3CONTENT Policy background ILO Convention 161 EU Legislation on OHS WHO Worker’s health: Global Plan of ActionBasic Occupational Health Services (BOHS)
4OCCUPATIONAL HEALTH AS A FUNDAMENTAL HUMAN RIGHT World Health Organization1 April, 2017OCCUPATIONAL HEALTH AS A FUNDAMENTAL HUMAN RIGHTEvery worker has the right to working conditions which respect his or her health, safety and dignity.(Art. 31 of the European Charter)
5IMPACT OF THE OCCUPATIONAL ENVIRONMENT ON HEALTH World Health Organization1 April, 2017IMPACT OF THE OCCUPATIONAL ENVIRONMENT ON HEALTHworkers die of work-related diseasesworkers die in occupational accidents (5% of all deaths due to accidents)Loss of 4% GDPIn absolute terms, 300,000 deaths per year are attributable to occupational related causes and to occupational accidents, the latter being 5 % of the total deaths due to accidents each year in the Region. Basically, we are losing 1000 workers everyday due to unhealthy and unsafe working conditions. However, the impacts are even more serious than these numbers of death counts.
7ILOJoint CommitteesRelated Conventions and Recommendations, Convention 161, Recommendation 171, in particularEthics in workers' health surveillance guidelinesNumerous Codes of PracticeGlobal StrategyPromotional Framework for Occupational Safety and Health Convention 187Fair globalization-Decent Work
8ILO CONVENTION 161 OH SERVICES Article 1: For the purpose of this Convention-(a) the term occupational health services means services entrusted with essentially preventive functions and responsible for advising the employer, the workers and their representatives in the undertaking on-(i) the requirements for establishing and maintaining a safe and healthy working environment which will facilitate optimal physical and mental health in relation to work;(ii) the adaptation of work to the capabilities of workers in the light of their state of physical and mental health;(b) the term workers' representatives in the undertaking means persons who are recognised as such under national law or practice.
9ILO CONVENTION 161(cont.) Article 2 In the light of national conditions and practice and in consultation with the most representative organisations of employers and workers, where they exist, each Member shall formulate, implement and periodically review a coherent national policy on occupational health services.
10ILO CONVENTION 161(cont.) Article 3 1. Each Member undertakes to develop progressively occupational health services for all workers, including those in the public sector and the members of production co-operatives, in all branches of economic activity and all undertakings. The provision made should be adequate and appropriate to the specific risks of the undertakings.2. If occupational health services cannot be immediately established for all undertakings, each Member concerned shall draw up plans for the establishment of such services in consultation with the most representative organisations of employers and workers, where they exist.
11ILO CONVENTION 161(cont.)Article 5…….occupational health services shall have such of the following functions as are adequate and appropriate to the occupational risks of the undertaking:(a) identification and assessment of the risks from health hazards in the workplace;(b) surveillance of the factors in the working environment and working practices which may affect workers' health, including sanitary installations, canteens and housing where these facilities are provided by the employer;(c) advice on planning and organisation of work, including the design of workplaces, on the choice, maintenance and condition of machinery and other equipment and on substances used in work;
12ILO CONVENTION 161(cont.)(d) participation in the development of programmes for the improvement of working practices as well as testing and evaluation of health aspects of new equipment;(e) advice on occupational health, safety and hygiene and on ergonomics and individual and collective protective equipment;f) surveillance of workers' health in relation to work;(g) promoting the adaptation of work to the worker;(h) contribution to measures of vocational rehabilitation;(i) collaboration in providing information, training and education in the fields of occupational health and hygiene and ergonomics;(j) organising of first aid and emergency treatment;(k) participation in analysis of occupational accidents and occupational diseases.
13ILO CONVENTION 161(cont.) Article 7 1. Occupational health services may be organised as a service for a single undertaking or as a service common to a number of undertakings, as appropriate.2. In accordance with national conditions and practice, occupational health services may be organised by-(a) the undertakings or groups of undertakings concerned;(b) public authorities or official services;(c) social security institutions;(d) any other bodies authorised by the competent authority;(e) a combination of any of the above.
14ILO CONVENTION 161(cont.) Article 9 1. In accordance with national law and practice, occupational health services should be multidisciplinary. The composition of the personnel shall be determined by the nature of the duties to be performed.2. Occupational health services shall carry out their functions in co-operation with the other services in the undertaking.3. Measures shall be taken, in accordance with national law and practice, to ensure adequate co-operation and co-ordination between occupational health services and, as appropriate, other bodies concerned with the provision of health services.
15EU Framework Directive 89/391-preventive and protective services Occupational health and safety strategyWorkplace health promotionEconomic loss/productivity
16PRINCIPLES OF EU LEGISLATION ON OCCUPATIONAL HEALTH AND SAFETY World Health OrganizationPRINCIPLES OF EU LEGISLATION ON OCCUPATIONAL HEALTH AND SAFETY1 April, 2017 Prevention Hierarchy of prevention measures Continuous improvement Health and Safety Employers’ responsibility Social dialogue and participation of employees Multidisciplinarity in preventive services & holistic approach to work
17FRAMEWORK DİRECTİVE 89/391/EEC Its scope is large: all sectors of activity, both public and private, with very few clearly described exceptions.Article 5 (1), the Directive's fundamental provision, states that "the employer shall have a duty to ensure the safety and health of workers in every aspect related to the work."
18World Health Organization 1 April, 201789/391/EHS – Framework Directiveon the introduction of measures to encourage improvementsin the safety and health of workers at workUsing of the work equipment89/655/EECWork Equipment (2)Specific group of workers92/85/EECPregnant and breastfeeding workers and worker who have recently given birth (10)Specific activities90/269/EECManual Handling of Loads (4)90/270/EECDisplay Screen Equipments (5)92/91/EECDrilling (11)Personal protection89/656/EECPersonal Protective Equipment (3)Exposure to agents90/394/EECCarcinogens (6)2000/54/ECBiological Agents (7)98/24/ECChemical Agents (14)2000/44/ECVibrations (16)2003/10/ECNoise (17)2004/40/ECElectromagnetic Fields (18)Workplace89/654/EECWorkplace (1)92/57/EECTemporary/Mobile Construction Sites (8)92/58/EECSafety and/or Health Signs (9)92/104/EECSurface and Underground Mineral-extracting Industries (12)93/103/ECFishing Wessels (13)1999/92/ECExplosive Athmospheres (15)2000/39/ECIndicative occupationalexposure limit values
19World Health Organization 1 April, 2017OHS directives whichare not directly underFramework Directive 89/391/EEC91/383/EECTemporary Workers94/33/ECYoung Workers93/104/EC2000/34/EC2000/79/EC2002/15/ECWorking Time1983/477/EC1999/77/EC2003/18/ECAsbestos
20WHO WHO HFA 2000 and HFA21 Alma Ata: Primary Health Care Health sector reformPublic health policy: Prevent the preventableEquity: odd distribution of risksSocial determinants of healthGlobal Strategy on OH for AllWorkers’ Health - Global Action Plan
21WHO’S CONCEPT ON WORKERS’ HEALTH AS A PUBLIC HEALTH ISSUE World Health Organization1 April, 2017WHO’S CONCEPT ON WORKERS’ HEALTH AS A PUBLIC HEALTH ISSUEThe Labour ApproachThe Public Health ApproachOccupational HealthLabour ContractEmployer's responsibilityOnly at the workplaceOnly work-related healthNegotiation between workers and employersWorkers HealthAll workers beyond the workplaceResponsibility of everyoneAll health determinantsOther stakeholders Health protection not subject to collective negotiationCan use the example of Move for Health Day, and initiatives at the work place to support diet and physical activity and sustainable commuting. Recall Move for health day 2007
2260TH WORLD HEALTH ASSEMBLY "WORKERS' HEALTH: GLOBAL PLAN OF ACTİON" The Global Plan of Action developed by the Member States, May 2007Consensus by all 192 Member States of WHOGlobal plan of action on workers' health ( )WHA60 urged Member States to take an number of measures on workers' health
23World Health Organization 1 April, 2017OBJECTIVE 1: TO DEVELOP AND IMPLEMENT POLICY INSTRUMENTS ON WORKERS HEALTHNational policy frameworkslegislationintersectoral collaborationfunding and resource mobilizationstrengthening the ministries of healthNational action on workers’ health (taking into consideration also ILO Promotional Framework for OSH Convention)national profiles and priorities for actionobjectives, targets and actionsmechanism for implementation, monitoring and evaluationhuman and financial resourcesNational approaches for prevention of priority occupational diseases and accidentsMinimizing gaps – high risk sectors, vulnerable groups, gender aspectsWHO assistance to strengthen the capacities of ministries of health; global campaigns: elimination of asbestos-related diseases and immunization of healthcare workers against HBV
24OBJECTIVE 2:TO PROTECT AND PROMOTE HEALTH AT THE WORKPLACE World Health OrganizationOBJECTIVE 2:TO PROTECT AND PROMOTE HEALTH AT THE WORKPLACE1 April, 2017Improving assessment and management of health risks at workplace:Essential interventions for prevention occupational hazardsIntegrated management of chemicalsElimination of smoking from all indoor workplacesHealth impact assessment of new technologiesBasic set of occupational health standardsMinimum requirements for health and safety protectionEnforcement and inspectionCapacities for primary prevention of occupational hazards, diseases and injuries: methodologies, training, healthy workplacesHealth promotion and prevention of noncommunicable diseases at workplace: diet, physical activity, mental health, family healthPrevention and control HIV/AIDS, malaria, TB etc. in workplace
25World Health Organization OBJECTIVE 3:TO IMPROVE THE PERFORMANCE OF AND ACCESS TO OCCUPATIONAL HEALTH SERVICES1 April, 2017Coverage and quality of occupational health servicesLinkage to national health strategies and health sector reformsStandards for organization and coverageMechanisms for resources and financing of the deliverySufficient and competent human resourcesQuality assurance systemsBasic occupational health services for all workersBuilding core institutional capacities – national and local levelsDevelopment of human resources for occupational healthPost graduate trainingCapacities for basic occupational health servicesworkers-’health in training of primary health careAttracting and retaining human resources
26World Health Organization OBJECTIVE 4: TO PROVIDE AND COMMUNICATE EVIDENCE FOR ACTION AND PRACTICE1 April, 2017Systems for surveillance of workers' healthNational information systemsCapacities to estimate burden of diseases and injuriesRegistries of exposures, diseases and accidentsEarly reporting and detectionResearchSpecial agendasPractical and participatory researchCommunication and awareness raisingWorkers and employersPolicy makers, mediaHealth practitionersWHO action: indicators for workers' health; incorporation of occupational causes of diseases in ICD11; diagnostic and exposure criteria for occupational diseases
27OBJECTIVE 5: TO INCORPORATE WORKERS’ HEALTH INTO OTHER POLICIES World Health OrganizationOBJECTIVE 5: TO INCORPORATE WORKERS’ HEALTH INTO OTHER POLICIES1 April, 2017Economic development policies and poverty reduction strategiesCollaboration with private sectors to avoid international transfer of risksNational plans and programmes for sustainable developmentConsider workers' health in the context of trade policiesAssess health impacts of employment policiesEnvironmental protection in relation to workers' health:Strategic approach to International Chemicals ManagementMultilateral environmental agreementsEnvironmental management systemsEmergency preparedness and responseSectoral policies for branches with highest health risksPrimary, secondary and higher level of education and vocational training
28ESSENTIAL PUBLIC HEALTH FUNCTIONS IN THE AREA OF OCCUPATIONAL HEALTH Assessment and management of occupational risksMonitoring and surveillance of workers' healthWorkplace health promotionParticipation of workers and employersDevelopment of policies and institutional capacityStrengthening of institutional capacity for regulation and enforcement in occupational healthEvaluation and promotion of equitable access to OH servicesHuman resources development and training in OHQuality assurance in OH servicesResearch in OHReduction of the impact of industrial accidents and technological disasters on healthWHO PAHO “Public Health in the Americas. Conceptual Renewal, Performance Assessment, and Bases for Action” 2002
29BOHSOccupational health services are available to only 10%–15% ofworkers worldwide.In industrialized countries, the coverage varies between 15% and 90% and in developing countries between a few percent and 20%, even where services are available, their quality and relevance may be low.The needs of occupational health services grow continuously and new challenges are set by the globalization of work life.To provide a response to such a global challenge the WHO/ILO/ICOH joint effort on the development of BOHS was launched.
30World Health Organization COVERAGE OF OHS1 April, 2017Workers without OHSWhat is the current coverage of occupational health services? There are unfortunately very few data on the percentage of economically active population covered with occupational health services. This figure shows the data available for 21 countries, mostly from the European region. The numbers range from almost universal (95% in Netherlands, 90% in Finland) to a very limited coverage (4% in Slovakia and 5% in Kenya).On average about 50% of the workers in the 15 Member States of the European Union (prior to 1 May 2004). Though this figure may seem very high compared to the average for the world (15%) it was considered unsatisfactory for the EU. In February 2005, the European Parliament expressed concern that only half of the European workers have access to occupational health services having in mind that the framework legislation of the European Union requires that all workers should have access to preventive services at the workplace. The low access to occupational health services was therefore considered as failure to implement the EU legislation on health and safety at work.The triangle on the right upper side of the diagram shows the underserved population which is the object of new models for provision of occupational health services, i.e. the basic occupational health services.
31BOHSThe ultimate objective of the BOHS initiative is to provide occupational health services for all working people in the world, regardless of economic sector, mode of employment, size of workplace or geographic location i.e. according to the principle of universal services provision
32BOHS There is a challenge to provide good practice guidelines and toolboxes for service providers on a number of specific activities, such as planning of occupational health services, risk assessment and management, ergonomics and safety, assessment of psychological conditions and stress, and diagnosis of occupational diseases.
33BOHSBOHS are most needed for countries and sectors that do not have services at all or which are seriously underserved.Particularly high-risk sectors such as agriculture, mining, fishery, forestry and construction have to be given priority.Governments, in collaboration with social partners and with support and guidance by international organizations, should strengthen their policies and clarify priorities with regard to organization and development of service infrastructures.
34BOHS CYCLE Workers health Work Organization Work environment Worker Orientationand planningEvaluationEvaluationMonitoring &Surveillance of WERecord keepingSurveillance ofworker's healthIndividualhealth recordWorkerAssessingWE Risk AssessmentGeneralhealth serviceAssessment ofindividual'shealth riskEmergencypreparednessFirst aidHealth educationand healthinformationDg of ODsand WRDsActionInformationAccident preventionInitiativesInteraction &EducationPrevention ofOH hazardsInitiativesWork OrganizationWork environment
35HIERARCHY OF PREVENTIVE MEASURES World Health Organization1 April, 2017HIERARCHY OF PREVENTIVE MEASURESStructural preventionLack of hazardEngineering controlsMinimising emissionsControl technologyVentilation, exhaustionWorking practices,wet processes,cleanliness, orderPersonal protection,respiratorsPreventive powerLimiting exposuretimesDecontamination,health surveillance,early diagnosis,treatmentBurden to health
36World Health Organization 1 April, 2017A STEPWISE STRATEGYFOR OCCUPATIONAL HEALTH SERVICESStage IVComprehensiveServiceStage IIIInternationalStandard ServiceIn-company or externalspecial OHS unitsComprehensive content:prevention, curative and promotion & development servicesContinuous developmentObjective for all!Stage IIBasic ServiceOHS InfrastructureILO No. 161, 155MultidisciplinarycontentPrevention pluscurative servicesStage IStarting levelPHC InfrastructureBasic OHS contentToolboxesAdvice in OHAccidents and ODsAcute ill-healthPHCField nurseSafety agentPhysician and nursewith short specialtrainingMultidisciplinary team with special trainingMultidisciplinaryspecialists' teamStarting point for Big industries and well organised SMEsSMEs,SSEs,SEs,IFSSMEs,SSEs,SEs,IFSBig industries andBig OHS Centres
37MODELS OF SERVICES PROVISION World Health OrganizationMODELS OF SERVICES PROVISION1 April, 2017Primary health care modelBig company modelGroup servicesSocial security modelPrivate physicianPrivate health centreLocal or regional hospitals
38CONTENT OF BOHSThe content of basic occupational health services includes, as a minimum, the following activities: • surveillance of work environment and risk assessment • health surveillance and health examinations • advice on preventive and control measures • health education and health promotion and promotion of work ability • first aid and treatment of acute illnesses • diagnosis of occupational diseases.
39World Health Organization MODERN OCCUPATIONAL HEALTH SYSTEM1 April, 2017Competent authorityin central governmentlabourhealthSecondary support levelLABOUR INSPECTORATEIOH or RESPOMOM CLINICSHyg, Erg, Psych,Safety, W-org, OMFrontline levelGROUP OHSPHCPrivate centerIN-COMPANY OHSBigcompanySMECompanySESMESSESMESESESEIFSIFSIFSIFSIFSIFSIFSBOHSIFS
40World Health Organization Example: OH service providers in FinlandWorld Health Organization1 April, 2017Räsänen et al 2002EnterpriseEnterpriseEnterpriseEnterprises 61%Employees 37%OHS units 31%Costs %MUNICIPALHEALTHFarmersCENTRESelf-employedEnterprises 2%Employees 25%OHS units %Costs %SatelliteEnterpriseBIG ENTERPRISEOHSEnterpriseEnterprises 4%Employees 6%OHS units %Costs %EnterpriseGROUP OHSEnterpriseEnterprises 33%Employees 32%OHS units %Costs %EnterprisePIVATE OHSCENTEREnterprise
41CONCLUSION Development of the whole occupational health system (policy, legislation, infrastructures, human resources, information systems and registration)Occupational health services should be provided by well-established service provision units with a sufficient size to be able to provide multiprofessional servicesTraining of multiprofessional expert resources for occupational health is recommended by upgrading and re-orienting the existing expert resources and by training new experts for broadening the scope of competence of occupational health services.
42CONCLUSIONDrawing up a National Policy and Strategy and systematic curricula for training in occupational health and their adjustment to European curriculum systems is recommended.Utilization of Basic Occupational Health Service (BOHS) model is recommended for expansion of coverage of occupational health services and particularly for serving the small enterprise, self-employed and informal sector workplaces.
43CONCLUSIONThe implementation of existing regulations is recommended to be supported by production of appropriate standards and good practice guidelines for practical implementation of occupational health services.Infrastructures for occupational health services are recommended to be institutionalized and developed on a multi-model basis: coverage of all working people!
44CONCLUSIONAn important part of infrastructure consists of the Institute of Occupational Health and SafetyA special information strategy on occupational health, including the development of national information service and dissemination system:- National ILO CIS Center- Focal Point for EU OSHA- WHO Collaborating Centre
45Dr. Buhara ÖNAL firstname.lastname@example.org 00 90 312 2571690/200 THANK YOU…Dr. Buhara ÖNAL/200