Global Occupational Health

Joseph LaDou, MD
International Center for Occupational Medicine
University of California
San Francisco

2006
Prepared as part of an education project of the Global Health
Education Consortium and collaborating partners

Learning objectives

Understand the importance of global occupational

health & the limited resources provided by industry and
governments
Understand prominent positions UN agencies have in
occupational health & limitations imposed by member
states
Appreciate complexity of the global workforce & the
inadequacy of laws and enforcement to protect workers
Appreciate importance of major industries such as
agriculture, construction, and electronics & role that
labor plays in occupational health
Appreciate difficulty of interpreting global programs
when industry asserts such commanding control over
occupational health
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Global Occupational Health

Global occupational health is largely ignored

Occupational Injuries and diseases are increasing
Working conditions are not improving
Access to care and benefits is very limited
United Nations agencies are politically obstructed
Agency funding is inadequate at all levels

Important Note: Most of the 49 content slides in this module are backed
up by extensive notes, references and suggested readings, and some
slides are supplemented by detailed case studies. These resources are
on a separate file with ~111 pp. of notes, each one of which is linked to a
specific numbered module slide. The notes are then followed by 17 quiz
questions and their answers. The notes filename is:
Global Occupational Health Supplementary Notes

Page 3

Global Working Conditions

The present-day upheaval is fundamentally similar
to the great industrial revolutions of the past, yet distinctive
in its size and scope. The current revolution counts recruits
in the billions.
William Greider, One World, Ready or Not, 1998
Although many countries have developed laws and
enforcement activities, working conditions for the majority
of the worlds workers do not meet the minimum standards
and guidelines set by the World Health Organization
(WHO) and the International Labor Organization (ILO).
United Nations, 2005
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Small and Medium-sized Enterprises*

19 million small and medium-sized enterprises
(SMEs) in the European Union. They
Operate in hugely different sectors
Employ nearly 75 million people
SMEs account for ~82% of all occupational
injuries, even rising to about 90% for fatal
accidents.

European Agency for Safety and Health at Work, 2005

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Informal Sector*
In developing, transitional, and developed countries,
bulk of new employment is in the informal economy
(ILO, 2005)
Informal economy is unrecognized and
unprotected by legislation
Jobs are not being created by a dynamic new
sector, pushing more people into survival and
subsistence activities.
*Informal sector is all economic activities by workers and
economic units that arein law or in practicenot covered or
insufficiently covered by formal arrangementsor are operating
outside the formal reach of the law.
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Migrant Workers
Migrant workers are assets to every country
where they bring their labor. Let us give
them the dignity they deserve as human
beings and the respect they deserve as
workers.

Juan Somavia, Director-General, ILO, 2006

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Women Workers

Often the decision to seek employment

abroad is not made by the individual woman
herself, but rather by her family, especially by
the male members. It is the family that
makes the decision to send daughters and
wives overseas to earn well, save and give
their family a bright future.
ILO, 2006
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Child Labor

Child labor is widespread

Prevention is difficult in developing countries
Perverse economic incentives prevail
Child workers are compliant and cheap
Injuries and illnesses go unreported
No real social benefit is achieved

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Globalization
Globalization is the process of corporations
moving their money, factories and products
around the planet at ever more rapid rates of
speed in search of cheaper labor and raw
materials and governments willing to ignore or
abandon consumer, labor and environmental
protection laws. As an ideology, it is largely
unfettered by ethical or moral considerations.
Mark Ritchie, Globalization vs. Globalism, 2005
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Multinational Corporations
Corporations are like the feudal domains that evolved
into nation-states; they are nothing less than the
vanguard of a new Darwinian organization of politics.
Multinational corporations are the most powerful
political institutions of our time. Of the worlds
hundred largest economies, fifty-one are not countries
but corporations. General Motors annual sales are
greater than the gross national products of Denmark
and Norway. Phillip Morris has a bigger economy than
Singapore.
Robert D. Kaplan, Atlantic Monthly, 2004
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International Agencies
With rare exception, the developed countries defer
to the United Nations or one of its units to assume
responsibility for international occupational health
and safety (OHS).
World Health Organization
International Labor Organization
International Program for Chemical Safety

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World Health Organization (WHO)

WHO is responsible for
Technical aspects of occupational safety and
health
Promotion of medical services and hygienic
standards
WHO encourages national occupational health
policies and strategies through annual World Health
Assembly Resolutions.

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WHO Collaborating Centers

WHO collaborating centers play a strategic role by
carrying out one or more of the following functions:
collection and dissemination of information
participation in collaborative research
education and training, including research
training
coordination of multi-institutional activities
provision of information and advice on scientific,
technical and policy issues

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Occupational Disease
Annual job-related injuries, diseases and deaths
100 million cases
Over 2 million deaths
Cases appear to be rising due to rapid
industrialization in some developing countries
Occupational disease causes about four times as
many deaths (1.7 million/year) as occupational
injuries
WHO, 2006
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Protective Standards
The standard setting process is very open to
manipulation by business interests, and this is not
limited to just a few chemicals. A health standard
is a governments way of telling workers what is
acceptable, if not quite safe, and the only honest
thing for public health workers to do with
unsupportable standards is to remove them as the
official illusions they are.
Barry Castleman, 2006
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International Labor Organization

The ILO is an international coordinating body that plays
an important role in promoting uniform policies for
occupational health and safety in all countries. The ILO
sets minimum standards in the field of occupational
health and safety that have a strong ethical component.
The ILO reports that occupational health and safety
laws cover only 10 percent of the population in
developing countries, omitting many major hazardous
industries and occupations. These omissions include
agriculture, fishing, forestry, and construction, smallscale enterprises, and the informal sector.

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Occupational Injury
The global challenge of providing for worker health
and safety is ever greater today. The magnitude of
the occupational health burden in the world is
overwhelming, and the causes and mechanisms
are multiple and complex.
ILO, 2005

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Reporting
Occupational injuries and diseases, if accurately
reported, would be among the five leading
causes of morbidity and mortality throughout the
world. While international standards obligate
employers to pay for occupational injury and
disease, inadequate prevention, detection, and
compensation make a mockery of these
standards.
WHO, 2000
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ILO Conventions
The ILO Conventions are intended to guide all
countries in the promotion of workplace safety and
in managing occupational safety and health
programs. ILO Conventions are international
agreements that have legal force only if they are
ratified by ILO member states. The most important
ILO Convention on Occupational Safety and
Health has been ratified by only 42 of the 179 ILO
member States

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Page 21

Consultation with Local Governments

The ILO's Tripartite Consultation (International
Labor Standards) Convention (No. 144) requires
governments to operate procedures which ensure
effective consultation of employers' and workers'
representatives on measures to give effect to
ratified Conventions.
ILO, 2003

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Developed Country OSH Models

A convincing government OSH policy, and close
cooperation between social partners and the
government are critical factors that guarantee
sustainable OSH programs in a developing country
over a long-term basis.
Finnish Institute of Occupational Health, 2004

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International Programme on Chemical

Safety
WHO is the Executing Agency of the IPCS, whose
main roles are to establish the scientific basis for safe
use of chemicals, and to strengthen national
capabilities and capacities for chemical safety.

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Funding of International Agencies

Lately practically all major donors have said that
they will provide funding only to the priority areas:
child labor and the ILO Core Conventions. We
(SafeWork) have established about half of all ILO
Conventions and numerous Codes of Practices and
Guidelines, but implementation is poor. Ratification
campaigns concentrate almost exclusively on the
Core Conventions.
Jukka Takala, ILO, 2002
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Case Study: Industry Infiltration of

International Agencies
See supplementary notes Word file about how
industry infiltrated and guided the work of the United
Nations International Program on Chemical Safety (IPCS).

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Bhopal Disaster
The Bhopal disaster shocked the world and raised
fundamental questions about government and
corporate responsibility for industrial accidents that
devastate human life and local environments.
Amnesty International, 2005

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Bhopal Cleanup
Despite determined efforts by survivors to secure
justice, they have been denied adequate
compensation and appropriate and timely medical
assistance and rehabilitation.
Amnesty International, 2005

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Agriculture
Agricultural workers account for a particularly high
proportion of unprotected workers, especially in
developing countries. Their work is generally heavy,
their working hours can be very long, they are often
exposed to difficult climatic conditions, and many are
exposed to hazardous chemicals, especially
pesticides. These problems are compounded by
poverty: living conditions are often extremely poor,
and many have limited access to clean water, fuel
and power, adequate shelter and nutrition. Literacy is
often low.
ILO, 2006
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Pesticide Exposure
In the agricultural sector, which employs half the
worlds workforce and is predominant in most
underdeveloped countries, the use of pesticides
causes at least seven million cases of acute and
long-term non-fatal illnesses.
ILO, 2006

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Occupational Cancer
Workers continue to be exposed to known human
carcinogens, especially rampant in the developing
countries. Chemical and associated industries, such
as asbestos, are opposed to spending money on
needless safety and exposure reduction
improvements and innovations.
James Huff, NIEHS, 2006
See Tables 1 and 2 in the notes

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International Agency for Research on

Cancer
The IARC is part of the World Health Organization.
IARC's mission is to coordinate and conduct
research on the causes of human cancer, the
mechanisms of carcinogenesis, and to develop
scientific strategies for cancer control.

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Asbestos

Asbestos exposure affects 20-40% of workers

Asbestos cancer may cost 10 million lives
Asbestos accounts for 5-7% of all lung cancers
The epidemic is worst in developing countries
Canada exports 200,000 tons of chrysotile asbestos
Without technological solutions, a ban on use of
asbestos is essential
See on the Word file the detailed case study: The Finnish
Institute of Occupational Health (FIOH) and misleading reporting
on asbestos
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Current Asbestos Bans and Restrictions, 2006

Argentina
Australia
Austria
Belgium
Chile
Croatia
Cyprus
Czech Republic
Denmark
Egypt
Estonia
Finland
France
Gabon
Germany
Greece
Honduras
Hungary
Iceland
Ireland
Italy

Japan
Kuwait
Latvia
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Saudi Arabia
Seychelles
Slovakia
Slovenia
South Africa
South Korea
Spain
Sweden
Switzerland
United Kingdom
Uruguay

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Ban Support by UN Agencies

To this day, WHO and ILO have played only minor
roles in the international campaign to end the
asbestos cancer epidemic. These new statements on
the health hazard of asbestos may be late, but they
are nonetheless milestones on the path to an
international ban on asbestos supported by all United
Nations agencies. The WHO states categorically that
all forms of asbestos cause cancer, including
chrysotile.
See on the Word file the detailed Case Study:
Asbestos and the UN Agencies
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Stakeholder Movements
Canadas support for the asbestos industry has gone
virtually unnoticed by the Canadian public. They
were not asked and were certainly not told of their
Governments generosity to the asbestos industry.
Since 1984, Ottawa spent $20 million supporting the
Chrysotile Institute (CI), the asbestos industrys trade
association. The current level of federal funding for
the CI is $250,000 a year.
Ban Asbestos Secretariat, 2005

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Electronics Industry
Electronics industry is important to the world
economy
Worker health problems have not been adequately
studied
Industry migration to developing countries hides
OSH problems
Reproductive and cancer cases are numerous
Chronic health problems have not been addressed
Industry has sought to block, or obfuscate research
See detailed Case Study: Cancer Risk in the
Semiconductor Industry on the Word file
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Printed Circuit Board Industry

Printed circuit boards (PrCB) are found in virtually all
electronics products
PrCBs are crucial to annual manufacture and sales of
about $1 trillion in electronic products
PrCBs are found in virtually all weapons systems and
aerospace hardware
PrCBs are platform for mounting semiconductor chips,
capacitors, etc., providing electrical interconnections between
components
PrCBs are increasingly complex, many are multilayer, highspeed products that compete with semiconductor technology
See Case Study: Regulation of Migrating Industries
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Construction Industry
The construction industry accounts for at least
60,000 fatal workplace accidents each year
worldwide or about one death every 10 minutes.
About 17 per cent of all fatal workplace accidents
occur in this sector, while construction workers also
face a number of health risks, including exposure to
asbestos-laden dusts, silica and hazardous
chemicals.
ILO, 2006

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Future Needs in Industrializing Countries

Government support of OHS

OHS Standards
Access to Benefits
Training of OHS personnel
International Labor Rights

Page 40

Government Support
Implementation of occupational health and safety
practices in South Africa is impeded not only by lack
of funds, expertise, and technologic sophistication,
but also by worker apathy and employer ignorance,
such that there is no pressure on government even
to enforce existing regulations.
D. M. Joubert, South Africa

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OSH Standards
Major developing countries do not want to highlight
OSH and are afraid of possible World Trade
Organization sanctions if any of the OSH standards
is classified as "fundamental". Equally they are afraid
of the consumers if OSH shortcomings would be
more public.
Jukka Takala, ILO

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Access to Benefits
At present, only 16 percent of workers in Africa, 43
percent in Latin America, and 23 percent in Asia
enjoy protection from social security schemes.
WHO, 2003

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OSH Standards
Major developing countries do not want to highlight
OSH and are afraid of possible World Trade
Organization sanctions if any of the OSH standards
is classified as "fundamental". Equally they are afraid
of the consumers if OSH shortcomings would be
more public.
Jukka Takala, ILO

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Workers Compensation Insurance

Only 5% to 10% of workers in developing countries
and 20% to 50% of those in industrialized countries
have access to adequate occupational health
services.
WHO, 2004

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World Trade Organization (WTO)

Ultimately, the only goal of the WTO is to expand the
freedoms of corporations to act beyond the reach of
any national regulations and to diminish the rights of
national governments to regulate commerce on
behalf of human beings or nature. In the end, the
WTO amounts to a kind of global deregulation
authority, and it is appalling that sovereign
governments have so enthusiastically signed their
constitutional rights over to this process.
International Forum on Globalization, 1999
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Training of OSH Personnel

It is difficult to predict the number of industrial
hygienists that will be required, since their role has
not been stressed by government agencies. It will be
some time before the discipline realizes its full
potential in India.

T. K. Joshi, New Delhi, India

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International Labor
Labor sought to incorporate universal labor rights in the global
trading system, a social clause in trade agreements that would
allow workers everywhere to organize their own collective
power and to punish exports from those nations that did not
honor the new rules. Political opposition to this approach was
overwhelming. Many leading politicians lent rhetorical support to
labors goal, but, in reality, most were aligned, one way or
another, with the imperative of the multinationals.
William Greider, One World, Ready or Not, 1998

Risks to safety and health are reduced where there is real social
dialogue and community consciousness and when workers and
employers can organize freely and bargain. -- ILO, 2002
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Conclusion
The desired outcome of industrial expansion and
prosperity through trade is peaceful coexistence.
Occupational health must be seen as a small
dividend in this much larger equation.

Page 49

Global Information Sources:

Occupational Health & Safety

Suggested Readings
Bloom DE, Canning D. The health and wealth of nations. Science.
2000;287:1207-1209.
LaDou J. Occupational health in the industrializing countries.
Occupational Medicine: State of the Art Reviews. 2002;17:349-354.
Rantanen J, Lehtinen S, Savolainen K. The opportunities and
obstacles to collaboration between the developing and developed
countries in the field of occupational health. Toxicology. 2004;198:6374.
Lists of international meetings are available at:
http://www.phs.ki.se/occupmed/news/upcomingevents.htm
http://www.cdc.gov/niosh/exhibits.html

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Global Information Sources:

Occupational Health & Safety

Internet Resources for Occupational Health Professionals

World Health Organization (WHO) Occupational Health:

http://www.who.int/occupational_health/en/
International Labor Office (ILO)
http://www.ilo.org/public/english/protection/safework/cis/oshworld/events.htm
English version of the ILO Encyclopedia of Occupational Health and Safety
http://www.ilo.org/encyclopaedia/
WHO/ILO Joint Effort on Occupational Health in Africa -- http://www.sheafrica.info/
Association of Societies for Occupational Safety and Health (ASOSH) -http://www.asosh.org/index.htm
European Agency for Safety and Health at Work
http://agency.osha.eu.int/news/events/index_en.htm
Occupational and Environmental Medicine Resource Index (Links to OSH
Agencies) -- http://links.occhealthnews.net
NIOSH, EPA, ATSDR, Chemfinder, NLM, teaching materials
http://www.elsevier.com/homepage/sah/tox/greenberg.pdf
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Global Information Sources:

Occupational Health & Safety

Internet Training Modules for OSH Professionals

ILO. Introduction to Occupational Health and Safety
www.itcilo.it/english/actrav/telearn/osh/intro/introduc.htm

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Credits
Joseph LaDou, M.D., Director
International Center for Occupational Medicine
Division of Occupational and Environmental Medicine
University of California School of Medicine
San Francisco, CA 94143-0924, USA
(415) 476-4951
FAX (415) 476-6426
E-mail: [email protected]

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The Global Health Education Consortium and the Consortium of

Universities for Global Health gratefully acknowledge the support
provided for developing teaching modules from the:
Margaret Kendrick Blodgett Foundation
The Josiah Macy, Jr. Foundation
Arnold P. Gold Foundation

This work is licensed under a

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States
License.