WHO/ILO Meeting on Strengthening Occupational Health and Safety, Kuala Lumpur, Malaysia, 23-25 November 2005 : report

(WP)HSE/ICP/HSE/4.3/001-E Report Series No.: RS/2005/GE/34 (MAA)

English only

REPORT

WHO/ILO MEETING ON STRENGTHENING OCCUPATIONAL HEALTH AND SAFETY

Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Kuala Lumpur, Malaysia 23-25 November 2005

Not/or sale Printed and Distributed by: World Health Organization Regional Office for the Western Pacific P.O. Box 2932 1000 Manila Philippines

February 2006

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NOTE The views expressed in this report are those of the participants in the WHO/ILO Meeting on Strengthening Occupational Health and Safety and do not necessarily reflect the policies of the World Health Organization.

This report has been prepared by the Regional Office for the Western Pacific of the World Health Organization for governments of Member States in the Region and for the participants in the WHO/ILO Meeting on Strengthening Occupational Health and Safety held in Kuala Lumpur, Malaysia from 23 to 25 November 2005

CONTENTS

SUMMARY 1. INTRODUCTION ........................................................................... ,. 4 1.1 1.2 1.3 Background information ......................... ·.···.··············· .................. 4

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1.4 1.5 2.

PROCEEDINGS ................................. ··· .............................................. 8 2.1 2.2 2.3 Country reports ............................................................................. 8 Summary of plenary sessions and discussions ...................................... 11 Break-out group discussions .... : ...................................................... 18

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CONCLUSIONS ......................................... · ........... ··· ......................... 20 3.1 3.2 Status of occupational health and safety programmes ............................ 20 Review of ILO 2003 Global Strategy and the process and interim outcomes of the development of a WHO Global Plan of Action for 2007-2015, and their relevance to the Region ..................................................... 21 Consideration of the future course of action for ILO and WHO Collaboration with Asian countries to strengthen their occupational health programmes ...................................................... 22

3.3

ANNEXES: ANNEX I - LIST OF PARTICIPANTS, TEMPORARY ADVISERS, OBSERVERS AND SECRETARIAT .............................................. 23 ANNEX 2 - PROGRAMME OF ACTIVITIES .......................................... 33 ANNEX 3 - LIST OF DOCUMENTS DISTRIBUTED DURING THE WORKSHOP .................................................. 37 ANNEX 4 - REGIONAL FRAMEWORK FOR ACTION FOR OCCUPATIONAL HEALTH ........................................ 39 ANNEX 5 - OPENING ADDRESS OF THE REGIONAL DIRECTOR, WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC AT THE WHOIILO MEETING ON STRENGTHENING OCCUPATIONAL HEALTH AND SAFETY ........................... 67 Keywords: Occupational health / Occupational safety / Occupational health services / Regional health planning / Inter-agency cooperation / International cooperation / Asia, Southeastern / Western Pacific

SUMMARY The WHO/ILO Meeting on Strengthening Occupational Health and Safety was held in Kuala Lumpur, Malaysia from 23 to 25 November 2005. The objectives of the meeting were: (1) to review the state of development and implementation of:

(a) the national programmes/action plans/profiles on occupational health and safety of participating countries, and identify areas that require strengthening; (b) the concept and approach of basic occupational health services and other similar initiatives to improve the provision of occupational health services;

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(c) the areas of action identified at the WHO/ILO meeting on strengthening occupational health in Asia and the Pacific in 2003; (2) to review the ILO 2003 Global Strategy and the process and interim outcomes of the development of a WHO Global Plan of Action for 2007-2015, and discuss their relevance to the Region; and, (3) to recommend the future course of action for ILO and WHO collaboration with Asian countries to strengthen their occupational health programmes. The meeting was attended by 26 participants from 12 countries: Australia, Brunei Darussalam, China, India, Indonesia. Malaysia, Mongolia, the Philippines, the Republic of Korea, Singapore, Thailand and Viet Nam. They are technical government officials from health and labour agencies and staff of relevant institutions involved in occupational health and safety. Four observers from India, Malaysia, the Republic of Korea, and three temporary advisers also attended the meeting. In addition, three WHO staff from the Regional Offices for South-East Asia and the Western Pacific as well as Headquarters, and one staff member from the International Labour Organization served as the meeting Secretariat. The meeting consisted of several plenary sessions and breakout group discussions. The plenary sessions focused on global and regional updates on issues of interest in occupational health. country reports, and a presentation and discussion of the draft Regional Framework for Action for Occupational Health and Safety. Breakout sessions dealt with strategies to foster national. regional and intercountry cooperation in occupational health and safety based on the proposed Regional Framework for Action.

-2The participants reached the following conclusions:

Status of occupational health and safety progranlllles (1) National occupational health and safety programmes and plans of action

Eleven countries reported on their current national programmes and plans of action for occupational health and safety. While the development and/or implementation of programmes and plans of action in these countries were in varying stages of progress, a number of priority issues emerged as shared concerns. The importance of intersectoral cooperation and coordination, particularly between the Ministries of Health and Labour, was highlighted. Countries are urged to pursue and strengthen collaboration between these ministries and other relevant sectors including social partners to ensure the successful implementation of national occupational health and safety programmes. Moving from vision to action requires political commitment, innovative enforcement measures, adequately trained occupational health and safety personnel and active participation of workers and employers. Emphasis should be given to training of local trainers to effectively expand the pool of skilled occupational health staff. Several countries have embarked on collaborative efforts fo~ occupational health and safety training, sharing expertise, modules and tools. Member States are encouraged to consider these bilateral and multilateral partnerships for resource sharing, to make use of lessons learnt from the experiences of other countries in the Region, and to utilize practical strategies when addressing these Issues.

,, A number of countries have begun shifting from a reactive/curative perspective towards a more proactive/preventive stance, signalling the growing recognition of prevention as a crucial element in reducing the burden of occupational morbidity and mortality. This is consistent with the global strategies of WHO and ILO, and Member States are urged to devote attention and resources towards making the workplace healthier and safer, and establishing a preventative occupational health and safety culture.

(2)

Ongoing initiatives to improve access to occupational health services

The experiences within the Region involving Basic Occupational Health Services, the Healthy Workplace approach and various ILO initiatives such as Work Improvement in Neighbourhood Development (WIND), Work Improvement in Small Construction Sites (WISCON) and Work Improvement in Small Enterprises (WISE) demonstrate the efficacy and feasibility of these practical and focused approaches to improving worker and workplace health and safety. Member States would benefit from the incorporation and expansion of these and similar initiatives, services, programmes, and practical tools and models within their national occupational health and safety programmes.

(3) The areas of action identified at the WHO/fLO meeting on strengthenillg uccupational health in Asia and the Pacific in 2003 The 2003 Phuket meeting identified three priority areas for action, namely (a) occupational health and safety training, (b) networking, and (c) interventions for vulnerable

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groups and high-risk sectors. It was felt that progress along these areas could have been accelerated if milestones and indicators to measure progress were specified, and monitoring mechanisms were established at the onset. Nonetheless, the meeting gave rise to significant achievements in the development of an occupational health and safety regional website, and the assessment of training needs and establishment of collaborative research efforts on silicosis, child labour and poison control in India. In addition, the efforts emanating from the Phuket meeting provided the foundation for the development of the Regional Framework for Occupational Health and Safety.

Review of the ILO 2003 Global Strategy and the process and interim outcomes of the development of a WHO Global Plan of Action for 2007-2015, and their relevance to the Region The changing nature of the Asian workforce, pressures from globalization and rapid industrialization within the Region and traditional and emerging occupational risks were discussed. The priority areas and strategies embodied in the 2003 ILO Global Strategy and key ILO OSH Conventions are in line with the concerns of the Region. The WHO Global Plan of Action is under development, and is envisioned to build on and expand the implementation of the 1996 WHO Global Strategy. The four priorities identified for the WHO Global Plan of Action, namely (a) supportive policy environments, (b) healthy and safe workplaces, (c) improved access to occupational health services and systems and Cd) networking, are likewise consistent with regional issues and concerns. Thus. these key global documents are relevant to the Region. and need to be seriously considered and incorporated into the proposed regional Framework for Action for Occupational Health and Safety. Member States are requested to participate and support the process of development and implementation of the WHO Global Plan of Action through national plans and programmes.

Consideration of the future course of action for ILO and WHO collaboration with Asian countries to strengthen their occupational health progrannnes The participants reviewed and offered expert advice towards the finalization of the proposed Regional Framework for Action for Occupational Health and Safety in line with the WHO Global Plan of Action. Building on previous and ongoing global and regional occupational health and safety initiatives, it embodies the critical issues and areas of action for the Region and provides sound guidance for Member States to strengthen their occupational health and safety capacity and infrastructure through national action plans and programmes. The Framework grants flexibility for countries at differing stages of development to arrive at a common basic platform for building capacity in occupational health and safety. It also encourages intercountry collaboration through the sharing of good practices and local research findings. As such. the Framework provides guidance to governments in the Region, WHO and ILO in achieving the capacity and readiness to implemem the global strategies of ILO and WHO. In addition, collaboration, both multisectorally within each country, and intercountry, among WHO, ILO, countries and WHO Collaborating Centres/relevant occupational health institutions and professional associations is strongly encouraged to effectively expand occupational health and safety services within the Region.

-41. INTRODUCTION 1.1 Background information

According to the most recent estimates of the labour force in Asia (including South Asia and East Asia) and the Pacific, approximately 1.6 billion of the region's 4 billion people comprise the workforce. This may not accurately reflect the considerable proportion of the region's population that work in the informal sector, given the scant data on this particular segment of the labour force, according to the International Labour Organization (ILO). The World Bank reports that the informal sector may account for up to 40%-60 % of urban employment in Asia, with women and children constituting a major proportion of workers in the informal economy. Thus, the number of workers in the region may be much greater than the estimates on record. While supporting high economic growth in recent years, rapid industrial developments in South-East and North-East Asian countries have resulted in an increase in the magnitude and diversity of occupational health and safety problems. Currently, the World Health Organization (WHO) estimates that about 430 000 lives and 14 million disability adjusted life years (DALY s) were lost in 2000 in Asia and the Pacific because of major health risks at the workplace. If other occupational health risks were included, such as psychological stressors and infections at health care institutions, the burden attributable to occupational exposures would be much higher. Many of these deaths are preventable, and the risks can be substantially reduced if adequate occupational health services are provided. Moreover, the direct health care expenditures for dealing with occupational diseases and injuries are a small fraction of the overall socioeconomic costs, including productivity losses. Therefore, the actual burden to society from work-related accidents and diseases is highly significant. However, the levels of occupational health service coverage have not changed much over the last 10 years. ILO estimates that workers' access to occupational health services is only 5 % to 10% in developing countries and 20 % to 50 % in most industrialized countries. WHO and ILO have supported Asian counties in developing and strengthening their capacity for occupational health and in improving the provision of occupational health services. The activities supported include the development of national programmes, action plans and profiles for occupational health and safety; promotion of workplace initiatives, such as healthy workplaces and occupational safety and health management systems: and the introduction of basic occupational health services in several Asian countries. A global strategy on occupational safety and health was developed by ILO in 2003. WHO and [LO jointly conducted an AsiaPacific regional meeting on occupational health in 2003. WHO is now reviewing the progress in implementing its 1996 global strategy on occupational health and developing its Global Plan of Action on occupational health to cover the period from 2007 to 2015. This meeting was convened to review critically these collaborative activities of WHO and [LO with Asian cOUlmies, assess the relevance of the global strategies and action plans to the Region, and discuss the future course of action for WHO and [LO collaboration with Asian countries to strengthen their occupational health and safety programmes.

-51.2 Objectives (1)

To review the state of development and implementation of: (a) the national programmes/action plans/profiles on occupational health and safety of participating countries, and identify areas that require strengthening; (b) the concept and approach of basic occupational health services and other similar initiatives to improve the provision of occupational health services; and (c) the areas of action identified at the WHO/ILO meeting on strengthening occupational health in Asia and the Pacific in 2003.

(2) To review the ILO 2003 global strategy and the process and interim outcomes of the development of a WHO Global Plan of Action for 2006-2015, and discuss their relevance to the Region. (3) To recommend the future course of action for ILO and WHO collaboration with Asian countries to strengthen their occupational health programmes. 1. 3

Participants

The meeting was attended by 26 participants from 12 countries: Australia. Brunei Darussalam, China, India, Indonesia, Malaysia. Mongolia. the Philippines, the Republic of Korea, Singapore, Thailand and Viet Nam. They were technical government officials from health and labour agencies and staff of WHO Collaborating Centres in Occupational Health and other relevant institutions. Four observers from the Malaysian Ministry of Health. the Sri Ramachandra Medical College and Research Institute (India), and the Occupational Safety and Health Research Institute (Republic of Korea), and three temporary advisers from Health Partners, L.L.C. (Guam), the International Commission on Occupational Health, and the University of Occupational and Environmental Health (Japan) also attended the meeting. In addition. three WHO staff from the Regional Offices for South-East Asia and the Western Pacific and Headquarters, and one staff member from the ILO served as the meeting secretariat. A list of participants. observers, temporary advisers and secretariat members is given in Annex 1. 1.4 Meeting organization

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The programme of activities is given in Annex 2. A list of documents distributed during the meeting is provided in Annex 3. The documents include country reports on the status of national programmes and plans of action on occupational health and safety. the draft Regional Framework for Occupational Health and Safety, and various presentations and papers prepared by members of the secretariat and temporary advisers covering a variety of occupational health and safety topics relevant to the region. Copies of these documents can be obtained upon request from the WHO Regional Office for the Western Pacific. The participants elected Dr Faridah Bt. Amin (Malaysia) and Dr Achmad Hardiman (Indonesia) as Co-chairpersons and Dr Koh Soo Quee David (Singapore) as Rapporteur.

-6The meeting consisted of several plenary sessions and breakout group discussions. The plenary sessions focused on global and. regional updates on issues and developments in . occupational health, country reports, and a presentation and discussion of the draft RegIOnal Framework for Action for Occupational Health and Safety, attached as Annex 4. Breakout sessions dealt with strategies to foster national. regional and intercountry cooperation in occupational health and safety based on the proposed Regional Framework for Action. 1.5 Opening Remarks

The Honourable Dato' Dr Shafie Ooyub, Deputy Director General of Health, Malaysian Ministry of Health opened the meeting by welcoming the participants to Malaysia. He alluded to the importance of intersectoral collaboration and cooperation, and to d1e importance of establishing a strong policy environment with good enforcement mechanisms together with a comprehensive, strategic action plan for occupational health and safety. Vulnerable worker groups need special attention, not only because of higher risks but also because of lack of access to occupational health services. Dr Shafie emphasized that people should be at the centre of all sound occupational health policies and plans, and commended Singapore for the work of its Health Promotion Board, because behaviour change is vital to ensuring a safe and healthy workforce. He reminded the audience that much attention is given to environmental and work safety, but it is people who operate machinery and carry out work processes. Therefore, modifying workers' behaviour to reduce vulnerability to occupational risks is critical. He ended his remarks by referring to multiple future challenges in occupational health and safety within the Asia-Pacific region, indicating that research is needed to derive the evidence base for effective interventions to address these challenges. The second speaker. Dr Tsuyoshi Kawakami from the ILO, observed that the world is still far from achieving the ILO vision of "decent and safe work." The protection of workers has been a core concern for ILO since its establishment in 1919. Globalization. rapid industrialization, and the spread of new products and technology contribute to new and emerging occupational risks and increases in occupational accidents and diseases. ILO estimates that the global fatality from work-related accidents and diseases is over 2 million yearly. The poorest, least protected and least trained are women, children. the dIsabled, migrants, informal and rural workers, and ethnic minorities. The cost of work-related accidents and diseases is unacceptably high at approximately 4 % of the annual global gross domestic product, or about US$I 250 billion in 2003. There is an urgent need to reinforce national prevention efforts and create a strong workplace safety and health culture. In 2003, ILO adopted a global strategy on occupational safety and health at the 91st session of the International Labour Conference in Geneva, Switzerland. The fundamental components of this strategy included building and maintaining national preventative safety and health cultures, and systems approach to national occupational safety and health management. In addition, ILO conventions can play an important role in strengthelllng national efforts to promote workplace safety and health. In this regard, mobilizing support for ratification of these key occupational health and safety conventions is crucial.

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Efforts are already underway to achieve safety and health in the region. New programmes on hazardous work, using participatory approaches, are being strengthened and intensive efforts are ongoing to extend these programmes to small and medium enterprises. Collaboration with both workers' and employers' organizations is growing, and needs to be strengthened and expanded. Despite these, challenges to occupational health and safety within the region are increasing. Therefore, the development and effective implementation of national occupational safety and health programmes are key to providing protection for workers. Dr Kawakanli concluded that countries must accelerate tripartite interrninisterial cooperation, boost interaction between the Ministries of Labour and Health and ratify and implement ILO conventions to make progress towards the common goal of health and safety at work for all. Dr Han Tieru, WHO Representative for Brunei Darussalam, Malaysia and Singapore, delivered welcome remarks on behalf of Dr Shigeru Omi, WHO Regional Director for the Western Pacific (see Annex 5). WHO considers this as a critical meeting because a healthy workforce is essential to healthy development. Rapid industrialization in the Asia-Pacific region has brought about high economic growth, with its benefits. However, without a concomitant expansion in occupational health services and the promotion of a 'safety culture' at the workplace, the gains from economic development will be cancelled, and perhaps overshadowed, by increasing rates of work-related mortality, morbidity and disability. Some countries have already begun the process of ensuring safe and healthy workplaces at the national and local levels. Much can be learnt from their experiences. At the regional and global levels, WHO and ILO have supported counties in developing and strengthening their capacity for occupational health and in improving the provision of occupational health services. WHO is now reviewing the progress in implementing its 1996 global strategy on occupational health while developing its Global Plan of Action to cover the period 2007 to 2015. The time has come to critically review country experiences and the collaborative activities of WHO and ILO with Asian countries, assess the relevance of the b"Iobal strateoies b and action plans to the region, and discuss the future course of action for WHO and ILO collaboration with Asian countries to strengthen their occupational health and safety programmes. By sharing experiences, practical insights and lessons learned, it is anticipated that the meeting participants shall produce a relevant and feasible Regional Framework for Action to ensure safe and healthy workers and workplaces. Dr Han thanked Malaysia for hosting this regional meeting, and for assisting WHO, through its Ministry of Health, in local arrangements. He ended by wishing the participants a productive and successful meeting.

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2. PROCEEDINGS 2. Country r~p~rts

Eleven countries (Brunei Darussalam, China, India, Indonesia, Malaysia, Mongolia, the Philippines, the Republic of Korea, Singapore, Thailand and Viet Nam) reponed on their current national progranunes and plans of action for occupational health and safety. The PowerPoint presentations of each of these countries are available upon request from the WHO Regional Office for the Western Pacific. The reports covered five key areas: (1)

Background information - A brief description of the country's general and occupational demographics. including total population, socioeconomic indicators (such as per capita income and gross domestic product), major industries, percentage of the population in the workforce, and percentage of the workforce in small and medium enterprises and informal sector. (2) Occupational health statistics - Rates and top causes for occupational mortality and morbidity, work-related accidents and work-related disability; also. if available, three to five of the most prevalent occupational exposures and factors that contribute to increased risk at the workplace. (3) Capacity - Key information on occupational health and safety resources and the prevailing situation regarding access to occupational health and safety services. (4) National policy, legislation, action plan and progranune - Existing laws and policies related to occupational health and safety, an overview of the national (action) plan or programme for occupational health and safety (if existing), and other ongoing iniliatives and projects to reduce risk and promote occupational health and safety. (5) Issues and challenges - Critical issues and challenges that the coumry faces in successfully ensuring safe and healthy workplaces for its workforce.

The development and/or implementation of progranunes and plans of action in these countries were in varying stages of progress. However, a number of priority issues emerged as shared concerns. Each country also highlighted key issues in the successful implementation of occupational health and safety plans of action within the region. 2 L1 Brunei Darussalam

Bnmei Darussalam's occupational health and safety programme was established in 1993 under the Envirollli1ental Health Division of the Department of Health Services. In 1999, the Occupational Health Division was established as a separate entity from Environmental Health. The country alluded to the importance of having adequate human resources and good llltersectoral coordination and establishing strong occupational health and safety laws to facilitate the implementation of occupational health and safety interventions.

-9 2.1.2 China

China emphasized the importance of establishing a sound legislative and policy framework to enable the successful conduct of occupational health and safety programmes. China also raised a cornman concern regarding the transboundary transfer of occupational hazards, particularly in conjunction with the increased flow of goods and technologies with increasing participation in the global economy. Prevention of work-related exposure is a key component of China's national occupational health and safety plan. 2.1.3 India

India addressed the need to pursue feasible solutions to local and regional problems to "put the plan into practice." Prioritizing areas of work based on the size of the worker population affected, magnitude and severity of potential exposures, possible risk to vulnerable groups such as women and children, and the availability of effective interventions, is essential so that resources are channelled properly. Capacity-building must occur in tandem with targeted interventions towards high-risk areas for the effective prevention of occupational diseases. 2. 1.4 Indonesia

Indonesia has a predominantly young workforce, with the majority of its workers in agriculture and trade. Its large population and unique geographical challenges make it critical to integrate all occupational health efforts within the private sector and government into one coordinated national health care delivery system to maximize the availability of occupational health and safety services to as many workers as possible. Indonesia also stressed the value of enhancing community and worker participation in health care delivery and workplace health promotion. 2.1.5 The Republic of Korea

The RepUblic of Korea launched its second five-year plan for the prevention of industrial accidents in 2005. The Republic of Korea's plan focuses 011 creating safe and clean workplaces for small enterprises and promoting workers· health. Because occupational diseases are moving with globalization, and occupational hazards do not discriminate across racial lines, the need for internationalization of standards, palticularly in relation to chemical safety, was highlighted. The Korea Occupational Safety and Health Agency is a not-for-profit agency that supports the government in preventing and managing work-related injuries and illnesses. It is funded through earmarked monies from the Prevention Fund through revenues coming from the Industrial Accident Compensation Insurance Fund. Through this agency, the country has pursued international and regional collaborative efforts for occupational health and safety, including exchange programmes with Viet Nam and Mongolia, and channelled resources to developing countries within the region through short -course training programmes.

- 10 2.1.6 Malaysia

Malaysia is committed to improving the status of occupational health and safety within the country. The integration of basic occupational health services through its primary care clinics is a strategy to expand coverage of occupational health services for its workforce. Expanding human capital through training programmes, establishing practical registration and data systems. and building the evidence base for occupational health and safety interventions through research are the key concerns of the country . 2.1.7 Mongolia

Mongolia is in transition from a centralized planned economic system to a marketoriented economy. Its National Programme on Occupational Safety and Health and Improving Working Enviromnent was implemented in two stages: from 1997 to 2000, and from 2001 to 2004. The current plan of action covers the period 2005-2010. The national programme identifies building and maintaining a preventive and safety culture in the workplace as a major goal, with occupational health and safety as "issue of all people." Multisectoral cooperation and coordination is a key feature of the national plan. 2.1.8 The Philippines

Small and medium-sized enterprises and micro-establishments make up about 99 % of all companies in the Philippines. The Philippines also has over 3 million workers who are employed overseas in over 190 countries. The country's occupational health and safety system has four key elements: prevention, enforcement, compensation and rehabilitation, and updating of standards. The system relies on close collaboration among various government agencies. professional organizations. academic institutions, and workers' and employers' associations for the creation and implementation of occupational health and safety standards, programmes and services. Incentive schemes, such as awards for workplaces with "no lost work time," are utilized to improve the enforcement of workplace health and safety standards. 2. 1. 9 Singapore

Singapore has an ageing workforce. While its occupational disease and accident rates have been declining over the past decade, several recent major industrial accidents have spurred the development of a new occupational health and safety framework, with the goals of reducing the current fatality rate by half by 2015. and attaining the standards of the current top 10 developed countries with good safety records. To do this. Singapore has shifted its perspective from managing risks to identifying and eliminating risks before they are created, through capacity-building, more stringent enforcement, recognition of best practices and good performance and partnerships with stakeholders.

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2.1.10 Thailand As a rapidly industrializing country. Thailand is witnessing a shift in its workforce from the agricultural to the industrial sectors. The Government recognizes that "human resources are the heart and soul of the New Economy;" thus, the protection of workers is a priority for the country. At the highest levels of leadership, Thailand has declared that all people in Thailand are to "have access to the acceptable national level of health care." Thus equity in occupational health and safety services is emphasized. 2.1.11 Viet Nam Viet Nam has an increasing rate of industrial accidents. Building human capacity to prevent work-related injuries and illnesses is a major element of its national strategy for occupational health and safety. A newly established Occupational Safety and Health Training Centre is providing much-needed opportunities to build capacity among Vietnamese workers. employers and occupational health and safety workers. Viet Nam is also initiating local research projects and collaborating with bilateral and international partners like the Republic of Korea, WHO and ILO to strengthen its national capacity for occupational health. 2.2 2.2.1 Summary of plenary sessions and discussions Regional updates on occupational health and safety

ILO and WHO presented regional updates on occupational health and safety. Dr Kawakami (ILO) outlined the common challenges in workplace safety and health within Asia. Coverage for occupational safety and health services needs to be expanded significantly given the region's double burden of traditional and emerging work-related risks. While numerous standards, guidelines and practice models exist, the real challenge lies in the implementation of these guidelines and models in a sustainable and locally relevant manner. Towards this end. Member States need to learn from local communities and selectively support interventions that are feasible and locally appropriate. National occupational safety and health programmes are the main pillars of the 2003 ILO Global Strategy. ILO recommends that national plans of action should have very practical and clear foci, with delineated outcomes and expected results and indicators to measure progress towards goals and objectives. These national plans should reflect key ILO occupational safety and health instruments. A chart showing the current status of national plan development within Asia was presented. Key features of the national programmes of China, the Lao People's Democratic Republic and Mongolia were highlighted Dr Kawakami concluded by emphasizing that policy and workplace interventions should be consistent with each other and should complement each other, so that grassroots actions reflect and support national policy, and vice versa.

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Dr Ogawa (WHO) presented an update of occupational health and safety initiatives undertaken by WHO in partnership with Member States in the Western Pacific Region. National occupational health infrastructure and capacity needs strengthening, and voluntary promotional programmes for workplace health need to be expanded in light of the rapid industrialization in the region. Globalization of regional economies, resulting in the transfer of technologies from industrialized to developing countries, is causing changes in industry and employment structures, and in the risks associated with work in the Region. The WHO Western Pacific Regional Office provides support to its Member States for the development and promotion of healthy workplaces, strengthening of national occupational health capacity and infrastructure, and facilitation of collaboration among occupational health and safety institutions in the Region. Country-specific examples of related activities were cited. Key priorities for the future include the establishment of a regional network of healthy workplaces, the continuation of support for building national capacity and enhancing collaboration among occupational health and safety institutions and support for the implementation of the Regional Framework for Action for Occupational Health and Safety. Dr Caussy (WHO) outlined the regional strategy of the WHO South-East Asia Region. Over 60% of the South-East Asia Region's workforce is within the agricultural sector. Considerable underreporting of work-related accidents and illnesses occurs. A needs assessment paved the way for identifying critical areas of work. Tlu'ough the involvement of major stakeholders within the South-East Asia Region, a Regional Strategy on Occupational Health and Safety was developed. The strategy has three main goals: (1) strengthening occupational health and safety infrastructure within countries, (2) promoting the health risk paradigm, and (3) building capacity. A four-year time frame for implementation of the strategy is in place. To date, India and Thailand have formulated their national plans based on this Regional Strategy while Bangladesh is in the process of drafting its plan. 2.2.2 Update on implementation of action areas or tasks and activities agreed at the WHO/ILO meeting on strengthening occupational health in Asia and the Pacific in 2003

In 2003, over 50 participants from 12 countries in the Asia-Pacific region, WHO, ILO and various WHO Collaborating Centres on Occupational Health, met in Phuket, Thailand, to discuss how best to strengthen occupational health in the region. Dr Takahashi (temporary adviser) described the three areas of action agreed upon at the meeting: (1) training and capacity-building, (2) networking/website development, and (3) development of national indicators for occupational health and safety. He provided an overview of the current status of country activities along these areas of action and highlighted the need for multisectoral commitment and integration of the various activities into a coherent regional framework. Ms Major (Australia) presented the progress achieved in the development of the regional website/web ponal, which was undertaken by Australia. Dr Saiyed (India) discussed collaborative research efforts undertaken in India on silicosis, child labour, and poison control, while Dr Balakrishnan (India) provided an update on a regional training needs assessment and the compilation of an inventory of training resources for occupational health and safety in India.

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Dr Caussy identified funding constraints and inadequate follow-up mechanisms as major challenges to progress in these three areas of work. Relevant milestones and indicators need to be developed to better measure progress. In addition, commitment and self-monitoring of progress from the network members are necessary for the complete implementation of the tasks and activities agreed upon in Phuket. 2.2.3 Emerging issues in the region

Dr Takahashi presented a synopsis of the recent asbestos episode in Japan. highlighting the roles of media and public pressure in initiating government action to control perceived occupational risks. An announcement was made of the Asian Asbestos Conference scheduled for July 2006 in Bangkok, Thailand, which would draw more attention to this important occupational health and safety issue in Asia. Dr Kawakami concluded a plenary discussion on some key issues related to the control and prevention of asbestos exposure in the developing country setting. Shifting hazards from the industrialized to the developing world is increasingly recognized as a side effect of globalization. Prevention remains the most effective strategy to curtail asbestos-related mortality and morbidity, which have a long lag time and serious health and economic consequences. Ultimately, a ban on the use of all asbestos products is needed, especially given the existence of safer alternatives. In the interim, developing countries that are transitioning towards a complete ban should put in place strong control measures to reduce workers' exposure to asbestos. Countries should also consider using a "national asbestos iiJdicator" as part of their country profile for occupational health and safety to monitor progress towards improved control and an ultimate ban of asbestos. Resources on safe alternatives to asbestos are available online. Also. the report of a recent International Agency for Research on Cancer (IARC) Meeting on asbestos ~hould be available in the near future. Dr Kawakami concluded the discussion by stressing the importance of finding practical ways to progressively ban asbestos within the region. 2.2.4 Improving access to occupational health and safety services

The plenary session on improving access to occupational health and safety services examined three current initiatives: (1) Basic Occupational Health Services (BOHS). (2) ILO country experiences in extending occupational safety and health protection, and (3) the WHO Healthy Workplaces initiative. Dr Rantanen (temporary adviser) described the fundamental principles underlying BOHS, and its relevance within the context of the region's occupational health challenges. He described BOHS as essential services for protecting people's health at work. for promoting health, well-being and work ability, as well as for preventing work-related ill-health and accidents. The BOHS provide services by using scientifically sound and socially acceptable occupational health methods through the primary health care approach.

- 14 Successfully integrating BOHS into a country's national health care delivery system involves a set of minimum requirements, ranging from legislation to tripartite collaboration. Coverage by BOHS remains low in developing countries, in contrast to highly developed economies. Integrating BOHS into national health care through a phased approach can increase the likelihood of successful implementation. Training of trainers is a key component to ensuring the full integration of BOHS into national health care systems. A public health approach is necessary to establish a permanent occupational health and safety infrastructure, and BOHS is part of this infrastructure. Dr Kawakami provided extensive country examples of various ILO initiatives to extend protection to workers. Work Improvement in Neighbourhood Development (WIND), Work Improvement in Small Construction Sites (WISCON), Work Improvement in Small Enterprises (WISE), Start and Improve Your Business (SIYB), and other worker-training projects. as implemented in Cambodia, China, the Lao People's Democratic Republic, Mongolia. Thailand and Viet Nam, demonstrated the feasibility of using practical and participatory approaches to build capacity among the workforce. These pilot projects directly empowered communities by ensuring the transfer of skills to the workers themselves, using simple but effective tools and interventions, encouraging interagency cooperation and political support for grassroots action, and linking the project activities to national policies and networks. Dr Ogawa introduced the Healthy Workplaces initiative as a component of the Healthy Settings programme, which calls for an intersectoral approach to identifying priority health problems in a given local setting and developing integrated, sustainable responses to these problems by facilitating community participation and addressing physical and social environments in a holistic manner. Healthy Workplaces does not take a regulatory approach but instead attempts to reinforce occupational health and safety standards by continuously improving conditions, addressing multiple determinants of health (e.g. environmental, organizational, community and societal factors, and personal lifestyle) and integrating health promotion and health protection at workplaces, including those not covered by occupational health services. The elements of a healthy workplace were enumerated, and the history of the development of the healthy workplaces initiative was outlined. Future areas of work under this initiative include the development of self-sustainable network for the sharing of experiences and information, recognition and documentation of good practices and evaluation of effectiveness of the approach in terms of reduction in risk factors and morbidity/mortality as well as economic benefits and costs. The plenary discussion focused on how to enhance access to occupational health and services in Asia. A participant from the Philippines commented on the length of training required under BOHS for occupational health and safety competence, and inquired on the feasibility of offering shorter courses. Dr Rantanen stressed that occupational health and safety training is a serious issue; people without full competence should not be made to practise occupational health. He cautioned that the content of training should not be compromised; instead experts and advocates should persuade governments and international organizations to commit to good training. One option would be to do a series of short modules over time to complete the full course of occupational health and safety training. Countries and expert institutions must make the investment in proper training if gains in worker health are desired.

- 15 -

A participant from India remarked on the need for new policy directions from WHO/ILO . and other expert bodies regarding the inclusion of newer diseases, such as severe acute respiratory syndrome (SARS) and HIY, under national occupational health and safety laws and programmes given the potential magnitude and consequences of these diseases. Also, successful models and stories exist iri many developing countries; these should be collected and used to advocate for greater political support and funding. Good occupational health and safety practices should be made into international standards; ILO standards exist but there remains a need for disease-specific international standards of care to help ensure uniformity of action and targeted approaches by countries. Dr Eijkemans (WHO, Geneva) mentioned that WHO will be participating in a tripartite meeting to update the list of officially recognized occupational diseases in December 2005. A follow up working group on diagnostic criteria for occupational diseases might be convened after this meeting. She also reinforced the need to find the "middle ground" to extend occupational health and safety services to workers who still have no access. How to arrive at this minimum set of standards is the challenge, and she urged countries to share their thoughts and experiences in this area. A participant from Thailand raised the question of whether grassroots efforts like WIND and WISE have been evaluated for impact on occupational outcomes. Large corporations in Thailand all have functional occupational health and safety systems, yet work-related injury rates in Thailand continue to rise. Dr Kawakami cited a project, in which Thailand partnered with Nagoya City University in Japan to assess the impact of WISE in Thailand. The study demonstrated the positive scientific evidence in post-intervention outcomes related to workers' report of symptoms, work environment measures. and productivity. The discussion concluded that expanding occupational health and safety services In Asia would need to strike the balance between national initiatives and grass roots actions. Local solutions, regional workshops and guidelines and country initiatives will all need to be in place to ensure the best possible coverage. 2.2.5 Global strategies: focuses and implementation mechanisms

The ILO and WHO Global Strategies were presented. The WHO Global Strategy on Occupational Health for All. which was approved by the WHO World Health Assembly in 1996, addressed as one of the key objectives, the need to enhance the access of workers to good quality occupational health services. In order to provide a renewed focus on occupational health in WHO and in the countries. WHO Global Plan of Action is under development. It will build on and expand the implementation of the 1996 WHO Global Strategy. Some priorities identified for the WHO Global Plan of Action to be presented with a Resolution in the WHA 2007 are (1) supportive policy enviromnents. (2) developing healthy and safe workplaces, providing evidence and communication for preventive action, (3) improved access to occupational health services and systems, and (4) networks and partnerships in line with regional issues and concerns. [n 2003. the ILO adopted its new Global Strategy on Occupational Safety and Health that promoted two areas for action: (I) preventive safety and health culture. and (2) systems approach to the management of occupational safety and health (lLO, 2003). The ILO. through its tripartite (government-employer-worker) mechanism, also spearheaded through the years the

- 16 -

. developmem of various international policy statements, recommendations, guidelines and conventions that are intended to guide all countries in the promotion of workplace safety and In managing occupational safety and health programmes. These include ILO InternatIOnal Conventions No. 81 (labour inspection), No. 155 (occupational safety and health), No. 161 (occupational health services), No. 170 (chemical safety), and No. 174 (prevention of major industrial accidents). The ILO Conventions on occupational safety and health are international agreements that have legal force if they are ratified by the Member States. However, many countries have yet to ratify these international conventions. Increasing the number of Member Slates that are Parties to these Conventions is necessary to ensure the uniform application of these global standards to the practice of occupational safety and health. Dr David (Temporary Adviser) presented a summary of the results of the WHO survey on the implementation of the 1996 WHO Global Strategy for Occupational Health for All as conducted in the Western Pacific Region. Twenty-two out of 36 Member States and areas completed the survey, for a response rate of61 %. The findings indicate that 55% 0f respondents have a national plan of action for occupational health and safety, and 83 % have some funding allotted for the implementation of their plans. Of those countries and areas with a national plan, half (50%) have evaluated its implementation. Insufficient technical capacity, financial resources and information were the main problems identified. The actions proposed by the responding Member States were given serious consideration in the development of the proposed Regional Framework for Action. 2.2.6 A proposed Regional Framework for Action

Dr David provided a concise summary of the proposed Regional Framework for Action fur Occupational Health and Safety. The Framework for Action on Occupational Health and Safety 2006-20 10 contains the vision and strategic directions for strength<:ning occupational health and safety. with a particular emphasis on improving the provision of occupational health services. in the region for the next five years. The 1996 WHO Global Strategy for Occupational Health for All, the ~003 ILO Global Strategy on Occupational Safety and Health, and the 2003 meeting on Strengthening Occupational Health in the Asia Pacific Region provide the foundation for this Framework. The Framework is designed to be in line with the WHO Global Plan of Action for Occupational Health 2007-2015. The Framework builds on the concept of "Basic Occupational Health Services" and the Occupational Safety and Health Management Systems (ILO) and Healthy Workplaces (WHO) approaches, as well as on the experiences of countries that have begun implelllentlllg national plans of action for occupational health. In addition, the various elements included under this Framework were developed taking into consideration the feedback of countries in the questiollnaire survey for the review of the 1996 WHO Global Strategy for Occupational Health for All. The goal of the Framework is to markedly reduce the health and socioeconomic burden from occupational fatalities and accidents. and work-related illnesses.

- 17 The Framework recognizes five over-arching principles: (1) (2) (3) using evidence for action; fostering intersectoral collaboration and networking at all levels; facilitating worker and cOimnunity participation;

(4) implementing a systematic and iterative process to ensure that successes and failures contribute towards strengthening and refining the Framework and national plans of action; and (5) recognizing and reducing social inequity.

The Regional Framework is organized along three distinct foci. which reflect the occupational medicine model. In this model, the enviromnent, the nature of the work and the inherent qualities of the worker interact in a complex manner to determine health status and vulnerability to work-related risks. The three foci also serve as targets for interventions to improve workforce health and to reduce work-related risks. Strategic actions for countries, WHO and ILO, and the WHO Collaborating Centres for Occupational Health and other relevant institutions are proposed. The Framework is intended to enhance countries' readiness and to reinforce national capacity for implementing the WHO Global Strategy for Occupational Health for All through the next lO-year WHO Global Plan of Action for Occupational Health. During the discussion. the participants expressed their agreement with the overall structure and contents of the proposed Framework, and commended WHO for undeliaking thiS effort. Suggestions to strengthen the document revolved around the following areas: • reinforcing the need for precautionary approaches when evidence regarding occupational risks has not yet been established; actions to address the issue of transboundary migration of hazards; and development of the capacity to respond rapidly to emergent occupational risks.

• •

Tile participants noted the close linkages between the proposed Framework and the ILO and WHO Global Strategies, and regional occupational health and safety initiatives and strategies. They recognized that the proposed Framework will be extremely useful to guide governments as they participate and support the process of finalizing the next lO-year WHO Global Plan of Action for occupational health and safety.

- 18 2.3 !?I(!_akout group discussions

2.3.1 Strategies for regional and intercountry cooperation for occupational safety and health, based on the Regional Framework for Action Four breakout groups presented summaries of their discussions regarding regional and intercountry cooperation for occupational safety and health, based on the Regional Framework for Action. Occupational health and safety needs for the region include technical assistance and expert advice, training modules/models/tools, guidelines and codes of practice that deal with norms, standards and good practices and collaborative efforts for research, data management and intercountry communications. The strategies proposed to enhance cooperation within the region included: • supporting and expanding the regional occupational health and safety website/portal developed by Australia; exploring joint country activities under the Regional Framework as "partnerships for action" for specific areas of work; promoting bilateral and multilateral exchange of expertise. tools and resources and experiences within the region, such as what is already transpiring between the Republic of Korea and Viet Nam, as well as collaborative effol'ls for research and training; continuing the regional inter,ectoral dialogue initiated through this meeting, and expanding the list of participants to include other relevant sectors. through follow up regional meetings; advocating for the promotion of occupational health and safety in high profile by mobilizing political support at the regional level through existing mechanisms such as the Association of Southeast Asian Nations (ASEAN); and expanding training opportunities. including the consideration for establishing a "virtual regional training centre" for occupational health and safety.

•

•

•

•

•

2.3.2

Strategies to enhance intersectoral collaboration within countries for occupational safety and health

The breakout groups discussed strategies to enhance intersectoral collaboration within countries. and identified areas for enhanced WHO/ILO collaboration with Member States. The benefits and costs of. and barriers to establishing collaborative relationships across the various sectors involved in worker and workplace health and safety were identified. Mechanisms to overcome the barriers and the role of WHO and ILO were explored.

- 19 -

The proposed strategies to overcome barriers to successful intersectoral cooperation for occupational health and safety included: • political advocacy to enhance awareness across all relevant sectors of shared goals and objectives and the benefits of collaboration; clarity in issuing the mandate for intersectoral cooperation, specifying tasks and responsibilities, delineating expected outcomes and results and delineating functions; strengthening networks through frequent and regular consultation and meetings; building competence at all levels through Collaborating Centres and national institutes; and relationship building through interministerial participation in occupational health and safety meetings and activities.

•

• •

•

The potential roles and actions from WHO/ILO included: • raising the profile of occupational health and safety at all levels through joint representation on issue~ related to occupational health and safety: providing regular opportunities for constructive discussion through periodic national and intercountry workshops and consultations; providing feasible models for organizational collaboration; expanding support to countries for training and capacity-building; encouraging the participation of workers and employers in national and local initiative; disseminating the outcomes and c:onclusions of this meeting to relevant sectors in Member States, such as the ministry of finance: developing and disseminating a rosterlregistry of experts that can be deployed to countries on an "as needed" basis; supporting the development of online resources such as the regional occupational health and safety website; integrating and harmonizing strategies (i.e. Healthy Workplace versus WIND/WISE/WISCON) at regional and country levels and integrating

•

• • •

•

•

•

•

recommendations into one shared document; and

- 20 -

•

making more frequent joint consultations and meetings to identify country needs and provide support for occupational health and safety.

The final plenary discussion highlighted the benefit of meetings with joint attendance by participants from the Ministries of Health and Labour, and relevant national institutions. In the future, more meetings of this sort are envisioned through joint invitations by WHO and ILO. Dr Ogawa mentioned the positive experiences WHO has had with the multisectoral environmental health model; this model is worth reviewing for application to occupational health and safety. The participants highlighted the importance of continually raising the profile of occupational health and safety particularly in relation to seeking endorsement for the WH 0 Global Plan of Action at the 2007 World Health Assembly. The body recognized that the proposed Regional Framework links to the Global Action Plan, and that once the Global Action Plan is endorsed, it will establish the new official mandate for WHO to further support occupational health and safety in countries. Dr Rantanen shared the nongovernmental organization (NGO) perspective held by the International Commission on Occupational Health (ICOH). He noted that support for occupational health and safety is becoming more difficult to obtain due to the failure to acknowledge the long-term benefits of investing in occupational health and safety. He called attention to developing and implementing coherent and consistent policies across countries so that deviations from the long-term goals are decreased. He also cautioned the participants to realize that a long-term developmental perspective is required, given the cumulative nature of workplace exposures and increasing human life spans. Finally, he requested the participants to strongly address the need to reach grassroots level through BOHS and ILO grassroots mechanisms, noting that occupational health and safety suprastructures (i.e. governments) are relatively well developed but that very little happens at grass roots level. He expressed satisfaction that the meeting emphasized grassroots coverage for occupational health and safety.

3. CONCLUSIONS

3. I

Status of occupational health and safety-programmes

National occupational health and safety programmes and plans of action 3.1.1 Eleven countries reported on their current national programmes and plans of action for occupational health and safety. While the development and/or implementation of programmes and plans of action in these countries were in varying stages of progress, a number of priority issues emerged as shared concerns. 3.1.2 The importance of intersectoral cooperation and coordination, particularly between the ministries of health and labour, was highlighted. Countries are urged to pursue and strengthen collaboration between these Ministries and other relevant sectors including social partners to ensure the successful implementation of national occupational health and safety programmes.

- 21 3.l.3 Moving from vision to action requires political commitment, innovative enforcement measures, adequately trained occupational health and safety personnel and active participation of workers and employers. Emphasis should be given to training of local trainers to effectively expand the pool of skilled occupational health staff. Several countries have embarked on collaborative efforts for occupational health and safety training, sharing expertise, modules and tools. Member States are encouraged to consider these bilateral and multilateral partnerships for resource sharing, to make use of lessons learnt from the experiences of other countries in the region, and to utilize practical strategies when addressing these issues. 3.1.4 A number of countries have begun shifting from a reactive/curative perspective towards a more pro-active/preventive stance, signaling the growing recognition of prevention as a crucial element in reducing the burden of occupational morbidity and mortality. This is consistent with the global strategies of WHO and ILO, and Member States are urged to devote attention and resources towards making the workplace healthier and safer, and establishing a preventative occupational health and safety culture. Ongoing initiatives to improve access to occupational health services 3.l.5 The experiences within the region involving Basic Occupational Health Services, the Healthy Workplace approach and various ILO initiatives such as Work Improvement in Neighbourhood Development (WIND), Work Improvement in Small Construction Sites (WISCON) and Work Improvement in Small Enterprises (WISE) demonstrate the efficacy and feasibility of these practical and focused approaches to improving worker and workplace health and safety. Member States would benefit from the incorporation and expansion of these and similar initiatives, services, programmes, and practical tools and models within their national occupational health and safety programmes. The areas of action identified at the WHO/ILO meeting on strengthening occnpational health in Asia and the Pacific in 2003 3.l.6 The 2003 Phuket meeting identified three priority areas for action, namely: (I) occupational health and safety training, (2) networking, and (3) interventions for vulnerable groups and high-risk sectors. It was felt that progress along these areas could have been accelerated if milestones and indicators to measure progress were specified. and monitoring mechanisms were established at the onset. Nonetheless, the meeting gave rise to significant achievements in the development of an occupational health and safety regional website. and the assessment of training needs and establishment of collaborative research efforts on silicosis, child labour and poison control in India. In addition, the efforts emanating from the Phuket meeting provided the foundation for the development of the Regional Framework for Occupational Health and Safety. 3.2 Review of the ILO 2003 Global Strategy and the process and interim outcomes of the development of a WHO Global Plan of Action for 2007-2015, and their relevance to the Region 3.2.1 The changing nature of the Asian workforce, pressures from globalization and rapid industrialization within the region and traditional and emerging occupational risks were discussed.

- 22 3.2.2 The priority areas and strategies embodied in the 2003 ILO Global Strategy and key ILO Occupational Safety and Health Conventions are in line with the concerns of the region. The WHO Global Plan of Action is under development, and is envisioned to build on and expand the implementation of the 1996 WHO Global Strategy. The four priorities identified for the WHO Global Plan of Action, namely (1) supportive policy environments. (2) healthy and safe workplaces, (3) improved access to occupational health services and systems, and (4) networking, are likewise consistent with regional issues and concerns. Thus, these key global documents are relevant to the region, and need to be seriously considered and incorporated into the proposed regional Framework for Action for Occupational Health and Safety. Member States are requested to participate and support the process of development and implementation of the WHO Global Plan of Action through national plans and programmes. 3.3 Consideration of the future course of action for ILO and WHO collaboration with Asian fountries to strengthen their occupational health programmes 3.3.1 The participants reviewed and offered expert advice towards the finalization of the proposed Regional Framework for Action for Occupational Health and Safety in line with the WHO Global Plan of Action. Building on previous and ongoing global and regional occupational health and safety initiatives, it embodies the critical issues and areas of action for the region and provides sound guidance for Member Stales to strengthen their occupational health and safety capacity and infrastmcture through national action plans and programmes. 3.3.2 The Framework grants flexibility for countries at ;:liffering stages of developmem (0 arrive at a common basic platform for building capacity in occupational health and safety. It also encourages intercountry collaboration through the sharing of good practices and local research findings. As such, the Framework provides guidance to governments in the region, WHO and ILO in achieving the capacity and readiness to implement the global strategies of ILO and WHO. In addition, collaboration, both muitisectorally within each country, and intercountry, among WHO, ILO, countries and WHO Collaborating Centreslrelevant occupational health institutions and professional associations is strongly encouraged to effectively expand occupational health and safety services within the region.

- 23 -

ANNEX 1

LIST OF PARTICIPANTS, TEMPORARY ADVISERS OBSERVERS AND SECRETARIAT

AUSTRALIA

Ms JoalUle Major Director, Occupational Health and Safety Policy Office of the Australian Safety and Compensation Council WHO Collaborating Centre for Occupational Health Department of Employment and Workplace Relations GPO Box 9879 Canberra ACT 2601 Tel. No.: +61 261219242 Fax No.: +6126264 5545 E-mail: J~_il1lQ~m.!LQr.@(:te_wr.gov.au Dr Pg Khalifah Pg Ismail Senior Medical Officer Occupational Health Ministry of Health Commonwealth Drive Bandar Seri Begawan BB 3910 Tel. No.: (6732) 4230 043 Fax No.: (6732) 381 640 E-mail: pgkhalifah@hotmail.com Dr Xu Kerning Deputy Section Chief Second Division of Health Inspection and Supervision, National Center for Health Inspection and Supervision No. 32 Jiaodaokou Beisantiao, Dongcheng District Beijing Tel. No.: 86 10 84023601 Fax No.: 86 1084023601 E-Mail: xkm@jdzx.net.cn Dr Zhang Min Director of Information and Policy Research Depal1ment National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention 29 Nanwei RD, Xuanwu District Beijing 10050 Tel No.: +861083132043 Fax No.: 861083132985 E-mail: mil}1;h~I}g.9_f~_@y.ip.sina.com

BRUNEI DARUSSALAM

CHINA

- 24-

Annex 1 INDIA

Dr Saiyed Habibullah Director National Institute of Occupational Health Meghani Nagar Ahmeddabad 380016 Tel. No.: 917922686351-2 Fax No.: 91 79 22686110 E-mail: saiyedhn@yahoo.com Dr Kalpana Balakrishnan Professor and Head Department of Environmental Health Engineering Sri Ramachandra Medical College and Research Institute No.1, Ramachandra Nagar, Porur Chennai 600116 Tel. No.: 91 44 2476 5609 Fax No.: 9144 2476 7008 E-mail: kalpanasrmc@vsnl.com Y!.Y{'!L,.~.[m(;:~h~~QIg

INDONESIA

Dr Achmad Hardiman Head, Center for Occupational Health Ministry of Health II. HR. Rasuna Said, Blok X.5 Kav. 4 - 9 Iakarta Tel. No.: +622186902958 Fax No.: +62 21 86902958 E-mail: achmad .. hardiman@vahoo.com Dr Faridah Bt. Amin Deputy Director Occupational Health and Safety Department Ministry of Human Resources Block D3 Level 2, Parcel D Federal GOVenm1ent Administrative Centre 62502 Putrajaya Tel. No.: 6038886 5084 Fax No.: 60388892339 E·mail: drfaridahamin@i1otmail.com

MALAYSIA

- 25 -

Annex I

MALAYSIA

Dr Sirajuddin B. Hashim Principal Assistant Director Occupational Health Unit Disease Control Division Level 6, Block ElO, Parcel E Federal Government Administrative Centre 62590 Putrajaya Tel. No.: 603 8834112 Fax No.: 603 8888 6276 E-mail: ~i[i~j@QIili.gov.my Hjh. Maimunah be Hj Khalid General Manager (Operation) National Institute Occupational Safety Helath (NIOSH) Lot I, lalan 1511, Seksyen 15 43650 Bandar Bam Bangi Selangor Daml Ehsan Tel. No.: 603 8929 6725 Fax No.: 603 8922 2967 E-mail: !l1i\.imunah@niosh.com.my

MONGOLIA

Ms Sh. Battsetseg Director of Labour Policy Coordination Department Ministry of Social Welfare and Labour Government Building 2 United Nations Street - 5 Ulaanbaatar 210648 Tel. No.: 97611 261844/97699161243 Fax No.: 976 11 328634 E-mail: balt5f!tseg@n)Ql)gol.net Ms Idesh Bolormaa Scientific Secretary Public Health Institute Enktaiwan Street 17 Bayanzurkb District Ulaanbaatar 211049 Tel. No.: 97611458645199-15-153171 Fax No.: 976 11 458645 E-mail: \Julrou~QjffiL\.ilIIQ(~._~_Qm

- 26 -

Annex I PHILIPPINES Dr Joseph Aricheta Medical Specialist II Enviromnental & Occupational Health Office Department of Health 2"d Floor, Bldg 13 San Lazaro Compound Sta Cruz, Manila Tel. No.: (632) 7329966 Fax No.: (632) 7117846 E-mail: ;yaricheta@yahoo.com ;0;0. aricheta@gmail.com Acty Maria Brenda L. Villafuerte Director, Bureau of Working Conditions Department of Labor and Employment DOLE Bldg, Muralla Street Intramuros, Manila Tel. No.: 5273472, 5273478, 5273481 Fax No.: 5273478 E-mail: mabrenda@yahoo.com Dr Maria Beatriz Villanueva Supervising Occupational Health Officer Occupational Safety and Health Center North Avenue corner Agham Road Diliman, Quezon City.1J05 Tel. No.: 6329286738 Fax No.: 632 929 6030 E-mail: !l.sh_cent~r@QsIl~ ,dole .g().vcpb \l~aLtll_dj yi sj() n@Q~hc,cl()I~. Z'lLPh REPUBLIC OF KOREA Mr Kim Jeong-Ho Deputy Director Team of Occupational Health and Wark Enviromnent Ministry of Labour 1 Chungang-dong Gwacheon-city Gyunggi-Do Tel. No: +8225070206 Fax No.: +8225034491 E-mail: j(jbmQI@!DOlaP.go.kr

- 27 -

Annex 1

Dr Kang Seong-Kyu Director, Occupational Health Department Korea Occupational Society and Health Agency 34-4 Gusan-dong, Bupyeong-gu Incheon 403-711

Tel. No.: +82325100-620 Fax No.: +82325186486 E-mail: ~lc@kQ.~hi!J1~t SINGAPORE Dr Ho Sweet Far Deputy Director for Occupational Medicine Occupational Safety and Health Division Ministry of Manpower 18 Havelock Road Singapore 05976

Tel. No.: 63131117 Fax No.: 63171140 E-mail: Sweet Far HQ/MQMLS1N.QQY@SlNGQV Dr Koh Yang Huang Manager, Workplace Health Promotion Health Promotion Board 3 Second Hospital Avenue Singapore 168037

Tel. No.: (65) 6435 3820 Fax No.: (65) 6438 3609 E-mail: .!ill.!:w::ang_huang@i1nb.goY.sg

- 28-

Annex I

SINGAPORE

Dr Koh Soo Quee David Professor and Head, Department of Community, Occupational and Family Medicine Yong Loo Lin School of Medicine National University of Singapore 16 Medical Drive Singapore 117597 Tel. No.: (65) 6874 4989 Fax No.: (65) 6779 1489 E-mail: cofhead@nus.edu.sg Ms Pensri Anantagulnathi Public Health Officer Bureau of Occupational and Environmental Diseases, Department of Disease Control Ministry of Public Health Tiwanon Road Nonthaburi 11000 Tel: 662 5904380 Fax: 6625904388 Email: pensr@hOlmail.com Ms Sompis Pantucharoensri Head of Occupational Medicine Branch Department of Labour Protection and Welfare (DLPW) Ministry of Labour Tel: 661 860 1066 Fax: 6624489164 Email: SOlllpis.p@gmaiJ.cQl11

THAILAND

VIET NAM

Dr Luong Mai Anh Deputy Director of Occupational Health and Injury Prevention Division Viet Nam Administration of Preventive Medicine Ministry of Health 138A Giang Vo Street, Ha Noi Tel No.: 844 736 6349 Fax No.: 8447366241 E-mail: maialli.J@moh.gQv.vn lm~nh2004@yah()o.cull1

- 29 .

Annex 1 VIETNAM Dr Tran Thanh Ha National Institute of Occupational and Environmental Health Department of Psycho Physiology at Work and Ergonomics IB-Yeoxanh Street Ha Noi Tel No.: (844) 8213787 E-mail: thanl}hatran55@y_ahQQ,,£Q!!'1 Ms Pham Thi Bich Ngan Chief of Hygiene and Environment Control Department National Institute of Labour Protection Sub-institute in Ho Chi Minh City 85 Cach mang thang tam Street, I District Ho Chi Minh Tel. No.: (848) 839 6998 / (848) 9255841 Fax No.: (848) 839 3230 E-mail: phambichngan@gmail.com Mr Bui Duc Nhuong Occupational Safety and Health Specialist Bureau of Safe Work, Ministry of Labour, Invalids and Social Affairs No.2 Street of Dinh Le Hanoi Tel. No.: 8449362955 Fax No.: 84 4 9362920

2. OBSERVERS MINISTRY OF HEALTH & FAMILY WELFARE, GOVT. OF INDIA Dr. Arora Vijay Kumar Addl. Director General Health Services, Room No. 252A NJRMAN Bhawan Ministry of Health & Family Welfare Gov!. of India New Delhi India # 11000 I. Tel: 91-11-30931321 Tel: 011-23061467 Mob: 0981 800 1160 E-mail: vk_raksha@yahoo.com

- 30 -

2. OBSERVERS MINISTRY OF HEALTH & FAMILY WELFARE, GOVT. OF INDIA Dr. Arora Vijay Kumar Addl. Director General Health Services, Room No. 252A NIRMAN Bhawan Ministry of Health & Family Welfare Govt. of India New Delhi India # 11000 l. Tel: 91-11-30931321 Tel: 011-23061467 Mob: 0981 800 1160 E-mail: vk_raksha@yahoo.com Dr Kalsom bt Maskon Deputy Director Healthcare Quality Section Medical Development Division Ministry of Health Malaysia Block EI, Level 4, Parcel E Federal Government Administrative Centre 62590 Putraiaya Malaysia Tel. No.: 60 3 8883 1185 Fax No.: 60 3 8883 1176 E-mail :~aJ.51)DJI)l<!'i"-91.1@hl)tl)1<ljl .• ~()1l} Assoc. Prof. Dr. Mohd. Yusoff Adon Department of Community Health Faculty of Medicine and Health Sciences University of Putra Malaysia 43400 UPM Serdang Se1angor Malaysia Tel. No.: 60 3 89468505/603 89468537 Fax No.: 60389450151 E-mail: llJY1mll§@m~gicc!lj~m_.~gl,l_.11lY yusoff@medic.upm.edu.mv

MINISTRY OF HEALTH MALAYSIA

- 31 -

Annex 1 OCCUPATIONAL SAFETY AND HEALTH RESEARCH INSTITUTE REPUBLIC OF KOREA Dr Jee Yeon Jeong Senior Researcher for Industrial Hygiene Occupational Safety and Health Research Institute 34-4 Gusan-dong, Bupyong-gu Incheon, 403-711 Republic of Korea Tel. No.: +82-32-510-0902 Fax No.: +82-32-518-0864 E-mail: Jeong@kosha.net

3. TEMPORARY ADVISERS Dr Annette David Health Partners, L.L.C. Suite 226. ITC Building 590 South Marine Corps Drive Tamuning Guam 96913 Tel. No.: (671) 646-5227/5228 Fax No.: (671) 646 5226 E-mail: amdavid@guamceU.net Dr Jorma Rantanen President International Commission on Occupational Health Topeliuksenkatu 41 aA 00250 Helsinki Finland Tel. No.: +36830474201OfCellphone: +358400405974 Fax No.: +359304742014 E-mail: jonna.rantanen@ttl.fi Dr Ken Takahashi Professor and Chair Df Environmental Epidemiology University of Occupational and Envirom11ental Health Orio. Yahatanishiku Kitakyushu City 807-8555 Japan Tel. No.: +81-93-691-7401 Fax No.: +81-93-601-7324 E-mail: ktaka@med.uoeh-u.ac.jp

- 32 -

Annex 1

4. SECRETARIAT Dr Hisashi Ogawa (Responsible Officer) Regional Adviser in Healthy Settings and Environment WHO Regional Office for the Western Pacific P.O. Box 2932 1000 Manila Philippines Tel. No.: (632) 528-9886 Fax No. (632) 521-1036/5260279 E-mail: Qgil~£h@!:YPl·SL.VdJ9_jm Dr Deoraj Caussy Scientist/Environmental Epidemiologist WHO Regional Office for South-East Asia World Health House Indraprastha Estate Mahatma Gandhi Road New Delhi 11000~ India Tel. No.: 26446/26430 Fax No.: E-mail: caussyd@whosea.org Dr Gerry Eijkemans Scientist Occupational and Environmental Health World Health Organization r:I:Hl1L(Jel!~a

21

Switzerland Tel. No.: (4122) 7913188 Fax No.: (4122) 791 0746 E-mail: eijkemansg@who.int Dr Tsuyoshi Kawakami Occupational Safety and Health Specialist International Labour Organization Sub-Regional Office for East Asia United Nations Building 11 ,\> Floor, Rajdamnern-nok A venue Bangkok 10200 Thailand Tel. No.: (662) 288 1743 Fax No.: (662) 288 3058 E-mail: kawakami@ilo.org

- 33 -

ANNEX 2 PROGRAMME OF ACTIVITIES

08:00-08:30 08:30-09: 15

Registration Opening ceremony • • • • • • Welcome address by Malaysian Govenunent Representative Opening remarks by Dr T. Kawakami, ILO Representative Opening address by the WHO Representative in Brunei Darussalam, Malaysia and Singapore on behalf of the WHO Regional Director for the Western Pacific Introduction of participants, temporary advisers and observers Election of Chairperson, Vice-Chairperson and Rapporteur Administrative announcements

09:15-09:45 09:45-10:00 10:00-10:30

Group photograph and coffee/tea break Introduction to the meeting (objectives, programme of activities) by Dr H. Ogawa Plenary session - Regional updates on occupational health and safety by Dr T. Kawakami, ILO • WHO SEARO and WPRO

10:30-12:00

Reports by individual Member States on National Occupational Health and Safety Profiles 15 minutes/country except as indicated • • • • • China (including National Programme and Action Plan - 20 minutes) India (including National Programme and Action Plan - 20 minutes) Indonesia Japan Malaysia.

12:00-13:30 13:30-15:30

Lunch break Reports by individual Member States on National Occupational Health and Safety Profiles (continued) . • • • • • • Mongolia (including National Programme and Action Plan - ·20 minutes) Philippines Republic of Korea Singapore Thailand (including National Programme and Action Plan - 20 minutes) Viet Nam

15:30C I6: 10

Plenary session - Update on implementation of action areas or task activities agreed at the WHO/ILO meeting on strengthening occupational health in Asia and the Pacific in 2003: Progress and gaps by Dr K. Takahashi and Dr D. Caussy, including other participants of the 2003 meeting Plenary discussion on emerging issues in the Region facilitated by Dr T. Kawakami High tea reception/adjourn for the day

16:10-16:30 16:30

- 34 -

Annex 2 DaY-£. 24 November

Charting the conrse for the Region's future: key elements and strategies 0800-08:30 08:30-09:30 Summary of DA Y 1 findings (Dr A. David) Plenary session - Improving access to occupational health and safety services: Concepts and cases (20 minutes/presenter) • • • 09: 30-1 0: 00 10:00-10:30 10:30-11:30 Basic occupational health services - International Commission on Occupational Health (Dr J. Rantanen) Extending occupational safety and health protection - InternatIonal Labour Organization (Dr T. Kawakami) Healthy workplaces - World Health Organization (Dr H. Ogawa) Focus on how to enhance access to occupational health and safety

Plenary discussion services in Asia Coffeeltea break

Plenary session - Global strategies: focuses and implementation mechanisms (20 minutes/presenter) • • • International Labour Organization (Dr T. Kawakami) World Health Organization (Dr G. Eijkemans) Results of WHO Global Strategy Survey in Asia (Dr A. David)

II :30-1 2:00 12: 00-13: 30 13: 30-14:00 14:00-15 :00 15 :00-15 :30 I 5: 30-16: 00 16:00-16:30 16:30

Plenary discussion on adapting the global strategies to the needs and situation in Asia Lunch break Plenary session - A Proposed Regional Framework for Action (Dr A. David) Plenary discussion on modifications and adoption of the Regional Framework for Action Break-out session - Fo cus on strategies for regionallintercountry cooperation in occupational health and safety, based on the Regional Framework for Action Coffee/tea break Break-out session - continued Adjourn for the day

- 35 -

Charting the course for the Region's future: Recommended future coursc of action fur ILO and WHO collaboration with Asian countries OR: 00-08: 30 OR 30-09:00 0900-10:00 10:00-10:30 10:30-11:00 1 1:()()-12:00 12 :00-1400 14:00-15:00 1500-15: 10 15: I ()

Summary of DA Y 2 findings (Dr K. Takahashi) Report of break-out groups on regional/intercountry cooperation Break-out session - Country participants to develop country - specific workplans based on the Regional Framework for Action Coffee/tea break Break-out session (continued) Reporl of break-out sessions in two groups (5 or 6 countries in a group) Lunch break/Working lunch for Chairperson. Vice-Chairperson. Rapporteur. meeting advisers. and secretariat to prepare draft conclusions of the meeting Presentation and discussion on draft conclusions Closing ceremony Adjournment

- 37 -

ANNEX 3 LIST OF DOCUMENTS DISTRIBUTED DURING THE MEETING

I. 2. 3. 4. 5. 6. 7. 8.

WPR/ICP/HSE/4.3/001/HSE( 1)2005.I(a) WPR/ICP/HSE/4. 3/001 IHSE(I )2005.l(b)

Agenda Timetable Programme of Activities Information Bulletin I Information Bulletin 2 Country Report: Brunei Darussalam Country Report: People's Republic of China Country Report: India Country Report: Indonesia Country Report: Malaysia Country Report: Mongolia Country Report: Philippines Country Report: Republic of Korea Country Report: Singapore Country Report: Thll1land Country Report: Viet Nam Update on implemelllatiun of action areas 01 task activities agreed at the WHO/ILO meeting on strengthening occupational health in Asia and the Pacifk 2003: Progress and gaps. (Dr K. Takahashi and Dr D. Caussy) Basic Occupational Health Services by Dr J. Rantanen Imernational Comnllssion on Occupational Health Extending Occupational Safety and Health Protection by Dr T. Kawakami lilternational Lahour Organization Health Work Places Dr H. Ogawa Regional AdViser in IIealthy Settings and Environment. World Health Organization Regional Office for the Western Pacific

WPR/ICP/HSE/4.3/00I/HSE( I )2005.I(c) WPR/ICP/HSE/4.3/00IlHSE( I )2005/IBI I WPR/ICP/HSE/4. 3/001 IHSE( I )2005/IB/2

WPR/ICP/HSE/4. 3/001 IHSE( 1)2005/INF.1 WPR/ICP/HSE/4. 3/001 IHSE( 1)200S/INF.2

WPR/ICP/HSE/4.3/00 1IHSE( I )200S/INF. 3 WPR/ICP/HSE/4.3/001 IHSE( I )200S/INF.4 WPR/ICP/HSE/4. 3/00 I IHSE( I )200S/INF. S WPR/ICP/HSE/4. 3/001 IHSE( 1)2005/INF.6 WPR/ICP/HSE/4.3/001/HSE( I )200S/INF. 7

9. 10.

11. 12. 13. 14. 15. 16. 17.

WPR/ICP/HSE/4.3/001 IHSE( I )200S/INF.8 WPR/ICP/HSE/4.3/00 I IHSE( 1)2005/INF. 9 WPR/ICP/HSE/4.3/00 I/HSE( I )2005/INF. 10 WPR/ICP/HSE/4.3/001/HSE( I )2005/INF.II WPR/ICP/HSE/4. 3/001 IHSE( I )2005.2

18.

WPR/ICP/HSE/4.3/00IlHSE( I )2005.3

19.

WPRIICP/HSE/4.3/001 IHSE( 1)2005.4

20.

WPRIICP/HSE/43/00I/HSE( 1)2005.5

- 38 -

21.

WPR/ICP/HSE/4.3/001/HSE( I )2005.6

Global Strategies: Focuses and International Mech,lIlisms Dr T. Kawakami International Labour Organization Global Strategies: Focuses and International Mechanisms Dr G. Eijkemans World Health Organization Headquarters Results of WHO Global Strategy Survey in Asia by Dr A. David (Temporary Adviser) Health Partners. L. L.c. Guam A Proposed Regiollal Framework for /\crioll for Occupational Health by Dr A. David (Temporary Adviser) Health Partners. L. L. C. Guam

22.

WPR/ICP/HSE/4. 3/00 I/HSE( 1)2005.7

23.

WPR/ICP/HSE/4. 3/00 I/HSE( 1)2005.8

24.

WPR/ICP/HSE/4.3/001/HSE( 1)2005.9

- 39 -

ANNEX 4

REGIONAL FRAMEWORK FOR ACTION FOR OCCUPATIONAL HEALTH

- 40 Annex 4

INTRODUCTION

A healthy workforce is the cornerstone for sustainable development. The modern day phenomenon of globalization sustainable development poses multiple challenges to of a healthy workforce.

and the maintenance

Globalization is changing the nature of work and the dynamics of the workplace, giving rise to new and emerging risks while shifting the boundaries of traditional employment. In turn, these drive an ever-widening gap between the resourcepoor and those with greater assets and capital, increasing inequity and its attendant health consequences (Neubauer and Mulrooney, 2005).

The social and economic consequences of globalization, such as increasing labour relocation away from rural areas into urban centres and increasing utilization of newly developed technologies, are often accompanied by novel or re-emerging health risks. For example, migration spurred by the

dynamics of global economic relocation can disrupt the conventional boundaries that separate microbial populations from human and animal populations. The erosion of the boundary between wild and domestic animal populations is at the heart of the current patterns of newly emerging infectious diseases. like SARS and avian flu. that have become inseparable from globalization. The Importation of migrant workers from countries with high endemic rates of tuberculosis (TB)can lead to a resurgence of TB in developed countries. On the other hand, rapid adoption of technological innovation can give rise to a different set of health risks. including those related to cumulative trauma and poor ergonomics. Globalization also brings with it a shift in the dynamics of power: whereas in the past, capital was the primary driver of power, today the "knowledge economy" requires workers to possess not only the skills required for a job but also the ability to access and utilize information in a speedy and efficient manner (Castells, 1996. 1997, 1998). This may add a separate level of occupational risk related to stress and mental dysfunction.

- 41 -

Annex 4

All these factors highlight the urgent need to broaden the scope and access to occupational health services, using innovative measures that address the various facets of globalization. New approaches are needed, but these

approaches, while addressing the health consequences of globalization, must nonetheless remain feasible, acceptable and relevant to local worker populations and communities, if they are to be adopted and implemented

This Regional Framework for Action for Occupational Health seeks to achieve the balance by addressing ways in which local solutions can be applied to risks and challenges arising from the globalization of work, including the social dimension of inequity, which impact on the health of the workforce At the same

time, it attempts to address specific occupational issues relevant to the Region in ways that are practical and integrative. The Framework is intended to guide

Member States and Territories in the development and strengthening of national policies and plans of action for occupational health, using evidence to drive policy and programme decisions that ultimately will reduce social inequity and improve workers' health. It encourages Member States to consider collaborative

approaches at the local, national and regional level to maximize resources and to benefit from each other's experiences. The Framework builds on previous work conducted at the global and regional levels by the World Health Organization (WHO), the International Labour Organization (ILO) and other relevant partners and stakeholders. It is anticipated that the Framework will assist Member States to achieve the capacity and readiness to implement the next 10-year WHO Global Strategy for Occupational Health for All 2006-2015.

- 42-

I Annex 4

BACKGROUND AND KEY ISSUES

The most recent estimates of the labour force in Asia (including South Asia and East Asia) and the Pacific state that approximately 1.6 billion of the region's 4 billion people comprise the workforce. This may not accurately reflect the considerable proportion of the region's population that work in the informal sector. given the scant data on this particular segment of the labour force (ILO, 2005). The World Bank reports that the informal sector may account for up to

40-60% of urban employment in Asia, with women and children constituting a major proportion of workers in the informal economy (Charmes, 1998). Thus, the number of workers in the region may be much greater than the estimates on record.

Work, the nature of employment, and the environment in which work occurs are determinants of health. Currently, WHO estimates that about 430,000 lives and 14 million disability adjusted life years (OAL Ys) were lost in 2000 in Asia and the Pacific because of major health risks at the workplace (WHO, 2000) If other occupational health risks were included, such as psychological

stressors and infections at health-care institutions, the burden attributable to occupational exposures would be much higher. Moreover, the direct health care expenditures from occupational accidents and injuries are a small fraction of the overall socio-economic costs, including productivity losses. Therefore, the actual burden to society from work-related accidents and diseases is highly significant.

The irony is that most, if not all, of these deaths, injuries and diseases, and their attendant costs, are preventable. Work-related exposures and risks can be minimized, if health care systems promote health and safety at the workplace and provide good-quality occupational workforce. health services to the

- 43 -

Annex 4 However, the levels of occupational health service coverage have not changed much over the last 10 years. Access to health care services remains low for most workers, especially in developing countries. The ILO estimates that coverage for occupational health services among the labour force in developing countries is about 5% to 10%. Even in developed countries, with very few

exceptibns, coverage is 20% to 50% at best (Fedotov, 2004). In addition, the ILO Convention No.161 on Occupational Health Services regarding "the requirements for establishing and maintaining a safe and healthy working environment which will facilitate optimal physical and mental health in relation to work," including (1) the obligation "to develop progressively occupational health services for all workers" and (2) the obligation to establish such services where none have yet been established, has been ratified by only 23 countries thus far (La Dou, 2005)

WHO recognized the importance of promoting occupational health and safety early on, in its history. The first meeting of the Joint ILOIWHO Committee on Occupational Health occurred in 1950, shortly after the founding of WHO,

initiating the collaboration between the two organizations.

The WHO Global

Strategy on Occupational Health for All, which was approved by the WHO World Health Assembly in 1996 (WHO, 1994), addressed the need to enhance the access of workers to good quality occupational health services.

Consistent with the WHO Strategy, the ILO Conference in 2003 adopted a new ILO Global Strategy on Occupational Safety and Health that promoted two areas for action: (a) preventive safety and health culture. and (b) systems approach to the management of occupational safety and health (ILO, 2003). The ILO, through its tripartite (governm~nt-employer-worker)

mechanism,

also

spearheaded through the years the development of various occupational health international policy statements, recommendations, guidelines and conventions that are intended to guide all countries in the promotion of workplace safety and in managing occupational health and safety programmes. These include ILO

International Conventions No. 81 (labour inspection), No. 155 (occupational

- 44 -

Annex 4

safety and health), No. 161 (occupational health services), No. 170 (chemical safety), and No. 174 (prevention of major industrial accidents) The ILO

Conventions on occupational safety and health are international agreements that have legal force if they are ratified b y the Member States. However, the most important ILO Convention on occupational safety and health (Convention 155) has been ratified by only 42 of the 178 ILO member states. The Occupational Health Services Convention (No. 161) has been ratified by only 23 Member States (La Dou, 2005). Increasing the number of Member States who are Parties to these conventions is necessary to ensure the uniform application of these global standards to the practice of occupational health and safety.

Recently, the WHO Commission on the Social Determinants of Health ident!fied "provision of occupational health services to all employees" as a concrete example of a health intervention designed to overcome the social barriers to health (WHO, 2005). For a large number of workers, lack of social

equity prevents access to on-site occupational health services. Workers who are self-employed, or who work in the informal sector or in small or medium-sized enterprises often have no worksite occupational health resources. These

individuals are forced to rely on external sources of health care to meet their occupational health and safety needs. Recognizing this, the International

Commission on Occupational Health (leOH) and WHO have recently developed the concept of "basic occupational health services" (BOHS). BOHS is based on the principles of primary health care; essential occupational health services are Integrated into primary health care, and are delivered as part of a comprehensive and holistic health package (Eijkemans, 2004). The Joint ILOIWHO Committee on Occupational Health, in November 2003, agreed to promote the further development and application of BOHS, and WHO and ILO are currently jointly introducing this initiative in China. In turn, this has led to a new emphasis on

expanding access to Occupational heaith services anticipated in the next Global Plan ::>f .'ictiol1 fer Occlipaiionar I i~altil :01

.411 2CO /-2015.

Additionally, ILO and

WHO have introduced approaches, such as the Occupational Safety and Health

- 45 -

Annex 4

Management Systems (ILO) and Healthy Workplaces (WHO), to improve occupational health service coverage at the wOrkplace level. Local initiatives

using these approaches have been implemented over the past several years, with several countries having completed evaluations of their experiences (Rantanen, 2004).

At the regional level, WHO and ILO began a systematic collaboration to improve occupational health in Asia and the Pacific in 2003, at a bi-regional meeting held in Phuket, Thailand. Participants at this meeting included

representatives from the WHO Collaborating Centres for Occupational Health staff from Health and Labour Ministries of Member States, and other academic institutions, and representatives from WHO and ILO. Three priority areas for

action were identified: (a) information collation and dissemination, (b) training, and (c) promotion of appropriate local solutions (WHO-SEARO. 2003).

At the national level, a number of countries have developed and begun implementing policies and plans of action that mandate the provision of goodquality occupational health services. The experiences of these countries -

Australia, China, Malaysia, Mongolia, New Zealand, Thailand, Viet Nam, and others - will be useful to the remaining countries within the Region that have yet to develop a national strategy to broaden the coverage of occupational health services.

- 46 -

Annex 4

OVERVIEW AND METHODOLOGY

This Framework for Action on Occupational Health 2006-2010 contains the vision and strategic directions for strengthening occupational health and safety, with a particular emphasis on improving the provision of occupational health services, in the Asia-Pacific region for the next five years. The 1996 WHO Global Strategy for Occupational Health for All, the 2003 ILO Global Strategy on Occupational Safety and Health, and the 2003 Bi-regional consultation on Strengthening Occupational Health in the Asia Pacific Region rrovide the foundation for this Framework, and will be in line with the WHO Global Plan of Action for Occupational Health.

The Framework builds on the concept of "Basic Occupational Health Services" and the Occupational Safety and Health Management Systems (ILO) and Healthy Workplaces (WHO) approaches, as well as on the experiences of countries that have begun implementing national plans of action for occupational health. In addition, the various elements included under this Framework were taking into consideration the feedback of countries in the

developed

questionnaire survey for the review of the 1996 WHO Global Strategy for Occupational Health for All.

VISION and GOAL

VISION:

The Framework for Action for Strengthening Occupational Health in ASlaPacific envisions a region where every individual is guaranteed the right to healthy and safe work, a healthy and safe work environment and good quality

- 47 Annex 4

occupational health services that enable him or her to enjoy good health and to live a socially and economically productive life.

GOAL:

The goal of this Framework for Action is to markedly reduce the health and socio-economic burden from occupational fatalities and accidents, and work-related illnesses, through:

1. policy environments that actively protect and promote health and safety for all workers; 2. workplaces and work processes that prevent, minimize, and control risky exposures; 3. systematic capacity building that empowers workers to use healthy work practices and to make healthy lifestyle choices; and, 4. gains in social equity that ensure occupatlonal health services are available to all workers.

- 48 Annex 4

CROSS-CUTTING PRINCIPLES

In constructing this Framework, five over-arching principles are recognized:

Using evidence for action

While the evidence base for new and evolving issues in occupational health may not yet be established, whenever good evidence exists, it must be utilized to guide the development of policies and programmes. This Framework for Action strongly encourages Member States and other stakeholders to seek out reputable data and information when developing their national policies and pLms of action, and workplace interventions. The Framework also urges

Member States to consider the experiences of other countries in the Region who may have pilot-tested some of the recommended approaches or implemented "good practices" (Chu, 2000), and to apply the lessons learned by these countries when adapting interventions for their own populations. Where evidence does not yet exist, particularly in relation to newly emerging occupational risks, the Framework supports the use of the precautionary principle to safeguard the health and safety of worker populations.

Fostering intersectoral collaboration and networking at all levels

Effective

occupational

health

policies

and

programmes

require

multisectoral participation and networking (Caussy, 2005). At the national level, the various Ministries within the public sector that are involved in work-related and workforce issues need to engage with private sector counterparts that include representatives of workers and employers, private insurance companies, and health providers. A number of countries already have intersectoral

mechanisms that facilitate the participation of the relevant national stakeholders in occupational health.

rJlember States ar3 elcouragE:: te

review these existing is also

examiJies for possible adaptation or repiiLatl :-n.

EffeG~, J:; collabo~atc:l

- 49Annex 4 A good example of global Information

necessary at the regional and global levels.

collaboration is the International Occupational Safety and Health

Centre (CIS), which focuses on knowledge management "to ensure that workers and everyone concerned with their protection have access to the facts they need to prevent occupational injuries and diseases. CIS was founded in 1959 as a

joint endeavour of the ILO, the International Social Security Association, the European Coal and Steel Community and the occupational safety and health authorities of 11 European countries. The original 11-member network of National Centres has grown to cover 120 countries all over the world." Currently. there are 136 CIS Focal Points at the regional and national levels who are linked to publishers of journals and reference materials on occupational health and safety (ILO, 2005). Another good example of international collaboration exists

within the WHO Occupationa! Health programmes at Headquarters and Regional Offices and the network of 64 Collaborating Centres. Through this network,

WHO is able to provide technical assistance to Ministries of Health and occupational health academic institutions in 192 WHO Member States and Territories, despite relatively limited resources. Mechanisms to foster these types of creative partnerships are essential for successful implementation of activities and strategies of this Framework.

Facilitating worker and community participation

At the workplace level, numerous studies demonstrate the positive impact of worker participation in decisions regarding occupational health policies and interventions. Thi~

was documented in Viet Nam (WHO-WPRO, 2001) and in using the "Healthy Workplace" approach. The

Malaysia (Daud,

2003),

Framework strongly encourages Member States to actively facilitate worker and community participation in the development, planning, implementation and evaluation of occupational health policies and interventions.

- 50 Annex 4

Implementing a systematic and iterative process to ensure that successes and failures contribute towards strengthening and refining the Framework and national plans of action

The process that underpins this Framework is an iterative one; that is, it should ideally incorporate an ongoing system for assessment, capacity building, prioritization, implementation, and evaluation that will provide continuous

feedback to improve and revise strategies and interventions.

Recognizing and reducing social inequity

Finally, and perhaps, most importantly, this Framework requires Member States to systematically address social inequities that directly or indirectly impact on worker health and safety. Incorporating a perspective that considers gender,

ethnicity and other socio-economic determinants is critical, if Member States are to build capacity to resolve the fundamental causes of poor health and elevated risks among those worker groups with increased vulnerabilities.

OBJECTIVES AND RECOMMENDED ACTIONS

ized along three distinct foci, which reflects the The Regional Framework for Action on Occupational Health is organ the nature of the work and the inherent qualities of the occupational medicine model. In this model, the environment, and vulnerability to work-related risks. The three foci also worker interact in a complex manner to determine health status to reduce work-related risks (David and Cullen, 2002). serve as targets for interventions to improve workforce health and WOR K Genera l Object ives: Monitor and manage risks effectively Promote safe work practices Specif ic Object ives: 1. Enhance regional and national capacities to assess, monitor and manage occupational risks 2. Promote the development. conduct. translation and dissemination of research to guide risk assessment and risk management. and promotion of safe work practices 3. Advocate for the use of evidence-based interventions to reduce work-related risks. using locally appropriate solutions when available

ENVIR ONME NT Genera l Object ive: Create physical and socio-political environments that support worker health and safet:L Specif ic Object ives: 1. Advance and mobilize support for evidencebased occupational health policies and plans of action in all Membe r States --;-. 2. Ensure that the infrastructure required for effective implementation of occupational health and safety policies and action plans is established at the regional and national levels 3. Develop and formally adopt measures to ensure sustainability of the occupational health and safety infrastructure -

WORK ER Genera l Object ive: Reduce workers' vulnerability to poor health and work-related risks Specif ic Object ives: 1. Broaden access to basic occupational health services. particularly for worker populations at highest risk 2. Build individual capacity to prevent and reduce vulnerability to occupational risks and hazards Vl

3. Promote research into the critical

determinants of workers' vulnerability to poor health and work-related risks -

It

Foe US:

Environment

;J> ;:l ;:l (1)

GE ERAL OBJECTIVE: Createphysical and socia-political environments that support worker health and safety.

x

SPE CiFIC OBJECTIVE 1: Advance and 1l10bilize support for evidence-based occupational health policies/plans of action Exp !cted Result 1.1: By 2010, all Member States will have official national occupational health action plans.

.j:>.

in all Member States.

Indi alor 11.1. Number of Member States with national action plans for occupational health officially endorsed by their Governments

Exp !cted Result 1.2: Member States with official national occupational health and safety action plans in 2010 will have included at least 50% of the Ireas for action recommended by the Global Strategy for Occupational health for All 2006-2015. Indl' afor 1.2.1: Official occupational health action plans in 2010 with at least 50% of the areas for action recommended by the Global Strategy Indl' ator 1.2.2.' Number of Member States with clearly articulated strategies to target high-risk and hard-to-reach worker populations !cted Result 1.3: All Member States with an official national action plan/strategy for occupational health in 2005 will have evaluated their nati nal plan/strategy implementation by 2010. Indi, alar 1.3.1. Number of Member States with a completed evaluation report of their occupational health and safety national plan/strategy _illljJ .!mentation Action by Collaborating Centres and other Actions by Countries Actions by WHO/ILO relevant institutions -~.

Exp

For countries without a national plan of act Ion/strategy: Develop, endorse and imp lement a national action plan/strategy for occ upational safety and health (OSH) For countries with an existing national action l/strategy tor for occupational occup health and plan/strateQY safety !v Initiate the systematic evaluation of nati onal action plan/strategy implementation Adv lcate for inclusion of occupational health in th e national health agenda and in the age ldas of relevant subreg'lonal and regional bod es, such as the ASEAN. -------"

Finalize and disseminate the Global Strategy for Occupational Health for All 2006-2015.

I Ensure that occupational health is included in all key organizational policies and the General Programme of Work, and advocate for the inclusion of occupational health issues in relevant global and regional forums Provide technical assistance to Member States in strategic planning, development and evaluation of national action plans/strategies for occupational health and safety. Review and disseminate tools and instruments for development and evaluation of national action plans/strategies for occupational health and safet~

Provide evidence-based guidelines and recommendations for strategies and interventions for occupational health national action plans/strategies, and ensure timely communications with regional office staff and Member States

Vl

IV

Support WHO/ILO in providing technical assistance to Member States for strategic planning, development and evaluation of national action plans/strategies for occupational health.

For all countries Participate in the finalization ofth e Global Strategy and incorporate the reco mmended areas for action and inte vent ions into natig!laLaction plan/strateg~

FOCUS: Environment GENERAL OBJECTIVE: Create physical and-socio-political environments that support worker health and safety. SPECIFIC OBJECTIVE 2: Ensure that the infrastructure required for effective implementation of OSH policies and action plans is established at th_e_regional and national levels .. _ ~ ___________________________________________-1 Expected Result 2.1: By 2010, all Member States. will have designated human resources for occupational health Indicator 2 1.1.' All Member States will have official national Focal Persons for occupational health and safety. Expected Result 2.2: Multisectoral regional and national committees/networks for coordinating occupational health planning and policy/programme development. Will exist in at least 75% or Member States by 2010. Indica/or 2.2.1. Number of Member States with a multisectoral national OSH committees Indica/or 2.22' Fully operational Regional OSH network in place Exp.".d R",plt H A meo'''"''m 'oe ',m.'y oomm"";~I;o", '"' ,,'oem""" "".m"",," b. M,m""! Slate,. Indica/or,? :3. L ~eglonal occupational health web portal will be 0 erational by 2007 ___ _ Actions by Countries Actions by WHOIILO Actions by Collaborating Centres and other relevant institutions ------I Designate a national Focal Person for Strengthen and further develop collaborative Expand and strengthen the network of occupational health partnerships with relevant stakeholders at the Collaborating Centres and other relevant international and regional level institutions for .occupational health and safety Facilitate inter-country collaboration through Assist WHOIILO by finalizing the web portal Provide for at least one full-time staff member, or equivalent, to coordinate national subregional and regional conferences and and managing the information that will be occupational health plan implementation and other venues for information and technical disseminated through the portal I evaluation. exchange amcJf1g Member States Support WHO and ILO in developing an Establish an integrated communications Establish, if none exists, a multisectoral integrated reg'lonal commun'lcat'lons committee to oversee occupational health network that links Member States to mechanism ~plannlng and policy development Collaborating Centres and other institutions Maintain and enlarge an electronic library of I Formalize links with relevant national Coordinate the development of an ! occupational health stakeholders, such as OSH resources occupational health web portal that will collate ! trade unions, academic institutions, employers' and transmit relevant information on OSH, i groups, local Collaborating Centres, etc , including training opportunities, research r . , activities, OSH resources (data banks, news, I Contribute actively towards development or a regulations, tools, standards, etc,) ~r§g~n.9l V\'e~p,--o,-r~ta_I_ _~_~~

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SPECIFIC OBJECTIVE 3: Dev~l()e_and formally adopt measures to ensure sustainability of the occupational health and safety infrastructure. Expected Result 3.1: By 2010, strategies to ensure adequate funding of occupational health programmes in at least 50% of Member States. Indicator 3. 1. 1: Number of Member States with funds allocated for occupational health within the national budget Indicator 3.1.2. Number of Member States with mechanisms to channel resources and funding to occupational health and safety. Expected Result 3.2: Member States with mechanisms and expertise to ensure adequate human resources for occupational health will be increased by at least 25% over the baseline. Indicator 3.2. l' Number of Member States with national institutes responsible for occupational health Indicator 3.2.2. Number of Member States integrating basic occupational health training in relevant educational/training curricula Indicator 3.2.3. Number of Member States with national post-graduate trainin9.programmes in occupational health Actions by Countries i Action by WHOIILO Action by WHO Collaborating Cent.es and I ._______ i other relevant institutions Advocate for occupational health funding from I Coordinate external support to Member States Develop recommendations for core curricular national budget appropriations/allocations i from international donors content for basic occupational health and I safety training - . - - - and pursue administrative and ! Disseminate relevant examples and models of Collect and disseminate existing Explore I ensuring sustainable funding for health, such recommendations and training modules for legislative mechanisms to augment funding as the WPRO publications on health care basic occupational health and safety training, support for occupational health, such as i financing and establishing health promotion including training in Basic Occupational through the earmarking of taxes and the I foundations, in multiple formats Health Services (BOHS) for all health care I creation of Health Promotion Foundations ! providers E;tabll~~-If none exists, or strengthen national Coordinate with international bodies in Develop recommendations for core curricular institutions capable of providing expert i developing guidelines for training curricula for content for training experts in occupational ser\iic.E'sJn occupational health and safe:y. ' occU£.ational health experts health and safetv Incorporate occupational health into the basic Collect and disseminate eXisting training Conduct, as requested, subregional and curricula of all health professionals, and in modules for basic occupational health training regional training for Member States unable :0 vocational and worker/employer training In multiple media formats , establish national traliling programmes in ._._________ i occupational health and safety. Incorporate basic occupational health and Coordinate subregional and regional training Further develop the concept of occupational safety (BOHS) trallllflg in primary health care for Member States unable to establish national health and safety electronic training as a curricula , training programmes and consider the regional resource. P;~vld~ i~· trai~-In-gcl~tional occup<ilion~-----; development of a standard regional heallh expel·ts [ accreditation process for occupational healttl l ancisafety' _ _. ____ _ _L _

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FOCUS: Work GENERAL OBJECTIVES: Monitor and manage risks effectively Promote safe work practices SPECIFIC OBJECTIVE 1: Enhance regional and national capacities to assess, monitor and manage occupational risks. Expected Result 1.1: By 2010, at least 50% of Member States will be collecting data on risk assessment and surveillance of occupational diseases and accidents. Indicator 1.1.1. Standard occupational health country profiles will be available for all Member States. Expected Result 1.2: By 2010, at least 25% of Member States will have developed the capacity for "rapid response/emergency responses" to emerging occupational risks. Actions by Countries Actions by WHOIILO Actions by WHO Collaborating Centres and other relevant institutions Develop, if none exists, or update country Provide technical assistance to countries in the Assist WHOIILO in providing technical profiles on occupational health and safety development or upgrading of occupational assistance and training on developing/upgrading OSH registries health and safety registries Oversee and manage a regional database of Establish, if none exists, or upgrade Assist countries with existing national occupational health and safety registries to occupational health and safety registries to country occupational health and safety capture the essential occupational health and align their data indicators with regional information safety indicators, consistent with regional recommendations, to ensure data recommendations comparability across countries Initiate the development of contingency plans Provide technical information and potential Support countries in developing capacity to to respond to emerging risks through "rapid models for countries to develop their "rapid respond rapidly to new and emerging response/emergency response" me ;hanisms. response capacities. occupational risks. Coordinate the development of a regional Provide technical information and potential contingency plan to respond to emerging risks models for WHOIILO to develop a regional through "rapid response/emergency response" "rapid response" contingency plan. mechanisms. Explore strategies to include marginalized Address the challenge of developing best Address the challenge of developing best worker groups, such as those in the informal practices to ensure inclusion of the informal practices to ensure inclusion of the informal sector, in surveillance and data collection sector dUring surveillance activities sector during surveillance activities

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OBJECTIVES: Monitor and manage risks effectively; Promote safe work practices SPECIFIC OBJECTIVE 2: Promote the development, conduct, translation and dissemination of research to guide risk assessment and risk management and the promotion of safe work practices SPECIFIC OBJECTIVE 3: Advocate for evidence-based interventions to reduce work-related risks, using locally appropriate solutions when available Expected Result 2,1: By 2010, at least 50% of Member States will be using health-based standards to determine acceptable levels of workrelated exposures Indicator 2.1.1. Number of Member States using health-based OSH standards to determine acceptable levels of exposure to work-related risks Expected Result 3.1: Evidence-based interventions and local "good practices" will be under implementation in at least 50% of Member States Indicator 3.1.1. Number of local "good practice" solutions to reduce or control work-related risks validated for replication within the Region J!!dicator 3.1.2.' Number of Member States adopting the "Healthy Workplaces" approach Actions by WHO Collaborating Centres and Actions by Countries Actions by WHOIILO other relevant institutions Conduct relevant research and coordinate Utilize evidence from research to drive Collaborate with relevant research and dissemination of research findings and interventions to prevent/reduce/control workstandard-setting organizations, such as guidance documents regarding "safe" levels of related risks. CISIlLO, IARC and the IRPTC, 10 finalize and exposure to work-related risks, and disseminate a set of essential health-based If available, share local data on research into interventions to manage/control these risks for standards and guidelines for acceptable levels acceptable exposure levels with other the regional populations. of work-related exposures to countries. countries. Adopt and enforce recommended healthFoster the dialogue among countries regarding Continue to develop evidence-based tools, based standards for acceptable levels of training materials· and other resources to aid potentially replicable local solutions/"good exposure to work-related risks, wilh special countries in risk assessment and risk practices" to prevent/reduce/manage workmanagement, and in promoting healthy work attention towards ensuring enforcement for related risks. Ihe highest-risk groups. practices. Evaluate and share information on local Work with countries to evaluate local Expand the implementation of the "Healthy solutions/"good practices" that may have solutions to prevent/reduce/control workI Workplaces" approach in countries. related risks that may be applicable to other relevance for the region. countries within the Region I Apply strategies within the "Healthy Pursue evaluation research on "Healthy ! Provide countries with guidelines on safe work Workplaces" approach to promote safe work Workplaces" initiatives in relation to promoting practices. practices. safe work practices.

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FOCUS: Worker GENERAL OBJECTIVES: Reduce workers' vulnerability to poor health and work-related risks SPECIFIC OBJECTIVE 1: Broaden access to basic occupational health services, particularly for worker populations at highest risk Expected Result 1.1: By 2010, at least 50% of Member States will be reporting coverage of at least 80% of all worker populations by basic occupational health services. Indicator 1.1.1: Number of Member States with at least 80% of all workers covered by basic occupational services Indicator 1.1.2: Number of Member States incorporating BOHS training in training of health care workers Indicator 1.1.3: Number of Member States with clearly articulated strategies to reach special worker populations, such as those in the informal economy Actions by WHO Collaborating Centres and Actions by Countries Actions by WHO/ILO other relevant institutions Assist WHOt/LO in providing technical Consider adopting the basic occupational Further promote the adoption of the BOHS assistance and training in, and evaluating the health and safety (BOHS) approach and approach in countries integrating this into national occupational efficacy of BOHS. health care service delivery Develop guidelines and recommendations to Incorporate BOHS training in primary health care curricula broaden the reach of occupational health services to include marginalized worker Develop feasible strategies to target hard-togroups, such as women and child labor and reach worker populations, such as those in the workers in the informal economy informal economy SPECIFIC OBJECTIVE 2: Build individual capacity to prevent and reduce vulnerability to occupational risks and hazards Expected Result 2,1: Programmes to build worker capacity to use safe work practices implemented in all Member States by 2010 Indicator 2.1.1: Number of Member States implementing capacity-building programmes for workers Expected Result 2.2: Health promotion programmes for worker populations implemented in all Member States by 2010 Indicator 2.2.1: Number of Member States adopting the "Healthy Workplaces" approach Actions by Countries Actions by WHOIILO Actions by WHO Collaborating Centres and other relevant institutions Develop strategies to ensure that worker Provide guidelines, tools and resources to Develop guidelines, tools and resources to training in occupational hazards, the hierarchy countries for worker training in occupational countries for worker training in occupational of controls, and safe work practices is available hea Ith and safety health and safety to all workers, including hard-to-reach groups Develop regional guidelines on health Evaluate the initial country experiences in on worker health promotion interventions to guide promotion programmes for workers based Integrate health promotion interventions into experiences of the initial group of countries expansion to other countries in the region occupational health programmes, such as I piloting this approach I through the "Healthy Workplaces" approach

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FOCUS: Worker GENERAL OBJECTIVES: Reduce workers' vulnerability to poor health and work-related risks SPECIFIC OBJECTIVE 3: Promote research into the critical determinants of workers' vulnerabilit~ to ~oor health and work-related risks Expected Result 3.1: By 2010, a regional research agenda into the critical determinants of workers' vulnerability will be under implementation. Indicator 3. 1. 1. Number of research studies on health consequences of globalization and other social determinants of health underway in the Region ~ Indicator 3. 1.2 Number of Collaborating Centres conducting these types of research within the region Indicator 3.1.3: Number of Member States implementing research into the determinants of workers' vulnerability Actions by Countries Actions by WHOIILO Actions by Collaborating Centres and other relevant institutions. Consider initiating local research into Develop a regional research agenda on critical Develop research protocols and instruments to determinants of worker health through determinants of workers' health to guide and capture information on critical determinants of collaborative arrangements with academic coordinate individual research efforts by workers' health institutions interested in occupational health Member States Share results and experiences from local Provide technical assistance in evaluating Provide technical assistance to countries research efforts with other countries wishing to conduct these types of research results of research to guide development of appropriate interventions to reduce worker vulnerability to poor health and work-related risks Disseminate research findings to worker Integrate research findings into a logical Establish mechanisms to make the practical populations and other stakeholders such as framework and communicate these findings to implications of research available to all occupational health and safety policy leaders, relevant stakeholders, especially worker Member States to guide countries in creating employer groups, and occupational health and and selecting appropriate interventions to groups safety service providers reduce worker vulnerabilit~

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Annex 4

CONCLUSION

Investing on occupational health and safety is necessary for sustainable development. strategic Ensuring a safe and healthy workforre in the Region requires and planning, resource allocation, and political

coordination

commitment.

This Regional Framework for Action on Occupational Health

provides the strategic directions to guide Member States in their efforts to promote the policy environments, and workplace and worker interventions that will maximize the potential for achieving good levels of health and high standards of safety for all worker populations.

Member States in this region bear a disproportionate health and economic burden caused by workplace exposures and unsafe work practices. At the same time, resources are available throughout the region to empower Member States in preventing and reducing occupational mortality, morbidity and disability. The Framework builds on past and ongoing efforts by multiple partners and stakeholders in occupational health and safety. By attempting to incorporate

existing initiatives into a coordinated approach, it is hoped that this Framework will point the way forward towards a rational way for Member States to address the current and newly emerging challenges in occupational health and safety, use resources judiciously, build on ongoing efforts, prevent overlap, learn from each other's experiences and expand institutional and individual capacities.

- 60 -

REFERENCES Castells, Manuel. 1996. The Rise of the Network Society, The Information Age: Economy, Society and Culture. Malden, MA: Blackwell Publishers Inc. - - - . 1997. The Power of Identity, The Information Age: Economy, Society and Culture. Malden, MA: Blackwell Publishers Inc. - - - . 1998. End of Millennium, The Information Age: Economy, Society and Culture. Malden, MA: Blackwell Publishers. Caussy, Deoraj. Building a network of occupational health in Asia: Opportunities and challenges. Asian-Pacific Newsletter on Occupational Vol. 12, No. 2: 47-51. Charmes, Jacques. 1998. "Informal sector, poverty and gender: a review of the empirical evidence", Background paper for the World Development Report 2001, updated February 2000, at http://www.wiego.org/main/publi1.shtml, Women in Informal Employment Globalizing and Organizing (WIEGO) website, last accessed 21 October, 2005. Chu, Cordia, et al. 2000. Health promoting workplaces-international settings development. Health Promotion International, Vol. 15, No.2: 155-167. Daud, Aziah. 2003. Healthy Workplace Report-November 2003: Government Printing Johor Bahru. Occupational Health Unit, Disease Control Division, Ministry of Health Malaysia. Unpublished report. David, Annette M. and Mark R. Cullen. 2002. "The Workplace", in Fundamentals of Clinical Practice, 2 nd Edition. New York, New York: Plenum Publishing Co. (Mengel M and Holleman W, eds.) Eijkemans, Gerry. 2004. Occupational health services as a part of primary health care. Asia-pacific Newsletter on Occupational Health and Safety, Vol. ii, NO.3: 51-53. Fedotov, Igor. 2004. Occupational health services - An IlO policy perspective. Asian-Pacific Newsletter on Occupational Health and Safety, Vol. 11 :4850. Fingerhut, Marilyn. 2005. Evaluation of the 2001 - 2005 Work Plan of the WHO Global Network of Collaborating Centers in Occupational Health. Unpublished report.

- 61 -

Annex 4

International Labour Organization. 2004. Global Strategy on Occupational Safety and Health. Conclusions adopted by the International Labour Conference at its 91 5t Session, 2003. Geneva, Switzerland: International Labour Organization. ___ . International Occupational Safety and Health Information Center, at http://www.ilo.org/public/english/protection/safework/cis/, last accessed 22 October, 2005. International Labour Organization Regional Office for Asia and the Pacific. 2005. Labour and Social Trends in Asia and the Pacific 2005. Bangkok, Thailand: International Labour Organization. Kim, Jim Yong, Joyce Millen, Alec Irwin, and John Gershman, eds. 2000. Dying for Growth: Global Inequality and the Health of the Poor. Monroe, Maine Common Courage Press. La Dou, Joseph. 2005. World Trade Organization, ILO Conventions and workers' compensation. International Journal of Occupational and Environmental Medicine, Vo1.11: 210-211. McMurray, Christine, and Roy Smith. 2001. Diseases of Globalization: Socioeconomic Transitions and Health. London: Earthscan Publications. Rantanen, Jorma. 2004. Developing basic occupational health services with special reference to China. Asian-Pacific Newsletter for Occupational Health and Safety, Vol. 11 :56-57. World Health Organization. 2005. Commission on Social Determinants of Health website at http://www.who.int/social determ inants/strategy/Qa nd~?l~!ljjQQ?)~ httDJ Last accessed 21 October, 2005. _ _--:-:-'. 1994. Global Strategy on Occupational Health for All: The Way to Health at Work. Recommendatiuns of the Second Meeting of the WHO Collaborating Centres on Occupational Health, 11-14 October, 1994, Beijing, China. ___ . 2005. Proposal for Global Collaborating Centre network Plan of Action 2006-2011. Unpublished report. ___ .1996. World Health Assembly Resolution WHA49.12, Agenda item 17, Annex 1. World Health Organization Regional Office for South East Asia. 2003. Strengthening Occupational Health in the Asia Pacific Region,

- 62Annex 4

Report of a Bi-regional Consultation -a joint activity among Headquarters, SEARO and WPRO, Phuket, Thailand, 16-18 December, 2003. Unpublished report. WHO-WPRO. 2001. Evaluation of a 1-year Implementation of the Regional Guidelines for Healthy Workplaces in Small and Medium-scale Enterprises in Ngo Quyen District, Haiphong City and in Hue City. Healthy Settings Case Study Documents Series, No.1. Manila, Philippines: WHO-WPRO.

ANNEX 1 COMPARISON OF AREAS FOR ACTION IN REFERENCE DOCUMENTS WHO Global Strategy for OH for WHO Global Plan of Action CC Network Workplan 2001Proposed CC Network Workplan

AII.1994 Strengthening of international and national policies for health at work and developing the necessary policy tools Development of healthy work environment Development of healthy work practices and promotion of health at work Strengthening of occupational health services (OHS) Establishment of support services for occupational health Development of occupational health standards based on scientific risk assessment -

2006-2015 Develop instruments and mechanisms for policy action; Provide support for interventions at the workplace; Build up institutional capacities for action; Enhance human capacities for action: Ensure evidence base and public support for action.

2005 Technical guidance in occupational health Intensive partnership in Africa Child labour and adolescent workers Elimination of silicosis Health care workers Health promotion activity Psychosocial factors at work Promotion of occupational health and safety in small enterprises and in

2006-2010 Global situation analysis Evidence for action, and national policies and action plans. Practical approaches to identify and areduce occupational risks Education, training, and technical materials Development and expansion of Occupational Health Services Communication and networking.

2003 Joint WHOtlLO Committee Recommendations Guidance and support for national aSH programmes Enhancing regional collaboration and coordination Coordination and enhancement of information and educational programs and materials Awareness-raising activities and instruments

ILO Global Strategy 2004

Biregional Consultation 2003 Phuket I

Promotion, awareness raising and advocacy ILO Instruments Technical assistance and Cooperation Knowledge development, management and dissemination International collaboration

Information collation and dissemination Training Promotion of appropriate local solutions.

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Wi-IOGlobal Plan of Action 2006-2015

CC Network Workplan 20012005 disorders Preventive technology Training of occupational health Personnel Internet resources and networks National and local profiles and indicators Economic evaluation Global burden of disease

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2003 Joint WHO/ILO Committee Recommendations

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- 65ANNEX 5

OPENING ADDRESS OF THE REGIONAL DIRECTOR, WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC AT THE WHO/ILO MEETING ON STRENGTHENING OCCUPATIONAL HEALTH AND SAFETY Kuala Lumpur, Malaysia 23 November 2005 DISTINGUISHED GUESTS, LADIES AND GENTLEMEN: I am pleased to welcome you and to address the opening of this joint WHO/ILO Meeting on Strengthening Occupational Health and Safety. This is a critical meeting, because a healthy workforce is essential to healthy development. Rapid industrialization in the Asia-pacific region has brought about high economic growth, with its benefits. However, without a concomitant expansion in occupational health services and the promotion of a 'safety culture' at the workplace, the gains from economic development will be cancelled, and perhaps overshadowed, by increasing rates of work-related mortality, morbidity and disability. Already, WHO estimates that about 430,000 lives and 14 million disability adjusted life years (DALYs) were lost in 2000 in Asia and the Pacific because of major health risks at the workplace. If other occupational health risks were included, such as psychological stressors and infections at healthcare institutions, the burden attributable to occupational exposures would be much higher. The irony is that most, ifnot all, of these deaths, injuries and diseases are preventable. Work-related exposures alld risks can be minimized, if health care systems promote health and safety at the workplace and provide good-quality occupational health services to the workforce. Some countries have already begun the process of ensuring safe and healthy workplaces at the national and local levels. We have much to learn from their experiences. At the regional and global levels, WHO and ILO have supported counties in developing and strengthening their capacity for occupational health and in improving the provision of occupational health services. Towards this end, ILO developed a global strategy on occupational safety and health in 2003. WHO is now reviewing the progress in implementing its 1996 global strategy on occupational health while developing its Global Plan of Action on occupational health to cover the period 2006 to 2015. Within the Asia-Pacific region, WHO and ILO jointly conducted a regional meeting in 2003 to form a network on occupational health and identify tasks and activities of the network. The time has come to critically review country experiences and the collaborative activities of WHO and ILO with Asian countries, assess the relevance of the global strategies and action plans to the Region, and discuss the future course of action for WHO and ILO collaboration with Asian countries to strengthen their occupational health and safety programmes. It is my hope that you will be able to accomplish these during the next three days. It is also my hope that by sharing experiences, practical insights and lessons learned amongst yourselves, we shall produce a Regional Framework for Action to ensure safe and healthy workplaces that is relevant and feasible. We will also initiate the development of country work plans based on the Regional Framework for Action and discussion on intercountry cooperation in this area. I would like to thank the host country of this regional meeting, Malaysia, for assisting us, through its Ministry of Health, in local arrangements. I wish you all a productive and successful meeting. Thank you.