Dr. Tawfik A. M. Khoja MBBS, DPHC, FRCGP, FFPH (UK) Director General – GCC/ HMC

1. OCCUPATIONAL HEALTH PRACTICES IN DEVELOPING COUNTRIES Dr. Tawfik A. M. Khoja MBBS, DPHC, FRCGP, FFPH (UK) Director General – GCC/ HMC Dr. Mohamed S. Hussein Dr. PH,M.PH,M.Sc. Head of Studies & Research Division Oman 20-22 Dhul-Qada 1427 H / 11-13 December 2006

3. IN THE NAME OF ALLAH, THE MOST GRACIOUS, THE MOST MERCIFUL

4. First World INTRODUCTION The term refers to countries that are capitalist democracies, that are technologically advanced, and whose citizens have a high standard of living. The United States, Canada, Japan, Australia, and most of the countries of Western Europe are examples of first-world countries.

5. Second World The term is a phrase that was used to describe the Communist countries within the Soviet Union's sphere of influence. Along with "First World" and "Third World", the term has been used to divide the nations of Earth into three broad categories. The term has largely fallen out of use because the countries to which it referred mostly abandoned Communism, and their mutual interests, after the 1991 collapse of the Soviet Union. The other two terms remain in widespread use.

6. Newly industrialized countries or NIC These are countries that were previously considered developing countries and that now have a more advanced economy, yet not fully developed. Countries that have more advanced economies than developing nations but haven't yet gained the level of those in the First World are grouped under the term Newly Industrialized Countries or NICs. Current examples includes China, India, Mexico, South Africa or Brazil to name a few.

7. Fourth World In recent years, as many "developing" countries have industrialized, this term has been coined to refer to countries that have "lagged behind" and still lack industrial infrastructure The term Fourth World (as least developed countries) is used by some writers to describe the poorest Third World countries, those which lack industrial infrastructure and the means to build it. More commonly, however, the term is used to describe indigenous peoples or other oppressed minority groups within First World countries.

8. Least Developed Countries (LDCs or Fourth World countries) are countries which according to the United Nations exhibit the lowest indicators of socioeconomic development, with the lowest Human Development Index ratings of all countries in the world.

9. A country is classified as aLEAST DEVELOPED COUNTRYif it meets three criteria based on: • low-income (GNI per capita of less than US $750) • human resource weakness (based on indicators of nutrition, health, education and adult literacy) and

10. economic vulnerability (based on instability of agricultural production, instability of exports of goods and services, economic importance of non-traditional activities, merchandise export concentration, and handicap of economic smallness, and the percentage of population displaced by natural disasters). • The classification currently applies to around 50 countries. As of 2006, the least developed country in the world is East Timor.

11. CHARACTERISTICS Least developed countries generally suffer conditions of extreme poverty, ongoing and widespread conflict (including civil war or ethnic clashes), extensive political corruption, and lack political and socialstability. The form of government in such countries is often authoritarian in nature, and may comprise a dictatorship, warlordism, or a kleptocracy. The majority of LDCs are in Sub-Saharan Africa.

12. Current LDCs ██ Least Developed Countries Asia (10 Countries) Oceania (5 Countries) Africa (34 Countries)

13. DEVELOPING COUNTRY ██ High human development ██ Medium human development ██ Low human development ██ Unavailable

14. DEVELOPING COUNTRY Is a country with a relatively lowstandard of living, undeveloped industrial base, and moderate to low Human Development Index(HDI). The term has tended to edge out earlier ones "Third World", which has come to have unintended negative connotations associated with it. Developed countries , in comparison, usually have economic systems based on continuous, self-sustaining economic growth in the tertiary and quaternary sectors and high standards of living.

15. Another term synonymous to developing country is Less developed country (LDC) or Less economically developed country (LEDC). LEDC is a term used by modern geographers to portray the countries classified as "developing countries" more accurately, specifying that they are less economically developed, which usually correlates best with other factors such as low human development.

16. The ultimate objective Occupational safety and health can be defined as a multidisciplinary activity aiming at: The ultimate objective of occupational health is a healthy, safe and satisfactory work environment and a healthy, active and productive worker, who is free from both occupational and non-occupational diseases and who is capable and motivated to carry out his or her daily job and is able to experience job satisfaction and develop both as a worker and as an individual.

18. Occupational safety and health problems Approximately 45% of the world’s population and 58% of the population over 10 years of age belong to the global workforce, I.e. 60-70% of the adult male and 30 - 60% of the adult female population of the world. Hundreds of millions of people throughout the world are employed today in conditions that breed ill health and/or are unsafe (WHO 1999).

19. - Annually, an estimated 160 million new cases of work-related diseases occur worldwide, including respiratory and cardiovascular diseases, cancer, hearing loss, musculoskeletal and reproductive disorders, mental and neurological illnesses. - Only 5-10% of workers in developing countries and 20-50% of workers in industrial countries (with a few exceptions) are estimated to have access to adequate occupational health services. In the USA, for example, 40% of the workforce of some 130 million employees do not have such access.

20. Even in advanced economies, a large proportion of work sites is notregularly inspected for occupational health and safety. • The International Labour Organization (ILO) has estimated that in 1997, the overall economic losses resulting from work-related diseases and injuries were approximately 4% of the world’s Gross National Product.

21. There is a universal shortage of both expert resources and training in developing and newly industrialized countries in the South. This is due to three main reasons: a) Lack of effective legislation and absence or lack of requests from authorities and employers make the employment opportunities for such experts minimal . b) The vocational training institutions and universities have not organized and developed curricula for the training of experts in occupational health .

22. c) Training is oriented to clinical occupational medicine only which , though important, does not give a full response to the needs for expertise in a preventive workplace - oriented occupational health service D) Problems related to growing mobility of worker populations and occurrence of new occupational diseases of various origins.

23. The overall exposure pattern There is a wide variation in economic structures, occupational structures, working conditions, work environment, and the health status of workers in different regions of the world, in different countries and in different sectors of economies. There are also special occupational settings and types of enterprises, where work and workplace deviate substantially from the norm.

24. The least developed countries that still employ the major part of the workforce in agriculture and other types of primary production face occupational health problems that are different from those experienced in the industrial countries. In the least developed countries the occupational factors are aggravated by numerous non-occupational factors such as parasitic and infectious diseases, poor hygiene and sanitation, poor nutrition, general poverty and illiteracy. Cont . .

25. Work usually takes place in an environment that does not always meet required standards. Family members of the entrepreneurs and workers, including children, pregnant women and elderly people, share the work in small-scale enterprises, such as home industries, small farms and cottage industries, particularly in developing countries.

26. Case Studies

27. Improving occupational safety and health standards in the tanning industry in South East Asia. Country surveys were carried out in several South East Asian countries by the United Nations Industrial Development Organization (UNIDO), in connection with its regional programme for Pollution Control in the Tanning Industry in India, Indonesia, Nepal, and Sri Lanka . The surveys indicated that the tanning industry’s performance in terms of safety and health at work and quality management was poor.

28. Lessons learned: • Change is best stimulated by starting from the real problems and conditions in the companies instead of the priorities of outsiders. • Approaches have to be flexible and informal. • - Exchange of experience amongst entrepreneurs can be used to promote positive attitude to change.

29. Emphasis should be put on local improvement measures which are already in use. • Highlight “demand driven” concept (designed at entrepreneur’s own initiative). • Link OSH standards and practices with improved profit, cost savings. • - Involve pro-active entrepreneurs to act as advocates of the cause.

30. Fighting the pesticide related health problem inCentral America. Despite awareness of the problems associated with pesticide use, they have persisted, and are even increasing in some regions of the developing world. Nowhere is this more apparent than in Latin America. The region produces 40% of the world’s bananas, 60% of the world’s coffee, and 25% of the world’s beans.

31. Health impact of occupational risks in the informal sector inZimbabwe. Information about occupational health in the informal sector is lacking, despite its size and growing contribution to employment. Work organization, hygiene and ergonomic problems accounted for a significant share of inspected and reported workplace risks across all areas of informal sector work.

32. The significant under-detection of occupational morbidity is exacerbated by the almost complete lack of coverage of occupational health services in the informal sector. There were few built-in safety measures. Personnel Protective Equipment was used by less than 5% of workers, compared to the 55% doing work where it was judged that PPE would be needed.

33. LEARNING TOGETHER TO WORK TOGETHER FOR HEALTH

34. “First do no harm” Occupational Health in the Gulf Countries :

35. United Arab Emirates Bahrain SAUDI ARABIA OMAN QATAR KUWAIT YEMEN

37. GENERAL FEATURES IN THE GULF COUNTRIES • Gulf countries have large industrial communities with a great workforce exposed to various hazardous agents in their occupations. • Occupational health statistics are few • Reporting is lacking or not available

38. Most of the countries have several limitations or constraints hindering occupational health and safety services and programmes at facility, local (municipal) and national levels. The main obstacles are related to :- • lack of enabling legislation • lack of standards • Not enough of expertise • Coordination between concerned authorities is not complete. • lack of participation of the employers’ organizations, nongovernmental organizations, etc.

39. Insufficient budgetary resources or human resources. • lack of educational programmes. • Conflicts between various authorities responsible for occupational health and safety services. • No full coordination between various partners responsible for occupational health program. • There is considerable under reporting of occupational morbidity, both injury or disease and mortality. • Policies that comprehensively address occupational health are not enough.

40. is brighter The outlook Always think

41. HEALTH MINISTERS’ COUNCIL & OCCUPATIONAL HEALTH IN THE GULF COUNTRIES The Health Ministers’ Council for the Cooperation Council states issued 3 resolutions in the field of occupational health, as follows: • Resolution # 8 issued by the conference 14 of the Health Ministers’ Council held in Riyadh, Kingdom of Saudi Arabia (26 October 1983) which included: • Approval on the work papers submitted by the General Secretariat in this respect. • Assigning the General Secretariat to call upon a technical committee involving specialized people from different authorities to study:

42. Setting a platform and clear vision about occupational health programmes in the light of the existing problems , the industrial development projects, and the rapidly increasing development witnessed in the region. • Setting a work plan for development of occupational health services according to the recent developments in this regard.

43. Organizing a symposium with participation of all concerned departments in the ministries of health and other related ministries and agencies for the purpose of : • Defining the responsibility of each, and methods of coordination between various partners. • Developing legislations and regulations of occupational health. • Human power development necessary for work in this field.

44. Resolution # 1 issued by the Conference 18 of the Health Ministers Council held in Doha – Qatar (21-23 /1/1985), as follows: • Follow up on the occupational health symposium to discuss specific subjects making full use of the symposium held lately in Iraq in cooperation with WHO.

45. Resolution No. 5 issued by the conference 20 of the Health Ministers Council held in Muscat – Oman (5-8/1/1986) which involved the following: • Circulation of the recommendations issued by the symposium held in Bahrain (27-29 /10/1989) as well as the reports of the subcommittees. • Each country of the member states should : • Establish a national committee for occupational health and safety which should define the responsible body for each activity of occupational health and safety as well as methods of coordination among them.

46. Developing the regulations and legislations of workers’ health and safety as well as the safety of the production facilities, work environment and the surrounding environment. • Setting a plan to make available and train specialized and technical caders at various levels to be involved in occupational health services.

47. Taking necessary actions to make occupational health services available and accessible through primary health care programmes especially for those working in agriculture, small workshops and distant places. Training of physicians, technical middle-level cader should be trained to conduct these services in addition to equipping the facilities to make their work easy.

48. VITAL MESSAGE AHEAD

49. The Executive Body in its 65th meeting held in Riyadh (4-6/11/1427 H – 25-27 /11/2006 G) discussed the subject of occupational health and issued recommendation # (1) which included : • Establishment of a Gulf Committee for Occupational Health and Safety affiliated to the Executive Board. Each country should nominate its representative from among those specialized in the field of occupational health and safety.

50. The committee shall review the working paper presented by Dr. Yousef Al-Nesf – Executive Body members of Kuwait as a platform for the work of this committee taking into consideration the issue of setting occupational health strategies in such a way that does not overburden the Ministers of Health in the Cooperation Council and does not add tasks for which other governmental sectors are responsible.