the global occupational health network - who...then, international collaboration, co-operation and...

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 1

The GlobalOccupationalHealth Network GOHNETGOHNETISSUE No. 5 GOHNET NEWSLETTER

IN THIS ISSUE:

SUMMER 2003

Dear GOHNET members and future members,

This is a special issue written to inform you about the ILO/WHO JointCommittee on Occupational Health, as well as some ongoing activities.The Committee first met in 1950 and will meet again from 2-5 Decemberin 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 entirespectrum of the working population‘– from working children, toadolescents, adults and the working elderly’.

In 1995, the ILO/WHO Joint Committee on Occupational Health metand developed a consensus statement on occupational health. It reads asfollows: ‘The main focus in occupational health is on three differentobjectives: (i) the maintenance and promotion of workers’ health andworking capacity; (II) the improvement of working environment and workto become conducive to safety and health; and (iii) the development ofwork organization and working cultures is intended in this context to meana reflection of the essential value systems adopted by the undertakingconcerned. Such a culture is reflected in practice in the managerial systems,personnel policy, principles for participation, training policies and qualitymanagement of the undertaking’.

The Committee found, that with respect to the areas for specific urgentcollaboration identified at the 11th and prior session, there had been littlereal progress achieved in many countries. Accordingly, the Committeerequested more specific reporting directly addressing the identified urgentareas of collaboration at its subsequent meetings. Then, internationalcollaboration, co-operation and co-ordination were stressed as the keys tosuccess in occupational health, and this has not changed to this day. It wasmentioned that intensified areas of co-operation should be identified andthat 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 developmentof joint work plans and co-ordination of strategies at global level betweenILO and WHO; discussions about occupational management systems andthe complementary roles of Ministries of Health and Labour. Selectedtopics include the African Joint Effort, silicosis, national OHS profiles andcontrol banding.

In this Newsletter, you will find a selection of articles about related activitiesin priority areas. International collaboration is the major theme andcontributors have delivered concrete examples. In addition, we will presentthe Occupational Health Programme at WHO Headquarters.

For general comments, questions and future contributions you may contactthe editor:

Evelyn Kortum-Margot ([email protected])Occupational & Environmental Health ProgrammeDepartment of Protection of the Human EnvironmentWHO/OMS20 Avenue Appia; CH - 1211 Geneva 27Fax: +41.22.791 13 83

The Occupational HealthProgramme of WHOHeadquarters

Dr Gerry Eijkemans ([email protected])Occupational Health Programme

WHO headquarters, Geneva, Switzerland

Background

Working conditions, for the majority of the three billion workersworldwide, do not meet the minimum standards and guidelinesset by the World Health Organization and the InternationalLabour Organization (ILO) for occupational health, safety andsocial protection. Throughout the world, poor occupationalhealth and safety leads to two million work-related deaths, 271million injuries and 160 million occupational diseases per year1.The majority of the world’s workforce does not have access tooccupational health services; only 10-15 % of the total globalworkforce has access to some kind of occupational health services.The main problem of the absence of occupational health servicesis the continuous presence of hazards in the workplace, such asnoise, toxic chemicals, and dangerous machinery, leading to ahuge burden of death, disability and disease. Also, psychosocialrisk factors at work such as stress and violence have become amajor issue in developed countries and are of growing concernin the developing countries and countries in transition. Anadditional problem is the massive inclusion of children in theworkforce, completely unprotected.

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

1ILO, 2002

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 k2

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 andnational policies for health at work; promotion of a healthy workenvironment, healthy work practices, and health at work;strengthening of occupational health services; establishment ofappropriate support services for occupational health;development of occupational health standards based on scientificrisk assessment; development of human resources; establishmentof registration and data systems and information support andstrengthening of research.

Implementation of the strategy is a task of the OCH Programmein the WHO Headquarters, the six WHO Regional Offices, andthe Network of over 70 WHO Collaborating Centres (CCs) inOccupational Health. The network members support each other;the synergy that is created is much larger than the sum ofindividual centres and activities. The CCs are organized in 15Task Forces to carry out a four-year Work Plan 2002-2005consisting of at least 130 funded projects. The Work Plan isperiodically updated and the progress is under constantevaluation. Projects focus on various priority areas in occupationalhealth and result in products, which range from documentsand brochures in different languages, to training courses foroccupational health personnel and/or students, to theestablishment of questionnaires, guidelines and increasedinternational collaboration and direct action at national andregional level, improving the workplaces and reducing hazards.

One of the priorities of the WHO OCH Programme is tostrengthen collaboration with ILO to avoid duplication and tosupplement each other. The ILO-WHO Joint Committee onOccupational Safety and Health, created in 1948, identified forits 12th Session, to be held in December 2003 the main areas ofintensified joint activity. These include the joint programmeincluding the global elimination of silicosis; OSH Managementsystems and promotion of training, education and competenceassurance. Important new areas of co-operation include theAfrican Joint Effort, Control Banding (practical tools forcontrolling exposure to chemicals) and the development ofnational profiles on occupational health.

Future challenges

Major traditional occupational health needs still prevail amongthe global workforce. In addition, due to the rapid changes ineconomic structures, technologies and demography, newoccupational health needs have appeared, while the traditionalproblems such as silicosis, injuries, hearing loss and so on, arefar from being solved. From a public and occupational healthpoint of view, global competition increases health and safety risks.Manufacturing firms everywhere face global competition, andoften argue that any additional expenditure on safety orprevention for workers threatens their viability, instead ofrecognizing the expenditure on occupational health as aninvestment.

Most people, both in urban and rural areas, work in small-scaleenterprises and in the informal economy. So far, success to providethose workers with adequate health and safety services, bothpreventive and curative, has been limited. Also, in many countries

the personnel of national and city health departments have beencut, weakening public health programmes including occupationalhealth, and health services; there is a drastic shortage of high-level or specialized professional expertise of all kinds in mostcountries. This situation is deteriorating due to the HIV/AIDSpandemic.

WHO’s strategic directions and activities

Within the framework of the Global Strategy, some of theactivities that the WHO, with its network of collaborating centresis carrying out are:

■ Through the Regional Offices, countries are encouragedto adopt national strategies for occupational health andsafety that set priorities and targets, such as reduction of“high incidence” or “high severity” risks; effectiveprevention of disease and injury; elimination of hazards atthe design stage, and improved capacity of businessoperators and workers to manage occupational health andsafety

■ Building strategic alliances with partners in the countriesand regions (ministries of health, labour, mining, workersand employer Organization, universities, Egos) and buildin-house (WHO) alliances with programmes such as StopTB, 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 nationaland regional development agendas and mobilizing resourcesfor occupational health with different partners (for example,explore collaboration with corporate sector)

■ Promote (applied) research (e.g. global burden ofoccupational disease, cost-effectiveness of health and safetyinterventions in the workplace, hazardous child labour) andfacilitate the exchange of positive experiences onoccupational risk assessment and improving workingconditions

■ Facilitate training and capacity building on occupationalhealth, involving the collaborating centres and otherpartners in the field

■ Support countries in improving data collection andsurveillance systems on occupational injuries and diseases

■ Support direct interventions to improve the safety of healthcare workers, particularly protecting them from HIV/AIDSat the workplace

A concrete example of collaboration, and creation of synergiesbetween different partners and activities, is the WHO-ILO JointEffort on Occupational Health and Safety in Africa (AJE), alsoin line with WHO’s renewed focus on regional and countrysupport (see article by the same author on the AJE in thisNewsletter).

The challenge to improve the health of workers worldwide isgreat. However, there is a growing understanding and interestamongst partners to regard occupational health as an essentialelement for sustainable development and poverty reduction. Thenecessity of synergy and co-ordinated action to make thedifference for the workers in the world is also understoodincreasingly.


The products include reports describing the literature reviewsand the net-costs economic analyses of interventions for lowback pain within the United States and Europe in selectedindustries. A report describing data findings and data-gaps inIndia on economic analyses on back pain interventions will beprepared, and a framework for data collection in selectedindustries in India will be developed and piloted. A smallinternational meeting in Delhi in July is planned to review theprogress of the project, to learn about the situation in India, tofirm up the data collection framework, and to plan for the useof the framework in case studies.

Additionally, at the meeting, discussions will take place on thefuture extension of the model to other workplace topics, andparticularly the application of the net-costs model to the problemof silicosis. It is anticipated that in 2004, there may be anextension of the project to extend the economic analyses indeveloped countries, to carry out net-costs analyses with datacollected in India, to conduct case studies in additionaldeveloping countries, to prepare scientific articles, and to generatea user-friendly framework for collection of data in specific settingsto allow local analyses of the net-costs of interventions.

The ILO/WHO Global Programmeon Elimination of Silicosis

Dr Igor Fedotov ([email protected])InFocus Programme Safework

International Labour Office (ILO), Geneva, Switzerland

The problem

Silicosis is a well-known fibrogenic lung disease. The occupationalorigin of silicosis was recognized far back in ancient times. Despiteall efforts to prevent it, this incurable disease still afflicts millionsof workers engaged in hazardous dusty occupations in manycountries. With its potential to cause progressive and permanentphysical disability, silicosis continues to be one of the mostimportant occupational health problems in the world.

Possibility of elimination

Today, society possesses all the necessary means to combat thispreventable disease and there is no excuse for silicosis persistencethroughout the world. In the absence of effective specifictreatment of silicosis, the only approach towards the protectionof workers‘ health is the control of exposure to silica-containingdusts. Experience gained by some countries has convincinglydemonstrated that it is possible to reduce significantly theincidence rate of silicosis with well-organized preventionprograms (Australia, Belgium, Canada, Finland, France,Germany, Japan, Switzerland, Sweden, United Kingdom, andthe United States). The success of the prevention of silicosisevidently results from a range of effective and imperativelypreventive measures at different levels.

At the national level : laws and regulations and their enforcement;adoption of occupational exposure limits and relevant technicalstandards; governmental advisory services; an effective inspection;a well-organized reporting system, and a national actionprogramme involving governmental institutions, industry andtrade unions

At the enterprise level : application of appropriate technologies to

An example of co-operation with the privatesector

Co-operation between theOccupational Health Programmeand Winterthur InsuranceCompany

Dr Gregory Goldstein ([email protected])Occupational Health Programme


In 2003, WHO commenced a collaborative programme inoccupational health with the Swiss Insurance CompanyWinterthur. 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 implementationof workplace health promotion (WHP)

WHO and collaborating partners will implement state-of-the-art workplace health promotion (WHP) pilot projects in anumber of countries and regions with deficient occupationalhealth conditions. They will also undertake a comprehensiveevaluation of the projects.

The WHP projects will develop and implement processes of goodpractice in management of occupational, lifestyle, social andenvironmental determinants of health. This involves thecombined efforts of employers, employees and society to improvethe work organization and working environment, increase workerparticipation in shaping the working environment, andencourage personal development. WHP will increaseemployability of workers, help workers and their families avoidpoverty, and support public health initiatives against majordiseases, such as musculoskeletal disorders, heart disease, AIDSand cancer.

(b) Cost-effectiveness of interventions for work-related backdisorders as a model for addressing additional topics

This programme is a joint project by three WHO CollaboratingCentres in Occupational Health (University of Massachusettsat Lowell in the United States, TNO Work and Employment inThe Netherlands, and the National Institute of OccupationalHealth in India) and by the Institute of Public Health Engineers,India. Funding for this project is provided by Winterthur ofSwitzerland, and by WHO.

The goal is to extend the current WHO cost-effectiveness studyof low back pain interventions (which focuses on health benefitsalone) more comprehensively to address.

“net costs”. The costs include changes in productivity and costsavings due to prevention of illness. The numerator in the cost-effectiveness ratio should reflect net costs, defined as the grosscost incurred in implementing the use of the intervention minusany cost savings due to avoided costs of compensation and illnessand reduction in cost due to improved productivity and productquality. The denominator would reflect effectiveness of theintervention either in terms of the number of healthy years gainedor incidence reduction, as may seem appropriate.


avoid the formation of silica-containing dust; use of engineeringmethods of dust control; compliance with prescribed exposurelimits and technical standards; surveillance of work environmentto assess effectiveness of preventive measures; surveillance ofworkers‘ health to detect early development of silicosis; use ofpersonal protective equipment (as a temporary measure); healtheducation and training, and co-operation between the employersand workers.

Technical knowledge, professional expertise, qualified personneltrained in using appropriate technologies and methods of dustcontrol, and access to relevant information are needed foreveryday activities to prevent silicosis. Evaluation of technologies,which are applied in various industrial processes where silica dustsare present, and methods of dust control are necessary to assessthe efficiency of prevention. They are also the basis ofrecommendations for effective measures and technical standardsfor a wider use (transfer of technology). In addition, furtherepidemiological studies and research are needed to learn moreabout the trend of the disease to prevent it effectively.

The ILO/WHO Global Programme

Over the years, the ILO and WHO have paid special attentionto the prevention of silicosis in close collaboration with nationaland international organizations, especially with NIOSH (USA)and the International Commission on Occupational Health(ICOH). Joint activities in developing countries aim atprevention of occupational respiratory diseases specificallytargeting silicosis and other pneumoconioses.

A special training program designed to upgrade practical skillsof specialists using the ILO International Classification ofRadiographs of Pneumoconiosis has considerably contributedto early diagnosis of silicosis in developing countries. TheProgram brought together specialists from industrialized anddeveloping countries.

The ILO/WHO long-term action program to preventpneumoconioses has been successfully implemented over theyears. It received a new impetus at the 12th Session of the JointILO/WHO Committee on Occupational Health in April 1995.The Committee identified the global elimination of silicosis as apriority area for action in occupational health, inviting countriesto place it high on their political agenda and requesting the ILOand WHO to establish a joint program of co-operation to achievethis goal. Later on, the Program received an internationalrecognition at the 9th International Conference on OccupationalRespiratory Diseases, which was jointly organized by the ILOand the Government of Japan in Kyoto in October 1997. TheConference concluded, that the implementation of thisimportant program should be widely supported throughout theworld.

Definition of the Program

The ILO/WHO Global Program on Elimination of Silicosis isan international technical co-operation program designed to assistcountries in their action to combat silicosis and eliminate it asan occupational health problem worldwide.

By establishing this Global Program, ILO and WHO have shapeda policy perspective for their member States for a wideinternational collaboration, which should be governed by a truepartnership between industrialized and industrializing countries.

Within the framework of this collaboration, every effort shouldbe made to promote the exchange of technical information andexpertise to attain the common goal of the global elimination ofsilicosis.

Purpose of the Program

The purpose of the Programme is to offer countries a frameworkfor a broad international collaboration and to contribute to theelimination of silicosis as an occupational health problemworldwide.

The immediate objective of the ILO/WHO Global Programmeis to promote the development by countries of NationalProgrammes on Elimination of Silicosis and reduce significantlythe incidence rate of silicosis by the year 2015.

The development objective of the ILO/WHO Global Programmeis to establish wide international co-operation on globalelimination of silicosis and eliminate it as an occupational healthproblem 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 andinternational organizations;

(ii) to promote the establishment by countries of NationalProgrammes on Elimination of Silicosis accompanied byNational Action Plans;

(iii) to provide technical assistance to countries in developingmodels of National Programmes and National Action Planson Elimination of Silicosis and support theirimplementation.

Program development

With due attention paid to the local conditions, a NationalProgram on Elimination of Silicosis should comprise thefollowing 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 implementationof the program;

(vi) tripartite consultation and co-operation;

(vii) institutional framework required for the programimplementation;

(viii) mechanism for monitoring and evaluation;

(ix) national standards and link with international standards;

(x) relationship with the protection of the general environment.

At the national level, the Program is considered as a nationalconsensus policy document for priority action in a specific area ofoccupational health outlining the roles and responsibilities ofpartners.


The National Action Plan on Elimination of Silicosis canaccompany the National Program and be prepared as a moredetailed document in the form of a compilation of requiredactions necessary to achieve targets set up by the NationalProgram. Among others, it should indicate actions to be takento mobilize resources, contributions in kind, exchange oftechnical information and expertise, institutional framework andco-operation, as well as the establishment of partnershipsnecessary for the successful program implementation.

The ILO/WHO Global Program on Elimination of Silicosis istargeting countries that are willing to join the Program andrequest the establishment of national programs. It will begradually expanding to include an increasing number ofcountries. Today, the national campaigns to eliminate silicosisare 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 silicosisis technically feasible. Positive experience gained by manycountries shows that it is possible to reduce significantly theincidence rate of silicosis by using appropriate technologies andmethods of dust control. The use of these technologies andmethods has proved to be effective and economically affordable.

Assistance provided within the framework of the ILO/WHOGlobal Program will contribute to the upgrading of nationalcapacities to prevent silicosis. Countries will need to ensure thatall necessary measures for the prevention of the disease be takenat the national and enterprise levels. It is strongly believed, thatthe goal of global elimination of silicosis is realistic and can beachieved through a very broad international collaborationsupporting national action programs and multi-disciplinaryefforts of occupational safety and health professionals, as well asthose from all economic sectors concerned.

The WHO/ILO Joint Effort (AJE) onOccupational Health and Safety inAfrica

Dr Gerry Eijkemans ([email protected])Occupational Health Programme


Background

The framework of co-operation between ILO and WHO is setby the Joint ILO/WHO Committee in the field of occupationalhealth. It is within this context that the African Joint Effort wasborn. A workshop in Africa (Pretoria, South Africa, October2000) of interested national and international institutions onstrengthening occupational health in Africa, concluded that abroad 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 healthof workers in the region. This initiative would be the liaison forall partners, in- and outside Africa, to join efforts and streamlineand co-ordinate activities. It would also facilitate fundraising.

The first official consultation, to develop a framework for thejoint effort in occupational health, took place in the WHO

Regional Office, Harare in March 2001. Agreement was reachedon the name of the initiative:

WHO/ILO Joint Effort on Occupational Health and Safety in Africa(AJE), and on the development objective: Improve conditions andenvironment of work in Africa, thus reducing the burden ofoccupational diseases and injuries, through intensified co-ordinationof occupational health and safety activities.

Furthermore, the meeting developed a framework for this jointeffort, 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 particularlyhazardous occupations and vulnerable groups in theinformal sector (women and children).

Gradually, partners from in- and outside Africa, became involvedin concrete activities of the AJE, particularly in the field oftraining, and information sharing. The AJE website was created(www.sheafrica.info), an AJE newsletter is produced periodically,and practical interventions are undertaken on groups especiallyexposed 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 hundredinterested partners, institutions and individuals, exists at themoment.

Two high-level meetings were held in Geneva in January andMarch 2003, with the participation of Regional and ProgrammeDirectors of WHO and ILO, who restated their strong politicalcommitment. The convenience of linking the AJE to the regionalintegration processes was particularly highlighted during thesemeetings. The AJE was considered by all parties to have a hugepotential for collaboration, touching on all importantdevelopment issues of the region, including poverty reduction,sustainable development and the HIV/AIDS epidemic. In thosemeetings it was also stressed that it was convenient to includethe Eastern-Mediterranean region in the AJE, thus ensuring aPan-African effort.

A meeting took place in Cairo in April 2003 between WHOand ILO to discuss the next steps to be taken in the AJE. Themeeting decided on two issues:

1. Formalization of the Joint Effort : The Regional directors ofILO and WHO will sign a letter of agreement defining theobjectives and areas of co-operation by end of August 2003.

After signing the letter of agreement, ILO and WHO will informcountries of the existence of the AJE, through a joint officialcommunication. This communication will also be used toidentify strong possible areas of work and interest in collaborationwith constituents.

2. Formalization through an official launching : The above-mentioned letter of agreement to the countries will be consideredas a launch. Furthermore, the organization of sub-regionalmeetings (aimed at making the AJE known, show results, andincrease visibility) with international and national institutionsand donors in 2004 was discussed.


Proposed joint activities

Traditionally, the AJE has been mainly involved in horizontalco-operation, supporting institutions, countries and sub-regionsto organize activities that go beyond the scope of a particularcountry. 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 executivedirectors, the convenience of opening the scope of the AJE toparticular joint country support became evident. It is in thislight that the Cairo meeting focused on developing this new,vertical component of the AJE.

A preliminary selection of countries was made, based on specificcriteria (regional distribution, ongoing work of WHO and ILO,established capacity in the countries). The selection of thecountries will be made public after discussion with the relevantstakeholders. The first step in the country approach will be tohold conceptual workshops with ILO/WHO experts with theirconstituents and possible donors in all selected countries. Theexact content of the workshop will be determined according tothe development stage, priorities and opportunities in each ofthe countries.

The objective of such national workshops will be to reachconsensus on the need and content of the national profiles, toidentify emerging elements for national policy and a plan ofaction, to identify and decide on action in specific industrialsectors where both organizations could have a joint impact , andto define priority areas for the short- and long-term perspective.The meeting agreed, that National Profiles were important forthe establishment of national policies on OHS and that theycould constitute the first activity on which to concentrate co-operation. WHO and ILO have started this work in somecountries.

For more information on the AJE, please consultwww.sheafrica.info or contact the author.

An example of successful pilottraining courses in South AfricaA Report on Pilot Courses on Hazard Preventionand Control in the Work Environment: AirborneDust, in South Africa, 10-28 March 2003

Dr Sophia Kisting ([email protected])University of Cape Town, South Africa

Background

Under the umbrella of the WHO/ILO Joint Effort for OHS inAfrica, pilot airborne dust control courses were held in SouthAfrica. Facilitators came from the National Institute for WorkingLife (NIWL), Sweden and the Finnish Institute for OccupationalHealth (FIOH) to contribute to regional efforts for greatercontrol of airborne dust. Ing-Marie Andersson, Gunnar Rosenand Lars-Erik Byström of the NIWL and Hannu Riipinen fromthe FIOH facilitated the courses. In Cape Town the course was

jointly hosted by the Occupational and Environmental HealthResearch Unit (OEHRU) at the University of Cape Town andthe Peninsula Technikon. In Johannesburg it was hosted by theNational Centre for Occupational Health (NCOH). TheOEHRU and the NCOH are in the process of becoming WHOCollaborating Centres in Occupational Health.

Many countries in the Southern African region have a highprevalence of preventable airborne dust related diseases. Historicand economic factors, as well as differential control standardsglobally, play an important role in the continued exposure ofworkers and communities to airborne dust. These factors weretaken into consideration in the planning and co-ordination stagesof the courses.

Organisational Aspects

Sponsorship The NIWL and the FIOH sponsored the facilitators,as well as the development and preparation of the coursematerials. The University of Michigan, Fogarty InternationalCenter, Southern African Programme in Environmental andOccupational Health, covered the cost of ten participants. WHOunder the umbrella of the WHO/ILO Joint Effort forOccupational Health in Africa, as well as the Occupational andEnvironmental Health Research Unit (UCT), supported theorganization and co-ordination of the courses.

Course Activities

Workplace Visits : During the week of 10-14 March differentworkplaces and industries in and around Cape Town were visited.The facilitators incorporated the information gathered locallyinto the course material. Members from these workplaces wereinvited to participate in the workshops and their participationin the discussions made an important contribution to thepractical orientation of the workshops.

Participants : There were 30 participants in the Cape Town course(including 6 students) and 28 participants in Johannesburg. Eightcolleagues from SADC member states (other than South Africa)participated. Their experience of airborne dust challengesenriched the discussions. Industrial hygienists, trade unionists,environmentalists, senior university/technikon lecturers andresearchers, labour inspectors, private occupational healthconsultants, occupational health nurses and doctors and a fewoccupational and environmental health students joined thecourses.

This integrated approach was deliberately encouraged andensured that participants involved in different aspects of airbornedust control came together to share practical experiences and toencourage a team approach at workplaces to prevent exposureto airborne dust.

The Courses : The first two days of the courses were based on theWHO 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 goodcontrol of airborne dust and where the incidence of diseases suchas silicosis have been reduced to less than 5 per year. What thefacilitators stressed repeatedly was the central role played byworkers engaged in dusty industries in achieving these remarkable


results in their countries. The important principle they impartedwas that the central focus of dust prevention should be theinformed participation of workers in dust control programmes.Technical measures are important but constitute but one aspectof a team approach to dust control programmes.

The teaching material included printouts of the power-pointslides used by the facilitators and video clips from differentworkplaces. This worked well and encouraged participation.There was good interaction and active participation in the smallgroup discussions, as well as in the feedback sessions.

The PIMEX Course : PIMEX is a method used to visualizeairborne pollutants as part of a strategy to control exposure. Astrategy for its use called Workplace Improvement Strategy byPIMEX was presented during the course. There was muchenthusiasm about the possibilities of the immediacy of thePIMEX method in dust control programmes.

Feedback from participants

The feedback on the course was enthusiastic and mostly positiveand participants indicated that they could use the courseinformation in different ways.

Concerns expressed by participants included…

…the required technology may not be readily available inresource-poor countries; more information on the relationshipbetween exposure and diseases is needed; financial constraintsespecially in the Public Sector are possible limitations to the useof the PIMEX Method; dust measurement needs to be coveredin future courses.

Policy Implications: Government departments need credibleinformation on which to base decisions concerning riskassessment and OHS. Procedures to arrive at conclusions areexpensive, time consuming, and exact details are required to makeinformed decisions. It is foreseen that the PIMEX Method willassist with risk assessment for airborne dust and facilitate theprocess of arriving at informed decisions with regard to certainpolicies.

SADC Member States: Participants from Botswana, Lesotho,Malawi, Namibia, Swaziland and Zambia all indicated that theinformation and course material obtained will be useful tosupplement their teaching at university, technikon andinspectorate level. It will also be useful in institutions introducingnew teaching curricula.

Teaching and curriculum development: The development of OHStraining tools that transcend language and education barrierspresents an ongoing challenge to OHS personnel. The coursematerial and the PIMEX method provide powerful educationand training tools that can be used to teach workers from differentlanguage backgrounds or different literacy levels.

The PIMEX Method is a most innovative means of raisingawareness. Immediate feedback and location to the source ofexposure makes it one of the most powerful methods todemonstrate exposure and intervene effectively. It will be usefulin teaching especially in analysis of problems to incorporate indesign.

Trade Unions:

Southern African Trade Union Coordinating Committee

(SATUCC): The material will be of great help to strengthenexisting OHS teaching material. The inclusion of images fromSouthern Africa is very important, as it helped participants toexperience the relevance of the situation with which they canidentify. It will be ensured that a dust lamp is used in futureworkshops and be encouraged that a dust lamp is used on everyvisit to workplaces.

National Union of Mineworkers (NUM): The participation ofTrade Unions in airborne dust control programmes is offundamental importance as it is our members who are gettingsick and we need to be part of the solution. This course has beeninspiring. We need to look at how many people are getting sick,we need to assess which production processes are making themsick and intervene effectively. The PIMEX method is a powerfultool for shop floor reality and will be useful in the constructionindustry.

Research

The PIMEX method and the course material are good tools forlecturers and students to use as part of their research projects. Inthe mining sector the course material will be useful for furtherresearch and intervention for the elimination of silicosis. Aresearch project has been started and the course information hasalready assisted with brainstorming and networking for theresearch. Information gathered from the research will be usedfor intervention purposes. Staff members at the bakery were in aposition to see first hand where they can improve on dust controlefforts. Course material will be extremely useful for Masterscourses and will be used for a planned copper and arsenicintervention 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 informalsector, the marked variation in the nature of exposures, withwomen and children often the worst affected. The courseinformation will be very suitable for intervention purposes butalso to gather information to influence policies.

Public lectures

The facilitators gave public lectures both in Cape Town andJohannesburg. They discussed the important steps their countries(Finland and Sweden) used to work towards the elimination ofsilicosis as an occupational disease. The information was asignificant addition to that already provided in the course work.The history of the steps taken by Sweden and Finland to worktowards the elimination of silicosis is of significance for countriessuch as South Africa where silicosis and associated tuberculosisare not yet controlled.

It was of central importance to hear first hand how two othercountries started to make systematic progress year by year whenresources were focused on the control of dust to prevent exposureand not only on the diagnosis and treatment of silicosis once ithad occurred.

Observations and reflections on the course

■ The airborne dust courses provide a beautiful example ofNorth-South and South-South collaboration, goodwill


amongst participating individuals and co-operation amongdiverse institutions.

■ The lack of adequate infrastructure in several countries andunequal access to information and communicationresources between and within countries must be recognizedby OHS institutions as a challenge to be overcome in theinterest of better health and safety.

■ Workers need to be an integral part of the process of dustcontrol.

■ The facilitators provided a striking example of a lack ofcompetitiveness and great willingness to share informationand resources without these being linked to financial gain.

Recommendations

■ The training material used and refined during the pilotcourses be compiled into a training course shall bedisseminated more widely via WHO.

■ As part of building and strengthening CollaboratingCentres internationally, the NIWL, FIOH and the WHOconsider running the course in different regions tostrengthen preventive dust control measures globally. Basedon the experience of the current course, it is important forthe facilitators to do the initial training of trainers and helpto establish a core of teachers familiar with the enablingmethods under discussion.

■ There should be a follow-up course preceding the 2005IOHA 6th International Conference, which will take placein Pilanesberg National Park in South Africa. Thisconference provides an ideal opportunity to consolidatethe pilot airborne dust course and provide participants andothers from Southern Africa with the opportunity to presentinformation on practical interventions undertaken, as wellas possible training in dust measurement techniques.

■ There will be ongoing support with regard to informationand advice for different institutions keen on implementingthe methods learnt during the course. There will also bediscussions in the different institutions about starting andmaintaining An Airborne Dust Control Network.

Conclusion

There is great value in international collaboration whereexperience and knowledge is shared and where we learn fromthe strengths and the challenges facing different countries in theirquest for a healthier and safer work environment. The experienceof the airborne dust courses indicate that the sharing ofinformation and experiences is increasingly taking place on thebasis of equality and in the spirit of addressing global problemsin an informed manner. It is foreseen that the networking, thathas started with the current courses, will be strengthened andconsolidated in the coming years.

An example of a successful pilottraining course in Arusha onPesticidesA Report on the Pesticide Training Course inArusha, 24– 29 March 2003

Dr Mohamed F. Jeebhay ([email protected])Occupational and Environmental Health Research Unit

University of Cape Town, South Africa

The course was organised as part of the University of MichiganFogarty International Centre grant to develop capacity inoccupational and environmental health in Southern Africa. Itwas hosted by the Tropical Pesticides Research Institute (TPRI),and co-facilitated by Leslie London from the University of CapeTown, and James Matee with the assistance of Vera Ngowi fromthe TPRIj. WHO provided financial support.

The course was officiated by high level public servants includinga representative of the Minister of Agriculture and Food Security,and closed by a representative of the Arusha RegionalCommissioner, indicating the level of importance accorded tothe course by local partners.

Participants : There were 15 participants, mainly from Tanzania,including delegates from Sudan, Kenya, Mozambique and twoparticipants from South Africa. The spread of participants wasimpressive, including a few medical graduates working inoccupational health, some inspectors/licensing officials,university academics and agronomic researchers.

Course : After a general introduction on the first day, the coursethemes were leading into health effects (day 2), exposure (day3), surveillance (day 4) and policy issues (day 5). The Saturdayinvolved a field trip to a chemical factory and a flower farm.

The course was marked by a lot of press coverage. Although itinvolved some financial outlay to cover the journalist’s costs,this idea worked well, and should be borne in mind for futurecourses in the region.

On the first day, some of the evaluations appeared to expresssome reservations about the unstructured format of teaching(they preferred handouts and formal teaching), but within a dayor two, all evaluations seemed to indicate great enjoyment andappreciation of the teaching methodology, which includedintensive student participation.

The quality of the inputs was high. Those who had been askedto teach on the course, had prepared their material well, andclearly thought carefully about the audience. TPRI staff made aconsiderable contribution to the teaching of course.

Nida Besbellin from WHO headquarter’s InternationalProgramme for Chemical Safety (IPCS), was keen to see inputfrom the course organisers into a planned WHO Manual, andthen later, the development of the course into a CD package.

Evaluations and feedback: It was pointed to the fact that the coursecovered too much material. Lack of time for discussion wasoften cited in feedback. Future courses should be less ambitiousin the breadth of material covered, or have a more narrow focus.However, feedback was almost uniformly positive. Participantsidentified benefits from both the content and the format ofteaching and valued the opportunities to share experiences


between countries. They particularly enjoyed practical sessions(risk perception and communication; cholinesterase testing inthe laboratory), the critical appraisal exercise and valued the slidepresentation and discussion for being realistic.

Worth noting is the discussion on training and safe use, whichwas described as a “revolutionary way of looking at pesticideproblems”. One participant reported that in the informationsession “I learnt for the first time how to do a literature searchon the internet”. This should be kept in mind for future coursesin which more time should be spent on developing hard skills.

It was also mentioned that more training should be provided,either as additional courses examining in-depth areas (such asacute poisoning surveillance, pesticide toxicology, chronic healtheffects, biological monitoring training, and so forth), or it shouldcontinue to exist as a general course repeated yearly in SADCcountries.

Recommendations

● One of the points to emerge in discussions on acutepoisoning was the need for training of health care providersin the region in the diagnosis and management of pesticidepoisoning, both acute and chronic. Since the WHO/IPCSrepresentative was present, it was possible to get an informalcommitment to pursue strategies to obtain training oftrainers supported by WHO in the region with the aim toimprove awareness, monitoring and surveillance ofpesticide-related morbidity and mortality.

● Research and description of the extent of the problem inthe region is desperately needed.

● The participants should stay in contact and follow-upinformation on the activities of Fogarty and other capacitybuilding initiatives should be made available.

● The WHO/IPCS representative at the meeting, NidaBesbellin, was particularly interested in setting up links withAfrican centres for surveillance activities for acute pesticidepoisoning. The course offered an opportunity to joindifferent initiatives – the Fogarty UoM programme in theregion, the SIDA Occupational Health Capacity Buildinginitiative, and the WHO surveillance project. It wasindicated that the CDC was also interested in setting up alink for acute pesticide poisoning surveillance, particularlyin Tanzania.

● Numerous participants expressed interest in trainingtowards further degrees – PhDs and Masters. Hence, theFogarty plan to get twinned supervision for higher degreeslocally would be in demand.

● Two areas that emerged as needing extensive input werethe critical appraisal of articles, and use of the Internet tosupport research. These are generic research skills, notspecific to pesticides, but are clearly critical to enhancingkey occupational health skills. Future courses should makethese integral elements of the training, or even focusspecifically on such skills, as major a theme.

● The course allowed us to continue to build South - Southcollaboration and to provide support for potential futureAfrican - Central American links through the SIDA project.

Control Banding – Practical Toolsfor Controlling Exposure toChemicals

Carolyn Vickers ([email protected])International Programme on Chemical Safety

WHO headquarters, Geneva, Switzerlandwith Heather Jackson ([email protected])

President of IOHA (International Occupational Hygiene Association)and Occupational Hygienist

Growth in the use of chemicals in small- and medium-sizeenterprises (SMEs) and in emerging economies, where access topeople with the experience to assess and control exposure tochemicals is limited, has led to the development of a newapproach to the control of chemicals, called Control Banding(1). Control Banding uses information from suppliers ofchemicals. It takes users through a series of simple steps to choosepractical control solutions for airborne contaminants that shouldreduce 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 currentlyrequired in the European Union, and with the implementationof the Globally Harmonised System (GHS) for Classificationand Labelling, will appear on products sold worldwide.

The concept of Control Banding was developed by the UKHealth and Safety Executive (HSE) in its COSHH Essentialspackage (2). COSHH stands for Control of Substances Hazardousto Health. An internationalized version was developed by theInternational Labour Organization (ILO) in conjunction withthe 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 causecancer. The user finds R phrases on the label or Material SafetyData Sheet provided by the chemical supplier. Based on the Rphrases for a particular chemical, the Control Banding approachthen assigns a ‘hazard group’. The next step is to consider theexposure 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 ultimatelythe selection of workplace controls.

Control Banding uses three broad control approaches: generalventilation; engineering control; and containment. However, itis recognized, that in some cases specialist advice will be neededand 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 simpletable. The controls are described in control guidance sheets,which comprise both general information and, for commonlyperformed tasks, more specific advice. This approach allowsbusinesses without ready access to specialist advice to effectivelyreduce the exposures of its employees to the chemicals used.

International Application – The ILO Toolkit

Under the auspices of the International Programme on ChemicalSafety (IPCS (comprising WHO/ILO/UNEP)), an internationaltechnical group has been established to further develop the ILOToolkit and to facilitate its application globally. Partners in thiseffort include: the ILO; World Health Organization (WHO);


IOHA; the UK HSE; and the US National Institute ofOccupational Safety and Health (NIOSH). In addition, anumber of WHO Collaborating Centres in Occupational Healthin countries have committed to piloting the Toolkit, whichinvolves translation and refinement of control recommendationsbased on local conditions.

The next steps for the technical group are to develop animplementation strategy, which will include activities such astraining and translation into local languages. Further informationon 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 HSEsite which includes an internet based version of the COSHHEssentials www.coshh-essentials.org.uk . The IPCS website is athttp://www.who.int/pcs/.

AbbreviationsCCs = WHO Collaborating CentresHSE = UK Health and Safety ExecutiveIOHA = International Occupational Hygiene AssociationICSCs = International Chemical Safety Cards. These cardscurrently contain EU R phrases and consideration is being givento the need to include the GHS phrases in future.

References

1. Oldershaw PJ. Control Banding – A practical approach tojudging control methods for chemicals; Journal of PreventiveMedicine 2001;9(4):52-58

2. UK Health and Safety Executive. COSHH Essentials – Easy steps

to control chemicals.

The Compendium of Activities ofthe WHO Collaborating Centres inOccupational HealthThe Work Plan 2001-2005 of the Network of the WHOCollaborating Centres in Occupational Health was developedover the period 2000 - 2001, and was reviewed during the FifthNetwork Meeting in Chiangmai by the participatingCollaborating Centres in November 2001. The plan incorporatesthe plans and commitments of the Occupational HealthProgramme, the Regional offices and the WHO CollaboratingCentres in Occupational Health, for the implementation of theGlobal Strategy on Occupational Health for All. The participatingCollaborating Centres expressed their willingness to contributeto specific tasks contained in the Work Plan.

The centres formed themselves in 15 Task Forces, which alloweda Task Force of Collaborating Centres to be created for each of15 priority areas, to carry out the Work Plan. Projects focus onvarious priority areas in occupational health, and will result inproducts which range from documents and brochures to trainingcourses for occupational health personnel and/or students, fromtranslation of occupational health materials to the establishmentof questionnaires, guidelines and increased internationalcollaboration. The Task Forces cover, in between others, theareas specifically discussed in this Newsletter.The 15 Task Forces comprise the following areas:Task Force 1: GuidelinesTask Force 2: Intensive partnership in Africa

Task Force 3: Child labour/adolescent workersTask Force 4: Elimination of silicosisTask Force 5: Health care workersTask Force 6: Health promotion activityTask Force 7: Psychosocial factors at workTask Force 8: Promotion of OSH in small enterprises and in

the informal sectorTask Force 9: Prevention of musculoskeletal disordersTask Force 10: Preventive technologyTask Force 11: Training programmes and modulesTask Force 12: Internet resources and networksTask Force 13: National and local profiles and indicatorsTask Force 14: Economic evaluation of interventionsTask Force 15: Global burden of disease

Details of individual projects under these headings can be foundon 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 copiescan be addressed to the editor.

Last, but not least…..The Editor’s Book Tips

Collaborating Centres in Occupational Health have, incollaboration with the Occupational Health Programme, alreadyproduced booklets in the Protecting Workers’ Health series withinthe Global Work Plan of the Network. To date, five bookletswith different foci have been published on

■ Preventing Health Risks from the Use of Pesticides inAgriculture

■ Understanding and Performing Economic Assessments atthe 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 orconsult our website (www.who.int/oeh) under the rubric WHOOSH Documents.

All publications will be available electronically in French andSpanish.

Compendium ofActivities of the WHOCollaborating Centres

in Occupational Health

Compendium ofActivities of the WHOCollaborating Centres

in Occupational Health

Network of Collaborating CentresWork Plan 2001-2005

15 Task Forces

Protection of the Human EnvironmentOccupational and Environmental

Health Programme

June 2003

World Health Organization

www.who.int/oeh


CONTACTS

WHO headquarters(www.who.int/oeh/)Department of Protection of the HumanEnvironmentOccupational and Environmental HealthProgrammeGeneva, SwitzerlandFax: (41) 22 791 1383

e-mail: [email protected]

WHO Regional Advisers inOccupational Health:Regional Office for Africa (AFRO)(www.whoafr.org/ )Brazzaville, CongoFax: (242) 81 14 09 or 81 19 39e-mail: [email protected]

Regional Office for the Americas (AMRO)(www.paho.org/ )Pan American Health Organization (PAHO)Washington DC, USAFax: (202) 974 36 63e-mail: [email protected]

Regional Office for the Eastern Mediterranean(EMRO)(www.who.sci.eg)Cairo, EgyptFax: (202) 670 24 92 or 670 24 94e-mail: [email protected]

Regional Office for Europe (EURO)(www.who.dk)Copenhagen, DenmarkFax: (45) 39 17 18 18

Regional Office for South-East Asia (SEARO)(www.whosea.org/)New Delhi, IndiaFax: (91) 11 332 79 72e-mail: [email protected]

Regional Office for the Western Pacific (WPRO)(www.wpro.who.int/)Manila, PhilippinesFax: (63) 2 521 10 36 or 2 526 02 79

e-mail: [email protected]

Editor: E Kortum-MargotDesign: J-C Fattier

© World Health Organization 2003

All rights reserved. Publications of the World Health Organization can be obtained from Marketingand Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland(tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permissionto reproduce or translate WHO publications – whether for sale or for noncommercial distribution– should be addressed to Publications, at the above address (fax: +41 22 791 4806; email:–[email protected]).

The designations employed and the presentation of the material in this publication do not implythe expression of any opinion whatsoever on the part of the World Health Organization concerningthe legal status of any country, territory, city or area or of its authorities, or concerning thedelimitation of its frontiers or boundaries. Dotted lines on maps represent approximate borderlines for which there may not yet be full agreement.

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