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Challenges and Opportunities of Occupational Health in the

Global Context of the 21st Century


36° CONGRESO COLOMBIANO DE MEDICINA DEL TRABAJO Y SALUD OCUPACIONAL

Cartagena Mayo 18-20, 2016

Dr Jukka Takala
Workplace Safety and Health Institute, Singapore
International Commission of Occupational Health
Challenges at Work
Priorities and Strategies

2
What we know - Facts
• The ILO estimates that each year about 2.3 million
workers die from occupational accidents and diseases1.
• 1 million workers will suffer a workplace accident at the
end of the day. 1000 worker deaths for injuries and
5,600 for illnesses every day.
• 4% of annual global GDP (US$2.8 trillion), is due to
direct and indirect costs of occupational accidents and
diseases (e.g lost working time, workers’ compensation,
the interruption of production and medical expenses).2
______
1 XX World Congress on Safety and Health at Work: Frankfurt, August 2014
2 International
Labour Organisation (ILO). World Day for Safety and
Health at Work 2009 ‘Facts on safety and health at work’. April 2009.
See “Global estimates”: http://goo.gl/0xSHGl
See “Global estimates”: http://goo.gl/0xSHGl
Occupational Deaths Colombia and L.America 2011
L. America Colombia
• Work-related circulatory diseases 46,232 3,602
• Occupational cancer 43,931 1022*-3,423
• Work-related communicable dis. 6,972 543
• Respiratory diseases 7,649 955*-596
• All work-related diseases 111,749 8,707
• Fatal occupational injuries 18,433_ 1,403
• Total occupational mortality 130,182 10,111
=========== ==============
* IHME/GBD Estimates, all others numbers from ILO
Work-related Annual Deaths – EU-27
Work-related Annual Deaths –
Latin America (WHO AMRO) distribution
of fatal injuries and illnesses, EU in brackets

Deaths attributed to work in Latin America 130,182 (EU: 192,000 )

1.666; 1% 18.433; 14%


6972; 5%
2.354; 2%
2.945; 2%
43.931; 34%

46.232; 36%

7.649; 6%
Communicable diseases Cancers
Respiratory Diseases Circulatory diseases
Mental Disorders Digestive systems diseases
Genitourinary system Accidents and violence

Sources: WSH Institute Singapore 2016, Hämäläinen P, Takala J, Saarela KL; TUT, ILO,
WHO, EU-OSHA, WSH Institute Singapore, JOEH May 2014, ref.data:WHO SEA region/ILO
Work-related Annual Deaths – EU-27
Work-related Annual Deaths –
Colombia ref. population Latin America (WHO
AMRO) distribution of fatal injuries and
illnesses
Deaths attributed to work in Colombia: 10,111 (EU: 192,000 )

130; 1% 1.403; 14%


543; 5%
183; 2%
229; 2%
3.423; 34%

3.602; 36%

596; 6%
Communicable diseases Cancers
Respiratory Diseases Circulatory diseases
Mental Disorders Digestive systems diseases
Genitourinary system Accidents and violence

Sources: WSH Institute Singapore 2016, Hämäläinen P, Takala J, Saarela KL; TUT, ILO,
WHO, EU-OSHA, WSH Institute Singapore, JOEH May 2014, ref.data:WHO SEA region/ILO
Selected Occupational
Risks, Latin America and
others, 2013 (IHME),
(underestimated)
Burden of Injury and Illness at Work
Globally and in Singapore

Dr Jukka Takala
Workplace Safety and Health Institute, Singapore

http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
In Singapore 2011 (some data from 2010): 1,439 Deaths Caused by Work
Germany Singapore 2011- 2014 EU 28 average 2011
1 fatal 1 fatal
42 - 93 accidents, 30 days+ 362 accidents, 30 days+
284 - 623 accidents, 4 days+ 880 accidents, 4 days+
516 - 1087 accidents w.sick leave 1208 accidents with sick leave
685 - 2111 accidents, all 1646 accidents , all

115 Fatal Occupational Injuries (compensated)

1 death
Singapore 2011- 2014 EU 28 average 2011
1 fatal 1 fatal
2.9 - 3.3 illnesses, 30+ days MC 30 illnesses, 30 days+
38- 36 illnesses, 4 days+ n/a illnesses, 4 days+
79- 106 illnesses w.sick leave 69 illnesses with sick leave
168- 257 illnesses, all 111 illnesses, all
Multi-mechanism

Multi-cause
1,323 Fatal Work-related Diseases
Magnitude of non-fatal work-related
illnesses and accidents: EU & SIN
2.2% in 2014
1.5 % in 56,603 self-reported
Singapore workplace injuries in
Singapore in 2008/11
7 million in Europe in 2007

11,113 reportable
workplace injuries in
10% in 2015
Singapore in 2012
6.9 % in
Singapore
20 million in Europe 2007

987 occupational diseases


(OD) were confirmed in
2012, self reported: 219,739
Singapore in 2008/11

13
A Leading Institute for WSH Knowledge and Innovations
Slide source: Tim Driscoll, University of Sydney
Concepts for measuring the Burden

Years of Lost Life, N=deaths, L = lost years

For cancer (UK): 19.8 years (average age ~60 years)


+ For injuries(UK): 45.3 years (average age ~35 years)

Years Lived with Disability


Measure of the burden due to early loss of full function
I = Number of incident cases
DW = Disability weight (0…1)
= L = Average number of years affected

Disability Adjusted Life Years


Concepts designed and accepted by:
How to calculate the Burdenwork

-We can easily count the lost years from GBD/IHME


from the two numbers per country/region: all deaths
and YLLs
+ -Number of fatal cases either from statistics and registers,
such as mesothelioma deaths, or
-Using Attributable Fraction, AFwork for each disease/
disorder and apply that to best all deaths number to
the disorder concerned
-Take all YLD’s from GBD/IHME
- Apply AFwork to these YLD’s, note that AFwork morbidity
= may be somewhat different from those of AFwork mortality

Disability Adjusted Life Years

GBD/IHME: http://www.healthdata.org/data-visualization/gbd-cause-patterns
Trends – change of mindset
Deaths in men in 2010 by age, Western Europe

Injuries

CVD, AFwork=14.4%

Cancer, AFwork=13.8%

Communicable AFwork=13.3% AF= Attributable


Fraction, re work
GBD= Global Burden
of Disease
DALYs
DALYs in women
in women in 2010
in 2010 by by age,
age, high-income
Western EuropeAsia-Pacif.
Injuries Injuries

Musculoskeletal, AFwork=
Musculoskeletal
37%

Mental health,
Mental health
AFwork= 30+ %
CVD,stressCVD
AFwork= 7.9 %

Cancer
Cancer
AFwork= 5.5-8 % DALY= Disability
Adjusted Life Years
DALY= Disability
Adjusted Life Years
AF= Attributable Fraction, re work

http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
w
w w
w
w
w

w w
Work- w
related
(w) w
w
w

W-r w
w
w
w
w
w w
Deaths in Developed Countries in 2013
Deaths in Colombia, GBD 2013

Occupational
injuries

Occupational cancer
underestimated
Disability Adjusted Life Years, DALY’s, Colombia in 2013
Deaths, Western Europe, selected causes by GBD

Occupational
injuries Occupational
cancer
Deaths U.K. selected causes by GBD

UK: 8,010
deaths/year
Occupational cancer
Brazil_ Deaths
Deaths, GBD, Occupational Carcinogens 94
1,880
selected causes (underestimates) 120
3
23
78
1,165
20
321
182
1,274
670
239
5

498,604
YLLs re
occ. injuries 375,105
YLLs re
occ. cancer
Example of poor emphasis on work exposures
Combined effect of exposures to asbestos and smoking on lung cancer

Age-standardized lung cancer death rates

Death rate (per Non- Smoker Attributable Fraction, AF is


100,000) smoker based on risk ratio, RR

No asbestos 11 123 AF = (RR-1)/ RR

Asbestos 58 602

AF Principle
GBD/IHME
Hammond EC, Selikoff IJ, Seidman H. Asbestos exposure, cigarette smoking and death rates.
Ann N Y Acad Sci 1979;330:473-90.
= 200,000 tons used/year Mesothelioma deaths
Today U.K

U.K 2005
U.K.
Deaths 1500
U.K.
Exposure

* *
Mesothelioma in the U.K., Real Numbers

2,538 deaths in 2013

Industrial Injuries Disablement Benefit (IIDB)


Metric Tons Historical Consumption of Asbestos and Mesothelioma in Colombia
25000 Max 27,057 tons
1980 Colombia Finland
mesothelioma real

20000 200 mesothelioma Singapore estim.


deaths mesothelioma
66per.
yearmedia
mov.avg con
móvil
15000 150 deaths (Singapore)
Max 12,035t (1970) 6 year mov.avg
Colombia
Year 2015-2020
10000 100 deaths
Max 8,671t. (1975) 6 per. media móvil
(Finland)
Year 2025-30
5000 50 deaths

1950 1970 1990 2010 2030 Year


Source:-5000
R. Virta, United States Geological Survey , U.S. Department of * Exports bigger than imports
Interior
http://goo.gl/hnEKnC

Singapore India
Table a. Estimated Global Mesothelioma Deaths (Annual N*), based on WHO data.
* Reported N in 49 countries (48+ Switzerland) are tallied as is, Takahashi et al17
Extrapolation method Reported Non-reported Colombia

(1) Crude (attr: none) 68,753

14,601* 54,152

(2) attr: Asbestos use 53,390 47-63-159

“none”, “low”, “middle”, “high” 14,601* 38,789

(3) attr: Employment % in industry sector 51,775 47

no data, lowest, middle, highest 33% ile 14,601* 37,173

Table b. Asbestos Related Lung Cancer Deaths (Takala et al)

Methods of estimated lung cancer deaths using mesothelioma as Lung cancer/ Asbestos related lung cancer deaths
a proxy for asbestos use, mesothelioma estimate based on mesothelioma rate
asbestos exposure above: 53,390 deaths, and 2,149 for Brazil World Colombia

McCormack, Peto et al.14 average estimate using chrysotile 6.1 325,679 287-384-970

McCormack, Peto et al., lowest and highest estimate 2.0-10 106,780 – 533,900

Nurminen, Karjalainen 8, using mixed fibres, asbestos exposure


verified by lung tissue fibre counting, AFmeso.work = 94.9%26 3.525 188,200

IHME based rate on global asbestos-related lung cancer and 311-416-1,051


mesothelioma at work: 166,774/25,212=6.61 16 6.61 352,908
Strategies for Occupational Health and Safety
• Evidence
science, research, knowledge on work life, sustainability
• Ethics
socially sustainable solutions, quality of work life, equal
treatment , defend the vulnerable in the world of work
• Engagement
openly engage in dialogue with policy makers, all
stakeholders, interested parties, all members
• Enforcement
regulatory measures
Priorities

1. Substance priorities
Death, disability and disease, risk management 2.0,
exposure elimination, and better analysis on:
- non-communicable: cancer, CVD, respiratory...
- communicable: tropical and others
- injuries, in particular in low/mid income economies
- musculo-skeletal,
- psychosocial factors and disorders,
2. Collaboration with stakeholders
- regional bodies,
Priorities, cntd.
- their member States and stakeholders, advocate
adopted solutions and strategies,
- establish and collaborate with programmes for
developing occupational health services for all,
total workplace safety and health, compliance,
and protection, prevention, health promotion
action at work, mindset of Zero Harm and Vision Zero,
- Propose/initialize new campaigns and
programmes, such as Eliminating work-related cancer.
3. Dialogue, communication, networking
PERCEIVED AND REAL RISKS

PERCEIVED RISK Evidence 2 Policy


Evidence 2 Practice
Terrorist
attack Violent
Mobile robbery
phones Avian flu
Stock exchange
Airline crash
accident
Glass of wine

Work-
related Work-
related Work-
related Work-
related Work-
Heat wave related
WAR
REAL RISK activities,
anywhere
Traffic
Accident Cancer
Circulatory diseases
http://goo.gl/gbnvAx
37 S. Hertlich, M.Hamilo, S.kuvalehti (FI), Journal Occ Env Hyg, 11: 326–337, May 9, 2014; Takala J ao.
Sources:
PERCEIVED AND REAL RISKS

PERCEIVED RISK Evidence 2 Policy


Evidence 2 Practice
Terrorist
attack Violent
Mobile robbery
phones Avian flu
Airline
Stock exchange WORK
crash
accident Glass of wine all

Work-
related Work-
related Work-
related Work-
related Work-
Heat wave related
WAR
REAL RISK activities,
anywhere
Traffic
Accident Cancer
Circulatory diseases
WORK
all
38 S. Hertlich, M.Hamilo, S.kuvalehti (FI), Journal of Occ Env Hyg, 11: 326–337, May 9, 2014; Takala ao.
Sources:
Conclusion

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