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Presentation on theme: "MINISTRY OF LABOUR & SOCIAL SECURITY DIRECTORATE GENERAL OF OHS"— Presentation transcript:

Dr. Buhara Önal OHS INSTITUTE (ISGUM) May 2010 Ankara - TURKEY


3 CONTENT Policy background ILO Convention 161 EU Legislation on OHS
WHO Worker’s health: Global Plan of Action Basic Occupational Health Services (BOHS)

World Health Organization 1 April, 2017 OCCUPATIONAL HEALTH AS A FUNDAMENTAL HUMAN RIGHT Every worker has the right to working conditions which respect his or her health, safety and dignity. (Art. 31 of the European Charter)

World Health Organization 1 April, 2017 IMPACT OF THE OCCUPATIONAL ENVIRONMENT ON HEALTH workers die of work-related diseases workers die in occupational accidents (5% of all deaths due to accidents) Loss of 4% GDP In 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.


7 ILO Joint Committees Related Conventions and Recommendations, Convention 161, Recommendation 171, in particular Ethics in workers' health surveillance guidelines Numerous Codes of Practice Global Strategy Promotional Framework for Occupational Safety and Health Convention 187 Fair globalization-Decent Work

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.

9 ILO 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.

10 ILO 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.

11 ILO 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;

12 ILO 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.

13 ILO 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.

14 ILO 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.

15 EU Framework Directive 89/391-preventive and protective services
Occupational health and safety strategy Workplace health promotion Economic loss/productivity

World Health Organization PRINCIPLES OF EU LEGISLATION ON OCCUPATIONAL HEALTH AND SAFETY 1 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

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."

18 World Health Organization
1 April, 2017 89/391/EHS – Framework Directive on the introduction of measures to encourage improvements in the safety and health of workers at work Using of the work equipment 89/655/EEC Work Equipment (2) Specific group of workers 92/85/EEC Pregnant and breastfeeding workers and worker who have recently given birth (10) Specific activities 90/269/EEC Manual Handling of Loads (4) 90/270/EEC Display Screen Equipments (5) 92/91/EEC Drilling (11) Personal protection 89/656/EEC Personal Protective Equipment (3) Exposure to agents 90/394/EEC Carcinogens (6) 2000/54/EC Biological Agents (7) 98/24/EC Chemical Agents (14) 2000/44/EC Vibrations (16) 2003/10/EC Noise (17) 2004/40/EC Electromagnetic Fields (18) Workplace 89/654/EEC Workplace (1) 92/57/EEC Temporary/Mobile Construction Sites (8) 92/58/EEC Safety and/or Health Signs (9) 92/104/EEC Surface and Underground Mineral-extracting Industries (12) 93/103/EC Fishing Wessels (13) 1999/92/EC Explosive Athmospheres (15) 2000/39/EC Indicative occupational exposure limit values

19 World Health Organization
1 April, 2017 OHS directives which are not directly under Framework Directive 89/391/EEC 91/383/EEC Temporary Workers 94/33/EC Young Workers 93/104/EC 2000/34/EC 2000/79/EC 2002/15/EC Working Time 1983/477/EC 1999/77/EC 2003/18/EC Asbestos

20 WHO WHO HFA 2000 and HFA21 Alma Ata: Primary Health Care
Health sector reform Public health policy: Prevent the preventable Equity: odd distribution of risks Social determinants of health Global Strategy on OH for All Workers’ Health - Global Action Plan

World Health Organization 1 April, 2017 WHO’S CONCEPT ON WORKERS’ HEALTH AS A PUBLIC HEALTH ISSUE The Labour Approach The Public Health Approach Occupational Health Labour Contract Employer's responsibility Only at the workplace Only work-related health Negotiation between workers and employers Workers Health All workers beyond the workplace Responsibility of everyone All health determinants Other stakeholders Health protection not subject to collective negotiation Can 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

The Global Plan of Action developed by the Member States, May 2007 Consensus by all 192 Member States of WHO Global plan of action on workers' health ( ) WHA60 urged Member States to take an number of measures on workers' health

23 World Health Organization
1 April, 2017 OBJECTIVE 1: TO DEVELOP AND IMPLEMENT POLICY INSTRUMENTS ON WORKERS HEALTH National policy frameworks legislation intersectoral collaboration funding and resource mobilization strengthening the ministries of health National action on workers’ health (taking into consideration also ILO Promotional Framework for OSH Convention) national profiles and priorities for action objectives, targets and actions mechanism for implementation, monitoring and evaluation human and financial resources National approaches for prevention of priority occupational diseases and accidents Minimizing gaps – high risk sectors, vulnerable groups, gender aspects WHO assistance to strengthen the capacities of ministries of health; global campaigns: elimination of asbestos-related diseases and immunization of healthcare workers against HBV

World Health Organization OBJECTIVE 2:TO PROTECT AND PROMOTE HEALTH AT THE WORKPLACE 1 April, 2017 Improving assessment and management of health risks at workplace: Essential interventions for prevention occupational hazards Integrated management of chemicals Elimination of smoking from all indoor workplaces Health impact assessment of new technologies Basic set of occupational health standards Minimum requirements for health and safety protection Enforcement and inspection Capacities for primary prevention of occupational hazards, diseases and injuries: methodologies, training, healthy workplaces Health promotion and prevention of noncommunicable diseases at workplace: diet, physical activity, mental health, family health Prevention and control HIV/AIDS, malaria, TB etc. in workplace

25 World Health Organization
OBJECTIVE 3:TO IMPROVE THE PERFORMANCE OF AND ACCESS TO OCCUPATIONAL HEALTH SERVICES 1 April, 2017 Coverage and quality of occupational health services Linkage to national health strategies and health sector reforms Standards for organization and coverage Mechanisms for resources and financing of the delivery Sufficient and competent human resources Quality assurance systems Basic occupational health services for all workers Building core institutional capacities – national and local levels Development of human resources for occupational health Post graduate training Capacities for basic occupational health services workers-’health in training of primary health care Attracting and retaining human resources

26 World Health Organization
OBJECTIVE 4: TO PROVIDE AND COMMUNICATE EVIDENCE FOR ACTION AND PRACTICE 1 April, 2017 Systems for surveillance of workers' health National information systems Capacities to estimate burden of diseases and injuries Registries of exposures, diseases and accidents Early reporting and detection Research Special agendas Practical and participatory research Communication and awareness raising Workers and employers Policy makers, media Health practitioners WHO action: indicators for workers' health; incorporation of occupational causes of diseases in ICD11; diagnostic and exposure criteria for occupational diseases

World Health Organization OBJECTIVE 5: TO INCORPORATE WORKERS’ HEALTH INTO OTHER POLICIES 1 April, 2017 Economic development policies and poverty reduction strategies Collaboration with private sectors to avoid international transfer of risks National plans and programmes for sustainable development Consider workers' health in the context of trade policies Assess health impacts of employment policies Environmental protection in relation to workers' health: Strategic approach to International Chemicals Management Multilateral environmental agreements Environmental management systems Emergency preparedness and response Sectoral policies for branches with highest health risks Primary, secondary and higher level of education and vocational training

Assessment and management of occupational risks Monitoring and surveillance of workers' health Workplace health promotion Participation of workers and employers Development of policies and institutional capacity Strengthening of institutional capacity for regulation and enforcement in occupational health Evaluation and promotion of equitable access to OH services Human resources development and training in OH Quality assurance in OH services Research in OH Reduction of the impact of industrial accidents and technological disasters on health WHO PAHO “Public Health in the Americas. Conceptual Renewal, Performance Assessment, and Bases for Action” 2002

29 BOHS Occupational health services are available to only 10%–15% of workers 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.

30 World Health Organization
COVERAGE OF OHS 1 April, 2017 Workers without OHS What 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.

31 BOHS The 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

32 BOHS 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.

33 BOHS BOHS 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.

34 BOHS CYCLE Workers health Work Organization Work environment Worker
Orientation and planning Evaluation Evaluation Monitoring & Surveillance of WE Record keeping Surveillance of worker's health Individual health record Worker Assessing WE Risk Assessment General health service Assessment of individual's health risk Emergency preparedness First aid Health education and health information Dg of ODs and WRDs Action Information Accident prevention Initiatives Interaction & Education Prevention of OH hazards Initiatives Work Organization Work environment

World Health Organization 1 April, 2017 HIERARCHY OF PREVENTIVE MEASURES Structural prevention Lack of hazard Engineering controls Minimising emissions Control technology Ventilation, exhaustion Working practices, wet processes, cleanliness, order Personal protection, respirators Preventive power Limiting exposure times Decontamination, health surveillance, early diagnosis, treatment Burden to health

36 World Health Organization
1 April, 2017 A STEPWISE STRATEGY FOR OCCUPATIONAL HEALTH SERVICES Stage IV Comprehensive Service Stage III International Standard Service In-company or external special OHS units Comprehensive content: prevention, curative and promotion & development services Continuous development Objective for all! Stage II Basic Service OHS Infrastructure ILO No. 161, 155 Multidisciplinary content Prevention plus curative services Stage I Starting level PHC Infrastructure Basic OHS content Toolboxes Advice in OH Accidents and ODs Acute ill-health PHC Field nurse Safety agent Physician and nurse with short special training Multidisciplinary team with special training Multidisciplinary specialists' team Starting point for Big industries and well organised SMEs SMEs,SSEs,SEs,IFS SMEs,SSEs,SEs,IFS Big industries and Big OHS Centres

World Health Organization MODELS OF SERVICES PROVISION 1 April, 2017 Primary health care model Big company model Group services Social security model Private physician Private health centre Local or regional hospitals

38 CONTENT OF BOHS The 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.

39 World Health Organization
MODERN OCCUPATIONAL HEALTH SYSTEM 1 April, 2017 Competent authority in central government labour health Secondary support level LABOUR INSPECTORATE IOH or RESP OM OM CLINICS Hyg, Erg, Psych, Safety, W-org, OM Frontline level GROUP OHS PHC Private center IN-COMPANY OHS Big company SME Company SE SME SSE SME SE SE SE IFS IFS IFS IFS IFS IFS IFS BOHS IFS

40 World Health Organization
Example: OH service providers in Finland World Health Organization 1 April, 2017 Räsänen et al 2002 Enterprise Enterprise Enterprise Enterprises 61% Employees 37% OHS units 31% Costs % MUNICIPAL HEALTH Farmers CENTRE Self-employed Enterprises 2% Employees 25% OHS units % Costs % Satellite Enterprise BIG ENTERPRISE OHS Enterprise Enterprises 4% Employees 6% OHS units % Costs % Enterprise GROUP OHS Enterprise Enterprises 33% Employees 32% OHS units % Costs % Enterprise PIVATE OHS CENTER Enterprise

41 CONCLUSION 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 services Training 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.

42 CONCLUSION Drawing 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.

43 CONCLUSION The 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!

44 CONCLUSION An important part of infrastructure consists of the Institute of Occupational Health and Safety A 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

45 Dr. Buhara ÖNAL 00 90 312 2571690/200
THANK YOU… Dr. Buhara ÖNAL /200


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