Directory UMM :Data Elmu:jurnal:E:Environmental Management and Health:Vol08.Issue5.1997:

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[ 1 9 9] Enviro nme ntal Manage me nt

and He alth 8 / 5 [1997] 1 9 9 –2 0 1

Occupational health for all: the strategy of the World

Health Organization

M ikhail Ivanovich M ikheev

Offic e o f Oc c upatio nal He alth, Wo rld He alth Organizatio n, Ge ne va, Switze rland

Observes that the World Health Organization (WHO) has promoted the goal of “ Health for All” since 1977. The Workers’ Health Pro-gramme of WHO aims to: strengthen international and national policies for health at work; develop a healthy work environment; develop healthy work practices and health promotion; strengthen occu-pational health care and services; establish appropri-ate support for occupational health; develop occupational health standards which are science-based; develop human resources for occupa-tional health; establish appro-priate information systems and raise public awareness; strengthen research; foster collaborative efforts.

Introduction

T h e con s t it u t ion a l ob ject ive of t h e Wor ld H ea lt h Or ga n iza t ion is t h e “a t t a in m en t by a ll p eop les of t h e h igh es t p os sible level of h ea lt h ”. Ba s ed on t h is gen er a l ob ject ive, WH O’s goa l of “H ea lt h for All” h a s b een a d op t ed by t h e Wor ld H ea lt h Ass em bly in 1977, a n d s in ce t h a t t im e “H ea lt h for All” h a s b ecom e a n a s p ir a t ion a l goa l for a ll cou n t r ies. It m a d e a n im p or t a n t con t r ibu t ion t o t h e a ch ievem en t s of b et t er h ea lt h t h r ou gh ou t t h e wor ld . Du r in g t h e la st d eca d e, im p r ovem en t s in b a sic h ea lt h in d ica t or s h ave b een

ob ser ved : for in s t a n ce, in cr ea se in life exp ect a n cy, d ecr ea se in in fa n t m or t a lit y, a n d b et t er a ccess t o b a sic h ea lt h s er v ices. St r iv -in g w it h d is ea ses, WH O con t -in u es t o give h igh p r ior it y t o t h e con t r ol, elim in a t ion a n d er a d ica t ion of p r even t a ble d is ea s es.

E r a d ica t ion , elim in a t ion a n d con t r ol of e p id em ics h ave a p osit ive im p a ct on occu p a -t ion a l h ea l-t h s in ce -t h e wor k in g p op u la -t ion con s t it u t es t h e la r gest se gm en t of t h e wor ld ’s p op u la t ion . How ever, goin g b a ck t o t h e s p e-cifi c p r oblem s of occu p a t ion a l h ea lt h in a h ist or ica l p er s p ect ive, on e s h ou ld a d m it t h a t less on s lea r n ed in t h is a r ea h ave n ot b een a p p r ecia t ed a n d a ck n ow led ged p r op er ly by t h e wor ld s ociet y. T h e m a jor p a r t of t h e wor k -in g p op u la t ion is st ill n ot cover ed by a p p r o-p r ia t e occu o-p a t ion a l h ea lt h s er v ices. M illion s of wor k er s t h r ou gh ou t t h e wor ld , p a r t icu la r ly in s m a ll en t er p r ises, d o n ot b en efi t fr om t h e ava ila ble k n ow led ge a n d exp er ien ce in occu -p a t ion a l h ea lt h .

Occupational health global burden

“Silen t ” e p id em ics of wor k -r ela t ed d is ea ses – som e of w h ich h ave b een k n ow s in ce Ra m a zz-in i’s t im e – w it h t h e m os t t r a gic h u m a n cos t in volved , s t ill occu r wor ldw id e.

T h e es t im a t ed a n n u a l glob a l fi gu r es of occu p a t ion a l illn esses, w h ich in clu d e t h e w h ole r a n ge of occu p a t ion a l d is ea ses, a s d efi n ed by WH O, is 160 m illion ca ses. T h ese es t im a t es h ave b een m a d e on t h e b a s is of ava ila ble s t a t is t ics fr om M em b er St a t es, a n d ext r a p ola t ed on t h e glob a l la b ou r for ce. Accor d in g t o t h e la st es t im a t es fr om t h e

In t er n a t ion a l La b ou r Or ga n iza t ion b a sed on t h e p r esen t wor ld la b ou r for ce, t h er e a r e wor ldw id e 125 m illion in ju r ies p er yea r w it h 3 d ay s or m or e a b sen ce fr om wor k , in clu d in g 10 m illion ca ses of s er iou s in ju r ies w it h m or e t h a n on e m on t h a b sen ce fr om wor k , t h e m a jor it y of w h ich lea d t o a r ed u ct ion in wor k -in g ca p a cit y or p er m a n en t d isa b ilit y. E ver y yea r, a b ou t 220,000 fa t a lit ies d u e t o wor k p la ce a ccid en t s occu r in t h e wor ld .

Wh a t k in d of illn ess is r ela t ed t o occu p a -t ion a l h a za r d s ?

A p r ior it y list of t en m a jor wor k -r ela t ed illn esses (by N IOSH / USA) is b a sed on t h r ee m a in cr it er ia : fr eq u en cy of occu r r en ce; sever -it y in in d iv id u a l ca s es; a n d p ot en t ia l for p r e-ven t ion .

With a ll th e ch a n ges in wor k in g life th a t h ave been obser ved a t th e en d of th is cen tu r y, th e r ole of occu pa tion a l r isk fa ctor s, su ch a s psych osocia l fa ctor s, m en ta l over loa d, etc., in th e developm en t of th e soca lled m u ltifa ctor ia l h ea lth disor der s, is in cr ea sin g. Th ese wor k -r ela ted disea ses of pu blic h ea lth im po-r ta n ce togeth er w ith th e com bin ed occu pa tion a l a n d n on -occu pa tion a l r isk fa ctor s, a s defi n ed by a WHO exper t com m ittee, a r e sh ow n below : 1 B eh a v iou ra l a n d p sych osom a tic d isord ers.

Risk fa ct or s: over loa d , u n d er loa d , sh ift wor k , r ole in t h e or ga n iza t ion , in t er -in d i-v id u a l r ela t ion sh ip, lifest y le fa ct or s (sm ok in g, a lcoh ol a bu s e, et c.).

2 H yp er ten sion . Risk fa ct or s: b ody w eigh t , h igh sa lt in t a k e, d iet a r y fa ct or s, h igh a lcoh ol con s u m p t ion , p lcoh y sica l in a ct iv it y, p sy -ch osocia l fa ct or s in clu d in g st r ess. 3 Isch a em ic h ea r t d isea se. Risk fa ct or s:

h y p er t en sion , sm ok in g, d iet , p sych osocia l fa ct or s-s t r ess.

4 Ch r on ic n on -sp ecifi c resp ira tor y d isea ses. Risk fa ct or s: p ollu t ion , clim a t e, sm ok in g, gen et ic fa ct or s, a t op ic p r ed isp osit ion , b r on ch ia l r ea ct iv it y, ch ild h ood r esp ir a t or y d isea ses.

WHO Programme on Occupational

Health

Programme objective and mission T h e WH O Occu p a t ion a l H ea lt h P r ogr a m m e (Wor k er s’ H ea lt h P r ogr a m m e) h a s b een

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es t a blis h ed s in ce t h e cr ea t ion of t h e Wor ld H ea lt h Or ga n iza t ion . Ba sed on t h e gen er a l ob ject ive of t h e or ga n iza t ion , t h e m iss ion of WH O’s Occu p a t ion a l H ea lt h P r ogr a m m e h a s b een for m u la t ed a s “t o a s sis t WH O M em b er St a t es in en su r in g t h e h ea lt h , w ell-b ein g a n d sa fet y a t wor k of a ll wor k er s, en a blin g t h em t o live a s ocia lly a n d econ om ica lly p r od u ct ive life”.

Ten global strategy objectives

On t h e b a s is of a sit u a t ion a n a ly sis u s in g ava ila ble in d ica t or s, t h e glob a l s t r a t e gy id en -t ifi es -t h e m os -t ev id en -t n eed s for -t h e im p r ove-m en t of occu p a t ion a l h ea lt h a n d s a fet y, in clu d in g p r ior it y a r ea s b ot h a t t h e n a t ion a l a n d in t er n a t ion a l level, a n d lis t s t h e follow -in g t en m a jor p r ior it y ob ject ives for a ct ion :

1 S tren gth en in g of in ter n a tion a l a n d

n a tion a l p olicies for h ea lth a t w ork a n d d ev elop in g th e n ecessa r y p olicy tools. M a jor

t r a d it ion a l a s w ell a s n ew occu p a t ion a l h ea lt h n eed s t o b e r ela t ed t o r a p id ch a n ges in econ om ic st r u ct u r es ; t ech n ologies a n d d em ogr a p h y sh ou ld b e t a k en in t o con sid -er a t ion in d evelop in g p u blic p olicies. Cou n t r ies s h ou ld p r e p a r e a n d im p lem en t a n occu p a t ion a l h ea lt h p r om ot ion p r o-gr a m m e w it h a p p r op r ia t e le ga l a n d ot h er p r ov ision s, a n d d evelop t h e n eces sa r y in fr a s t r u ct u r e for it s im p lem en t a t ion a s p a r t of in t e gr a t ed com m u n it y h ea lt h s er -v ices. Occu p a t ion a l h ea lt h p r ogr a m m es s h ou ld b e con sid er ed es sen t ia l com p o-n eo-n t s of s ocio-ecoo-n om ic d evelop m eo-n t . 2 Dev elop m en t of a h ea lth y w ork en v ir on

-m en t. Ach ieve-m en t of t h e t a r get s for

eq u it y in h ea lt h s t ip u la t ed in t h e WH O h ea lt h -for -a ll st r a t e gy r eq u ir es in t en s ive a ct ion t o en s u r e b et t er wor k en v ir on m en t s in v ir t u a lly ever y cou n t r y. M os t h a za r d ou s con d it ion s a t wor k ca n in p r in cip le b e avoid ed a n d p r im a r y p r even t ion is s t r es s ed a s t h e m ost cost -effect ive st r a t e gy for t h eir elim in a t ion a n d con t r ol. Cr it er ia a n d a ct ion s for t h e es t a blis h m en t of h ea lt h y a n d sa fe wor k en v ir on m en t s t h a t a r e con d u cive t o p h y sica l, m en t a l a n d s ocia l w ell-b ein g sh ou ld b e con sid er ed . 3 Dev elop m en t of h ea lth y w ork p ra ctices a n d

p r om otion of h ea lth a t w ork . T h e d evelop

-m en t of h ea lt h y wor k p r a ct ices r eq u ir es k n ow led ge of h ea lt h h a za r d s a t wor k a n d of w ay s t o m it iga t e or avoid t h em . H ea lt h p r om ot ion a im ed a t in t r od u cin g h ea lt h y lifes t y les a n d h ea lt h y b eh av iou r, t oget h er w it h a h ea lt h y wor k en v ir on m en t s h ou ld effect ively b e u n d er t a k en . Com b in ed effect s of lifes t y le r isk fa ct or s a n d occu p a -t ion a l r isk fa c-t or s sh ou ld b e avoid ed . H ea lt h p r om ot ion s h ou ld b e a com p on en t of occu p a t ion a l h ea lt h p r ogr a m m es.

4 S tren gth en in g of occu p a tion a l h ea lth ca re

a n d ser v ices. T h e em er gin g p r oblem s of

occu p a t ion a l h ea lt h ca ll for fu r t h er d evel-op m en t a n d st r en gt h en in g of occu p a t ion a l h ea lt h ca r e a n d ser v ices a s a n in t e gr a l com p on en t of com m u n it y h ea lt h ser v ices for a ll wor k er s in a ll sect or s of t h e econ om y. F u ll cover a ge of t h e wor k in g p op u la -t ion by m u l-t i-d is cip lin a r y occu p a -t ion a l h ea lt h s er v ices w it h in t h e fr a m ewor k of occu p a t ion a l h ea lt h sy st em s sh ou ld b e m a d e t h e u lt im a t e ob ject ive of t h e n a t ion a l p r ogr a m m e on occu p a t ion a l h ea lt h in ever y cou n t r y.

5 E stablish m en t of a p p r op r ia te su p p or t ser

-v ices for occu p a tion a l h ea lth . E ffect i-ve

occu p a t ion a l h ea lt h p r a ct ice r eq u ir es in p u t fr om exp er t a dv isor y a n d a n a ly t ica l ser v ices of occu p a t ion a l h ygien ist s, er gon om ist s, p sych ologist s, sa fet y en gi-n eer s a gi-n d t oxicologist s ; a gi-n d t h ese ser v ices sh ou ld b e m a d e ava ila ble w it h in t h e fr a m ewor k , for exa m p le, of a n a t ion a l in st it u t e of occu p a t ion a l h ea lt h or ot h er n a t ion a l cen t r e.

6 Dev elop m en t of occu p a tion a l h ea lth sta n

-d a r-d s b a se-d on scien tifi c r isk a ssessm en t.

To en su r e b a sic levels of h ea lt h a n d sa fet y a t wor k , st a n d a r d s a r e n eed ed w h ich a r e d er ived fr om scien t ifi c r isk a ssessm en t a n d sp ecify sa fe levels of va r iou s exp osu r es a n d ot h er con d it ion s of wor k . St a n -d a r -d -set t in g s h ou l-d b e a t a sk in clu -d e-d in n a t ion a l p r ogr a m m es on occu p a t ion a l h ea lt h . St a n d a r d s a lso s er ve a s a r efer en ce for a ssess in g t h e r es u lt s of wor k en v ir on -m en t -m on it or in g, a n d p r ov id e gu id elin es for p la n n er s.

7 Dev elop m en t of h u m a n resou rces for occu

-p a tion a l h ea lth . Occu -p a t ion a l h ea lt h is a

b r oa d exp er t a ct iv it y t h a t u t ilizes t h e b a sic k n ow led ge of sever a l d iscip lin es. T r a in in g cu r r icu la for t h e p r ofession s con cer n ed , occu p a t ion a l p h y sicia n s, occu p a t ion a l h ygien ist s a n d occu p a t ion a l n u r ses in p a r t icu la r, sh ou ld b e m od ifi ed t o cor r e-s p on d t o t h e n ew con d it ion e-s of wor k in g life. T h er e is a u n iver s a l n eed for t r a in in g in occu p a t ion a l h ea lt h a t a ll levels. 8 E stablish m en t of registra tion a n d d a ta

system s, d ev elop m en t of in for m a tion ser -v ices for ex p er ts, effecti-v e tra n sm ission of d a ta a n d ra isin g of p u blic a w a ren ess th r ou gh p u blic h ea lth in for m a tion . Det er

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la r ge, d ecision m a k er s, p olit icia n s, em p loyer s a n d wor k er s is of t h e u t m os t im p or t a n ce for en su r in g t h a t t h e n ecessa r y p olit ica l d ecision s a n d p r a ct ica l m ea -su r e a r e t a k en .

9 S tren gth en in g of resea rch . Res ea r ch is a cr u cia l p r er eq u is it e for a d m in is t r a t ion a n d p la n n in g, t r a in in g a n d ed u ca t ion , r isk id en t ifi ca t ion , a s sess m en t a n d p r a ct ice in occu p a t ion a l h ea lt h .

10 Dev elop m en t of collab ora tion in occu p a

-tion a l h ea lth w ith oth er orga n iz a -tion s.

Su cces s fu l im p lem en t a t ion of t h e WH O Glob a l St r a t e gy for Occu p a t ion a l H ea lt h for All a n d t h e Wor ld H ea lt h Ass em bly Res olu t ion (WH A49.12) on t h is su b ject r eq u ir es clos e colla b or a t ion b et w een WH O, ot h er Un it ed N a t ion s b od ies, esp e-cia lly t h e ILO, a n d in clu d in g UN E P, UN DP a n d ot h er in t er gover n m en t a l a n d n on -gover n m en t a l or ga n iza t ion s, s u ch a s t h e Com m is sion of t h e E u r op ea n Un ion , t h e In t er n a t ion a l Com m is sion on Occu p a -t ion a l H ea l-t h , -t h e In -t er n a -t ion a l

E r gon om ic As socia t ion a n d t h e In t er n a -t ion a l Occu p a -t ion a l H ygien e Ass ocia -t ion .

Role of industry

In d u st r y is a m a jor p a r t n er in t er es t ed in con t r ibu t in g t o occu p a t ion a l h ea lt h a n d sa fet y. P er s on a l p r ot ect ive eq u ip m en t , p r ot ec-t ive d ev ices, in sec-t r u m en ec-t s for id en ec-t ifi ca ec-t ion a n d m on it or in g of occu p a t ion a l h a za r d s a r e b a sic elem en t s for h ea lt h p r ot ect ion a t t h e wor k p la ce.

T h e WH O P r ogr a m m e on Occu p a t ion a l H ea lt h h a s a ver y lim it ed in t er a ct ion w it h occu p a t ion a l h ea lt h a n d sa fet y in d u st r y, h ow -ever colla b or a t ion b et w een t h ese t wo p a r t ies is n eed ed . WH O ch a n n els ca n b e u sed t o im p r ove a ccess t o t h e in for m a t ion on p r ot ec-t ive eq u ip m en ec-t , d ev ices a n d in sec-t r u m en ec-t s. WH O ca n p r om ot e t h e b est eq u ip m en t a n d m a k e it a ffor d a ble t o d evelop in g cou n t r ies a n d cou n t r ies w it h t r a n sit ion a l econ om ies. T h er efor e, t h e d ia logu e b et w een in t er gover n -m en t a l a n d n on -gover n -m en t a l or ga n iza t ion s on occu p a t ion a l h ea lt h a n d n a t ion a l a n d in t er n a t ion a l fed er a t ion s of m a n u fa ct u r er s a n d d ist r ibu t or s of p er son a l p r ot ect ive eq u ip -m en t a n d ot h er sa fet y in st r u -m en t s sh ou ld b e st r en gt h en ed .