The Global Occupational Health Network ISSUE No. 5SUMMER 2003 GOHNETGOHNET GOHNET NEWSLETTER The Occupational Health Dear GOHNET members and future members, Programme of WHO This is a special issue written to inform you about the ILO/WHO Joint Committee on Occupational Health, as well as some ongoing activities. Headquarters The Committee first met in 1950 and will meet again from 2-5 December Dr Gerry Eijkemans ([email protected]) in Geneva at the ILO headquarters office. Occupational Health Programme At the WHO 89th Session of the Executive Board in 1992, Dr Nakajima, WHO headquarters, Geneva, Switzerland then Director-General of WHO, underlined the fact that ‘over the years, Background WHO has given insufficient attention to the diseases affecting the entire spectrum of the working population‘– from working children, to Working conditions, for the majority of the three billion workers adolescents, adults and the working elderly’. worldwide, do not meet the minimum standards and guidelines In 1995, the ILO/WHO Joint Committee on Occupational Health met set by the World Health Organization and the International and developed a consensus statement on occupational health. It reads as Labour Organization (ILO) for occupational health, safety and follows: ‘The main focus in occupational health is on three different social protection. Throughout the world, poor occupational objectives: (i) the maintenance and promotion of workers’ health and health and safety leads to two million work-related deaths, 271 working capacity; (II) the improvement of working environment and work million injuries and 160 million occupational diseases per year1. to become conducive to safety and health; and (iii) the development of work organization and working cultures is intended in this context to mean The majority of the world’s workforce does not have access to a reflection of the essential value systems adopted by the undertaking occupational health services; only 10-15 % of the total global concerned. Such a culture is reflected in practice in the managerial systems, workforce has access to some kind of occupational health services. personnel policy, principles for participation, training policies and quality The main problem of the absence of occupational health services management of the undertaking’. is the continuous presence of in the workplace, such as The Committee found, that with respect to the areas for specific urgent noise, toxic chemicals, and dangerous machinery, leading to a collaboration identified at the 11th and prior session, there had been little huge burden of death, disability and disease. Also, psychosocial real progress achieved in many countries. Accordingly, the Committee risk factors at work such as stress and violence have become a requested more specific reporting directly addressing the identified urgent areas of collaboration at its subsequent meetings. Then, international major issue in developed countries and are of growing concern collaboration, co-operation and co-ordination were stressed as the keys to in the developing countries and countries in transition. An success in occupational health, and this has not changed to this day. It was additional problem is the massive inclusion of children in the mentioned that intensified areas of co-operation should be identified and workforce, completely unprotected. that the basic principle of the ILO/WHO collaboration should be a 1ILO, 2002 ‘common goal and complementary strategy’. The agenda of the next Joint Committee meeting foresees the development IN THIS ISSUE: of joint work plans and co-ordination of strategies at global level between ILO and WHO; discussions about occupational management systems and The Occupational Health Programme of WHO Headquarters 1 the complementary roles of Ministries of Health and Labour. Selected topics include the African Joint Effort, silicosis, national OHS profiles and An example of co-operation with the private sector 3 control banding. The ILO/WHO Global Programme on Elimination of Silicosis 3 In this Newsletter, you will find a selection of articles about related activities The WHO/ILO Joint Effort on Occupational Health and Safety in priority areas. International collaboration is the major theme and in Africa 5 contributors have delivered concrete examples. In addition, we will present the Occupational Health Programme at WHO Headquarters. An example of successful pilot training courses in South Africa on Airborne Dust 6 For general comments, questions and future contributions you may contact An example of a successful pilot training course the editor: in Arusha on Pesticides 8 Control Banding – Practical Tools for Controlling Evelyn Kortum-Margot ([email protected]) Exposure to Chemicals 9 Occupational & Environmental Health Programme Department of Protection of the Human Environment The Compendium of Activities of the WHO Network WHO/OMS of Collaborating Centres in Occupational Health 10 20 Avenue Appia; CH - 1211 Geneva 27 The Editor’s Book Tips 10 Fax: +41.22.791 13 83 WHO Contacts 11 GOHNET Member Application Form 12

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 WHO Occupational Health Programme the personnel of national and city health departments have been cut, weakening public health programmes including occupational The framework for WHO’s Occupational Health (OCH) health, and health services; there is a drastic shortage of high- Programme is’The Global Strategy on Occupational Health for All, level or specialized professional expertise of all kinds in most which was approved by the World Health Assembly in 1996. countries. This situation is deteriorating due to the HIV/AIDS The main priority areas are: strengthening of international and pandemic. national policies for health at work; promotion of a healthy work environment, healthy work practices, and health at work; WHO’s strategic directions and activities strengthening of occupational health services; establishment of Within the framework of the Global Strategy, some of the appropriate support services for occupational health; activities that the WHO, with its network of collaborating centres development of occupational health standards based on scientific is carrying out are: ; development of human resources; establishment of registration and data systems and information support and ■ Through the Regional Offices, countries are encouraged strengthening of research. to adopt national strategies for occupational health and safety that set priorities and targets, such as reduction of Implementation of the strategy is a task of the OCH Programme “high incidence” or “high severity” risks; effective in the WHO Headquarters, the six WHO Regional Offices, and prevention of disease and injury; elimination of hazards at the Network of over 70 WHO Collaborating Centres (CCs) in the design stage, and improved capacity of business Occupational Health. The network members support each other; operators and workers to manage occupational health and the synergy that is created is much larger than the sum of safety individual centres and activities. The CCs are organized in 15 Task Forces to carry out a four-year Work Plan 2002-2005 ■ Building strategic alliances with partners in the countries consisting of at least 130 funded projects. The Work Plan is and regions (ministries of health, labour, mining, workers periodically updated and the progress is under constant and employer Organization, universities, Egos) and build evaluation. Projects focus on various priority areas in occupational in-house (WHO) alliances with programmes such as Stop health and result in products, which range from documents TB, HIV/AIDS, injury prevention, gender, mental health, and brochures in different languages, to training courses for child health and to mainstream, from different angles, occupational health personnel and/or students, to the occupational health in the health agenda establishment of questionnaires, guidelines and increased ■ Supporting the inclusion of occupational health on national international collaboration and direct action at national and and regional development agendas and mobilizing resources regional level, improving the workplaces and reducing hazards. for occupational health with different partners (for example, One of the priorities of the WHO OCH Programme is to explore collaboration with corporate sector) strengthen collaboration with ILO to avoid duplication and to ■ Promote (applied) research (e.g. global burden of supplement each other. The ILO-WHO Joint Committee on occupational disease, cost-effectiveness of health and safety Occupational Safety and Health, created in 1948, identified for interventions in the workplace, hazardous child labour) and its 12th Session, to be held in December 2003 the main areas of facilitate the exchange of positive experiences on intensified joint activity. These include the joint programme occupational risk assessment and improving working including the global elimination of silicosis; OSH Management conditions systems and promotion of training, education and competence ■ Facilitate training and capacity building on occupational assurance. Important new areas of co-operation include the health, involving the collaborating centres and other African Joint Effort, Control Banding (practical tools for partners in the field controlling exposure to chemicals) and the development of national profiles on occupational health. ■ Support countries in improving data collection and surveillance systems on occupational injuries and diseases Future challenges ■ Support direct interventions to improve the safety of health Major traditional occupational health needs still prevail among care workers, particularly protecting them from HIV/AIDS the global workforce. In addition, due to the rapid changes in at the workplace economic structures, technologies and demography, new occupational health needs have appeared, while the traditional A concrete example of collaboration, and creation of synergies problems such as silicosis, injuries, hearing loss and so on, are between different partners and activities, is the WHO-ILO Joint far from being solved. From a public and occupational health Effort on Occupational Health and Safety in Africa (AJE), also point of view, global competition increases health and safety risks. in line with WHO’s renewed focus on regional and country Manufacturing firms everywhere face global competition, and support (see article by the same author on the AJE in this often argue that any additional expenditure on safety or Newsletter). prevention for workers threatens their viability, instead of The challenge to improve the health of workers worldwide is recognizing the expenditure on occupational health as an great. However, there is a growing understanding and interest investment. amongst partners to regard occupational health as an essential Most people, both in urban and rural areas, work in small-scale element for sustainable development and poverty reduction. The enterprises and in the informal economy. So far, success to provide necessity of synergy and co-ordinated action to make the those workers with adequate health and safety services, both difference for the workers in the world is also understood preventive and curative, has been limited. Also, in many countries increasingly.

2 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 An example of co-operation with the private The products include reports describing the literature reviews sector and the net-costs economic analyses of interventions for low back pain within the United States and Europe in selected Co-operation between the industries. A report describing data findings and data-gaps in Occupational Health Programme India on economic analyses on back pain interventions will be and Winterthur Insurance prepared, and a framework for data collection in selected industries in India will be developed and piloted. A small Company international meeting in Delhi in July is planned to review the Dr Gregory Goldstein ([email protected]) progress of the project, to learn about the situation in India, to Occupational Health Programme firm up the data collection framework, and to plan for the use WHO headquarters, Geneva, Switzerland of the framework in case studies. In 2003, WHO commenced a collaborative programme in Additionally, at the meeting, discussions will take place on the occupational health with the Swiss Insurance Company future extension of the model to other workplace topics, and Winterthur. Two principal foci of the programme are: particularly the application of the net-costs model to the problem (a) Development of WHO guidance on the implementation of silicosis. It is anticipated that in 2004, there may be an of workplace health promotion (WHP) extension of the project to extend the economic analyses in (b) Cost-effectiveness of interventions for work-related back developed countries, to carry out net-costs analyses with data disorders as a model for addressing additional topics collected in India, to conduct case studies in additional (a) Development of WHO guidance on the implementation developing countries, to prepare scientific articles, and to generate of workplace health promotion (WHP) a user-friendly framework for collection of data in specific settings to allow local analyses of the net-costs of interventions. WHO and collaborating partners will implement state-of-the- art workplace health promotion (WHP) pilot projects in a number of countries and regions with deficient occupational health conditions. They will also undertake a comprehensive The ILO/WHO Global Programme evaluation of the projects. on Elimination of Silicosis The WHP projects will develop and implement processes of good Dr Igor Fedotov ([email protected]) practice in management of occupational, lifestyle, social and InFocus Programme Safework International Labour Office (ILO), Geneva, Switzerland environmental determinants of health. This involves the combined efforts of employers, employees and society to improve The problem the work organization and working environment, increase worker Silicosis is a well-known fibrogenic lung disease. The occupational participation in shaping the working environment, and origin of silicosis was recognized far back in ancient times. Despite encourage personal development. WHP will increase all efforts to prevent it, this incurable disease still afflicts millions employability of workers, help workers and their families avoid of workers engaged in hazardous dusty occupations in many poverty, and support public health initiatives against major countries. With its potential to cause progressive and permanent diseases, such as musculoskeletal disorders, heart disease, AIDS physical disability, silicosis continues to be one of the most and cancer. important occupational health problems in the world. (b) Cost-effectiveness of interventions for work-related back Possibility of elimination disorders as a model for addressing additional topics Today, society possesses all the necessary means to combat this This programme is a joint project by three WHO Collaborating preventable disease and there is no excuse for silicosis persistence Centres in Occupational Health (University of Massachusetts throughout the world. In the absence of effective specific at Lowell in the United States, TNO Work and Employment in treatment of silicosis, the only approach towards the protection The Netherlands, and the National Institute of Occupational of workers‘ health is the control of exposure to silica-containing Health in India) and by the Institute of Public Health Engineers, dusts. Experience gained by some countries has convincingly India. Funding for this project is provided by Winterthur of demonstrated that it is possible to reduce significantly the Switzerland, and by WHO. incidence rate of silicosis with well-organized prevention The goal is to extend the current WHO cost-effectiveness study programs (Australia, Belgium, Canada, Finland, France, of low back pain interventions (which focuses on health benefits Germany, Japan, Switzerland, Sweden, United Kingdom, and alone) more comprehensively to address. the United States). The success of the prevention of silicosis evidently results from a range of effective and imperatively “net costs”. The costs include changes in productivity and cost preventive measures at different levels. savings due to prevention of illness. The numerator in the cost- effectiveness ratio should reflect net costs, defined as the gross At the national level : laws and regulations and their enforcement; cost incurred in implementing the use of the intervention minus adoption of occupational exposure limits and relevant technical any cost savings due to avoided costs of compensation and illness standards; governmental advisory services; an effective inspection; and reduction in cost due to improved productivity and product a well-organized reporting system, and a national action quality. The denominator would reflect effectiveness of the programme involving governmental institutions, industry and intervention either in terms of the number of healthy years gained trade unions or incidence reduction, as may seem appropriate. At the enterprise level : application of appropriate technologies to

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 3 avoid the formation of silica-containing dust; use of engineering Within the framework of this collaboration, every effort should methods of dust control; compliance with prescribed exposure be made to promote the exchange of technical information and limits and technical standards; surveillance of work environment expertise to attain the common goal of the global elimination of to assess effectiveness of preventive measures; surveillance of silicosis. workers‘ health to detect early development of silicosis; use of Purpose of the Program personal protective equipment (as a temporary measure); health education and training, and co-operation between the employers The purpose of the Programme is to offer countries a framework and workers. for a broad international collaboration and to contribute to the elimination of silicosis as an occupational health problem Technical knowledge, professional expertise, qualified personnel worldwide. trained in using appropriate technologies and methods of dust control, and access to relevant information are needed for The immediate objective of the ILO/WHO Global Programme everyday activities to prevent silicosis. Evaluation of technologies, is to promote the development by countries of National which are applied in various industrial processes where silica dusts Programmes on Elimination of Silicosis and reduce significantly are present, and methods of dust control are necessary to assess the incidence rate of silicosis by the year 2015. the efficiency of prevention. They are also the basis of The development objective of the ILO/WHO Global Programme recommendations for effective measures and technical standards is to establish wide international co-operation on global for a wider use (transfer of technology). In addition, further elimination of silicosis and eliminate it as an occupational health epidemiological studies and research are needed to learn more problem by the year 2030. about the trend of the disease to prevent it effectively. Means of action The ILO/WHO Global Programme The principal means of action of the Program are: Over the years, the ILO and WHO have paid special attention (i) to catalyse long-term efficient co-operation between to the prevention of silicosis in close collaboration with national industrialized countries, developing countries and and international organizations, especially with NIOSH (USA) international organizations; and the International Commission on Occupational Health (ICOH). Joint activities in developing countries aim at (ii) to promote the establishment by countries of National prevention of occupational respiratory diseases specifically Programmes on Elimination of Silicosis accompanied by targeting silicosis and other pneumoconioses. National Action Plans; A special training program designed to upgrade practical skills (iii) to provide technical assistance to countries in developing of specialists using the ILO International Classification of models of National Programmes and National Action Plans Radiographs of Pneumoconiosis has considerably contributed on Elimination of Silicosis and support their to early diagnosis of silicosis in developing countries. The implementation. Program brought together specialists from industrialized and Program development developing countries. With due attention paid to the local conditions, a National The ILO/WHO long-term action program to prevent Program on Elimination of Silicosis should comprise the pneumoconioses has been successfully implemented over the following main elements: th years. It received a new impetus at the 12 Session of the Joint (i) socio-economic context of the problem of silicosis in the ILO/WHO Committee on Occupational Health in April 1995. country; The Committee identified the global elimination of silicosis as a priority area for action in occupational health, inviting countries (ii) economic incentives for the prevention of silicosis; to place it high on their political agenda and requesting the ILO (iii) identification of target groups of workers at risk; and WHO to establish a joint program of co-operation to achieve this goal. Later on, the Program received an international (iv) definition of a prevention strategy; th recognition at the 9 International Conference on Occupational (v) involvement of principal partners in the implementation Respiratory Diseases, which was jointly organized by the ILO of the program; and the Government of Japan in Kyoto in October 1997. The Conference concluded, that the implementation of this (vi) tripartite consultation and co-operation; important program should be widely supported throughout the (vii) institutional framework required for the program world. implementation; Definition of the Program (viii) mechanism for monitoring and evaluation; The ILO/WHO Global Program on Elimination of Silicosis is (ix) national standards and link with international standards; an international technical co-operation program designed to assist countries in their action to combat silicosis and eliminate it as (x) relationship with the protection of the general environment. an occupational health problem worldwide. At the national level, the Program is considered as a national By establishing this Global Program, ILO and WHO have shaped consensus policy document for priority action in a specific area of a policy perspective for their member States for a wide occupational health outlining the roles and responsibilities of international collaboration, which should be governed by a true partners. partnership between industrialized and industrializing countries.

4 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 The National Action Plan on Elimination of Silicosis can Regional Office, Harare in March 2001. Agreement was reached accompany the National Program and be prepared as a more on the name of the initiative: detailed document in the form of a compilation of required WHO/ILO Joint Effort on Occupational Health and Safety in Africa actions necessary to achieve targets set up by the National (AJE), and on the development objective: Improve conditions and Program. Among others, it should indicate actions to be taken environment of work in Africa, thus reducing the burden of to mobilize resources, contributions in kind, exchange of occupational diseases and injuries, through intensified co-ordination technical information and expertise, institutional framework and of occupational health and safety activities. co-operation, as well as the establishment of partnerships necessary for the successful program implementation. Furthermore, the meeting developed a framework for this joint effort, as well as a work plan with activities in four areas: The ILO/WHO Global Program on Elimination of Silicosis is targeting countries that are willing to join the Program and 1. Human resource development focused on capacity building request the establishment of national programs. It will be 2. National policies, programmes and legislation gradually expanding to include an increasing number of countries. Today, the national campaigns to eliminate silicosis 3. Information, research and awareness raising are gathering momentum in China, Vietnam, Thailand, India, 4. Promotion of OHS to protect workers in particularly Indonesia, Lebanon, South Africa, Poland, Russia, Ukraine, hazardous occupations and vulnerable groups in the Brazil, Venezuela, Turkey, Mexico and the United States. informal sector (women and children). Concluding remarks Gradually, partners from in- and outside Africa, became involved Despite many obstacles, the idea of global elimination of silicosis in concrete activities of the AJE, particularly in the field of is technically feasible. Positive experience gained by many training, and information sharing. The AJE website was created countries shows that it is possible to reduce significantly the (www.sheafrica.info), an AJE newsletter is produced periodically, incidence rate of silicosis by using appropriate technologies and and practical interventions are undertaken on groups especially methods of dust control. The use of these technologies and exposed to hazards. In the WHO Collaborating Centre Network, methods has proved to be effective and economically affordable. a special Task Force (Task Force 2: Intensive partnership in Africa) was created on collaboration in Africa. A network of over hundred Assistance provided within the framework of the ILO/WHO interested partners, institutions and individuals, exists at the Global Program will contribute to the upgrading of national moment. capacities to prevent silicosis. Countries will need to ensure that all necessary measures for the prevention of the disease be taken Two high-level meetings were held in Geneva in January and at the national and enterprise levels. It is strongly believed, that March 2003, with the participation of Regional and Programme the goal of global elimination of silicosis is realistic and can be Directors of WHO and ILO, who restated their strong political achieved through a very broad international collaboration commitment. The convenience of linking the AJE to the regional supporting national action programs and multi-disciplinary integration processes was particularly highlighted during these efforts of occupational safety and health professionals, as well as meetings. The AJE was considered by all parties to have a huge those from all economic sectors concerned. potential for collaboration, touching on all important development issues of the region, including poverty reduction, sustainable development and the HIV/AIDS epidemic. In those The WHO/ILO Joint Effort (AJE) on meetings it was also stressed that it was convenient to include the Eastern-Mediterranean region in the AJE, thus ensuring a Occupational Health and Safety in Pan-African effort. Africa A meeting took place in Cairo in April 2003 between WHO Dr Gerry Eijkemans ([email protected]) and ILO to discuss the next steps to be taken in the AJE. The Occupational Health Programme meeting decided on two issues: WHO headquarters, Geneva, Switzerland 1. Formalization of the Joint Effort : The Regional directors of Background ILO and WHO will sign a letter of agreement defining the The framework of co-operation between ILO and WHO is set objectives and areas of co-operation by end of August 2003. by the Joint ILO/WHO Committee in the field of occupational After signing the letter of agreement, ILO and WHO will inform health. It is within this context that the African Joint Effort was countries of the existence of the AJE, through a joint official born. A workshop in Africa (Pretoria, South Africa, October communication. This communication will also be used to 2000) of interested national and international institutions on identify strong possible areas of work and interest in collaboration strengthening occupational health in Africa, concluded that a with constituents. broad African initiative in Occupational Health and Safety (OHS) with leadership from WHO and ILO was opportune, 2. Formalization through an official launching : The above- because it had a huge dynamic potential for improving the health mentioned letter of agreement to the countries will be considered of workers in the region. This initiative would be the liaison for as a launch. Furthermore, the organization of sub-regional all partners, in- and outside Africa, to join efforts and streamline meetings (aimed at making the AJE known, show results, and and co-ordinate activities. It would also facilitate fundraising. increase visibility) with international and national institutions and donors in 2004 was discussed. The first official consultation, to develop a framework for the joint effort in occupational health, took place in the WHO

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 5 Proposed joint activities jointly hosted by the Occupational and Environmental Health Research Unit (OEHRU) at the University of Cape Town and Traditionally, the AJE has been mainly involved in horizontal the Peninsula Technikon. In Johannesburg it was hosted by the co-operation, supporting institutions, countries and sub-regions National Centre for Occupational Health (NCOH). The to organize activities that go beyond the scope of a particular OEHRU and the NCOH are in the process of becoming WHO country. This is, for example, how the website, the clearinghouse, Collaborating Centres in Occupational Health. and the international training courses started. The work plan, that was developed in 2001 in Harare, reflects this approach. Many countries in the Southern African region have a high This work plan is in the process of being evaluated and updated. prevalence of preventable airborne dust related diseases. Historic and economic factors, as well as differential control standards However, based on the meetings with the regional and executive globally, play an important role in the continued exposure of directors, the convenience of opening the scope of the AJE to workers and communities to airborne dust. These factors were particular joint country support became evident. It is in this taken into consideration in the planning and co-ordination stages light that the Cairo meeting focused on developing this new, of the courses. vertical component of the AJE. Organisational Aspects A preliminary selection of countries was made, based on specific criteria (regional distribution, ongoing work of WHO and ILO, Sponsorship The NIWL and the FIOH sponsored the facilitators, established capacity in the countries). The selection of the as well as the development and preparation of the course countries will be made public after discussion with the relevant materials. The University of Michigan, Fogarty International stakeholders. The first step in the country approach will be to Center, Southern African Programme in Environmental and hold conceptual workshops with ILO/WHO experts with their Occupational Health, covered the cost of ten participants. WHO constituents and possible donors in all selected countries. The under the umbrella of the WHO/ILO Joint Effort for exact content of the workshop will be determined according to Occupational Health in Africa, as well as the Occupational and the development stage, priorities and opportunities in each of Environmental Health Research Unit (UCT), supported the the countries. organization and co-ordination of the courses. The objective of such national workshops will be to reach Course Activities consensus on the need and content of the national profiles, to Workplace Visits : During the week of 10-14 March different identify emerging elements for national policy and a plan of workplaces and industries in and around Cape Town were visited. action, to identify and decide on action in specific industrial The facilitators incorporated the information gathered locally sectors where both organizations could have a joint impact , and into the course material. Members from these workplaces were to define priority areas for the short- and long-term perspective. invited to participate in the workshops and their participation The meeting agreed, that National Profiles were important for in the discussions made an important contribution to the the establishment of national policies on OHS and that they practical orientation of the workshops. could constitute the first activity on which to concentrate co- operation. WHO and ILO have started this work in some Participants : There were 30 participants in the Cape Town course countries. (including 6 students) and 28 participants in Johannesburg. Eight colleagues from SADC member states (other than South Africa) For more information on the AJE, please consult participated. Their experience of airborne dust challenges www.sheafrica.info or contact the author. enriched the discussions. Industrial hygienists, trade unionists, environmentalists, senior university/technikon lecturers and researchers, labour inspectors, private occupational health consultants, occupational health nurses and doctors and a few An example of successful pilot occupational and environmental health students joined the courses. training courses in South Africa This integrated approach was deliberately encouraged and A Report on Pilot Courses on Prevention ensured that participants involved in different aspects of airborne and Control in the Work Environment: Airborne dust control came together to share practical experiences and to Dust, in South Africa, 10-28 March 2003 encourage a team approach at workplaces to prevent exposure to airborne dust. Dr Sophia Kisting ([email protected]) University of Cape Town, South Africa The Courses : The first two days of the courses were based on the WHO Prevention and Control Exchange Programme (PACE) Background document on airborne dust to be found at the following location: Under the umbrella of the WHO/ILO Joint Effort for OHS in http://www.who.int/peh/Occupational_health/dust/ Africa, pilot airborne dust control courses were held in South dusttoc.htm. The third day covered the PIMEX Method http:/ Africa. Facilitators came from the National Institute for Working /www.niwl.se/pimex/. Life (NIWL), Sweden and the Finnish Institute for Occupational The facilitators are from countries which managed to have good Health (FIOH) to contribute to regional efforts for greater control of airborne dust and where the incidence of diseases such control of airborne dust. Ing-Marie Andersson, Gunnar Rosen as silicosis have been reduced to less than 5 per year. What the and Lars-Erik Byström of the NIWL and Hannu Riipinen from facilitators stressed repeatedly was the central role played by the FIOH facilitated the courses. In Cape Town the course was workers engaged in dusty industries in achieving these remarkable

6 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 results in their countries. The important principle they imparted (SATUCC): The material will be of great help to strengthen was that the central focus of dust prevention should be the existing OHS teaching material. The inclusion of images from informed participation of workers in dust control programmes. Southern Africa is very important, as it helped participants to Technical measures are important but constitute but one aspect experience the relevance of the situation with which they can of a team approach to dust control programmes. identify. It will be ensured that a dust lamp is used in future workshops and be encouraged that a dust lamp is used on every The teaching material included printouts of the power-point visit to workplaces. slides used by the facilitators and video clips from different workplaces. This worked well and encouraged participation. National Union of Mineworkers (NUM): The participation of There was good interaction and active participation in the small Trade Unions in airborne dust control programmes is of group discussions, as well as in the feedback sessions. fundamental importance as it is our members who are getting sick and we need to be part of the solution. This course has been The PIMEX Course : PIMEX is a method used to visualize inspiring. We need to look at how many people are getting sick, airborne pollutants as part of a strategy to control exposure. A we need to assess which production processes are making them strategy for its use called Workplace Improvement Strategy by sick and intervene effectively. The PIMEX method is a powerful PIMEX was presented during the course. There was much tool for shop floor reality and will be useful in the construction enthusiasm about the possibilities of the immediacy of the industry. PIMEX method in dust control programmes. Research Feedback from participants The PIMEX method and the course material are good tools for The feedback on the course was enthusiastic and mostly positive lecturers and students to use as part of their research projects. In and participants indicated that they could use the course the mining sector the course material will be useful for further information in different ways. research and intervention for the elimination of silicosis. A Concerns expressed by participants included… research project has been started and the course information has …the required technology may not be readily available in already assisted with brainstorming and networking for the resource-poor countries; more information on the relationship research. Information gathered from the research will be used between exposure and diseases is needed; financial constraints for intervention purposes. Staff members at the bakery were in a especially in the Public Sector are possible limitations to the use position to see first hand where they can improve on dust control of the PIMEX Method; dust measurement needs to be covered efforts. Course material will be extremely useful for Masters in future courses. courses and will be used for a planned copper and arsenic intervention study. Policy Implications: Government departments need credible Informal Sector information on which to base decisions concerning risk assessment and OHS. Procedures to arrive at conclusions are Course participants, who have done work in the informal sector, expensive, time consuming, and exact details are required to make consider the visualisation method to be a useful tool for teaching, informed decisions. It is foreseen that the PIMEX Method will for awareness raising and for preventive purposes in the sector. assist with risk assessment for airborne dust and facilitate the Given the absence of OHS laws and regulations in the informal process of arriving at informed decisions with regard to certain sector, the marked variation in the nature of exposures, with policies. women and children often the worst affected. The course SADC Member States: Participants from Botswana, Lesotho, information will be very suitable for intervention purposes but Malawi, Namibia, Swaziland and Zambia all indicated that the also to gather information to influence policies. information and course material obtained will be useful to Public lectures supplement their teaching at university, technikon and The facilitators gave public lectures both in Cape Town and inspectorate level. It will also be useful in institutions introducing Johannesburg. They discussed the important steps their countries new teaching curricula. (Finland and Sweden) used to work towards the elimination of Teaching and curriculum development: The development of OHS silicosis as an occupational disease. The information was a training tools that transcend language and education barriers significant addition to that already provided in the course work. presents an ongoing challenge to OHS personnel. The course The history of the steps taken by Sweden and Finland to work material and the PIMEX method provide powerful education towards the elimination of silicosis is of significance for countries and training tools that can be used to teach workers from different such as South Africa where silicosis and associated tuberculosis language backgrounds or different literacy levels. are not yet controlled. The PIMEX Method is a most innovative means of raising It was of central importance to hear first hand how two other awareness. Immediate feedback and location to the source of countries started to make systematic progress year by year when exposure makes it one of the most powerful methods to resources were focused on the control of dust to prevent exposure demonstrate exposure and intervene effectively. It will be useful and not only on the diagnosis and treatment of silicosis once it in teaching especially in analysis of problems to incorporate in had occurred. design. Observations and reflections on the course Trade Unions: ■ The airborne dust courses provide a beautiful example of Southern African Trade Union Coordinating Committee North-South and South-South collaboration, goodwill

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 7 amongst participating individuals and co-operation among An example of a successful pilot diverse institutions. training course in Arusha on ■ The lack of adequate infrastructure in several countries and unequal access to information and communication Pesticides resources between and within countries must be recognized A Report on the Pesticide Training Course in by OHS institutions as a challenge to be overcome in the Arusha, 24– 29 March 2003 interest of better health and safety. Dr Mohamed F. Jeebhay ([email protected]) ■ Workers need to be an integral part of the process of dust Occupational and Environmental Health Research Unit control. University of Cape Town, South Africa ■ The facilitators provided a striking example of a lack of The course was organised as part of the University of Michigan competitiveness and great willingness to share information Fogarty International Centre grant to develop capacity in and resources without these being linked to financial gain. occupational and environmental health in Southern Africa. It Recommendations was hosted by the Tropical Pesticides Research Institute (TPRI), ■ The training material used and refined during the pilot and co-facilitated by Leslie London from the University of Cape courses be compiled into a training course shall be Town, and James Matee with the assistance of Vera Ngowi from disseminated more widely via WHO. the TPRIj. WHO provided financial support. ■ As part of building and strengthening Collaborating The course was officiated by high level public servants including Centres internationally, the NIWL, FIOH and the WHO a representative of the Minister of Agriculture and Food Security, consider running the course in different regions to and closed by a representative of the Arusha Regional strengthen preventive dust control measures globally. Based Commissioner, indicating the level of importance accorded to on the experience of the current course, it is important for the course by local partners. the facilitators to do the initial training of trainers and help Participants : There were 15 participants, mainly from Tanzania, to establish a core of teachers familiar with the enabling including delegates from Sudan, Kenya, Mozambique and two methods under discussion. participants from South Africa. The spread of participants was ■ There should be a follow-up course preceding the 2005 impressive, including a few medical graduates working in th IOHA 6 International Conference, which will take place occupational health, some inspectors/licensing officials, in Pilanesberg National Park in South Africa. This university academics and agronomic researchers. conference provides an ideal opportunity to consolidate the pilot airborne dust course and provide participants and Course : After a general introduction on the first day, the course others from Southern Africa with the opportunity to present themes were leading into health effects (day 2), exposure (day information on practical interventions undertaken, as well 3), surveillance (day 4) and policy issues (day 5). The Saturday as possible training in dust measurement techniques. involved a field trip to a chemical factory and a flower farm. ■ There will be ongoing support with regard to information The course was marked by a lot of press coverage. Although it and advice for different institutions keen on implementing involved some financial outlay to cover the journalist’s costs, the methods learnt during the course. There will also be this idea worked well, and should be borne in mind for future discussions in the different institutions about starting and courses in the region. maintaining An Airborne Dust Control Network. On the first day, some of the evaluations appeared to express Conclusion some reservations about the unstructured format of teaching (they preferred handouts and formal teaching), but within a day There is great value in international collaboration where or two, all evaluations seemed to indicate great enjoyment and experience and knowledge is shared and where we learn from appreciation of the teaching methodology, which included the strengths and the challenges facing different countries in their intensive student participation. quest for a healthier and safer work environment. The experience of the airborne dust courses indicate that the sharing of The quality of the inputs was high. Those who had been asked information and experiences is increasingly taking place on the to teach on the course, had prepared their material well, and basis of equality and in the spirit of addressing global problems clearly thought carefully about the audience. TPRI staff made a in an informed manner. It is foreseen that the networking, that considerable contribution to the teaching of course. has started with the current courses, will be strengthened and Nida Besbellin from WHO headquarter’s International consolidated in the coming years. Programme for Chemical Safety (IPCS), was keen to see input from the course organisers into a planned WHO Manual, and then later, the development of the course into a CD package. Evaluations and feedback: It was pointed to the fact that the course covered too much material. Lack of time for discussion was often cited in feedback. Future courses should be less ambitious in the breadth of material covered, or have a more narrow focus. However, feedback was almost uniformly positive. Participants identified benefits from both the content and the format of teaching and valued the opportunities to share experiences

8 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 between countries. They particularly enjoyed practical sessions Control Banding – Practical Tools (risk perception and communication; cholinesterase testing in the laboratory), the critical appraisal exercise and valued the slide for Controlling Exposure to presentation and discussion for being realistic. Chemicals Worth noting is the discussion on training and safe use, which Carolyn Vickers ([email protected]) was described as a “revolutionary way of looking at pesticide International Programme on Chemical Safety WHO headquarters, Geneva, Switzerland problems”. One participant reported that in the information with Heather Jackson ([email protected]) session “I learnt for the first time how to do a literature search President of IOHA (International Association) on the internet”. This should be kept in mind for future courses and Occupational Hygienist in which more time should be spent on developing hard skills. Growth in the use of chemicals in small- and medium-size It was also mentioned that more training should be provided, enterprises (SMEs) and in emerging economies, where access to either as additional courses examining in-depth areas (such as people with the experience to assess and control exposure to acute poisoning surveillance, pesticide toxicology, chronic health chemicals is limited, has led to the development of a new effects, biological monitoring training, and so forth), or it should approach to the control of chemicals, called Control Banding continue to exist as a general course repeated yearly in SADC (1). Control Banding uses information from suppliers of countries. chemicals. It takes users through a series of simple steps to choose Recommendations practical control solutions for airborne contaminants that should reduce exposures to levels, which present no danger to health. ● One of the points to emerge in discussions on acute The information needed from suppliers is in the simple form of poisoning was the need for training of health care providers ‘Risk phrases’, also called ‘R phrases’. Such phrases are currently in the region in the diagnosis and management of pesticide required in the European Union, and with the implementation poisoning, both acute and chronic. Since the WHO/IPCS of the Globally Harmonised System (GHS) for Classification representative was present, it was possible to get an informal and Labelling, will appear on products sold worldwide. commitment to pursue strategies to obtain training of trainers supported by WHO in the region with the aim to The concept of Control Banding was developed by the UK improve awareness, monitoring and surveillance of Health and Safety Executive (HSE) in its COSHH Essentials pesticide-related morbidity and mortality. package (2). COSHH stands for Control of Substances Hazardous to Health. An internationalized version was developed by the ● Research and description of the extent of the problem in International Labour Organization (ILO) in conjunction with the region is desperately needed. the International Occupational Hygiene Association (IOHA), ● The participants should stay in contact and follow-up and is called the ‘ILO Toolkit’. information on the activities of Fogarty and other capacity R phrases are assigned to chemicals based on their health hazards, building initiatives should be made available. for example, whether the chemical is a sensitiser or may cause ● The WHO/IPCS representative at the meeting, Nida cancer. The user finds R phrases on the label or Material Safety Besbellin, was particularly interested in setting up links with Data Sheet provided by the chemical supplier. Based on the R African centres for surveillance activities for acute pesticide phrases for a particular chemical, the Control Banding approach poisoning. The course offered an opportunity to join then assigns a ‘hazard group’. The next step is to consider the different initiatives – the Fogarty UoM programme in the exposure potential in the workplace being assessed, for example, region, the SIDA Occupational Health Capacity Building the quantity used and whether the substance is a solid or a liquid. initiative, and the WHO surveillance project. It was Thus, the user is guided through a risk assessment and ultimately indicated that the CDC was also interested in setting up a the selection of workplace controls. link for acute pesticide poisoning surveillance, particularly Control Banding uses three broad control approaches: general in Tanzania. ventilation; engineering control; and containment. However, it ● Numerous participants expressed interest in training is recognized, that in some cases specialist advice will be needed towards further degrees – PhDs and Masters. Hence, the and this is control option 4. Fogarty plan to get twinned supervision for higher degrees The user takes the hazard group, quantity and level of dustiness/ locally would be in demand. volatility and matches them to a control approach using a simple ● Two areas that emerged as needing extensive input were table. The controls are described in control guidance sheets, the critical appraisal of articles, and use of the Internet to which comprise both general information and, for commonly support research. These are generic research skills, not performed tasks, more specific advice. This approach allows specific to pesticides, but are clearly critical to enhancing businesses without ready access to specialist advice to effectively key occupational health skills. Future courses should make reduce the exposures of its employees to the chemicals used. these integral elements of the training, or even focus International Application – The ILO Toolkit specifically on such skills, as major a theme. Under the auspices of the International Programme on Chemical ● The course allowed us to continue to build South - South Safety (IPCS (comprising WHO/ILO/UNEP)), an international collaboration and to provide support for potential future technical group has been established to further develop the ILO African - Central American links through the SIDA project. Toolkit and to facilitate its application globally. Partners in this effort include: the ILO; World Health Organization (WHO);

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 9 IOHA; the UK HSE; and the US National Institute of Task Force 3: Child labour/adolescent workers Occupational Safety and Health (NIOSH). In addition, a Task Force 4: Elimination of silicosis number of WHO Collaborating Centres in Occupational Health Task Force 5: Health care workers in countries have committed to piloting the Toolkit, which Task Force 6: Health promotion activity involves translation and refinement of control recommendations Task Force 7: Psychosocial factors at work based on local conditions. Task Force 8: Promotion of OSH in small enterprises and in The next steps for the technical group are to develop an the informal sector implementation strategy, which will include activities such as Task Force 9: Prevention of musculoskeletal disorders training and translation into local languages. Further information Task Force 10: Preventive technology on Control Banding can be found on the ILO website: http:// Task Force 11: Training programmes and modules www.ilo.org/public/english/protection/safework/ctrl_banding/ Task Force 12: Internet resources and networks index.htm, the IOHA website www.ioha.com, and the UK HSE site which includes an internet based version of the COSHH Task Force 13: National and local profiles and indicators Essentials www.coshh-essentials.org.uk . The IPCS website is at Task Force 14: Economic evaluation of interventions http://www.who.int/pcs/. Task Force 15: Global burden of disease Details of individual projects under these headings can be found Abbreviations on our website: CCs = WHO Collaborating Centres HSE = UK Health and Safety Executive http://www.who.int/oeh/OCHweb/OCHweb/OSHpages/ IOHA = International Occupational Hygiene Association CCWorkPlan/Compendium/Compendium_files.htm. ICSCs = International Chemical Safety Cards. These cards The Compendium will be printed in June and requests for copies currently contain EU R phrases and consideration is being given can be addressed to the editor. to the need to include the GHS phrases in future. References 1. Oldershaw PJ. Control Banding – A practical approach to Compendium of judging control methods for chemicals; Journal of Preventive Activities of the WHO Medicine 2001;9(4):52-58 Collaborating Centres in Occupational Health 2. UK Health and Safety Executive. COSHH Essentials – Easy steps Network of Collaborating Centres to control chemicals. Work Plan 2001-2005 15 Task Forces

Protection of the Human Environment Occupational and Environmental Health Programme

The Compendium of Activities of June 2003 the WHO Collaborating Centres in

World Health Organization Occupational Health www.who.int/oeh The Work Plan 2001-2005 of the Network of the WHO Collaborating Centres in Occupational Health was developed Last, but not least….. over the period 2000 - 2001, and was reviewed during the Fifth The Editor’s Book Tips Network Meeting in Chiangmai by the participating Collaborating Centres in November 2001. The plan incorporates Collaborating Centres in Occupational Health have, in the plans and commitments of the Occupational Health collaboration with the Occupational Health Programme, already Programme, the Regional offices and the WHO Collaborating produced booklets in the Protecting Workers’ Health series within Centres in Occupational Health, for the implementation of the the Global Work Plan of the Network. To date, five booklets Global Strategy on Occupational Health for All. The participating with different foci have been published on Collaborating Centres expressed their willingness to contribute ■ Preventing Health Risks from the Use of Pesticides in to specific tasks contained in the Work Plan. Agriculture The centres formed themselves in 15 Task Forces, which allowed ■ Understanding and Performing Economic Assessments at a Task Force of Collaborating Centres to be created for each of the Company Level 15 priority areas, to carry out the Work Plan. Projects focus on various priority areas in occupational health, and will result in ■ Work Organisation and Stress products which range from documents and brochures to training ■ Psychological Harassment at Work, and courses for occupational health personnel and/or students, from translation of occupational health materials to the establishment ■ Preventing Musculoskeletal Disorders in the Workplace. of questionnaires, guidelines and increased international For copies you can either contact the editor of this Newsletter or collaboration. The Task Forces cover, in between others, the consult our website (www.who.int/oeh) under the rubric WHO areas specifically discussed in this Newsletter. OSH Documents. The 15 Task Forces comprise the following areas: All publications will be available electronically in French and Task Force 1: Guidelines Spanish. Task Force 2: Intensive partnership in Africa

10 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 CONTACTS

WHO headquarters Regional Office for the Eastern Mediterranean (www.who.int/oeh/) (EMRO) Department of Protection of the Human (www.who.sci.eg) Environment Cairo, Egypt Occupational and Environmental Health Fax: (202) 670 24 92 or 670 24 94 Programme e-mail: [email protected] Geneva, Switzerland Fax: (41) 22 791 1383 Regional Office for Europe (EURO) e-mail: [email protected] (www.who.dk) Copenhagen, Denmark Fax: (45) 39 17 18 18 WHO Regional Advisers in Occupational Health: Regional Office for South-East Asia (SEARO) (www.whosea.org/) Regional Office for Africa (AFRO) New Delhi, India (www.whoafr.org/ ) Fax: (91) 11 332 79 72 Brazzaville, Congo e-mail: [email protected] Fax: (242) 81 14 09 or 81 19 39 e-mail: [email protected] Regional Office for the Western Pacific (WPRO) (www.wpro.who.int/) Regional Office for the Americas (AMRO) Manila, Philippines (www.paho.org/ ) Fax: (63) 2 521 10 36 or 2 526 02 79 Pan American Health Organization (PAHO) Washington DC, USA e-mail: [email protected] Fax: (202) 974 36 63 e-mail: [email protected] Editor: E Kortum-Margot Design: J-C Fattier

© World Health Organization 2003

All rights reserved. Publications of the World Health Organization can be obtained from Marketing The mention of specific companies or of certain manufacturers’ products does not imply that they and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland are endorsed or recommended by the World Health Organization in preference to others of a (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary to reproduce or translate WHO publications – whether for sale or for noncommercial distribution products are distinguished by initial capital letters. – should be addressed to Publications, at the above address (fax: +41 22 791 4806; email:– [email protected]). The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning Printed in Geneva, Switzerland the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border Printed on paper made from managed softwood plantations, where lines for which there may not yet be full agreement. at least one tree is planted for every tree cut down.

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 11 Application form for GOHNET membership

If you would like to join the Global Occupational Health Network, please fill in the form below. Please print clearly or use a typewrite and send to the editor. Alternatively you may request a copy of the form by e-mail from [email protected] or consult our website for an electronic version: (http://www.who.int/oeh/)

Global Occupational Health Network (GOHNET) Survey Application form for GOHNET membership

Name of Institution: ...... Mailing Address: Street & Number: ...... P.O. Box* ...... City ...... postcode: ...... Sector & Province* ...... * only include if necessary for mailing Country: ...... Tel**: ...... Fax**: ...... ** Please include codes of country and town E-mail(s):...... Please indicate if you have access to the Internet: yes  no  Do you have a Web address? If so, please state: ...... Do you have access to a computer with a CD-ROM reader? yes  no  Contact person: First Name: ...... Family Name: ...... Title (Dr, Mr, Mrs, Ms, etc.): ...... Sex: F  M  Organizational Position/Function: ...... Department: ...... Please state any area(s) of expertise which your organization would be willing to share: ...... Do you have training activities? If so, please describe: ...... How many staff work in Occupational Health your Organization? ...... Do you belong to any other health, safety or environmental networks? If so, please describe? ...... Efforts are being made to supply information in three languages. Please specify your preference: English  French  Spanish  (if certain materials are unavailable in the language of your choice, they will be supplied in English)

12 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