S. Lehtinen Occupational Health Program, WHO ECEH Bonn Office Acting Manager: Dr Rokho Kim Scientist: Dr Domyung Paek

Occupational Health ?  One of the health field  One of the industrialization field  One of the employment field  Dealing with accidents and diseases at workplace  In fact, dealing with risks of accidents and causes of diseases originating from or while doing work

WHO ECEH Background  Long tradition of occupational health from the first industrialization  Coexisting newly independent and newly developing countries  Heterogeneous cultural, political, economic and ethnic background  New concepts and new models are continuously experimented, such as EU

WHO ECEH Challenges  Magnitude of the burden 400 million workers An estimated 5 million economically active children Every year an estimated die in occupational accidents Every year an estimated die of a work- related disease  Diversity Various sub-groups of the 53 countries: EU-27, Nordic countries, Baltic Sea countries, CIS countries, SEE countries, NIS, Central Asia. Access to occupational health services varies widely among the Member States (10–90%)

WHO Response to Challenges  Develop the “Global Plan of Action for Workers’ Health ”, and ‘Regional Implementation’ 1.To develop and implement national policies, action plans and programmes on workers health 2.To protect and promote health in the workplace 3.Improve the performance of and access to occupational health services 4.Provide and communicate evidence for action 5.Address workers health in all policies for sustainable human and economic development  Provide services to member countries in need of establishing occupational health program from the scratch

Occupational Health Strategy?  Previously, Global strategy of occupational health for all workers ( )  Occupational Health Strategy centers on risk assessment and risk management at the workplace Core idea is about how to recognize the risks and manage them in the field, that is, at the workplace

Risk Assessment and Management  Traditionally, risk assessment and management cycle proposes the following concept  Does this really work?, especially in the field?, at least in developed countries? Risk Assessment Risk Management Disease Reduction

Risk Assessment and Management  Has been practiced all the time with human cultural evolution Avoidance of pork in hot weather Avoidance of potential infection source/people with disfiguring face or physique Quarantine of traveling people at the entrance of town  However, very poor or no practice against the risks of industrialization

Occupational Risk Assessment and Management  Why poor during the industrialization of industrialized countries, especially in Europe?  Why still poor in currently industrializing countries even with existing references from the already industrialized countries?  What should be done to improve occupational health in Europe now?

Review of Risk Assessment and Management →  Risk Recognition → Risk Management  Temporal changes of RA & RM → → Case Study → → Lessons from Asbestos Regulation  Regional Differences of RA & RM → → Country Comparison → → European Situation Analysis

Old Risk Assessment and Old Risk Management  To be managed, the risks should first be recognized → → By human nature, unfamiliar risks are difficult to ascertain → → New risks without social memory such as industrialization is difficult to recognize → → Necessity to build social learning process

Old Risk Assessment and Old Risk Management  To be recognized, the risks should first be manageable → → By human nature, only those that can be willfully changed are accepted as risks, otherwise just fates → → Measurement is the first step toward to the management, and usually those professionals who can measure are the first to recognize → → Often the first step of social learning is building infrastructures of measurement

Analysis of National H & S Program  Focus on Input-Output-Outcome linkage → → Exp Assmnt, Dis Assmnt, and H & S Solution Exp Monitoring Exp Reduction Disease Reduction Exp Monitoring Disease Increase Exp Reduction versus

Croatia, even with active high level of noise assessment, low rate of detection of hearing loss

Israel, with lot of hearing loss cases, still high proportion of overexposed

New Risk Assessment and New Risk Management  To be managed, the risks should first be recognized → → By human nature, cooperation is critical to the survival of mankind, and un/fairness recognition or reciprocity is well developed even from childhood → → The first risk recognized and managed during industrialization was child labor in most countries → → Necessity to get social recognition, not just infrastructure building

New Risk Assessment and New Risk Management  To be recognized, the risks should first be manageable or changeable → → Experts, who can measure the quantity of risk, try to solve the problem by reduction not elimination → → Victims, who can not measure but can imagine the world without risks, try to solve the problem by elimination not just reduction → → Have victims be involved in the RA and RM as early as possible

New Risk Assessment and New Risk Management  Risk Recognition and Risk Management are just two different sides of one coin → → Scope of the H & S program is important in that the coverage determines the detection rate of NIHL and pneumoconiosis, and for accidents, it determines the over-all accident rates of the society. → → Target priority may be important, but general universal acknowledgement of H & S values by the society is more fundamental to the effectiveness of the program. → → Risk population is at risk, not because of high risk works, but because of acceptance of high risks for that particular working population. → → Minority populations including non-standard workers and illegal migrant workers should be given particular considerations in this issue of the H & S program scopes.

Recommendations  Look for strategy, first from the common sense  Goal setting: Not the best ever possible textbook solutions, but the most practical alternatives from the neighboring countries → Phased and feed-backed approach: every input should get a feed-back by examining outcomes etc.  Faced with a quandary, inevitable conditions needs to be reexamined, so that current results could be the cause of the current problem, vise versa. → Social development including health and safety is the prerequisite of economic development, not the other way around.  Risk is there, not because of the risk itself, but because of the conditions that make it risky. → Socio-cultural bias against risk perception and management is the real difference between different societies, and mechanical or managerial approaches should always be preceded by cultural approaches.