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Occupational health: a world of false promises



Abstract The response of the World Health Organization (WHO) to the Ebola outbreak in West Africa in 2015 demonstrated that the global health system is unprepared to address what should be its primary mission, control of disease epidemics while protecting health workers. Critics blamed WHO politics and its rigid culture for the poor response to the epidemic. We find that United Nations agencies, WHO and the International Labor Organization (ILO), are faced with the global problem of inadequate worker protections and a growing crisis in occupational health. The WHO and ILO are given monumental tasks but only trivial budgets, and funding trends show UN agency dependence on private donations which are far larger than funds contributed by member states. The WHO and ILO have limited capacity to make the necessary changes occupational health and safety demand. The UN could strengthen the national and global civil society voice in WHO and ILO structures, and by keeping conflict of interest out of policy decisions, ensure greater freedom to operate without interference.
C O M M E N T A R Y Open Access
Occupational health: a world of false
Joseph LaDou
, Leslie London
and Andrew Watterson
The response of the World Health Organization (WHO) to the Ebola outbreak in West Africa in 2015 demonstrated
that the global health system is unprepared to address what should be its primary mission, control of disease
epidemics while protecting health workers. Critics blamed WHO politics and its rigid culture for the poor response
to the epidemic. We find that United Nations agencies, WHO and the International Labor Organization (ILO), are
faced with the global problem of inadequate worker protections and a growing crisis in occupational health. The
WHO and ILO are given monumental tasks but only trivial budgets, and funding trends show UN agency dependence
on private donations which are far larger than funds contributed by member states. The WHO and ILO have limited
capacity to make the necessary changes occupational health and safety demand. The UN could strengthen the
national and global civil society voice in WHO and ILO structures, and by keeping conflict of interest out of policy
decisions, ensure greater freedom to operate without interference.
Keywords: Human rights, ILO decent work, ILO conventions, Occupational health, Occupational safety, UN funding,
WHO program of work
The worlds workforce sustains at least 370 million injuries
every year, a figure that would be much higher if reliable
reporting existed. Occupational illnesses attributed to haz-
ardous exposures or heavy workloads may be as numerous
as occupational injuries [1]. Very few workers worldwide
have access to occupational health services that provide
for prevention of occupational risks, health surveillance,
training in safe working methods, first aid, and consulting
with employers on occupational health and safety. Yet ac-
cess to occupational health services is a right recognized
by the United Nations whose absence should be framed as
a violation of the right to health [2,3].
There are nearly 3 million workers known to die each
year from occupational injuries and diseases. Diseases re-
lated to work cause the vast majority of deaths among
workers. Occupational cancer is responsible for almost a
third of all work-related deaths. More than one million
workers die each year due to exposure to hazardous sub-
stances. The overall worker death rate is steadily increas-
ing. The vast majority of these deaths are occurring in the
poorest of countries with the least legal protections for its
workers, yet they are avoidable and preventable [4].
The global epidemic of occupational injury and disease
is not new. It is inherent in the nature of industrial de-
velopment that poorer countries are left with far more
than their share of hazardous production and unsafe
work environments. Growing economic competition has
led some countries to compete, not only in the quality
and productivity of work, but also in minimizing the
costs of labor by paying less than reasonable minimum
wages. Poverty and poor social conditions too often have
serious adverse impacts on workershealth. Moreover,
standards such as those for occupational health and
safety may be set far below those accepted in UN Inter-
national Conventions. While international standards ap-
pear to obligate employers to provide occupational
health and safety procedures, and to pay for occupa-
tional injury and disease, inadequate prevention, absence
of worker protections, and a failure to provide compen-
sation make a mockery of these standards.
Global working conditions
More than 1.4 billion people, almost four out of five
workers in developing countries, work in hazardous
* Correspondence:
Emeritus Clinical Professor, Division of Occupational and Environmental
Medicine, University of California School of Medicine, San Francisco, USA
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LaDou et al. Environmental Health (2018) 17:81
settings or occupations. The number of workers in vul-
nerable employment increases by around 11 million each
year [5]. Developing countries seldom have enforceable
occupational and environmental regulations, and even in
many developed countries, populist governments are
moving away from workplace regulation and enforce-
ment. Occupational health and safety laws cover only
about 10% of workers in developing countries. These
laws omit many major hazardous industries and occupa-
tions. Progress in bringing occupational health to the in-
dustrializing countries is painfully slow. In the poorest
countries, there has been no progress at all.
Occupational health should have high priority on the
international development agenda because occupational
injuries and diseases have a serious impact on the econ-
omy of all countries. Occupational injuries cause per-
manent disabilities and economic losses amounting to
46% of national incomes, costs to developing countries
in excess of $10 trillion [6]. Similar costs are anticipated
from occupational diseases although studies are only
now being considered [7]. These preventable injuries
and diseases also have profound impacts on the work
productivity, income, and social well-being of workers
and their families.
Often ignored is the reality that a single occupational
injury or illness can tip an entire family into poverty.
The UN Universal Sustainable Development Goals
(USDG) emphasise the need to prevent catastrophic ill-
ness from tipping families into poverty but has a blind
spot in that it does not recognise occupational causes of
such catastrophic illness and injury--if it did, it would
emphasise prevention of workplace illness and injury.
USDG calls upon developed countries to assist the de-
velopment process in developing countries, particularly
the least developed countries and to deliver on their
long-standing pledges to commit 0.7% of their Gross
National Income (GNI) to official development assist-
ance programs, again without explicit mention of occu-
pational health and safety [8].
The workers most vulnerable to workplace injury and
disease are those with the least secure employment, low
incomes, long hours, virtually no unionization, and inad-
equate diets, housing, transport, and access to broader
health care or social security nets. Migrant workers, sea-
sonal workers, indigenous workers, women, and child
workers are the most likely to be exposed to hazardous
and toxic work, financial and sexual exploitation, envir-
onmental pollution, systems of workplace organization
injurious to heath, and social deprivation. In developing
countries, workers are threatened in many ways with lit-
tle government protection, from simply losing their jobs
if they speak up, to losing their lives. There is remark-
ably little objection to deplorable working conditions
anywhere in the world. Unions provide a protective
effect on workerssafety. Anti-union legislation increas-
ingly advanced in populist governments has a deleterious
effect on occupational health [9].
The global response
Many countries and organizations have attempted to
deal with the problem of worker protections and occu-
pational health. The efforts are seldom sustained long
enough to make any real difference. The United Nations
(UN) budget is just large enough to create a public rela-
tions effort suggesting that the problem is being ad-
dressed, which it is not. This largely paper program
provides an opportunity for most countries to simply
agree to the principles, and to essentially ignore the
Academic institutions use the developing world as a
place for clinical and research training, again with little
or no effect on worker protections and occupational
health. Global Health is in danger of becoming a funding
stream that generates global healthprograms and insti-
tutes that may do research and training in poor coun-
tries, but whose esssential purpose is to capture a share
of the funder market for their institutions, staff and
One example of the scope of the problem--and the in-
adequate international response--is seen in worker mi-
gration. The worlds largest population migration is
taking place at this time one in seven of the worlds
people are on the move. In 2003, the UN adopted the
International Convention on the Protection of the Rights
of All Migrant Workers and Members of Their Families
to guarantee equality of treatment and the same working
conditions for migrants and nationals. Not one single
migrant-receiving country in Western Europe or North
America has ratified the Convention.
Many thousands of migrant workers on construction
sites in Qatar, including those building stadiums for the
2022 World Cup, are subjected to potentially life-threat-
ening heat and humidity. The campaign group Human
Rights Watch (HRW) claims that the Qatar authorities
have refused to provide information to the public on
hundreds of workers who die every year, or to properly
investigate the deaths. Working conditions in the re-
gions fierce climate places millions of workers at risk,
including those in the other Gulf Cooperation Council
(GCC) countriesBahrain, Oman, Kuwait, Saudi Arabia
and the United Arab Emirates [10].
International agencies
Most countries defer to the United Nations guidance of
international occupational health. The UNs inter-
national agencies have had a very limited success in
bringing occupational health to the industrializing coun-
tries. The lack of proper World Health Organization
LaDou et al. Environmental Health (2018) 17:81 Page 2 of 8
(WHO) and International Labor Organization (ILO)
funding severely impedes the development of inter-
national occupational health.
There are 194 UN member states that agree to support
the activities of the WHO and the ILO. The WHO
structure is designed to limit the power of any one
member state to influence policy or direction. However,
not all UN agencies provide democratic channels for
global governance. For example, the Rotterdam Conven-
tion, which should include all forms of asbestos and
many pesticides in the schedule of highly hazardous che-
micals, allows single countries to block rulemaking,
which powerful countries use to protect their hazardous
industries. Moreover, all member states are meant to
contribute a proportion of the core WHO and ILO bud-
gets based on their wealth and population size. Member
states are supposed to provide the support regardless of
agency priorities or performance. However, member
states increasingly attempt to influence the actions of
WHO and ILO by threatening to quit membership, or
more stealthily by proposing changes to the budget.
The WHO International Agency for Research on Cancer
(IARC) provides unbiased evaluation of products intro-
duced commercially by industry. Yet even IARC, with its
highly regarded reputation, has witnessed an infiltration by
industry forces in recent years. After the breakup of the
Soviet Union, Russia stopped paying annual dues to IARC.
Some years later, Russia resumed payments, followed by
pressure to get IARC to collaborate with a discredited Rus-
sian institute to conduct epidemiologic research on Russian
miners, relying on gravimetric analysis of asbestos rather
than fiber counts. IARC later participated in a Kiev confer-
ence, organized to promote the continued use of asbestos,
and the publication of a paper (co-authored by IARC staff)
with several industry-propaganda assertions [11].
The WHO and ILO may receive voluntary contribu-
tions from most any source, including corporations,
other organizations such as trade associations, and indi-
viduals. The reliance on voluntary contributions to the
operation of the WHO and ILO has increased dramatic-
ally over the past two decades. Voluntary contributions
now comprise about 80% of the WHOs overall budget.
In 2017 the ILO received voluntary funding from donors
of $375 million, about half its total funding [12]. More-
over, member states may use their contributions to act
in the interests of their countrys corporations. There is
no public accounting of the inherent conflicts of interest
in this funding arrangement.
Voluntary contributions are characteristically desig-
nated for specific purposes proposed by the donor.
Which leaves the WHO and ILO open to member state
and corporate mischief, influence, and outright control
[13,14]. The benefits to the tobacco industry, asbestos
and other mining and manufacturing industries are
achieved with rare public reporting. It is quite likely that
the trivial WHO and ILO funding and human resource
allocated to support occupational health and safety are
the result of donor influence and control of governance.
World Health Organization
The WHO is responsible for the technical aspects of oc-
cupational health and safety, the promotion of medical
services and hygienic standards. The WHO global policy
on occupational health addresses occupational health
through a network of unfunded Collaborating Centers.
The concept is consistent with overall WHO policy of in-
stitutional innovation, broadly defined as network govern-
ance, by which collective action is achieved through
interconnected institutions spanning government, busi-
ness and civil society [15].
Many Collaborating Centers are major governmental
and academic institutions. The National Institute for Oc-
cupational Safety and Health (NIOSH) in the United
States defines it primary international effort as one of
participation in the writing of WHO documents as a
Collaborating Center. The most recent example of this
collaboration is a WHO document about preventing dis-
ease through a healthier and safer workplace [16]. In the
widely circulated document there is not one mention of
trade and inequity as a cause of the global burden of dis-
ease associated with work; and not one mention of hu-
man rights. There appears to be no formal editing
process at WHO before contributions go into print.
The problem is that such participation with WHO
limits the interest member states have in pursuing
further avenues of assistance to developing countries.
The prominent position taken by Finland in occupa-
tional health and safety is widely respected, but it
may have been used by some countries as a reason
for inaction instead of an exemplar of what can and
should be done globally. This provides most member
states with an excuse to turn their attention to other
The WHO produces a blizzard of paperwork that states
virtually every possible goal of an international program of
occupational safety and health, none with any measured
effect. The WHO plan to protect workers and prevent ill-
ness and injury is periodically stated in work programs.
The 12th General Program of Work 20142019 proposed
to establish health protection at all workplaces, to de-
crease inequities in workershealth between and within
countries, ensure access of all workers to preventive health
services and link occupational health to primary health
care, improve the knowledge base for action on protecting
and promoting the health of workers, and to stimulate
incorporation of actions on workershealth into other
policies, such as sustainable development, poverty
LaDou et al. Environmental Health (2018) 17:81 Page 3 of 8
reduction, trade liberalization, environmental protec-
tion, and employment[17].
The 12th General Program of Work does not appear to
recognize what the WHO Commission on Social Determi-
nants of Health stated so clearlythat the conditions in
which people live and die are, in turn, shaped by political,
social, and economic forcesand that the unequal distri-
bution of health-damaging experiences is not in any sense
anaturalphenomenon but is the result of a toxic com-
bination of poor social policies and programs, unfair eco-
nomic arrangements, and bad politics[18].
The 13th Global Program of Work 20192022 is
currently in draft and risks continuing this pretense. Al-
though the new program will add more goals, e.g., Pro-
tect against climate and environmental change, support
national health authorities to focus on green health facil-
ities; substantially reduce the number of deaths and ill-
nesses from hazardous chemicals and air, water and soil
pollution and contamination, and improve water and
sanitation, and energy[19], the likelihood of meaningful
changes emerging from this program are slim.
There is a growing problem of credibility with the
WHO, a problem exploited by the private sector to shift
authority for key decision-making in occupational health
and safety away from the WHO to other UN agencies
and to the private sector itself. Lack of trust in the man-
agement of the WHO could partly explain why funding
agencies are increasingly becoming directly involved in
defining how and on what their money should be spent.
In all too many cases, organizations and member states
use the WHO imprimatur to burnish their reputations
as contributors to an international effort, but offer little
in the way of participation.
Moreover, the selection of WHO Collaborating Cen-
ters is arbitrary, and fails to protect the organization
from opportunistic participants. This makes WHO Col-
laborating Centers soft targets for industry manipulation.
As an example, consultants affiliated with Philip Morris
(PM), the worlds leading tobacco corporation, estab-
lished close links with the Chulabhorn Research Institute
(CRI) in Bangkok. Over a period of many years they
were able to influence scientific research and debate
around tobacco and health, to link with academic insti-
tutions, and to develop relations with key officials and
local scientists so as to advance the interests of PM
within Thailand and across Asia. During this period, the
CRI assumed international significance with its designa-
tion as a WHO Collaborating Center [20].
A decade later, PM announced its support for the
establishment of a new entity - the Foundation for a
Smoke-Free World, and to support the Foundation by
contributing approximately $80 million annually over the
next 12 years. UN Guidelines now state that governments
should limit interactions with the tobacco industry and
avoid partnership, but no attempt was ever made to ex-
plain the activities of the CRI-WHO Collaborating Center
[21]. Moreover, the first CEO of the Foundation for a
Smoke-Free World, a supposedly-independent research
foundation established by PM to promote its new range of
smokeless-tobacco products is Derek Yach. Yach is a
former senior WHO official, who drove the WHOspro-
gram of work on the Framework Convention on Tobacco
Control and his fronting of the Foundation reflects a very
high level of capture of key policy makers by corporate
International Labor Organization
The ILO is the only UN tripartite organization consist-
ing of government, employer, and worker representatives
designated to set labor standards, develop policies and
devise programs promoting decent work for all women
and men[22]. The ILO adopts two kinds of standards:
Conventions and Recommendations. Only Conventions
can be ratified and thus become legally binding on
member states.
The ILO Conventions guide all countries in the pro-
motion of workplace safety and in managing occupa-
tional health and safety programs. Ratification by
member countries is entirely voluntary. No sanctions are
provided against member countries that do not ratify
conventions, and there is usually no time limit set for
ratification. Moreover, even if a country has ratified a
convention, the ILO cannot enforce compliance.
Ratifications are made by a disappointingly small per-
centage of ILO member states. The Convention that
seeks to promote a safe and healthy working environ-
ment has received only 43 ratifications. Conventions di-
rected at managing occupational health and safety
programs have only 33 ratifications, Conventions for
safety and health in construction, 31 ratifications, and
safety and health in agriculture, a mere 16 ratifications.
The ILO Tripartite Declaration of Principles Concern-
ing Multinational Enterprises and Social Policy (MNE
Declaration) asserts that the ILO provides direct guid-
ance to enterprises on social policy and inclusive, re-
sponsible, and sustainable workplace practices. The ILO
states that the MNE Declaration is the only global in-
strument adopted by governments, employers and
workers from around the world [23]. This is yet another
example of sweeping assertions that something is being
done but without any measure of reality.
The ILO Decent Work program has been a means of
generating interest in and some action on worker protec-
tions in industrializing countries. The ILO is a major source
of information for government, employers and workers.
The ILO Labor administration assists constituents in pro-
moting Decent Work through the strengthening of labor
LaDou et al. Environmental Health (2018) 17:81 Page 4 of 8
administration machinery, including labor inspection [24].
Yet employers and workers are also calling for better re-
sources for Ministries of Labor and inspectorates to make
Decent Work a reality [25].
The number of workplaces subject to inspection dwarfs
the resources available to inspect them, leading to a situ-
ation in which workers are unprotected, violators operate
with impunity, and unfair competition for compliant
businesses pervades [26]. ILOs strategic compliance
model provides labor inspectorates with a methodology to
achieve compliance outcomes in light of limited resources
[27]. Independent assessment of such programs will be
needed to evaluate their full effectiveness.
The ILO has a number of highly controversial projects
with industry. The stated purpose of ILO technical co-
operation with industry is the implementation of the De-
cent Work agenda at a national level [28]. None of these
industry-friendly projects is more controversial than the
ILO acceptance of funds from the tobacco industry, pre-
sumably to help in the control of child labor in Africa.
The ILO receives funding from the Eliminating Child
Labor in Tobacco Growing Foundation (ECLT), a
non-profit foundation operating under the supervision
of the Swiss government, but funded by tobacco com-
panies. To date, the total amount of funding received by
ILO from the ECLT is $5,332,835 [29]. Notably, critics
have argued that industry-funded child labor projects
such as ECLT are primarily used to enhance corporate
reputations and conceal the fact that the economic
benefit of ongoing use of child labor by large tobacco
corporations outweighs by more than 16-fold the
amount of money budgeted for ECLT [3032].
A majority of the ILO member states want the
organization to end its financial ties with the tobacco in-
dustry. However, employer groups and a few countries,
mostly in the African region, continue to defend the in-
dustry program. The ILO partnership with the tobacco
industry has no record of achievement, and fails to ad-
dress the root causes of child labor. Ending child labor
in tobacco-growing countries can be achieved without
accepting money from the tobacco industry [33].
Current status
Nearly half of the working-age population around the
world is unemployed, inactive, or underemployed [34].
The global workforce is facing increasing unemployment
as transnational corporations build state-of-the-art pro-
duction facilities where machines replace workers.
Low-skilled workers with limited education cannot com-
pete with the cost efficiency, quality control, and speed
of delivery achieved by automated manufacturing [35].
Moreover, automation is also occurring in the largest
global employment sectors - agriculture, manufacturing,
and services.
In developing countries, nearly 780 million workers,
about one in three, live in moderate to extreme poverty.
These workers are less likely to have secure jobs with
regular incomes and access to social protection. They
are in need of a serious effort to assure worker protec-
tions and occupational health. Yet these impoverished
workers are in no position to make demands, and if they
do make demands, they are not likely to be received.
There is a glaring weakness of organized labor around
the world, and its absence contributes to the overall
problem of worker protections and occupational health.
However, there are a number of small but global and re-
gional trade unions and NGOs, with even less funding
and fewer staff than much better resourced international
agencies, that have been able to reach workers with in-
formation, advice and support on occupational health
and safety matters and contribute to improving working
Developing countries are far behind industrialized
countries in the development of workerscompensation
programs. In many countries of Asia, Latin America,
and Africa, only a small fraction of the workforce is cov-
ered by workerscompensation programs. In countries
as large as Egypt, India, Pakistan, and Bangladesh, fewer
than 10% of workers are covered by workerscompensa-
tion. Developing countries, including China, seldom
reach a level of 20% coverage. In many developing coun-
tries, workerscompensation is little more than a paper
program where the government works in concert with
industry to minimize the provision and the costs of
The United Nations currently has limited ability to take
on the problems of a globalized world and has limited
capacity to affect major issues within member states. But
it can have a useful influence in facilitating stronger
oversight by broader civil society. It can do this by
strengthening the national and global civil society voice
in WHO and ILO structures, and by keeping conflict of
interest out of policy decisions. Corporate influence on
international organisations is not a new problem. It goes
on in all member states and is evidenced in the neglect
of occupational health and safety, and the weakness of
workerscompensation laws, in all developing countries.
UN agencies should develop stronger and unambigu-
ous processes to manage conflict of interest in ways that
equalize the influence of powerful interests with those of
communities, Non-Governmental Organizations, Civil
Society Organizations and Social Movements [36] More
support should be given to protect the WHO from in-
dustry attacks and to help it increase its supply of infor-
mation on occupational health and safety to developing
countries, free of industry influence.
LaDou et al. Environmental Health (2018) 17:81 Page 5 of 8
The WHO provides information, but insufficient sup-
port, for developing countries about prevention, worker
engagement, and risks including occupational diseases,
introduction of occupational health and safety standards,
and increased regulation of hazards with effective en-
forcement. The ILOs generation of national occupa-
tional health and safety profiles to monitor the state of
play in developing countries and to help to plan im-
provements is useful. Its success will, however, again de-
pend on sufficient resources and staff being available to
ensure reported advances are real and not simply
The lack of unconditional funding for the WHO and
ILO severely impedes the development of successful
international programs. The budgets are spent on office
staffs and publications that overstate the scope of their
operations. The accomplishments claimed by the agen-
cies are not apparent and not evidenced. However, some
regional examples of good practice are identified which
suggest possible ways forward. The UN could strengthen
the national and global civil society voice in WHO and
ILO structures, and, by keeping conflict of interest out
of policy decisions, ensure greater freedom to operate
without interference. The WHO could increase informa-
tion and support for developing countries to aid preven-
tion initiatives on occupational health and safety. This
could complement the expansion of ILO work on stan-
dards, and hence possibly contribute globally to an in-
creased and necessary regulation of hazards with
effective enforcement.
The Office of the United Nations High Commissioner
for Human Rights (OHCHR) also hosts Special Rappor-
teurs (SRs) whose role is to examine a specific human
rights theme of whom two are particularly relevant for
occupational health. The SR on the Right to Health
noted in 2012 that occupational health is an integral
component of the right to health and in his report made
a set of recommendations that address the needs of vul-
nerable worker populations, place obligations on States
for the formulation and implementation of occupa-
tional health policies and programs with strong partici-
pation of workers [3]. Further, the SR on toxics has
argued human rights must be integrated into occupa-
tional safety and health discussions at the national and
international levels. Such global analyses provide lever-
age for civil society and organised labor to strengthen
protections for workershealth at all levels [37].
Central to contributing to such a shift will be the ILOs
commitment to collective bargaining and workersrights
to a safe and healthy workplace. The ILO does endorse
collective bargaining and workersrights to a safe and
healthy workplace, including regulation and enforce-
ment, in line with the ILO Decent Work and other pro-
grams. It would not therefore be a major change of
policy for the WHO and ILO to expand these activities
with appropriate funding.
Locating human rights treaty commitments and ILO
occupational health and safety provisions as prerequi-
sites within Trade Treaties could also trigger a positive
emphasis on occupational health and safety globally.
There is a marked inequality between trade treaties and
human rights treaties. The inequality can, however, be
mitigated by UN agencies. Countries sign and ratify hu-
man rights treaties because there is no cost to them if
they are flouted. Trade treaties, on the other hand, ex-
tract substantial economic punishments when violations
are confirmed. If trade treaties were required to fully en-
dorse human rights treaties in their enforcement mecha-
nisms, they would bring about a dramatically different
emphasis on occupational health and safety. If human
rights treaties and ILO Conventions had more enforce-
ability through trade treaties, some progress might well
be made. Even if the change is slight, the impact is
The staff assigned to WHO and ILO agencies respon-
sible for occupational health and safety should have ap-
propriate credentials and backgrounds. The selection
process is currently removed from public view, and not
subject to approval by relevant international authorities.
There is no current method of finding conflicts of inter-
est in staff assignments. An international organization
with no industry bias exists in the Collegium Ramazzini,
headquartered in Bologna, Italy. The Collegium should
be considered as an independent approval authority for
WHO and ILO staff positions, and for technical review
of publications.
CRI: Chulabhorn Research Institute; ECLT: Eliminating Child Labor in
Tobacco; GCC: Gulf Cooperation Council; GNI: Gross National Income;
HRW: Human Rights Watch; IARC: International Agency for Research
on Cancer; ILO: International Labor Organization; MNE: Multinational
Enterprises and Social Policy (MNE Declaration); NGO: Non-Governmental
Organization; PM: Philip Morris; SR: Special Rapporteur; UN: United
Nations; USDG: Universal Sustainable Development Goals; WHO: World
Health Organization
Availability of supporting data
Not Applicable.
Not Applicable.
All authors read and approved the final manuscript.
Not Applicable.
Ethics approval and consent to participate
Not Applicable.
LaDou et al. Environmental Health (2018) 17:81 Page 6 of 8
Consent for publication
Not Applicable.
Competing interests
All three authors are fellows of the Collegium Ramazzini.
Springer Nature remains neutral with regard to jurisdictional claims in published
maps and institutional affiliations.
Author details
Emeritus Clinical Professor, Division of Occupational and Environmental
Medicine, University of California School of Medicine, San Francisco, USA.
School of Public Health and Family Medicine, University of Cape Town,
Cape Town, South Africa.
Occupational and Environmental Health Research
Group, Stirling, UK.
Received: 17 August 2018 Accepted: 29 October 2018
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... 5 Despite the efforts put in managing OSHMS, threats to the health and safety of employees continue to exist in the workplace 6 , including in developing countries which are subject to a disproportionate amount of hazardous production and unsafe working condition due to their industrial development conditions. 7 The International Labour Organization (ILO) statistics note that the world's workforce sustains at least 2.78 million deaths and 374 million non-fatal injuries because of poor OSHMS. 8 Poor OSHMS contributes to about 5.4% of the global Gross Domestic Product (GDP). ...
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Introduction: Since Heinrich's early studies, work has been recognized as a substantial contributor to psychological and physical illness. Fast technological, economic, and social advancements have increased the number of occupational fatalities and illnesses in developing nations. Nonetheless, it is demonstrated that the creation, application, and enforcement of Occupational Safety and Health Management Systems (OSHMS) reduce accidents and enhance employees' well-being. This study aims to understand Sudan's current occupational safety and health situation and identify any challenges or gaps in the current system. Methods: A mixed methods approach deploying a literature review and secondary data was adopted to answer the research question about the status of occupational health and safety in Sudan. Results: A comparison of the artisanal and organized gold mining sectors over the years 2018-2020 shows an increase in the number of accidents in the artisanal sector but a sharp decrease in both the number and severity of accidents in the organized sector. The frequency rate declined in the organized sector but fluctuated in the artisanal sector. It was also found that many OSH incidents of different types and levels of severity occurred. In 2020, the Fatal Accident Rate (FAR) was 66.48 in artisanal gold mining, 0.55 in organized gold mining, and 0.01 in oil and gas. However, calculating and comparing other sectors' performance indicators to evaluate OSH's status was not possible for many reasons. Conclusion: Findings were constrained, possibly due to the limited occupational health and safety data. There is an urgent need to strengthen and improve the governance of occupational safety and health in Sudan. A more comprehensive study needs to be undertaken to assess the status of the OSH in formal and non-formal sectors and investigate the correlation of OSH to workers’ well-being and the Sudanese economy.
... However, as there is no global unification, these regulations might vary among individual countries or even may not exist at all. This is specifically important in the industrial activities in the low income countries (LaDou et al. 2018). ...
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Vinyl acetate (VA) is a volatile compound and the main compound of the carpenter's glue. VA causes upper respiratory tract irritation, cough, and hoarseness in occupational exposure. As Iran is one of the biggest carpet producers in the world, this study was carried out to determine the inhalational health risk for employees exposed to VA. To the best of our knowledge, this was the first health risk assessment and the first evaluation of the lung functions and respiratory symptoms in employees exposed to VA. In the six finishing shops of carpet manufacturing industry in Kashan city, Iran the cross-sectional studies were conducted in 2022. The subjects comprised of forty male employees exposed to VA and of forty non-exposed employees in the reference group. VA analyses in the workers' breathing zones were performed based on the National Institute for Occupational Safety and Health (NIOSH) 1453 Method. VA concentrations were measured using Gas Chromatography-Mass Spectrometry (GC-MS). Inhalational risk assessment to VA was performed using the United States Environmental Protection Agency method and the Monte Carlo simulations. Respiratory functions were determined using the spirometry indices. In the exposed employees, considerably higher prevalence rates of pulmonary symptoms were observed in comparison with the control group. Statistical analysis showed a remarkable difference between lung function parameters measured in the case and the control groups. The VA Hazard Quotient (HQ) values for all working posts, except the quality control unit, were > 1 indicating the substantial inhalational non-cancerogenic risk. The sensitivity analysis revealed that the VA concentrations and exposure time had the most significant contribution in the uncertainty assessment. Therefore, it is recommended to decrease exposure to VA concentrations and to reduce the working time of exposed employees.
... Every worker must be protected from diseases and injuries arising from the workplace. However, in developing countries, this is not the case more often 1 t h a n n o t . T h e r e i s a c o m p l e x interrelationship of immediate and remote factors that lead to poor health outcomes for many workers, especially those in sub- 2 Saharan Africa. ...
... However, these estimates are staggering. Agencies of the UN estimate more than 2.3 million work-related deaths (ILO, 2021;LaDou et al., 2018). How many more workers will be made ill or injured? ...
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This chapter examines the relationship between justice and health and safety in the workplace. However, this chapter also intends to contribute by taking a larger look at justice than would normally be addressed in an organizational setting. As part of this handbook’s overall goal, this chapter updates the reader on current streams of research and urges the scholars in our field to take a broader view of justice in organizations to better understand the connection between justice and occupational health and safety. This chapter ambitiously seeks to push the closely related fields of industrial-organizational (IO) psychology and organizational behavior into some new directions, beginning with a review of justice in the organizational context including an explanation of the construct of organizational justice (OJ) over the past quarter of a century. This section includes an update of empirical work about the prevailing construct of OJ since the last publication of this handbook. Next, the chapter presents the probable etiology of justice as a universally held human value, relying primarily on the fields of evolutionary biology and primatology. Next, normative views of justice, with a principal focus on the work of John Rawls (1971), are described. The following section provides a glimpse of a few glaring injustices external to organizations and their potential impact upon occupational health and safety. The chapter concludes with a synthesis of the research presented and a call to action.
... Desde una perspectiva territorial, los países desarrollados prestan mayor atención a las prácticas de la SST, debido a la presión de las partes interesadas (Gonzalez-Gonzalez y Zamora Ramirez, 2016; Surroca et al., 2013). Estudios recientes revelan el hecho de que los países con ingresos medianos bajos y emergentes soportan la mayor parte de los incidentes de accidentes y enfermedades relacionados con el trabajo (Ali et al., 2021;Fan et al., 2020;Hahn y Kühnen, 2013;LaDou et al., 2018), siendo una de las razones atribuibles precisamente la falta de cumplimiento de las leyes relacionadas con la SST (King y Lenox, 2000;Li et al., 2022;Ruiz-Frutos et al., 2019). En general, la falta de restricciones regulatorias estrictas de prevención de riesgos laborales tiende a fomentar el desarrollo de enfoques de autorregulación. ...
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The 2030 United Nations Goal 8 for sustainable development focuses on decent work. There is utility in identifying the occupational safety and health aspects of Goal 8, as they pertain to the four pillars of decent work: job creation, social protection, rights of workers, and social dialogue. A workgroup of the International Commission on Occupational Health and collaborators addressed the issue of decent work and occupational safety and health (OSH) with the objective of elaborating a framework for guidance for practitioners, researchers, employers, workers, and authorities. This article presents that framework, which is based on an examination of the literature and the perspectives of the workgroup. The framework encompasses the intersection of the pillars of decent (employment creation, social protection, rights of workers, and social dialogue) work with new and emerging hazards and risks related to various selected determinants: new technologies and new forms of work; demographics (aging and gender); globalization; informal work; migration; pandemics; and OSH policies and climate change. The OSH field will need an expanded focus to address the future of decent work. This focus should incorporate the needs of workers and workforces in terms of their well-being. The framework identifies a starting point for the OSH community to begin to promote decent work.
This article advocates the transgression of incumbent theoretical divisions between rural and urban abodes of production and draws on new analyses of contemporary spaces of capital and labour antagonisms in Brazil. It does so to articulate a broadening of the definition of class and class struggle towards an emancipatory praxis that does not necessarily prioritise industrialised workers. The study has a particular focus on the reconfiguration of socio-spatial arrangements linked to 21st century commodity cultivation, extraction and trade and subsequent class tensions on the material and epistemological frontier between (hydro, agro and mineral) mega projects and the autonomous territories of rural subjects. The renewed degradation of conditions for a labour force that has always been precarious, the dissolving dichotomy between proletarianised and peasant labour, and the ongoing resistance to corporate capture by communities is evoked to contrast distinct metabolic relations within rural territories with the objectification of labour and nature under capitalism. The analysis reveals new configurations of class domination, tension and counter movements. Many critical scholars, particularly those in the Global South, have been attentive to alternate readings of the world by indigenous, African descendent, peasant and agro-extractivist communities that may be unfamiliar yet underpin vociferous, and often fatal, resistance to capital accumulation. The task to effectively situate these struggles within a theory of broader, heterogeneous class struggle and integrate this ‘wealth’ of collective struggle and knowledge towards societal transformation remains important work in progress. In this spirit, the paper offers some possibilities for making new conceptual and material connections between rural and urban productive spaces and across currently fragmented class formations and identities.
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Despite the relatively benign characteristics of construction and demolition waste, its mismanagement can result in considerable harm to human health for 200 million workers and those who live and work in proximity to construction and demolition activities. The high number of workers classified as informal, results in a large unregulated and vulnerable workforce at a high risk of exposure to hazards. We focused a systematic scoping review (PRISMA-ScR) on evidence associating construction and demolition waste with hazards and risks in low- and middle-income countries. We reviewed more than 3,000 publications, narrowed to 49 key sources. Hazard-pathway-receptor scenarios/combinations were formulated, enabling indicative ranking and comparison of the relative harm caused to different groups. Though the evidential basis is sparse, there is a strong indication that the combustible fraction of construction and demolition waste is disposed of by open burning in many low- and middle-income countries, including increasing quantities of high chloride-content PVC; risking exposure to dioxins and related compounds. A long-standing and well-known hazard, asbestos, continues to represent a health threat throughout the world, claiming 250,000 lives per annum despite being banned in most countries. In the coming decades, it is anticipated that more than half of all deaths from asbestos will take place in India, where it is still sold. Comparatively, the highest risks from construction and demolition waste exist in low- and middle-income countries where attention to risk mitigation and control is needed.
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### Summary box In 1948, my (RS) grandfather bought a car; a Morris Minor. It was slow, cramped and unreliable. Yet, as his needs changed over the years, he did not buy another car because ‘it was too difficult’ to decide. Today, he does not own a car. He can use community transport, Uber drivers and car sharing schemes. Transport has evolved remarkably since 1948, driven by technological innovation, but also institutional innovation in how we mobilise new technologies. Unlike transport, global health governance has not seen such institutional innovation, even though diseases have globalised and health emergencies become more complex. Historically, global health governance has rested with the WHO. Criticisms of WHO have become frustratingly familiar—weak internal coordination, cumbersome bureaucracy, political appointments and ineffective leadership. The Ebola outbreak prompted some to describe it as facing a ‘do or die’ moment.1 Despite the Director-General admitting that ‘WHO was overwhelmed’2 by the outbreak, WHO has not ‘done’, in the sense of fundamental reform to address criticisms, but nor has it ‘died’. Although the global health community widely accepts that WHO is no longer fit-for-purpose, the design and …
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Tobacco companies have come under increased criticism because of environmental and labour practices related to growing tobacco in developing countries. Analysis of tobacco industry documents, industry websites and interviews with tobacco farmers in Tanzania and tobacco farm workers, farm authorities, trade unionists, government officials and corporate executives from global tobacco leaf companies in Malawi. British American Tobacco and Philip Morris created supply chains in the 1990 s to improve production efficiency, control, access to markets and profits. In the 2000s, the companies used their supply chains in an attempt to legitimise their portrayals of tobacco farming as socially and environmentally friendly, rather than take meaningful steps to eliminate child labour and reduce deforestation in developing countries. The tobacco companies used nominal self-evaluation (not truly independent evaluators) and public relations to create the impression of social responsibility. The companies benefit from $1.2 billion in unpaid labour costs because of child labour and more than $64 million annually in costs that would have been made to avoid tobacco-related deforestation in the top 12 tobacco growing developing countries, far exceeding the money they spend nominally working to change these practices. The tobacco industry uses green supply chains to make tobacco farming in developing countries appear sustainable while continuing to purchase leaf produced with child labour and high rates of deforestation. Strategies to counter green supply chain schemes include securing implementing protocols for the WHO Framework Convention on Tobacco Control to regulate the companies' practices at the farm level.
Objective Economic policies can have unintended consequences on population health. In recent years, many states in the USA have passed ‘right to work’ (RTW) laws which weaken labour unions. The effect of these laws on occupational health remains unexplored. This study fills this gap by analysing the effect of RTW on occupational fatalities through its effect on unionisation. Methods Two-way fixed effects regression models are used to estimate the effect of unionisation on occupational mortality per 100 000 workers, controlling for state policy liberalism and workforce composition over the period 1992–2016. In the final specification, RTW laws are used as an instrument for unionisation to recover causal effects. Results The Local Average Treatment Effect of a 1% decline in unionisation attributable to RTW is about a 5% increase in the rate of occupational fatalities. In total, RTW laws have led to a 14.2% increase in occupational mortality through decreased unionisation. Conclusion These findings illustrate and quantify the protective effect of unions on workers’ safety. Policymakers should consider the potentially deleterious effects of anti-union legislation on occupational health.
British American Tobacco Cambodia (BATC) has dominated the country's tobacco market since its launch in 1996. Aggressive marketing in a weak regulatory environment and strategies to influence tobacco control policy have contributed to an emerging tobacco-related public health crisis. Analysis of internal tobacco industry documents, issues of BATC's in-house newsletter, civil society reports and media demonstrate that BATC officials have successfully sought to align the company with Cambodia's increasingly controversial political and business leadership that is centred around the Cambodian People's Party with the aim of gaining access to policy-makers and influencing the policy process. Connections to the political elite have resulted in official recognition of the company's ostensible contribution to Cambodia's economic and social development and, more significantly, provided BATC with opportunities to petition policy-makers and to dilute tobacco control regulation. Corporate promotion of its contribution to Cambodia's economic and social development is at odds with its determined efforts to thwart public health regulation and Cambodia's compliance with the Framework Convention on Tobacco Control.
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