• clinical approach
• impact in high-exposure
categories
• ignores other than
individuals at high-risk
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Two possible approaches
Work-related
diseases
Occupational
diseases
Public health approach
• broad population strategies in
prevention
• attention to overall
improvement of work conditions
• in addition to OH experts
primary health care
professionals and other health
care providers important
High-risk approach
• attention to specific
working conditions and workers at risk
• special OH expertice needed
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Objectives of the Community strategy
2007-2012
The European Commission has set itself an ambitious overall
objective: to reduce by 25% the total incidence rate of
accidents at work per 100 000 workers in the EU 27 for the
period 2007-2012
In order to achieve this goal, the following main instruments
are proposed:
• guarantee the proper implementation of EU legislation;
• support SMEs in the implementation of the legislation in force;
• adapt the legal framework to changes in the workplace and simplify it,
particularly in view of SMEs;
• promote the development and implementation of national strategies;
• encourage changes in the behaviour of workers and encourage their
employers to adopt health-focused approaches;
• finalise the methods for identifying and evaluating new potential risks;
• improve the tracking of progress;
• promote health and safety at international level.
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Objectives of the ILO strategy
The ILO adopted in the 91st session of the International Labour
Conference, 2003 a global strategy on OSH to
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reduce occupational accidents and diseases
prevent and control hazards and risks at work
raise awareness of OSH
promote safety and healt culture
foster political committment and tripartite participation
have a systems approach to OSH management
and in 2006:
the Convention 187 and Recommendation 197 on the Promotional
Framework for Occupational Safety and Health
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Objectives of the WHO strategy 20082017
The 60th World Health Assembly in May 2007 urged member
states to take action on workers' health to have:
 National policies, plans and legal framework on workers'
health
 Universal coverage with essential interventions and basic
occupational health services
 Institutional and human capacities and evidence for action
 Community based services and surveillance when health is
endangered due to mining, industrial and agricultural
activities
 Collaboration and concerted action by all national health
programmes relevant to workers' health
 Incorporation of workers' health in all policies at all levels
 Inter-country collaboration
 Reintegration of sick and injured workers into the mainstream
of society
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The European strategy for the prevention
and control of noncommunicable diseases
Adopted by the WHO regional committee for Europe, 2006
• NCD = CVDs, DM, MSDs, cancer, mental health
problems
The strategy promotes:
• population level health promotion and disease
prevention
• target high-risk individuals and groups
• maximizes population coverage of care
• integrates policy and action to reduce inequalities of
health
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Why both public health and high-risk
strategies are important?
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People have a fundamental right to
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know
work
health and safety
good quality health services
Inequalities in health are not inevitable or ethically acceptable
Public health will improve more effectively when the health of
the groups with accumulating problems is promoted
Health inequalities are of considerable significance for labour
policy
Reducing inequalities will help to secure sufficient services as
population ages
Poor health is a factor in social exclusion
Health inequalities have negative economic effects
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What is needed to build up a good OH
system?
• Government leadership
• Tripartite participation and collaboration in all levels (makro,
meso,micro)
• National OHS strategy and plan incorporated in all policies
• Enforcement of legislation
• Institutional framework; health systems development, centres
of excellence on OHS; labour inspection
• Human resource capacities
• Basic and applied research
• Evidence based practices; guidelines
• Simple tools for practice
• Information dissemination; experts/workplaces/public; internet
to raise awareness and to build up a preventiv work culture
• Mainstreaming OSH into trainig and education
• Follow-up and evaluation of progress; national OSH profiles
and indicators
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WHO TAKES CARE OF
WORKERS' HEALTH
Thank You
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