Title of the presentation Author

1. . . III HEMISPHERIC WORKSHOP ON OCCUPATIONAL HEALTH AND SAFETY “Searching for improvements in the Occupational Health and Safety conditions of our workers” Cusco, Peru October 21st, 2008 Dr. Luz Maritza Tennassee Senior Regional Advisor on Workers' Health Marie-Claude Lavoie Title of the presentation Author

2. National Councils for Occupational Health Civil Society Unions Employers Academia WHO/PAHO colleagues Acknowledgments • OAS • Minister of Labor and Employment Promotion of Peru • ILO • OAS Members countries • WHO/ PAHO Collaborating Centers in Occupational Health

3. Global Burden of Disease from Occupational Diseases and Injuries • 25% of the global burden of disease and mortality is due to occupational and environmental risk factors1 • 2 million deaths per year globally are attributable to occupational diseases and injuries2 • 90,000 die annually from asbestos-related diseases3 Global burden of disease: occupational risk factors 1. Pruss-Ustun & Corvalan 2006; 2. ILO/WHO 2005; 3. WHO 2006

4. Workers' Health in Latin America and the Caribbean Inequities 27,000 – 68,000 work-related fatalities/ year1 Only 10 - 15 % of workers have access to a basic occupational health services3 20 - 80 million workers suffer from occupational injuries or diseases1 Mortality is higher among temporary workers compared to permanent workers4 20 - 40% of the employed population do not have sufficient economic resources to meet the minimum for the healthy living1 Hispanic workers in the US have a 25% higher risk of dying than non-Hispanic workers2 1. PAHO Health in the Americas 2007; 2. NIOSH World Health Chartbook 2004; 3. Rosenstock et al. 2005; 4. WHO Commission on the Social Determinants of Health 2008

5. Only 5 - 10% of all occupational diseases are reported5% of occupational research is conducted in developing countries which possess 90% of the burden of disease

6. Regional and Global Mandate IV Summit of the Americas DECLARATION 33. We will promote integrated frameworks of public environmental, employment, health, and social security policies to protect the health and safety of all workers and foster a culture of prevention and control of occupational hazards in the Hemisphere ACTION 16. To promote occupational health and safety conditions and facilitate healthy work environments for all workers, and, to that end, ensure effective labor inspection systems. For this purpose, it is essential to foster strategic alliances between the labor, health, environment and education sectors. • Universal Declaration of Human Rights 1948 • ILO Occupational Cancer Convention (C139) 1974 • UN Conference on Environment and Development, Brazil 1992 • WHO Global Strategy on Occupational Health for All 1995 • Rotterdam Convention 1998 • World Summit on Sustainable Development, South Africa 2002 • Millenium Development Goals 2000-2015 • Summit of the Americas 2005 • ILO Promotional Framework for OSH Convention (C187) 2006

7. WHO Workers’ Health Global Plan of Action (2008-2017) • Provide and communicate evidence for preventive action Systems for surveillance of workers’ health for the identification, and control of occupational hazards and occupational diseases and injuries • Devise national policyinstruments on workers' health • Protect and promote health at the workplace • Improve the performance of and accessto occupational health services • Incorporate workers' health into other policies http://www.who.int/gb/ebwha/pdf_files/WHA60/A60_R26-en.pdf

8. Information System for Action • Action • Policies and legislation • Healthy workplace environment • Promotion of decent work • Comprehensive occupational health services • DrivingForces • Globalization • Pressures • Agriculturalindustrialization • Technology transfer • Situation • Composition of the labor force • Migration • Exposure • Psychological, ergonomic, chemical, safety, biological and physical • Effects • Lostworkdays, accidents and occupationaldiseases • Lowproductivity and social costs Information systems

9. Occupational Health Surveillance Systems Ongoing systematic collection, analysis, interpretation, and dissemination of data for purposes of improving health and safety Used to record occupational injuries, illnesses, hazards and exposures Data Sources Governmental Institutions Academic Measurement Data Functions International Databases Situation analysis Research Sub-group Population Private Sector Unions Policy Individual Others Programs and interventions Extrapolated Social, economic, political, cultural contexts,

10. PLAGSALUD (Occupational and Environmental Aspects of Exposure to Pesticides) Community participation- Policies-Training- Inter Sectorial Coordination-Surveillance- Research Situation • CA: one of the major consumers of pesticides in the world • 85% of pesticides used in agriculture • 4 millions agricultural workers exposed to pesticides • 7000 acute pesticide poisonings/year (80% underreporting) Local health care facilities Acute Pesticide Poisoning Health Impact • Lung cancer • Cervical cancer • Skin cancer • Neurological dysfunction Civil Society

11. PLAGSALUD Impact Reduction of occupational mortality and incidence of acute intoxications in Nicaragua, 1994-2006 • Acute pesticide poisoning surveillance integrated into national epidemiological system; • 300 (CLIPS) Intersectoral local commissions across 7 countries; • Legislation for the ban or restriction of 119 pesticides across 7 countries • Education (various topics, and audiences) • Development of alternatives agriculture

12. Worker’s Health Referral Centres (CEREST) North 19 North-east 56 Middle-west 14 South 28 150 installed (2007) Goal – 200 (2008) Functions: Give technical support for workers’ health assistance, surveillance and promotion to all levels of public health services (primary, secondary, hospitals and surveillance services) Number of Workers’ Health Referral Centres (proportionally with regions’ population) South-east 83 150 services (2007)

13. National Plan-Program components • Implementation of control methodology • Laboratory Analytical Techniques • Respiratory Protection Training • Training courses on spirometry & radiologic ( ILO technique) • Silicosis Surveillance System ILO/WHO International Programme on the Global Elimination of Silicosis Americas Silicosis Initiative • Crystalline silica • Group1 human carcinogen • Million of workers exposed Silicosis • Incurable and irreversible lung disease WHO, PAHO, ILO, U.S NIOSH, Chile Institute of Public Health and Ministry of Health, Brazil FUNDACENTRO, Peru

14. Other Examples of Information System in the Region • Jamaica and Guyana • Surveillance system for work-related injuries • Canada • Workplace Hazardous Materials Information System • Costa Rica, Nicaragua, Colombia • CAREX (exposure to carcinogenic agents) • Peru and the Caribbean • Hepatitis B Immunization Coverage among health-care workers. • Brazil • Informal work in the health-care sector

15. Reaching Higher • Information Systems • Responding to the situation • Policies • Preventive Programs and measures • Access to health services • Determinants factors • Regional Commitment to Occupational Health and Safety (Summit of the Americas) • Collaboration, Coordination, Commitment, Cooperation

16. Gracias Thank you Merci Obrigado Solpay