Jukka Takala

Global Estimates of the Burden of Injury and Illness at Work in 2012

This article reviews the present indicators, trends, and recent solutions and strategies to tackle major global and country problems in safety and health at work. The article is based on the Yant Award Lecture of the American Industrial Hygiene Association (AIHA) at its 2013 Congress. We reviewed employment figures, mortality rates, occupational burden of disease and injuries, reported accidents, surveys on self-reported occupational illnesses and injuries, attributable fractions, national economic cost estimates of work-related injuries and ill health, and the most recent information on the problems from published papers, documents, and electronic data sources of international and regional organizations, in particular the International Labor Organization (ILO), World Health Organization (WHO), and European Union (EU), institutions, agencies, and public websites. We identified and analyzed successful solutions, programs, and strategies to reduce the work-related negative outcomes at various levels. Work-related illnesses that have a long latency period and are linked to ageing are clearly on the increase, while the number of occupational injuries has gone down in industrialized countries thanks to both better prevention and structural changes. We have estimated that globally there are 2.3 million deaths annually for reasons attributed to work. The biggest component is linked to work-related diseases, 2.0 million, and 0.3 million linked to occupational injuries. However, the division of these two factors varies depending on the level of development. In industrialized countries the share of deaths caused by occupational injuries and work-related communicable diseases is very low while non-communicable diseases are the overwhelming causes in those countries. Economic costs of work-related injury and illness vary between 1.8 and 6.0% of GDP in country estimates, the average being 4% according to the ILO. Singapores economic costs were estimated to be equivalent to 3.2% of GDP based on a preliminary study. If economic losses would take into account involuntary early retirement then costs may be considerably higher, for example, in Finland up to 15% of GDP, while this estimate covers various disorders where work and working conditions may be just one factor of many or where work may aggravate the disease, injury, or disorders, such as traffic injuries, mental disorders, alcoholism, and genetically induced problems. Workplace health promotion, services, and safety and health management, however, may have a major preventive impact on those as well. Leadership and management at all levels, and engagement of workers are key issues in changing the workplace culture. Vision Zero is a useful concept and philosophy in gradually eliminating any harm at work. Legal and enforcement measures that themselves support companies and organizations need to be supplemented with economic justification and convincing arguments to reduce corner-cutting in risk management, and to avoid short- and long-term disabilities, premature retirement, and corporate closures due to mismanagement and poor and unsustainable work life. We consider that a new paradigm is needed where good work is not just considered a daily activity. We need to foster stable conditions and circumstances and sustainable work life where the objective is to maintain your health and work ability beyond the legal retirement age. We need safe and healthy work, for life.

Estimation of the global burden of mesothelioma deaths from incomplete national mortality data

Background Mesothelioma is increasingly recognised as a global health issue and the assessment of its global burden is warranted. Objectives To descriptively analyse national mortality data and to use reported and estimated data to calculate the global burden of mesothelioma deaths. Methods For the study period of 1994 to 2014, we grouped 230 countries into 59 countries with quality mesothelioma mortality data suitable to be used for reference rates, 45 countries with poor quality data and 126 countries with no data, based on the availability of data in the WHO Mortality Database. To estimate global deaths, we extrapolated the gender-specific and age-specific mortality rates of the countries with quality data to all other countries. Results The global numbers and rates of mesothelioma deaths have increased over time. The 59 countries with quality data recorded 15 011 mesothelioma deaths per year over the 3 most recent years with available data (equivalent to 9.9 deaths per million per year). From these reference data, we extrapolated the global mesothelioma deaths to be 38 400 per year, based on extrapolations for asbestos use. Conclusions Although the validity of our extrapolation method depends on the adequate identification of quality mesothelioma data and appropriate adjustment for other variables, our estimates can be updated, refined and verified because they are based on commonly accessible data and are derived using a straightforward algorithm. Our estimates are within the range of previously reported values but higher than the most recently reported values.

The Ratification Status of ILO Conventions Related to Occupational Safety and Health and Its Relationship with Reported Occupational Fatality Rates

The Ratification Status of ILO Conventions Related to Occupational Safety and Health and Its Relationship with Reported Occupational Fatality Rates: Donald J Wilson, et al. Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences (IIES), University of Occupational and Environmental Health—The aim of this study was to assess the relationship between the ratification status of occupational safety and health (OSH)‐related ILO conventions and reported occupational fatality rates of ILO member countries, while controlling for possible confounding factors. ILO member states were divided into 4 levels of income status, based on the gross national income per capita. Seventeen conventions designated as OSH‐related were examined. Reported country occupational fatality rates were compared according to the ratification status of these 17 conventions and multiple regression analyses were conducted to assess the relationship between the fatality rates, ratification status, income level and length of ILO membership. Fatality rates were inversely and significantly related to income levels. In general, non‐ratifying countries had higher work‐related fatality rates than ratifying countries. A statistical model for identifying predictors of fatal injury rates showed that a larger number of conventions ratified was significantly associated with lower fatality rates. The fact that nonratifying countries generally have higher fatality rates than ratifying ones supports the notion that all countries should promote ratification of ILO conventions aimed at improving OSH conditions.

International dimension of occupational and environmental health

Describes the Global Programme on Occupational Safety, Health and Environment of the International Labour Office (ILO). The inculcation of a safety culture, access to knowledge, standard setting and self‐regulation are key points of the ILO Programme.

Recent Trends in ILO Conventions Related to Occupational Safety and Health

The present study was conducted to analyze the ratification status of International Labour Organization (ILO) conventions related to occupational safety and health (OSH) by ILO member states in terms of national indicators (length of ILO membership and national income status) and regional affiliation. 17 conventions designated as OSH-related by the 2003 International Labour Conference were examined. In general, countries with longer ILO membership ratified higher numbers of conventions related to OSH. With some variation, long-membership countries had the largest number of ratifications, followed by middle- and short-membership countries in all regions. There were also incremental increases in the number of ratifications for OSH-related conventions according to the national income status. Common regional characteristics that could not be explained by the factors studied also existed. Future efforts to increase ratification at an international level will need to consider the factors influencing ratification practice among the member states.

Global estimates of fatal work-related diseases by region and disease group, 2002.

Abstract Work-related and occupational diseases are multifactorial diseases among the working population that have a heavy impact on workers, enterprises, and society. We calculated estimates for 2002, using global regional estimates of disease mortality, and adjusted attributable fractions produced for work-related diseases in Finland. The estimated number of fatal work-related diseases is about 2 million worldwide. The most common fatal workrelated disease groups are cancers (25%), circulatory diseases (21%), and communicable diseases (28%). Though estimates of fatal work-related diseases have some limitations, they are needed for prevention.

Associations between occupational hazards detected with log-linear statistical methods

Abstract Background. This study is based on observed hazards at enterprises in a developing country. The data collection and processing was carried out using a Walk-Through Survey method. The risk prevalences in small and large enterprises reported earlier revealed key elements for prevention. Method. This paper, based on a collected data matrix of safety and health information in industries in Thailand, attempts to analyse associations between various hazards or problems in industries grouping selected problems together. Altogether 27 groups were established to act as trial models where associations were expected, and as an initial hypothesis to be confirmed by the statistical analysis. The initial 27 models were based on more than 2000 crosstabulations between pairs of hazards or influencing factors. Three successfully tested models each containing eight interlinked hazards or factors are presented. The method used was hierarchical log-linear analysis. Results. A number of associations between various hazard categories were established. The data were obtained from a developing country but it is likely that similar associations exist in other countries where similar industries exist as well. Lack of knowledge about hazards, poor personal protection and poor housekeeping were found to be interlinked with a number of mechanical, physical, chemical and ergonomic hazards or problems. Conclusions. These detected interrelationships of individual hazard categories help us in understanding the reasons of occupational accidents and diseases and this information can be of particular interest for accident prevention programmes.

Global Asbestos Disaster

Introduction: Asbestos has been used for thousands of years but only at a large industrial scale for about 100–150 years. The first identified disease was asbestosis, a type of incurable pneumoconiosis caused by asbestos dust and fibres. The latest estimate of global number of asbestosis deaths from the Global Burden of Disease estimate 2016 is 3495. Asbestos-caused cancer was identified in the late 1930’s but despite today’s overwhelming evidence of the strong carcinogenicity of all asbestos types, including chrysotile, it is still widely used globally. Various estimates have been made over time including those of World Health Organization and International Labour Organization: 107,000–112,000 deaths. Present estimates are much higher. Objective: This article summarizes the special edition of this Journal related to asbestos and key aspects of the past and present of the asbestos problem globally. The objective is to collect and provide the latest evidence of the magnitude of asbestos-related diseases and to provide the present best data for revitalizing the International Labor Organization/World Health Organization Joint Program on Asbestos-related Diseases. Methods: Documentation on asbestos-related diseases, their recognition, reporting, compensation and prevention efforts were examined, in particular from the regulatory and prevention point of view. Estimated global numbers of incidence and mortality of asbestos-related diseases were examined. Results: Asbestos causes an estimated 255,000 deaths (243,223–260,029) annually according to latest knowledge, of which work-related exposures are responsible for 233,000 deaths (222,322–242,802). In the European Union, United States of America and in other high income economies (World Health Organization regional classification) the direct costs for sickness, early retirement and death, including production losses, have been estimated to be very high; in the Western European countries and European Union, and equivalent of 0.70% of the Gross Domestic Product or 114 × 109 United States Dollars. Intangible costs could be much higher. When applying the Value of Statistical Life of 4 million EUR per cancer death used by the European Commission, we arrived at 410 × 109 United States Dollars loss related to occupational cancer and 340 × 109 related to asbestos exposure at work, while the human suffering and loss of life is impossible to quantify. The numbers and costs are increasing practically in every country and region in the world. Asbestos has been banned in 55 countries but is used widely today; some 2,030,000 tons consumed annually according to the latest available consumption data. Every 20 tons of asbestos produced and consumed kills a person somewhere in the world. Buying 1 kg of asbestos powder, e.g., in Asia, costs 0.38 United States Dollars, and 20 tons would cost in such retail market 7600 United States Dollars. Conclusions: Present efforts to eliminate this man-made problem, in fact an epidemiological disaster, and preventing exposures leading to it are insufficient in most countries in the world. Applying programs and policies, such as those for the elimination of all kind of asbestos use—that is banning of new asbestos use and tight control and management of existing structures containing asbestos—need revision and resources. The International Labor Organization/World Health Organization Joint Program for the Elimination of Asbestos-Related Diseases needs to be revitalized. Exposure limits do not protect properly against cancer but for asbestos removal and equivalent exposure elimination work, we propose a limit value of 1000 fibres/m3.

1543 The value of safety and health to society – new global and european estimates of economic impact

Introduction Establishing a reliable and comprehensive estimate of the cost to society of all occupational accidents and work-related illnesses or acquired disabilities is a complex task. However, it is vital that policy-makers be aware of the scope and scale of poor or non OSH in order to implement effective measures in this policy area. If we do not value life and health impacts, we will implicitly make a trade-off or these values may get even assigned zero-weight. Methods The first phase of the large-scale study commissioned by EU-OSHA in 2015, consisting of an identification and assessment of the available data relevant to costing models that is available in each of the Member States. We concluded that the development of a comprehensive, comparable estimate covering all EU member states would not be feasible at present due to the lack of data at national level. Therefore it was decided that the second phase of the project would consist of two strands. Results First, EU-OSHA collaborated in the development of updated ILO estimates, based on available data at international level, to calculate an approximate cost estimation for each EU member state including Norway and Iceland. The findings reveal that work-related injury and illness result in the loss of 3.7% of GDP globally (EU28 3.1%), at an annual cost of roughly €2.206 billion (EU28 €446 billion) Second we commissioned research to develop a comprehensive cost estimate for five member states, where sufficient data for such a calculation is available. These results can also be used to validate and refine the ILO estimates for the European level. Discussion The results confirm earlier research that a high level of prevention contributes to the productivity and wealth of a country. Lower prevention results in higher costs to society

Bibliometric analysis of gaps in research on asbestos-related diseases: declining emphasis on public health over 26 years

Objectives The global burden of asbestos-related diseases (ARDs) is significant, and most of the world’s population live in countries where asbestos use continues. We examined the gaps between ARD research and suggestions of WHO and the International Labour Organization on prevention. Methods From the Web of Science, we collected data on all articles published during 1991–2016 and identified a subset of ARD-related articles. We classified articles into three research areas—laboratory, clinical and public health—and examined their time trends. For all and the top 11 countries publishing ARD-related articles, we calculated the proportions of all ARD-related articles that were in each of the three areas, the average rates of ARD-related articles over all articles, and the average annual per cent changes of rates. Results ARD-related articles (n=14 284) accounted for 1.3‰ of all articles in 1991, but this had declined to 0.8‰ by 2016. Among the three research areas, the clinical area accounted for the largest proportion (65.0%), followed by laboratory (26.5%) and public health (24.9%). The public health area declined faster than the other areas, at −5.7% per year. Discrepancies were also observed among the top 11 countries regarding emphasis on public health research, with Finland and Italy having higher, and China and the Netherlands lower, emphases. Conclusions There is declining emphasis on the public health area in the ARD-related literature. Under the ongoing global situation of ARD, primary prevention will remain key for some time, warranting efforts to rectify the current trend in ARD-related research.