1. OEH Training Summary Thoughts Hong Kong 29 October 2013 Thomas H Gassert MD MSc Harvard School of Public Health

2. OEH Diagnosis and Causation Two steps: – Medical diagnosis requires quality OEH training – Causation (work related, or not) should be an impartial judgment Need to use subject and group information – Epidemiology, toxicology, risk assessment – Understanding work place and job imperative Causation is a judgment (more probable than not): – Strength of association – Consistency – Specificity – Time relationship – Biological gradient – Biological plausibility – Coherence (synthesis of evidence) 29 Oct 2013 HK THGOEH Summary Thoughts2

3. Obstacles for Parties to OEH GovernmentEnterprise/WorkLabour/NGOsMedical/Prevention Contradictory OEH laws and practices Poor treatment, abuse and threats Bear burden of disease; lack of primary OEH protection Lack of OD diagnostic knowledge and skills and primary OEH prevention Inadequate OEH standards and policies Fear of worker rights realization and protests/claims Fear of job loss, discrimination Almost no one trained in OEH prevention/care No whistleblower protection, and other political abuses Do not understand $ and social value of OEH Lack of OEH prevention methods, rights, hazard risk knowledge, and how to relate to medical providers Those trained are overwhelmed, not dedicated, or co- opted; fear of legal and defamation repercussions 29 Oct 2013 HK THGOEH Summary Thoughts3

4. OEH Motivation & Advantages GovernmentEnterprise/WorkLabour/NGOMedical/Prevention Lift cost of diseaseLeadership Standards upgradingReputationTrainable in OEH, tailored to culture, language, job conditions, literacy (example, Hesperian book model) Trainable in OEH if they know they can help workers without penalty; case based is holistic; see one, do one, teach one Medical practice regulatory reforms Cost advantagesHighly motivatedNeed OEH teamwork and PHC integration Trainable in OEHPress: (1)work place (2)public Need standards and credentials 29 Oct 2013 HK THGOEH Summary Thoughts4

5. Approaches – Two? Obstacles are serious Two approaches 1.Root levels, subtle but strong, holistic, integrated, from bottom-up a.Choose motivated partners from all parties b.Start with work-site OEH skills (e.g., safety reps) c.Empower workers with knowledge of OEH recognition, diagnoses and how to relate with OSH profs and medical d.Emphasize training primary care in OEH 2.Public a.Campaigns, expert and grassroots publications, ratings, media, handbooks (Hesperian style), videos b.Call out abuses and reward good practices using science and experts (medical and legal) 29 Oct 2013 HK THGOEH Summary Thoughts5

6. Projects - ? Signed resolution stating need for training Identify rapid and practical ways to integrate OEH training locally with existing PHC services Complete baseline needs assessment, nation- by-nation (publish and post) Assemble an interim international OE medical panel to assist urgent cases and disasters 29 Oct 2013 HK THGOEH Summary Thoughts6

7. Possible Solutions Root work to educate all parties – OEH/OSH prevention skills (1, 2, 3 levels) – Technical skills and knowledge transfer Shop floor Medics, hygienists, engineers, managers, gov’t workers Raise legal (labour and OEH law) and medical standards – OD diagnoses (see WHO handout from Finland) – Access to health care and primary prevention experts – Accreditation/certification of medical teams Integrate and embed OEH training in primary care service Consider Taiwan NODIS internet OD reporting system as it has had significant boost to OD diagnosis and compensation (see handout article from IJOEH 2013) Bring “value-added” achievable projects to funders – Funds will come if payors see value-added (benefits outweigh costs) Establish new generation of OEH specialists by having national capacity building in OEH training, certification and materials 29 Oct 2013 HK THGOEH Summary Thoughts7

8. Work Site Technical Training Walk-through survey and checklists OSH committee (labour and management) Periodic inspections Access to experts and records/reports – Occupational hygiene, safety manager, consultant – Nursing, Rehab, Medical – Worker has right to his/her medical and exposure records Hazard Communication tools, access Barefoot epidemiology – Each case – Group applications 29 Oct 2013 HK THGOEH Summary Thoughts8

9. Final Thought Training and Funding Jump start for OEH at all levels Eliminate costs and financially support those being trained in OEH skills/knowledge Use international support to eventually build national competencies/capacity New Generation Univ – U. British Columbia linked with superior programs for certifications (Harvard, U.I. Chicago, U. Wash., others) Work with Partners in Health to create Partners in Occupational & Environmental Health – Realize human rights to OEH – Access funding from World Bank for team training 29 Oct 2013 HK THGOEH Summary Thoughts9

10. 17 Ways NextGenU Differs from MOOCs* and Traditional Education Credit Free Financial sustainability Higher level education Best available resources Coordinated curriculum Competency-based foundation Multiple languages Extensive human interactions Interactive computerized learning Extensive computer and human assessment Open use Customizable Active educational partnerships A new way to teach Open research policy Warm prestige *MOOCs=Massive Open Online Courses

11. Seek Free Methods 29 Oct 2013 HK THGOEH Summary Thoughts11 4 Freedoms – Cost – Barriers – Ads – Carbon New Gen U Partnerships 4 Freedoms – Cost – Barriers – Ads – Carbon New Gen U Partnerships

12. Motivation Feel impowered Feel motivated Try not to feel overwhelmed Seek global support, partners Integrate environment with occupational There’s no turning back! 29 Oct 2013 HK THGOEH Summary Thoughts12