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Occupational health: a world of false promises

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Occupational health: a world of false promises

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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
promises
Joseph LaDou
1*
, Leslie London
2
and Andrew Watterson
3
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.
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: drjoeladou@gmail.com
1
Emeritus Clinical Professor, Division of Occupational and Environmental
Medicine, University of California School of Medicine, San Francisco, USA
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
LaDou et al. Environmental Health (2018) 17:81
https://doi.org/10.1186/s12940-018-0422-x
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
problem.
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
students.
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
issues.
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
interests.
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
conditions.
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
benefits.
Conclusions
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
cosmetic.
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
substantial.
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.
Abbreviations
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
Acknowledgements
None
Availability of supporting data
Not Applicable.
Funding
Not Applicable.
Authorscontributions
All authors read and approved the final manuscript.
Authorsinformation
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.
PublishersNote
Springer Nature remains neutral with regard to jurisdictional claims in published
maps and institutional affiliations.
Author details
1
Emeritus Clinical Professor, Division of Occupational and Environmental
Medicine, University of California School of Medicine, San Francisco, USA.
2
School of Public Health and Family Medicine, University of Cape Town,
Cape Town, South Africa.
3
Occupational and Environmental Health Research
Group, Stirling, UK.
Received: 17 August 2018 Accepted: 29 October 2018
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... Occupational Health and Safety (OH&S) could be accepted as the science of anticipation, recognition, evaluation and control of occupational hazards (accidents, injuries and diseases, and major industrial disasters) which would impair the health and well-being of workers and thus cause concern from individual workplace to national and international levels (Ali, 2008). This could be echoed in the most recent global estimate of the International Labour Organisation (ILO) 1 and in other studies (LaDou et al., 2018;Mona et al., 2019) according to which every year, 2.78 million work-related deaths are recorded, including 2.4 million occupational diseases like cancer, and 370 million workforce injuries which cause 4% yearly loss to the nation's Gross Domestic Product (GDP). The lack of access to broader health care and safety-security net, long hours in the workstation, inadequate diets, housing, transport and so on, are responsible for the vulnerability in the workforce to injury and diseases which claim more than one million deaths each year (LaDou et al., 2018). ...
... This could be echoed in the most recent global estimate of the International Labour Organisation (ILO) 1 and in other studies (LaDou et al., 2018;Mona et al., 2019) according to which every year, 2.78 million work-related deaths are recorded, including 2.4 million occupational diseases like cancer, and 370 million workforce injuries which cause 4% yearly loss to the nation's Gross Domestic Product (GDP). The lack of access to broader health care and safety-security net, long hours in the workstation, inadequate diets, housing, transport and so on, are responsible for the vulnerability in the workforce to injury and diseases which claim more than one million deaths each year (LaDou et al., 2018). Occupational hazards not only called for immense suffering for the workers and their families but also caused huge economic pressure on the source of employment for loss of work productivity, work compensation, health-care expenditure, training and reconversion, interrupted production and absenteeism. ...
... Occupational hazards not only called for immense suffering for the workers and their families but also caused huge economic pressure on the source of employment for loss of work productivity, work compensation, health-care expenditure, training and reconversion, interrupted production and absenteeism. 2 In the worldwide context, developing countries share more severe findings on workforce occupational illness and diseases than that of the developed ones for their hazardous production and unsafe work environment (LaDou et al., 2018). It could be found in the report of the ILO (2017) that amongst more than 1.4 billion people, almost four out of five workers in developing countries have to work in hazardous occupations whose number has been increased gradually and now stands at around 11 million yearly. ...
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In any developing country like India, Micro and Small Enterprises (MSEs) showed its best effort in improving the mass standard of living by ensuring employment generation. Thus the grass root people who otherwise might not get entered into the formal sector due to lack of technical skill and education could get their employment there easily. But the lack of technical know-how of the participants of MSEs may not allow them to have awareness of occupational hazards. This calls for a severe problem in Health and Safety related issues in MSEs for those individuals. The present study, therefore, takes its objectives to highlight on the maintenance of Occupational Health and Safety (OH&S) related issues in MSEs where the perceptions of the participants play an important role. To fulfil these objectives, the study takes its attempt to pursue a primary survey on 95 randomly selected participants out of 24 registered MSEs of select sectors of West Burdwan, an industrially developed district of West Bengal. The sectors are selected purposively based on their significant presence in West Burdwan. The data have been collected through questionnaire and non-parametric tests has been used for further assessment. It is found that creating cozy atmosphere, privacy, artificial lighting conditions, ventilation, facilities for rest and meals, and so on are the factors to be maintained under OH&S in MSEs. The responses of the participants are found as sector specific and socio-demographic characteristics specific. In this issue, while the young male members like ‘facilities for rest and meals’, the female members prefer ‘privacy’ as the factor to be maintained for OH&S in MSEs. Thus the paper in its policy implication exhibited the sector-wise and socio-demography wise preferences of the participants on OH&S related issues.
... Alarmingly, lower-middle-income countries (LMICs) bear more than 80% of worldwide incidents due to work-related accidents and illnesses (Meswani, 2008). For instance, LaDou et al. (2018) reveal that a significant proportion of OHS related deaths occurred in developing and poor economies. Likewise, recently Fan et al. (2020) reports that the ratio of work-related injuries in some developing countries of Asian and Gulf regions is four times higher than in developed countries. ...
... Likewise, recently Fan et al. (2020) reports that the ratio of work-related injuries in some developing countries of Asian and Gulf regions is four times higher than in developed countries. Besides this, OHS related injuries cause lifetime disabilities and result in more than 10 trillion dollars loss to developing and emerging countries (LaDou et al., 2018). The plausible reasons for such huge loss are because only 20% to 50% of the total labour force have access to basic health facilities (Lucchini and London. ...
Article
A R T I C L E I N F O Keywords: Occupational health and safety Global reporting initiative (GRI) Benchmarking-scoring technique Content analysis Pakistan-a lower-middle income country A B S T R A C T Providing a safe and healthy work environment is a significant challenge for firms operating in today's dynamic and competitive world. Since firms voluntarily report their occupational health and safety (OHS) performance through annual or sustainability report; there is often variation in the quality of disclosure, especially in lower middle-income countries such as Pakistan. The current study considered manufacturing companies listed at Pakistan Stock Exchange. Due to the scant literature in Pakistan, the study adopted an exploratory mixed design. Data was gathered from the annual reports of 181 manufacturing firms between 2018 and 2019. Due to a lack of accounting methodology to assess the quality and quantity of occupational health and safety disclosure (OHSD), this study used content analysis, benchmarking technique and statistical analysis. The findings reveal inadequate OHS disclosure as only three companies reported OHS information according to the GRI indicators. Furthermore, compared with other aspects of OHS, the results reveal that 'occupational safety' is widely reported. Through the benchmarking technique, the quality assessed showed poor OHSD as the accountability index scores in 2018 and 2019 were 3.22 and 3.44, respectively, both of which are lower than the benchmark score (16.5). The statistical results reveal differences in disclosure of company-specific factors. Such methodology highlights to focus on GRI standards and can help managers and stakeholders assess the effectiveness of the OHS management practices adopted by firms. This research paper proposes an assessment methodology to examine OHS disclosure information in corporate annual reports by analyzing subjective and objective data specific to companies.
... Critics have asked why not more is being done to prevent occupational accidents and diseases considering the substantial economic losses they cause the global economy (Takala et al. 2014(Takala et al. , 2017. Others (Lucchini and London 2014;LaDou et al. 2018) question the capacity of the WHO and the ILO to protect workers' health, considering the weak coverage of occupational safety and health legislation in many countries and high number of workers exposed to risks. This section takes a closer look at some of the circumstances that complicate the work of international occupational health organizations. ...
... The share of extra-budgetary funding in the total budget is growing. In the ILO, some 45% of the total resources are extra-budgetary (ILO 2019g), and in the WHO, about 80% of total resources derive from other sources than regular budget (LaDou et al. 2018). One feature of extra-budgetary funding is that it is often ear-marked for a particular question, topic, or region. ...
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This chapter presents the background, mandate, and reason for existence of international occupational health organizations and the role they play as drivers of change. The main focus is on the International Labour Organization (ILO) and the World Health Organization (WHO) because they are intergovernmental and thus more influential than nongovernmental organizations. International occupational health organizations have played important roles in the struggle for peace and social justice for more than 100 years. Today they face dilemmas and problems, including silo-thinking and insufficient funding, but there are also reasons for optimism, such as growing political recognition of decent work and occupational health. The recent suggestion to make occupational safety and health one of ILO’s fundamental principles and rights at work is potentially very promising for the future of international occupational health organizations as drivers of change.
... They are prone to several kinds of accidents, diseases, and injuries, which significantly contributes to the interference of work processes and eventually create heavy financial costs. According to LaDou et al. (2018), the world's labor force experiences at least 370 million injuries every year, a figure that could be much higher if a more reliable analysis was conducted. ...
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Safety climate can be regarded as a summary of moral perceptions that employees share about their work environments. This study explores the attitude of employees (working on production sites) towards the safety climate of a manufacturing firm producing medical equipment located in Kuala Lumpur (Malaysia). The data were collected through an open-ended questionnaire from 30 employees working in the manufacturing section of Setia Tek Limited. All the responses from open-ended questionnaires were analyzed descriptively and interpretively simultaneously using a thematic content analysis method. The findings indicate that the overall perception of the majority (67%) of employees about safety climate is positive. The research findings further reveal that majority of employees share a common understanding of the significance of the managerial strategies in business operations. With regard to the contribution of dimensions to shaping safety climate perceptions, the analysis reveals that all nine dimensions (safety concept, risks associated with daily work, cause of accidents, safety policies, regulations, and procedures, balance productivity goals and safety goals, commitment of the upper management, commitment of the immediate supervisor/ manager, commitment of employees, adequate training and competency, disciplinary actions for safety violations, accident investigations) positively contribute to employees’ safety perceptions.
... Extensive literature is available which shows similar results [1,2,8,18]. Working conditions and occupational safety in the developing countries is significantly different from the industrial countries [19][20][21]. Due to increased workload the brunt of the work falls upon the young training dentists resulting in prolonged sitting hours for them [22]. The back pain might be related to the poor quality of dental stools provided to the students along with extended sitting hours [5,12,23]. ...
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Aim: Musculoskeletal disorders have significantly been related to poor ergonomics practice during clinics. There is limited data regarding the prevalence and reasons for work-related musculoskeletal disorders in young dentists. This study was conducted to find out the prevalence of musculoskeletal disorders in young dentists, identification of the perceived reasons for musculoskeletal disorders, and measures taken to manage them. Study Design: Cross-sectional observational study. Methods: A cross-sectional study was conducted on 408 house officers from ten dental institutes of twin cities and Karachi, Pakistan. The subjects were inquired through a validated questionnaire about the presence of muscular pain, affected body regions, frequency, intensity, nature of onset, aggravating factors, and average duration of the pain episodes. They were also asked about measures taken to counter musculoskeletal pain and their effectiveness. Results: The overall prevalence of musculoskeletal disorders was n=231(56.6%) with n=172(39.2%) of participants reporting it to be work-related with a higher percentage of females n=138/172 (80.2%) The most affected body regions were the back n=101/172 (58.7%), shoulders n=91/172 (52.9%) and neck n=80/172(46.5%). Improper posture n=108(62.8%) followed by prolonged sitting n=88(51.2%) were the most common reasons perceived by the young dentists for their pain. Bed rest was adopted 93(54.1%) to alleviate pain followed by posture rectification 76(44.2%). Most n=134(77.9%) of them thought that these measures are helpful for the alleviation of pain. Conclusion: The prevalence of work-related musculoskeletal disorders among young dentists is high. The back, shoulder, and neck areas were more frequently affected. A higher percentage of females suffered from MSD as compared to males. Bed rest was the most common measure adopted to alleviate the pain. Very few of them sought professional help for their musculoskeletal disorders.
... The life and health of the worker and, consequently, his ability to work depends on the level of safety at work. World statistics states that 3 million workers die every year from work-related injuries and occupational diseases [3]. The growth of injuries, the number of deaths, the increase in occupational diseases at work -all this provides the foundation for the development and improvement of measures aimed at minimizing the impact of harmful and hazardous factors on workers around the world. ...
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The article considers the sources of noise that have a negative effect on the electrician of the power plant, as well as on the environment. The analysis showed that noise is the main harmful production factor that adversely affects the working conditions of an electrician. In the course of the study, a set of measures to reduce the impact of industrial noise on the worker and the environment, including the installation of silencers, was proposed. The material used for the manufacture of the silencer, which can significantly reduce the level of industrial noise, was proposed. Recommendations for adjusting the work and rest regime were developed, and more effective personal protective equipment for an electrician was selected..
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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.
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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.
Article
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.
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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.
Ending child labour in Tobacco Production by 2025: The tobacco industry is the problem, not part of the solution
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