Occupational HealthOccupational Health in the Eastern Mediterranean Regionin the Eastern Mediterranean Region

Challenges & OpportunitiesChallenges & Opportunities

Dr. Said ArnaoutDr. Said ArnaoutRA/HSGRA/HSG,,WHOWHO--EMROEMRO

arnaouts@emro.who.intarnaouts@emro.who.int

Occupational Health ConferenceOccupational Health Conference11-1311-13 December 2006December 2006

Muscat - OmanMuscat - Oman

Six WHO Regional OfficesSix WHO Regional Offices

Palestine

Bahrain

22 Member States

Eastern Mediterranean RegionEastern Mediterranean Region

LEB

Population: 540 Million

Per capita GDP in international dollars, Per capita GDP in international dollars, 20042004

Source: WHO Core Health Indicators 2006Source: WHO Core Health Indicators 2006

0 10000 20000 30000

SOMAFG

DJISUDYEMPAKSYRIRQ

EGYMO

JORLEBLIB

TUNIRNOM

KSAKU

UAEBAHQAT

GDP US$

QatarQatar: 2728427284

Afg:Afg: 430430

Population of EMRPopulation of EMRin thousandsin thousands, WHO 2005, WHO 2005

0 50000 100000 150000 200000

BAHDJI

QATOMA

KULEBPALUAEJORLIB

SOMTUNSYRYEMKSAIRQ

AFGMORSUDIRN

EGYPAK

Percentage of 15-64 Age GroupPercentage of 15-64 Age Group

0 20 40 60 80 100

SOMAFGYEMPALIRQ

SUDSYRPAKOMAJORDJI

KSAMOR

LIBLEBIRN

TUNBAHUAEQAT

KUW

15-64%

0%

10%

20%

30%

40%

50%

60%

70%

80%

BAH KUW KSA UAE

Percentage of non-nationalsPercentage of non-nationals in the in the 15-6415-64 age group age group

Labour Labour FForce in EMRorce in EMR

•10 – 50% of the active population

•Non-local/ immigrant workers represent the majority of the

workforce in some Gulf countries

0 20 40 60 80 100

AFGDJI

SOMMorSyr

OmnIrnIrq

EgyKuwTunPalLibLebSauUAEJor

Bah

Ser.

Ind.

Agr.

Labor Force by Sector in EMRLabor Force by Sector in EMR

Unemployed in EMR Unemployed in EMR 13%13%Source: RD’s AR 2004Source: RD’s AR 2004

0 20 40 60 80

EMR AVAFGBAH

DJIEGYIRNIRQJOR

KUWLEBLIB

MOROMNPAKPALQATSUDSYRTUNUAE

YEM

%

IInformal labour fornformal labour forccee

•No precise estimates

•However, it represents about 24.7% of the currently employed labour force in Bahrain and about 46.8% in Pakistan

Working childrenWorking children•Working children (Child labour)

are present in several countries•Figures are available only in few

of them •The working children are usually

present in:– agricultural activities ,– construction,– industrial activities and – small workshops

Working Women Are in increaseWorking Women Are in increase

What are the main What are the main challenges, facing challenges, facing

occupational occupational health in EMRhealth in EMR??

The Definition of Occupational The Definition of Occupational Health (ILO & WHO)Health (ILO & WHO)

““The promotion and The promotion and maintenance of the highest maintenance of the highest degree of physical, mental, degree of physical, mental,

social well-being of workers social well-being of workers in all occupations – in all occupations – total total

health for all at workhealth for all at work””

OH&S Dilemma in EMROH&S Dilemma in EMR•Rapid growth of general population and

young people reaching adulthood (huge increase in labour force, unemployment)

•Inequity, poverty, conflicts, disasters•Conventional as well as new challenges•Insufficient and inadequate OH&S

services (human resources, infrastructure, education, training, research)

•Diverse spectrum of occupational and general health risks (Triple Burden)

Triple Burden of DiseaseTriple Burden of Disease

•Communicable Diseases

•Non-communicable Diseases

•Occupational and Work-related Diseases

Regional SituationRegional Situation•OH Services are significantly varied from

one EM country to another •Variations include both qualitative and

quantitative parameters•There are very good amount of

experience in some EM countries, and could be used, exchanged or even

replicated by other countries•There is a pressing need to enhance and

progress OH services in every EM country

The greatest challengeThe greatest challenge

•How to transform the

difficulties into

opportunities?

Role of WHO/EMRORole of WHO/EMRO

•Extensive efforts are being made in countries of the region, in collaboration

with the Regional Office to further develop and strengthen national programmes on

occupational health and work safety

•Main Goal: By 2020 healthy workplaces and work practices will be widely

adopted in Eastern Mediterranean Countries

Important Country ActivitiesImportant Country Activities•Bahrain: OSH Authority•Tunisia : -Regular publication of OHS Journal -Annual OHS Conference on regular basis•Jordan: National Strategy OHS•Iran: Training Course on ILO Classification of

Pneumoconiosis•Kuwait: Healthy Work Places Workshop•KSA: national Workshop on OHS in Medical practices•UAE: National Training Workshop on OHS for PHC

Physicians•Egypt: Several training courses for PHC workers

–National workshop on protecting HCWs & preventing needlestick injuries, 4-5 Dec. 2006

Important Regional ActivitiesImportant Regional Activities•Regional Consultative meeting on the

development trends of occupational health and safety in the EMR “Current

status and perspective”, Damascus, Syria, 16-18 Dec. 2003

•Intercountry workshop on primary health care and basic occupational health

services: Challenges and opportunities in Eastern Mediterranean Region, Sharm

ElSheikh, Egypt, 12-14 July 2005

•Regional activities at GCC Level

Some Regional PublicationsSome Regional Publications

Inter-regional activitiesInter-regional activities the WHO/ILO Joint Efforts on the WHO/ILO Joint Efforts on

Occupational Health and Safety in AfricaOccupational Health and Safety in Africa •Unified Country Profile on Occupational Health

in Egypt, prepared jointly with all partners concerned on occupational health and safety at

national level •A workshop on the national occupational

health and safety profile in Egypt was successfully organized in EMRO, Egypt, 29–30

October 2003, as an activity of these joint efforts

Palestine

Bahrain

17 Countries

Collaborative Programmes With WHO Collaborative Programmes With WHO in OSH for the in OSH for the 06-0706-07 Biennium Biennium

LEB

The WHO Global Plan of The WHO Global Plan of Action on Workers HealthAction on Workers Health

2008-20172008-2017

A Fresh LookA Fresh Look

& &New OpportunitiesNew Opportunities

In 1996, the 49In 1996, the 49thth WHAWHA with with Resolution 49.12 endorsedResolution 49.12 endorsed the the

Global Strategy on Global Strategy on Occupational Health for AllOccupational Health for All

(i)strengthening of international and national policies for health at work

(ii)promotion of a healthy work environment, healthy work

practices and health at work(iii )strengthening of

occupational health services(iv )establishment of

appropriate support services for occupational

health

(v )development of occupational health standards based on

scientific risk assessment ;

(vi )development of human resources ;

(vii )establishment of registration and data

systems; and (viii )strengthening of

research

NNew political realities, ew political realities, initiatives and requests by initiatives and requests by the Member States the Member States call forcall for

renewed attention and renewed attention and global actionglobal action by WHO on by WHO on

occupational healthoccupational health

WHO ResponseWHO Response

•There is a need to move from strategy to practical action in the area of

workers health

•WHO developed the Global Plan of Action on Workers Health 2008-2017 to

provide new impetus for action

The plan is based on the The plan is based on the proposals for action made byproposals for action made by::

•the Member States,• the consultations with:

– WHO Regional Offices ,–relevant WHO technical programmes ,–the WHO Collaborating Centres for

Occupational Health ,–the International Labour Office/ILO and– international organizations of employers and

workers

The health of the workers depends on a The health of the workers depends on a combination of factors and a complex combination of factors and a complex

interaction between theminteraction between them •Working environment: mechanical, physical,

chemical, biological, ergonomic, psycho-social factors;

•Social determinants related to work: employment status, occupational position, social

inequalities and poverty ;•Work-related health behaviour: individual

preventative health practices and personal health-related behaviour ;

•Access to health services: adequate and affordable occupational health services for

promotion, prevention, cure and rehabilitation ;

This plan of action deals withThis plan of action deals with workers healthworkers health in a broader contextin a broader context

•Workers health is a public health approach to addressing the health

problems of working populations• It focuses on:

– primary prevention of occupational and work-related diseases and injuries

–protection and promotion of the health of workers

•Occupational health constitutes the core of this approach

GPA on Workers’ HealthGPA on Workers’ Health2008 - 20172008 - 2017

•Outlines newly emerging challenges

•Sets goals for protection and promotion of

workers health

•Recommends a series of strategic actions to be taken by the Member States and the

WHO Secretariat over a ten year period

Objectives of GPA on Workers’ HealthObjectives of GPA on Workers’ Health.1Develop and implement policy

instruments on workers’ health

.2Protect and promote health at the workplace

.3Improve the performance of and the access to occupational health services

.4Provide and communicate evidence for action and practice

.5Incorporate workers’ health into other polices

The ChallengesThe Challenges•Too many workers are still:

–exposed to unacceptable levels of occupational hazards ,

–fall victim to occupational diseases and work accidents, and

–lose their working capacity and income potential

•In many countries the existence of occupational health services is very limited and less than 15% of workers have access

to them

The Challenge & Opportunity The Challenge & Opportunity Globalization

•Major impact through:–growing internationalization, competition,–changes in the regulatory strategies ,–major changes in enterprise structures and

associated technology changes.•Numerous positive effects:

–Increasing world trade –Growing interaction among countries ,–The development of new information

technologies

Positive Role of Positive Role of Some Multinational EnterprisesSome Multinational Enterprises

•Play an increasing role in shaping working conditions in the different

countries

•They can bring jobs, expertise, new work practices, better working

conditions, and preventive health culture to the host countries

Negative Role ofNegative Role of Some Multinational EnterprisesSome Multinational Enterprises

•Different standards for health protection at work in the different

countries

•Commercial advantage

The Challenge The Challenge UnemploymentUnemployment,, Job InsecurityJob Insecurity

&& increasing human interactionincreasing human interaction •Certain working methods and emerging

forms of work organization such as:–outsourcing ,–downsizing, and –flexible work practices have an impact on workers

•Psychosocial hazards, and work-related stress, resulting in burn-out, depression,

coronary heart disease, musculoskeletal and other physical and mental disorders

The Challenge The Challenge IInformal Economynformal Economy

•The traditional worker-employer relationship does not exist

•No healthy and safe working conditions

• The costs are borne by the community and not by the employers

The Challenge & OpportunityThe Challenge & OpportunityCCollaboration between ollaboration between

all actors in the health sectorall actors in the health sector •Occupational health is an integral

part of public health and its activities can be enhanced with

the involvement of:–health promotion ,–environmental health ,–disease prevention,–the provision of general health

services at work and other public health programmes

The Challenge & OpportunityThe Challenge & Opportunity

MDGsMDGs

What actions

are needed to break the

vicious cycle?

HazardousHazardous workingworking

conditionsconditions

Ill Ill HealthHealth

PovertyPoverty

The Challenge & OpportunityThe Challenge & Opportunity

MDGsMDGs •Elimination of hazardous child labour ,•Promotion of women's health and

protection of reproductive health at work ,

•Combating HIV/AIDS, tuberculosis, malaria, and other major diseases at

the workplace•Introduction of clean technologies

and systems for management of health at work

Further improvement of the Further improvement of the health of workers requires a health of workers requires a

holistic public health approachholistic public health approach

•Combining occupational health with health protection and promotion ,

•Reaching out to workers families and communities,

•Tackling social determinants of health

•Providing health services adequate to the specific needs of working populations