Yawen Cheng, ScD Associate Professor Institute of Health Policy and Management, College of Public Health, National Taiwan University Essentials of Global Health April 20, 2012 Unless noted, the course materials are licensed under Creative Commons Attribution- NonCommercial-ShareAlike 3,0 Taiwan (CC BY-NC-SA 3.0)Attribution- NonCommercial-ShareAlike 3,0 Taiwan

 Choose one type of the health problems, and answer the following questions Occupational injuries or occupational diseases Coronary heart disease or hypertension Obesity Smoking Alcoholism  In your country or region, is there health inequality of this health problem by social categories (e.g., education, occupational grade, income, gender, ethnicity, neighborhood) ?  If so, what might be the cause (s)?  What kinds of public policies do we need to reduce social inequalities of this health problem?  What obstacles and opportunities may exist?

World Map of Gini coefficient (2009) 1A – Smoking in Brazil 1B – CVD in Honduras 2A – Occupational Injuries in UAE 2B – Obesity in Morocco 3A – Alcoholism in India 3B – Occupational injuries in Indonesia 4A – Alcoholism in Russia 4B – Alcoholism in Russia 5A – ? 5B – Smoking in SA

GroupSocial inequality? Causes?Public policy? Obstacles? Opportunities? Smoking1A 5B Brazil SA Obesity2B Morocco CVD1B Honduras Alcoholism3A 4A 4B India Russia Occupational injuries 2A 3B UAE Indonesia

Longest, Health Policymaking in the US (1998)

Public Health Policy Knowledge base (scientific evidences and social strategies) Politics (power struggle /political will) Social values/ Attitude/ethics National Taiwan University Yawen Cheng

Wikipedia Factoryjoe

8 Attitudes toward occupational health and related social protection systems

9 A job is just a way of earning money, no more. A job is just a way of earning money, no more. (1)strongly agree (2)agree (3)neither agree nor disagree (4)disagree (5)strongly disagree

10 Personally you think … Job security is (1)very important (2)important (3)neither important nor unimportant (4)not important (5)very unimportant

11 Personally you think … High Income is (1)very important (2)important (3)neither important nor unimportant (4)not important (5)very unimportant

12 Personally you think … Job that is useful to society is (1)very important (2)important (3)neither important nor unimportant (4)not important (5)very unimportant

13 Personally you think … Good opportunities for advancement is (1)very important (2)important (3)neither important nor unimportant (4)not important (5)very unimportant

14 Personally you think … Job that allows to help other people is (1)very important (2)important (3)neither important nor unimportant (4)not important (5)very unimportant

15 Employer should limit workers ’ working hours, in order to avoid working overtime. (1)strongly agree (2)agree (3)neither agree nor disagree (4)disagree (5)strongly disagree

16 Once employer and employees reach a consensus on working hours, the government has no need to regulate working hours by legislation. (1)strongly agree (2)agree (3)neither agree nor disagree (4)disagree (5)strongly disagree

17 No matter whose fault, the employer has the responsibility to compensate workers who suffered from work-related injuries and disease. (1)strongly agree (2)agree (3)neither agree nor disagree (4)disagree (5)strongly disagree

 Transformation of WC in developed countries  Negligence liability   Employers’ liability   No-fault principle and social insurance  Goals To reduce labor conflicts and social cost To ensure compensation in a timely manner To share employers’ financial burden  Principles No-fault Compulsory social insurance Financed (mainly) by employers

Country (year) Population (covered by social insurance) Fatal occupational injuries ____________________ Occupational diseases _____________________ number Rate （ per 100,000) number Rate （ per 100,000) Taiwan(2011)9,725, France(2009)18,108, , Sweden(2008)4,401, , Finland (2008)1,732, , Denmark(2009)2,831, , Korea (2010)14,198,7482, , UK(2008)29,022, , Japan (2009)52,788,6811, , Germany(2008)74,285,6331, ,

 Disease doesn’t exist until we have agreed that it does, by perceiving, naming, and responding to it. (Rosenberg, 1997)  The social political meaning of ‘occupational disease’ - The power to diagnose was the power to legitimize economic claim.

National Taiwan University Yawen Cheng

Compensation rates for occupational diseases in Taiwan and in selected countries: National Taiwan University Yawen Cheng

Case1: System of Job Responsibility  29 year-old senior engineer  Sudden death at home  Overworked more than 95 hours monthly  Average working hour: hours daily  Family: died of overwork (Karoshi)  Employer: self-motivated  Occupational physicians: occupational disease  Council of Labor Affairs: ? 25 聯合知識庫

 Definition of “overwork” according to Taiwan’s diagnosis guideline (revised on 12/17/2010)  Unusual stressful events that trigger extreme fear, anger, stress … etc.  Short-term workloads (within 1 week prior to the event)  Long-term workloads (within 6 months prior to the event)  Overtime work > 92 hrs/m within 1 month (totaling ~65 work hours/week)  Overtime work > 72 hrs/m during the 2 nd ~6 th months  Overtime work > 37 hrs/m during the 1 st ~6 th months

National Taiwan University Yawen Cheng

Case2: Mental disorder as occupational disease? 28 Occupational disease often refers to a disease which is primarily due to physical, chemical or biological factors associated with work. In general, psychic or mental disorders are less likely to be compensated as occupational disease.

National Taiwan University Yawen Cheng

Occupational health services Health monitoring, health promotion & education Workers Regulations Work place Monitoring of workplace hazards and risk assessment Compensation and rehabilitation Inspection Monitoring and reporting systems Of occupational injuries and diseases National Taiwan University Yawen Cheng

Workers at Foxconn, a Taiwanese-own electronics company located in China. This single factory hires 300,000 workers! Wikimedia CommonsSteve Jurveston The chairperson in the spotlight. Company installed safety net along the stairwell to prevent suicide. 聯合知識庫

 Occupational injuries >60% occurring in China, India and other Asian countries ~25% Latin America and Africa  Solutions? Corporate Social Responsibility International labor (human right) standards? Regulations through trade policies? Pressure from consumer movement?

Page WorkLicensing Author/ Source 3 Wikimedia commons Hysohan 2012/05/28 d_CIA_Report_ png 2012/05/24 10:30 a.m. 5 Longest, Health Policymaking in the US (1998) 6 National Taiwan University Yawen Cheng 7 Wikipedia Factoryjoe 2012/05/24 eeds.svg 21 National Taiwan University Yawen Cheng

PageWorkLicensing Author/ Source 22 National Taiwan University Yawen Cheng 23 National Taiwan University Yawen Cheng 24 National Taiwan University Yawen Cheng 25 This work is licensed by 聯合知識庫 for the use of “Essentials of Global Health” ONLY. The copyright belongs to the above mentioned creator(s) and GET does not have the authorization right. 27 National Taiwan University Yawen Cheng

PageWorkLicensing Author/ Source 29 National Taiwan University Yawen Cheng 30 National Taiwan University Yawen Cheng 31 Wikimedia Commons Jurveston 2012/05/28 nzhen.jpg 31 This work is licensed by 聯合知識庫 for the use of “Essentials of Global Health” ONLY. The copyright belongs to the above mentioned creator(s) and GET does not have the authorization right.