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JOINT !J.J)jwHo SECOND REGICNAL SEMINAR 00
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OCCUPATICNAL HEALTH
Sponsored by the WORID HEAIll'H DmANIZATICN REGIONAL OFFICE FOR '!HE WESTERN PACn<'IC
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Manila, Philippines
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24 - 31 October 1967
FINAL REPORr
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Not for Sale Printed and D1str1buted by the
Reg10nal Office for the Western Pacific of the World Health Organizat1on Man1la, Philippines June 1969
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mI'R(I)t1Cl'ICIl .................................................................... .
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1.1 1.2 1., 1.4 1.5
0pen1x1g session •.................................• ObJectives. • . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . • • Work of the Seminar ................................................. Presentation of the report •••••••••••••••••••••••• Doouments and working papers ••••••.••..••.•.•...••
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PIENAI« SESSI~. 25 October 1967 (morning) ••••••.••••••• 2.1 2.2 The development and extension of occupational health services in developing countries ••••••••••• The co-ord1nation of occupational health services with national health services •••••••••••• The International Labour Organization, occupational health and safety.................... The World Health Organization and occupational heal"tll ........ '" . • .. .. .. .. .. .. .. .. • . .. .. .. .. • . • • .. .. .. .. .. • .. • .. • • .. .. • • •
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2., 2.4
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5 6
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Report on discussion ••••..•.•.••••••••.••••••.•.•• Ocoupational health and safety considerations 1rl sma.ll 1:ld.UBt.rles ............................................ Legislation for medical services ••••••••••••••.••• Medical examinations in industry •••••••••••••••••• Singapore's flatted factories ••••••••••••••••••••• Occupational health centres in New Zealand •••••••• The role of an industrial medical association ••••• Report on discussion •••••••••.••••.••••.•••.••••.• The development and extension of industrial hygiene services in developing cOWltries •••••••••• Practice of industrial hygiene in the Ph1l1ppirles ••...•...•..........•......•...•......• The development and extension of oocupational health nursing in developing countries ••••••••.••• Occupational health nursing in the Philippines.... Report on discussion •••..•••••••••..•.•..••••.••••
7 8 8 10 II 11 II
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PIENAI« SESSION. 25 October 1967 (afternoon) ••••••••••••
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'.6 '.7 4. 4.1 4.2
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PIENAI« SESSI~, 26 October 1967 (morning) ••••••••••••••
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PIENARl SESSIm, Zl October
1967 (morning) ••••••••••••••
lB lB 19 20 20
5.1 5.2 5.3 5.4 5.5
Ul1dergraduate and postgraduate medical education in occupational health •••••••••••••••••• The education and training of industrial hygienists in developing countries ••••••.•.••••••• The training of occupational health nurses •••••••• Is there a need for regional occupational health training centres and co-operation? ••••••••• Report on discussion ................................... ~ .. . .... . .....
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PIENARl1' SESSION, 30 October 19&7 (morning) ••.•••••.•••••
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The role of the doctor. in an occupational health 1rlst1tute .................................................................. g}
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The role of industrial health centres ••••••••••••• Why occupational medical services are not
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6.3 6.4 6.5 6.6 6.7
always successful. ................................................................
Legislation and enforcement ••.•••••••••••••••••••• The industrial hygienist and enforcement •••••••••• Co-operation between the departments of laooUI' aIld health ................................................................ Report on discussion ...........................................................
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SESSION, 31 October 1967 •...•..•..........•.•.••
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Occupational health, productivity and production ................................................................................ Environmental aspects in productivity ••••••••••.•• Report on discussion ............................................................
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GROOP DISCUSSION I, 26 October 19&7 (afternoon) •••••••••
8.1 8.2
Public health problems in occupational health ••••• Health education .................................•
30 }O 30
8.3 8.4 9.1
Health education and the occupational health n\1I'Se •••••••••••••••••••••••••••••••••••••••••••••
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Report on discussion ••••••••.....•...•.•••••.••..• Industrial safety in developing countries ••••••••• The role of ergonomics in developing countries •••• Report on discussion •••.•..•.•.•...•.•..•..•.•...•
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GROOP DISCUSSION II, 26 October 1967 (afternoon) ••••••••
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GROOP DISCUSSIW III, Z1 October 1967 (afternoon) •••••••• 10.1
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Occupational health as a component of labour development projects ••••.•••••••••••.••••.•••••••••
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10.2 The role of pUblic health inspectors in ocoupational health ••.•••••••••••••••.••••••••.••••
10., Training of non-med1cal factory inspectors and other personnel connected with health 8Ild. safety ...........................................
10.4 11. 11.1 11.2 11., 11.4 12.
Report on discussion ....................... ".......... The role of voluntar,y agencies ••••.•••••••••.•••••• The role of non-medical university departments ••••• Training of non-med1cal inspectors •••.•.••••••••••• Report on discussion ••..••....•••..•.•.•.•.••••••••
GROOP DISCUSSION IV, Z1 October 1967 (afternoon) •••.•• •••
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GROOP DISCUSSIW V, ~ October 19f/7 (a£'ternoon) •••••••••• 12.1 Occupational health in agriculture ••••••••••••••••• 12.2 Agricultural field investigations •••••••••••••••••• "12., Report on disoussion ••••••.••••••.•••••••.••...•.••
40 41 41 41 42 42
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GROOP DISCUSSIW VI. ~ October 19f/7 (afternoon) ••••••••• l,}.l The plaoe of research in developing countries •••••• l,}.2 Teamwork in occupational health ••••.••••••••••••••• l,}., The health and safety aspects of the employer/employee relationship •••••••.••••••••••••• ~.4
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Report on discussion •••.••.•••••••••..••.•.•••..•.• .........................................
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CI,OODfG AJ][)~
ANNEX 1 ANNEX 2
- SEMINAR CONCLUSIONS ••••.••••.••.•..•••.••••• - LI8r OF PARrICIPANTS •..•.•......•.••...••••• GQmRAL C<HmNTS ON PRE-sEMlNAR VISn'S "B:l i'1IB 'l!IIIEE COllSlJI..lrAHrS ••••••••••••••••••••
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ANNEx:, ANNEx: 4 ANNEX 5
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QPESrlOONAIRE CWCERNlNG OCCUPATIONAL lIF.AIlDi SElW'ICF.S ••••••••••••••••••••••••••••• ~
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OF 'lEE REPLIES TO A QUESrIamAIRE ctI SMA.U, .na1B'rRI&S •••••••••••••••••••••••••
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r • 1. INTROWCTION
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"Wi th the rapid industrialization taking place in so many countries, the protection and promotion of the health of the worker is of paramount importance. Productivity depends on a healthy worker in a healthy environment. 'lbis, however, must become clear not only to this gathering and to our professions, but also to the industrial planners, economists and all those whose task it must be to lend support to occupational health services with money and resources." With these words, Dr Francisco J. ])y, Regional Director of the WHO Regional Office for the Western Pacific struck the keynote of the Joint ILO,IWHO Second Regional Seminar on Occ'dpational Health which was held at Manila, Philippines, from 24 - 31 October 1967. ~ Seminar was attended by twenty-two participants from fourteen countries and territories, thirteen observers, two consultants and three temporary advisers as well as by members of ILO and WHO Secretariats. A full list of those present will be found in Annex 2.
1.1
Opening session
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Dr DY welcomed the partiCipants, observers, consul~ts and advisers to the Seminar and said he was glad to see such a wide representation from countries and territories of the Region. '!he present occasion was an example of the excellent relations and ready co-operation existing between the WHO Regional Office in Manila and the ILO Regional Office in Bangkok. Seven years had passed since the first occupational health seminar in the Region had been held in Tokyo. A great deal had happened in occupational health in that period, and it was for the present seminar to set guidelines and give stimulation. Dr M.A. EL BATAWI, ILO Regional Adviser on Occupational Health, Bangkok. stressed the importance of co-operation between ILO and WHO in promoting the health and the safety of workers all over the world. He hoped that the countries represented would benefit through the exchange of ideas, in:foI'IIBtion andex:perience, and that co-operation between them would be strengthened and be refleoted in the improvement of conditions of work in all countries going through an active industrialization programme. ~ following officers were elected: Chairmen of the discussion groups, Dr A.G. Hernandez and Dr T. Taylor; rapporteurs, Drs K.S. Cho, C.P. Kee, A.K.B. Bahan, G.Y. McCririck, A.Paul, G.C. SID1th, and Mr H. Chang. Dr A. Bell, WHO, Geneva, was the seminar Director.
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Objectives The objectives of the seminar were: (a) To consider and identify the occupaUonal health8l¥1 safety problems and hazards, including those related to rapid industrial1zation in many countries in the Region and those of small industries. To discuss the establ1shment, organization and development of ocoupational health and safety servioes and their co-ordination with national health services at all levels, and. To consider advanoes and developments in occupational health and safety.
(b)
(c)
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Work of t.he Seminar
In addition to the opening session, six moming or at'temoon plenary sessions were held. At each of these, presentations of different aspeots of the seminar theme were made by 1nd1v1dual participant.s and were followed by general discussion. On three aftemoons the seminar divided into two disoussion groups which met concurrent.ly • At. each of these, presentations of various sUbjects by individual participants were followed by group disoussions.
With the assistance of the Philippines' Departments of Health and Labor, exhibits were organized and a field visit arranged to the San Miguel glass works and brewery. A number of occupational health and safety fUms were screened. 1.4 Presentation of the report
Owing to the multiplicity and diversity of the sUbJeots treated, it was found convenient to present first the reports of the six plenary sessions, in chronological order, and second the reports of the discussion groups. The partioipants' recOlll1l8lldatlons are reprod.uced in Annex I. 1.5 Doouments and working papers The following working papers were distributed to part1cipants: Development and Extension of Occupational Health Services in Developing Countries by Dr A. Bell (WPll/Occ. Health/29);
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The Role of the Industrial Hygienist by Mr A.T. Jones (wpR/Occ.Health/30) ; The Role of the Occupational Health Nurse by Miss R. SIQ1llIJKrvi
(WpR/Occ.Health/31) :' The Role of the Occupational Health Institute by Dr. M. Yamaguchi (WPR/Occ.Health/32) : Occupational Health and Safety in Small Industries by Dr M.A. El Batawi (WPR/Occ.Health/33); The ILO,' Occupational Health and Safety byDr M.A. El Batawi (WPR/Occ.Health/34) • A certain number of written reports desc~ the main features of occupational health in individual countries were requested from participants and were subsequently discussed. These are available under the title "Country Reports as to the practice of occupational health in the Western Pacific Region, October 1967". All the above-mentioned reports and documents may be obtained, upon request, from the WHO Regional Office for the Western Pacific, Manila, Philippines. 2. 2.1 PLENARi SESSI(]f, 25 October 1967 (morning)' The development and extension of occupational health services in developing countries
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Dr A. BELL, in a general review of this subject, said that in order to convince governments of the need to allocate money for occupational health services, it migbtbe necessary to advance arguments based on coxu;iderations other than heal,.th, sUCh as productivity. In developing countries, the reduction of absenteeism amongst skilled factory workers was particularly important; the same was true on the land where environmental conditions were often of a lower standard. Many countries were industrializing: the proVision of occupational health and safety services should be regarded as an integral part of that process and planned accordingly. The staff of industrial development organizations must be informed. on occupational health matters and thus be able to help educate both management and men.
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Particular attention should be paid to small factories where occupational mortality andmor.b1d1ty rates were usually particularly high. In many countries an enomous increase was to be expected in the numbers of such factories, which were of major economic importance.
- 4 potential lll...tteots ot urbaN _tion and indwstriali..tion sbould not be torgotten. Industry had definite responsibilities in that reprd. ')he
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']he aims of oocupational health had been variously det1bed; the tacets of this disoipline were numerous and resources otten 11m1ted. At first it might therefore be neoessary to seleot a tew Priorit7 itelllS. To practise general medioine in a taotoI7 was not oocupational medicine; there must be a strong preventive component.
Betore an occupational health servioe could be estabUshed, several basio matters had to reoe! ve oonsideration; tor example the extent and nature ot the indwstries ooncerned must be known and an inventoI7 made ot existing national resources for the proteotion ot the workers' health. 'lhe known incidence ot oocupational diseases or aooidents was not necessarily a suitable 7&rdatiok for measuring the need for suoh a service. '!be relationships between the occupational health progrume and the general medical servioes ot the area must be studied; in some countries there were great advantages in integration, where that was possible. ']he pattezn ot governmental occupational health prograumes varied from countI7 to oountr,v. However, in general their main tunotions were the tormulation and administration ot legislation, the inspection of working oondi tions, the correction of deteoted deteets, eduoation, training and research. Because in most oountries of the Region oocupational health servioes were poorly developed, itm1gh.t be advantageous i f regional training taoilities oould be established. '!hese would complement international assistance activities such as stuQy tours and the provision of fellowships. 'lhe need tor efteoti ve oo-operation between the faotory doctor, nurse, industrial hygienist and the general praotitioner oould not be over-emphasized. Many others, such as faotory inspeotors, were also directly involved in the provision of good woridng oonditions.
'!he influenoe ot ocoupational health institutes was enonDOus; since the initial cost of setting them up need not be great. it was doubtf'ul. if any industrializing oountry could afford not to possess such an organi. .tion. In conolusion, Dr Bell drew attention to the major contributions that ergonomics could make in industry in both developed and developing countries. 2.2 'lbe oo-ordina:t1on ot oOcupational health servioes with national. health servioes
2.2.1 Dr J.R. HIRSEIIAN said that occupational health servioes were established in II'IIU\Y different W8¥S in difterent oountries,
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and i t could not be said that there was only one correct pattem.
'!here must be effective oo-ordination between the various national authorities oonoerned, such as departments of health, labour, mines and agriculture, partioularly in cases where statutory responsibilities and fields of action were diVided. Co-ordination was also important in fields related to occupational health such as air and· water ·pollution and the health aspects of zoning and industrial planning. In that regard, there was need for oontaot between occupational health personnel. national planning adm1nistrations and, sometimes, produoti vi ty counoils. While the required inter-departmental or inter-ministerial oo-ordination might be obtained through liaison offioers, the speaker suggested that better results would be aohieved through a national ocoupational health and safety oo-ordinating oommittee oomposed of' all the various authorities, eaoh represented at a suffioiently high level. 2.2.2 Dr M.A. EL BATAWI pointed out that, as conditions of woIic: and labour greatly affected oocupational health, factors such as hours of work, wages, labour adm1nistration, woIic: relations, economic stability, etc. were important for both health and productivity. Co-ordination was therefore required between oocupational health services, public health activities and labour development progr&l1llles. In realizing the above co-ordination, there was, however, a danger of creating services in one government department which duplicated those already existing in another. It was preferable to direct efforts towards the strengthening and co-ordination of available services. Liaison could be assured either through committees meeting periodically, or through close and regular contaots between off1oials representing different aotivities and profess10ns • ." .
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'!he International Labour Organization, occupational health and safety
Dr M.A. EL BATAWI said that the International Labour Organization had always attempted to ensure that woIic:ing for a living did not enta1l being subJeoted to what was hanuf'ul or intolerable and that industrial production was safe and healthy. '1b realize these obJeotives, the ILO undertook three major categories of actiVities: ConventiOns and recOllllJendations of basic standards and principles: Research, education and the spread of information and technioal experience: and Technical co-operation with different countries.
2.3.1
Convent10ns and reoommendations relating to oocupational health
Early in the oentury, the ILO had made a recOlJlllendation for the establishment ot govertlllent services to safeguard the health of woIic:ers. 'lhis had been followed by the organization of labour inspection in industry and oommerce in order to secure the enforcement
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- 6 of safe woricing conditions and the provision of means of control ot hUa't'dous exposures. A model code, indicating the known standards, bad been recomnended. Numerous other ILO conventions and reOOlllllendations ex1ated on such matters as the employment of women and children, WOntel'll' compensation and rehabilitation, the health and seourity of seafarers and dock workers, the sate use ot ionizing radiation and certain toxic subatanoes. ~ had served as the basis for leglslatlon. As a reoent example, Dr El Satawi mentioned a Convention and a HecOlllllendation on the DBX1mum load to be carried by one person. 2.}.2 Hesearch, eduoation and the spread of information
A new Enoyolopaedia of Occupational Health and Safety containing approximately 850 articles was in preparation. '!he speaker went on to describe the International Ocoupational Safety and Health Information Centre (CIS) which abstraoted the scientific literature and published a regular series of cards and bulletins of use to research and field workers. '!here were also the well-known ILO publications produced after expert meetings on different subjects such as agrIoultural health. An expert panel on the safe use of benzol had reoently been held. In 1967 the ILO, in collaboration with the International Social Security Assooiation, organized the Fifth World Congress on the Prevention of Occupational Accidents and Ddseases in Yugoslavia and, with the Government of Czechoslovakia, a soientifio meetdng on ergonomiCS and maohine design. A meeting of heads of offioial services for occupational health and safety was to be held in November 2.,., Teohnical cO-Operation with developing countries
1967.
As examples of such activities, Dr El Batawi mentioned the Un!ted Nations Special Fund projects that the ILO was sponsoring in India, the United Arab Republ1c, 'l\tlicey, Central America and Brazil. In India, a Central Mining Research Stat10n had been established, and. the Central and Regional Labour Inst1 tutes in Bombay, Calcutta, MadraS and Kanpur had be.en supported by the provision of experts and equipment. In Asia a regional project in occupat1onal health and. satety had made good progress. ILO experts were being recruited this year tor Burma, Korea, India, Singapore and South Viet-Ham. 2.4 '!he World Health Organization and occupational health
Dr J.H. HIJ&IMAN said that the World Health Organization's progrumes in its six regions varied because of differences in the degree ot industrialization and in national characteristics. He did not propose to discuss the numerous general public health pro-
gnmmes undertaken, but would concentrate on speoific occupatIonal health issues.
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2.4.1
Headquarters activities
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The unit of Sooial and OcoupatiC'nal Health was established in 1950 and dealt with road traffic acoidents and certain aspeots of· industrialization in addition to its activities ~n the oocupational field. The Organization had set up a series of expert panels, including one on oocupational health and the health of seafarers. Prom those panels the Direotor-General seleoted members to sit on Expert COIIIIIdttees whose reports were authoritative doouments. '!he Organization also convened scientific groups. WHO publications such as the WHO Chroniole, Publio Health Papers, the International Digest of Health Legislation and the Bulletin all contained ocoupational health articles from time to time. WHO had set up many reference centres; one had recently reported upon "nonnal" values for certain toxic substances in the human body.
A few years back a programme for the evaluation and testing of new inseotioides had been put into operation; m.unerous toxioity studies had been oarried out. '!here was close liaison with other international agencies such as FAO and ILO. '!he Joint ILO,IWHO reports on oooupational health were well known. WHO was also in offioial relations with 68 non-governmental organizations; one was the Pennanent CoDlDission and International Association on Occupational Health. Grants were made to research workers and to institutes.' Great efforts' were devoted to the field of education and training which extended to personnel at many levels. 2.4.2 Regional aotivities
All programmes were planned two years in advance. Considerable emphasis was given to the education of medical and paramedical health workers and to the Organization's fellowship progr&\1lDe. Regional aotivities included conferences, seminars, study tours and training oourses. Whenever possible, WHO's oooupational health aotivities were olosely oo-ordinated with those of ILO. '!hey included, for example, advisory services to ChiIB (Taiwan) and to Viet-Name Before giving assistanoe to any country, an international organization had to receive a request from that country's government. WHO aimed to provide the best advisory services available in order to encourage, stimulate and assist governments to improve the health of their people. 2.5 Report on disoussion
The importance of the role of trade unions was emphasized; they should be partioularly aotive in eduoation. It was equally important to bring about f'ull co-operation between management and unions. Where small industries were concerned, it was specially
- 8 desirable that both should be teahn1cally informed oonoerning the benefits to be derived fXoom occupational health and safet7 88"lo.s, u th1s was indeed essential to co-operat1on and understand1ns between them. Unplarmed industrialization and urbanization were well-known to produce sooial and economio ill effects such as overorowd1nc and water and air pollution. Stresses and pathologioal states could arise, also. fXoom reverse migration to rural. areas when factories olosed down. OVerpopulation in ~ countries caused under-emplo7mente Some managements regarded that as advantageous as it then beoame easy to recrl.11t. cheap labour. but' it might have an adverse effect on the policies and activities of the ocoupational health service. There was therefore general agreement among the partiCipants on the advantages of fam1l;y plann1ng. The Australian partioipant explained how the fact that occupational health measures led to greater productivit7 oould be an effective weapon in the field of education and tra1n1ng. It was agreed that, although group cOUllll1ttees were a new oonoept, they should be encouraged as a help in the development of occupational health services. Such oOlllll1ttees should have an appreciation of ergonomics. Dr El Batawi stressed the need for regional applied research aimed. at determ1n1ng suitable standards with regard to safet7, ergonomic factors, and IMX1P1UD pel'1ll1ssible concentration values. Beoause of anthropological differenoes, the sizes of certain items of personal proteotive equipment should probabl;y vary from oount17 to oountry. The Singapore partioipant stressed the need to oonsider oertain oultural and sociologioal differences before drawing up standards. The h1gh and rap1dl;y rising cost of health problems resulting from industrial diseases and aco1dents was mentioned. Partioipants agreed on the importanoe of effective co-operation and oo-ordJ.nation between all workers in occupational health servioes. It was pointed out that III&I'll' different types of nursing personnel oould take part in such activities arter suitable tra1n1ng. Attention was drawn to the need for standardization of industrial hygiene instrumentation. The apparent racial differenoes in skin susceptibllit7 to dermatitis was suggested as a field for research.
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PIENAHlC SEBSIW, ?5 October 1967 (artemoon) Ocoupational health and safety oonsiderations in 8IIIall industries
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This subJeot was treated b;y Dr M.A. EL &TAW! who se.1d. that there waa no univeraal. definition of what oonstituted a "8IIIall" 1nd.ust17. In Japan, for in&Jtance, a small-sized anufaotur:lng 1Ddwrt1'7
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- 9 employed fewer than ~ peraona~ whereas in China (Ta1wan) it would. be less than 30. According to the ILQ, the dist1ngu1sh1ng characters of a small :1OO.ust17 were: (a) a closer relationah1p between the owner/ manager and the workers; (b) llttle if e.rl¥ specialization in the perfOl"lllance of ma.nagement functions; and (c) a smaller ueconom1o compass" of 1ndiv1dual. establishments expressed in terms of number employed, capital, products, etc. For present purposes, small plants were work-places run by family members with a few workers and a limited capital. Almost all types of industries were therefore 1ncluded, many of them hazardous. Not all used power~iven machinery. 3.1.1 Thepr1ncipal factors affeoting health and. safety were: (a) The lack of specialized teohn1cal knowledge among employers and workers. Poor construction of work-places and uncontrolled hazards. The disadvantaseous economic conditions due either to poor financial .support from banks or to competition from large-scale industry. Difficulties in obta1n1ngraw materials were an added handicap at times. The low economic level was reflected in wages, the employer's capacity to provide essential and often basic services and the standard of environmental controls. Moreover the low income worker could not afford medical care and had to depend. on state services which were often inadequately developed • The fact that in some countries labour protection legislation was not applicable to industries where less than a certain number of workers were employed. The ineffective .adm1n1stration of legislation establlshing proteotive standards and the lack of an adequate system of visiting and inspection of work-places. Legal action had sometimes to be instituted to secure compliance. It was often difficult to organize an effective system of spec1al1zed inspection, particularly for small estab-· . l1shments. The small employer experienced many difficulties in complying with the provisions of the law. Social factors such as a higher incidence of nonoccupational endemic dis.eases due to the lower health, educational and teohn1cal standards COlllllOnly foWld among workers in small plants.
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The importanoe .of amall 1ndustr1ea
Dr El Batawi stated that 8IIIal.l industries plqec1 an 1IIIportant part in total industrial production and also in the uational eooacIIIIY;
in sa. places they employed the great majority of the laboUr torce.
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Approach In dealing with the health and safety problems of 8IIIal.l in-
dustl'7an integrated approach was needed in view of their interrelation with labour problems. It was often necess&l'J' to make use of the available public health servioes; governments should therefore inol~ industrial health activities in the services provided by public health centres. In some countries an attempt had been made to establish occupational health and safety centres in areas where aggregates of small plants were located. Such centres undertook preventive medical examinations and exercised environmental supervision and oontrol. They might be adm1n1stered by government, management oo-operative sch_s, health insurance schemes, individuals, or 8117 combinations of those. In conclusion the speaker said that ocoupational health should be given prominenoe in the training of both managtDent and workers, and that an effective policy was needed with- respeot to inspeotion and legislation.
,.2
Legislation for medioal servioes
Mr S.C. YOCW said that the a1m of preventive medioal services in industry was the promotion and maintenance of the physical and mental health of workers and the avoidanoe of adverse effeots from their oooupation. A psycho-pbysical balance between the worker and his Job should be the goal. Effective measures included in-plant medioal examinations, med1calcare within available resources, the provision of first-a1d facUities, the supervision of work-places and protection against environmental hazards, health education and the maintenanoe and analysis of reoords. In Korea, the speaker said, there was a labour standards law requiring supervision of environmental safety and health conditions. There were also regulations requiring preventive medical servioes to be provided in industry, and health officers and. ass1stants with speoifically defined duties to be appointed in certain factories.
-11t
. Dr S. ISHm1 said .that·JII8l'I8g8IAents were respoMiblt' :tor ensuring that all their ampl.oyees were. given.a pre-ernplOJlllM.t·arJd..in saneinstanoes, a per1od±cali.health exam1.nat1.an.· In Ma¥ 1956•. the Japanese Ministry of Labour had issued .regulations providing. for examinations to detect occupaUonal.. diseases, and had des1gnated. the occupations and the exami nation methods. to be used. Factori1ts wb1ch did not have a tUll-time ·doctorwere .~red to arrange with a • private pract1tioner,mecUoal.Wl1versito¥ .,0rorgan1zation (e.g,··an . ocoupa't1onal. health serv1ce centre) to ,do.th1s work on their .behalf; the plants were visited.' Speo1allzed screening tests were USACl,·an/1 more detailed med1cal examinations performed. where neoessary. The type of e xami nat10n was suited to the hazard; for .lead. workers the screening test consisted of a v1sual inspection to .detect&n¥~ead line and todeterm1ne the' general pb7s1cfd.-appearanoe. Haemoglobin and urinary caproporphyr1n est1mat1ons Kere, also required. The more detailed e:ram1 nation included a l1ver function test, detezminat10n 01' blood or urinary. lead conoentrat1ons ·ando.l1n1ical tests of the oentral nervous system. In 1987. tenplEtr .oentJ ot' tbose.examined had abnoImal findings. ;,
., "
Dr CHEW pm .KEE sa1d that when.SIIIall factor1es were being. set up in Singapore in 1964, ~ .entrepreneurspreferred, .for var.1ous reasons, a ·location wtthin .the city ~area to one on the outlying in~ dustrial estates. Consequently, III\.U.t1ple-s:toreyed b1l1 Jd;lnp were erected,. each able to house aeveral .. ~'tor1ea ... ~.,,,development resulted from three main faotors: l1m1ted land availability, the prox1m1tyof large populations and the part1c\llaz! eoonomic oonditions of small 1n4ustries. Flatted factories would appear to be suitable for SIIIall-soale and light industries fl'Olll the points ot;. v:Lew of capital costs, easy labour recru1~t, transport and the provision o.f a good ·worldng environment. An in-plant medical service became possible. by. pooling resources. Among the disadvantages of flatted factories, the speaker mentioned their unsuitability for trades emitting fumes or causing exoessive noise.
}.5
Ooopt:1onal health .centres.in- New·.Zealand ...
Dr A.H. PAUL said that a 1947 survey on the Wellington waterfront had l'evealed a deficiency in f1rst~ sel"V:fices ,and led to the establ1abMnt· of a oUnic where rn:Lnpr inJuries cCOUl4 he treated and moreaer1ous ones referred elsewhere. Apart .f'roaI pravW.ng treatment . faoilities, one of the ma:1n purposes of an occupational. health service
- 12 anv~" practices and habits with a view to malC1ng employment healthier and safer. 'lbe first centre to be bull" specU'1oel ]7 'tor auob purpoaes was at P8D1"oSe 1n the larpat concentration -of SIIIall 1Ddustries in the oountry. ,It prov1d.e4- ol1n1c and pbp10tberapy tac1l1t1e8 and an .ud 1 ometric roaD, and was .et&fted by llUNe. and a v1siting 4ootor and phys1otherap1at. Working f'raD this and ten s1mi]er oentres, nurses visited factories point1ng out and repdrt11ls on hazards, (e.s., no1M), ·,..,..inins lead. and eleotroplat1ngworkera and tollow1ns up not1t1ed oases of certain 1ndwstr1al dise..e., And de1'ects tound ,1n the course 01' lII8d1oal exam1 n ationa of Juven1l.e.. All services were tree. '.L'he oentres were also used for eduoational meet1np.
was to alter the working
'l'he- establishment 01' a oentre was not oons1dered to be Justif'1ed tor fewer than 2000 workers within a half-mUe rad1wI. Develop1ns 1ndustr1al areas were surveted and sit.. for new centres were obta1ned early to allowbu Ud 1 ns toprooeed as soon .. warranted.
A lIIOb1l.e cl.1n:1c to .serve smaller areas had been tried );)ut, Dr Paul aaid, ha4 been d.1aoont1nued tor want of support.
J.6
'rhe role of an 1ndustr1al JIIed10al aasoc1at1.on
Dr Kro SANG CHO said that the sreat majority of 1nduatr1al workers in all dewJ.op1ng countries wereemplo;yed in - U plants most of ldUch had no orpn1zed 'lII8d1oal aervl.oe. 'rhey' were thus ent1rely dependent on any facUlties that III1sI;lt be prov14ed by the sovenaeator by an authorbed orpnizat1on. Moreover, there were not enoush sovel"Dllent-tra1nec11ruJpeotora to oover all such tactories. An 1ndustrial health and safety aerv1.ce was essent1al for an effective health prosraume. It m1sht be adm1n1stered,as in Korea, by d1str1.ot 1ndustr1al med1.cal asaoc1.at1ons wh1ch carried out surveys, made NOCV!!!!!McJat-1ons for the 1IIIprovement of work environment. and the detection of bothoccupatlonal and non-oooupat1onal d.1aeaaes, and. prov14ed an advisory health servioe to pbya1.o1.ans, employers and. inspectors.
..
J.7
R!POrt on diSCUSSion
It was po1nted out that in every oountry there were very larse numbers of small. 1ndustries ~ a wi4e range of artioles .ome of which showed the native artistio sen1us of the people. A detailed disoussion took place on Dr El Bataw1' sreferenoe paper (WPIi/Ooc. Health/J4, S88 1.5). 'lbe lWIIIerous oooupational health ,and safety problema of small. indUstries were reviewed and it w&spo1.nted out that a.Dbers of' the oooupat1.onal health team oUSht to
-13be reasonably conversant with the spec11'1o eoonom1o, techn1cal and
emplOJlllent diff1oult:1es faced by anagements. In many cOWltries it was difficult for several reasons t o '
inspect large numbers of SIIIall industries, even when that was required The question was raised whether, in such circumstances, an attempt should be made to increase the number of inspections or to visit factories not inclUded in the legislation. As a l.ong-term pol.1cy, however, it was thought that both l.eg1slation and inspect10n shoul.d be gradually dev~loped. In any case 1t was important for management to be aware of and to W1derstand the leg1slative provisions. by legislation.
The point was made that legislative action to institute workers' rights to compensation was urgently required in many countries. Sometimes medical and occupat10nal hygiene coverage was provided by private organizations, and sometimes by group clinics oonstructed by the government. The support of both management and workers was essent1al for success in all such schemes: the example of the centre at Slough, England was mentioned. It was pointed out that some financial assistance might be necessary' especially in the early stages. It was agreed that, despite certain noteworthY efforts, the occupational health re~irements of small faotories were inadequately met as a general rul.e. The roles of insurance and compensation authorities were considered. It was suggested that a start be made with medioal schemes linked with publ.1c health oentres and providing a few services such as medical examinations. Stress was laid on the importance of educating both workers and management to understand safety and health problems and the reasons for the oontrol methods required. SUch tuition should be included in management development progr8111118s and vocational training courses. The importance of occupational health and safet;r should also be appreciated by the staffs of vocational training institutes, international technical assistance projects and small business adviSOry centres. . The very dangerous and unhealthy conditions frequently existing in small factories, espec1al.ly. 1n developing oountries, shoul.d be ",iven particul.ar attention, and the nature and magrdtude of the resu1ting problems shoul.d be assessed. Although some surveys had been carried out, more were'required, especially among the very smallest factories lUlich it was not custaJl8ry to include in such investigations. SUrveys shoul.d be care~ planned and not be larger in scope than .was statistioally necessary. The suggested survey would require to be given some arbitrary numerical definition. It was
.. y
- 14 -
ooaa1del'ed that it abould 1Dclude as ~ S1'O\1P8 01' workers at epec1al. r1ek as possible, since certa1n sroups were eoonau1cally 1IDportctt even tboush not nUlll8r1cal17 large. In view 01' the tacts alreIId;r known, soverm.ats and. ."el"Jbod¥ else coneemac! abould slva turtber 48ta1led oons1derat1on to r-ed1al control actions such as the foUowinCt (1) (2) ~a tor suitable t1nanoial ass1atanoe to be obta1ned. 1d1en 1o-plant alterations are needC;
init1atlon 01' certain co-operat1on schemu auob as: <a) sroup medical serv10ea; the cho1ce between the III8nIY tJPU avallable abould be cleteJ'lll' ned b7
local c1rcu.atanoes; and (b) flatted factor1es; 1t waa iq)ort;ant however that their occupational heal:th. safety and. aocial aspecta should be studied. 10 detail at the pl.a.nn1ng stage.
(')
oons1deration of the poISsible contribution that national pub11c health serv1ces could. make w1th rsprd to oertain aspects of occupat1onal health, espec1all7 where such service. were relat1vely large.
The leg1alative approach to the problems waa ci1aowssed., part1cularly 10 regard to countr1es where control legislation d14 not cover IIIIall plants. It waa thol.lght thatleg1slat1on could. be of value in the case of IIIIall plants provided that the larse number of
iMpeotors needed for enforcement was available. The major role of governments was emphasized. 10 a formal reoOlllllendat1on. The two reooamendatlons conoern.1ng ISIII&l.l industries IIIade by the 8 ....'nar following the above dlscwss10n are repI'OdUoecl 10 sectlon 1 of Annex I.
iI
... i
4.
PIBNAR'i
SF:SSItN.
as October 198Z
(morn1Pg)
4.1
The developeant and. extens10n of 1ndwrtr1al blgiene servloes 10 develop!M countries
Mr A.T. Jams aa1d. that 1ndustr1al exper1eDoe was essential for effioient 1ndustrial ~e work. For the bl'PeD:tst to O&rl7 out an effectIve 1nspectlon he must make a cOlllPreben81ve stUllY of the manufacturing process 10 order to determine 1Ihere 1nha1 ation and/or other exp08Ul'e8 occurred. The effectlveness of e.x18t1ng control measures, such as local uhau8t ventilation, must be
cletel'lll1ned.
'- 15 ~c,.:tn ,~. ~~.!'M~~~_~,t_~:D$:~'IIIIJQ~.a.b8o_ion route: breathing zone samples must be t~~Lf.9l"3Utt..~~nt ~iocls
'"
of time to be reasonab~ representative of total exposures. Extensive sampling at general points throughout the' work area was usually unnecessary and tended to' compl1cate the question and delq results# with the risk that industry III1aht underestimate the importance of the problem. The analJtioalresw.ta obta1iled should" be related to known facts of tox1cology,s\lS88stec1 Standards and other, considerations. For example, in maldng en average dust evaluation, the dust Qonoentration JIIU8t be' known, 1ta ailica content determined, those particleain the respirable range evaluated, and the~t related to a standard. suggested tor the Particular 1nBtl"Ulllen't used. ' In many instances, standards quoted in the literature were based. on h1sheff:1c1ency collection JDethods Which were not alw~a available. This was the case with SOllIe ot the CODlll8ro1al~ procurable gas and vapour detection tubes that were of'ten uset'ulf'or preliminary investigations. All instruments used JIIU8t be calibrated an4ma1nta1ned to an acceptable standard of' aeoUl'aQY. The ac1ent1fiQ f'1nd1ngs must be correlated with the medical OMS'; the latter Wer. ot' ,the utmost value indeterm1n1ng suitable threshold. Um1ts. Among the oontrol methods to be· considered were the substitution of' less toxic materials where possible, rotation of' employees, enclosure of' the process, efficient 10Qal exhaust ventilation, wet or vacuum cleaning and, lastly, the use of' eff1QieJlt pe.~onal protect-ive devices. . . ... , ..
The exposure standards used and Qontrol methods suggested should be .pted to the eoonomio ·strength of the undertaking cone.mad. Ready aocess to instrumentation, l1terature and ~ical facUlties was necessary f'or the development of an effective service. '
4.2
Practice of induatr1al hYgiene in the Phllippines Dr J .B. AI.H<IfrB said. that in his.Country 1ndustrial hygiene
was re:J.atively young; asa govel'rllD8Dt,act1vity it had started in 19" when the Seotion of Industrial Hygiene had been oreated in the Bureau of Health. Its main fUnction was to protect, ma1ntain and promote the health of the ga1n1'ul.~ elllPloyed b7 exem1n11'18 environmental conditions in the workl'oQIII, controll1n& hazards, and preventing oCQupational dise&$es. In 1957, the Section had been converted 1nto a Division rand divested of most of its field work. It provided advisory services to regional industrial.hygiene wnts tIlnch were vesteel with line fUnotions, and it W14ertook .SOllle research.
• - 16 4.3 Th! d!Velopment and extension of occupational health nursing in. AAYelop1n5 cOWltri.es
..
Miss R. ~ said that with the rapid development of general pUblic health legislation and activities in Asian cOWltries, interest was also developing in occupational health. Most of the many nurses working 10 industry were not praotising preventive oocupational. health nursing, but were fWlotioning as general nurses, assisting dOctors and giving medical oare. Difficulties resulted from staff Shortages, the extremely Wide demand for general public health nursing and the lack of suitable training facilities. A specialist occupational health nurse should nevertheless be included as a member of the team as soon as possible. Some specific occupational health training should also be given to industrial nurses; their enthusiasm was not in doUbt and they should be encouraged to play a more active role. One way of providing some degree of medical coverage in. small industries was to make use of the nurses of the local health service who could, for example, assist with examinations, do health COWlSelling, inspect first-aid facilities and check up on factory hygiene. The pUblic health nurse already had many of the required qualifications.
4.4
Occupational health nursing in the Philippines
Mrs L.R. PEROCHO said that since 1933, a nurse had been employed in the Section of Industrial Hygiene of the philippines .Bureau of Health. She assisted in research and in the medical examination of women workers, she collected specimens for pathology aysmination and did health education. As a result of the reorganization, the five pUblic health nurses in the speaker's offioe subsequently acted as consultants to outside industrial nurses, taught trainees, implemented the RepUblic Act 1054 (which required management to employ a nurse for 30 to 300 labourers), detected hazards, and assisted in research. In private oompanies and factories the nurses kept the required stocks of medicines and gave emergency treatment as required by the law. Many worked Without medical superviSion and dispensed medicine, making the necessary referrals. If a full-time physician was employed, the nurse assisted him in his work. UnfortWlately, few nurses did either plant tours or home viSiting.
...
It was regrettable that there were no courses in occupational nursing; however, the Division of Industrial Hygiene invited nurses to the occupational health seminars that it organized. The Department of PUblic Health Nurses of the Philippines Nurses Association had recently sponsored a seminar on industrial nursing whose participants agreed on the need for special courses on the sUbject.
,.
I
. I
- 11 4.5..
~.
. Part1.c1pams agreed that team :work1l&8 esaent1.al to·the develQpDant 'of: 1nd1,Ultr1al.b:1g1ene;. there. JllUSt be an· 1.ntercbanp of teebn1oal1nformat1.on knowledge . aDd 8xper1.enoe·,between thephJ'alotan and b;ygien1.st. S1m,ple obser¥'aUon of·:the. 1'acto17 env1rollment .... ~a necessary step before embarldng on deta1.led 1.nvest1gat1ona and meuUl'Ul8llts. It waa oona1.dered ,important that both· 801ent1.f1c eval~tlonG ·and reports to III8I'lI!IgeIIInt ooncern1ng1.napect1.ons shoUld beeoQUl'ate 1Zld, 1.f' p0sa1ble, eoUatedwith,'the med1Calf1nd1ng8~ .BQ&1fD~r,1ng contrel _1C.8· given 'to IIIBD8g8IIIIItJ mwrt ~be' asd.etdled and helpfulu posaib-le.. 'l'h18 .was par1i1oul.arlJ' 1mportant.in d~()P-1ns OOUQ.tl'les wh4Jre .tbebygieni.stJll4.gbt be the onJ.7 sp801al1Bt on matters such as local. vfUltllat1.on aDd Ught1ng. SUch knowledge was part1cularly valuable where applied at the design and planning ~~.
.
In.'l1ewof the comparative lack of 1nt'oraaaUon, lmowledge and expertise on methods and dif'f'1cultiu arising f1'Olll the use and maintenance of 1.nstruments, emphasis should be placed on simply perf'ormecitechn1q,ues. It Wa.JI. at-,.ted that aciYlce on instrumentation, a.nalTt1.oal prcoedures and. s~11ar matters could be obta1ned'from sources suchai3: thel'8j)resentat1v" of reput.able 4Cl11111eJ'cial manutaot~rs of instruments, fNm tbe. hRlen1.oguide .aeria8 and ·other l)UblJ.0ationa. of the. American ~ri.al ~giene~ Aaaoo1.at1.on, from agenoies such as the International Union Chem1~ry, from the International Labour World Health Organization. Advice as to health and hygiene literature could.' also the above international organization&. of' PUre and Applied Organization or frail the the ava1.labl. occupational be obtained frOIIIeither of
and teaching facUit1.e8 was repeatedly eiDpbaa1zed. It might be . pos81.ble to develop. ~J.'c,~ ~8t1.J)g regional, facilities for .obt&1.n1zlg spare p~ for..1.nstl'Ulll8nt~\'lete~ atan4ards and making . prec~s ava1.laPle for j,.nve~1gation and' analy8i8. In furthering co-operation, . attention should be given to certain. anthropological, cultural and social s1.m1larities in countries of this region.
The need for regionalco.:.operatlon
aDd. r8s1onal. tra1n1ng
Explanations weresiven conce~ ~e \1Be of'WHO's revolving fund .to .enable 1natl'Ullllmtationto be p\U'ObA!.Sed when d1tf'1cult1ea arose due to the non-av&1i,aoUity of',oertain cur:reno1ea •.
4.5.2 1
Nurses
It was pointed out. that the role of the occupational health nurse depended on ~ factors and in aome countriea might be a major one; as a member of the occupational health team, she coUld often
- 18 make specific and important contr1bl.1tions of her own. Although her main function had usually been to assist the doctor, she must as quickly as possible be given the opportWl1ty to pla¥ a wider role.
•
•
In some coWltries suitably trained male nurses played an important part in curative and. preventive health services in industry and. on plantations. When the nurse was the only medical person in the taotoZ'J',. she must take a leading part in initiating occupational
health activities inoluding the inspection of sanit&Z'J' aoOOllll104ation, canteens, etc. and the investigation of accidents. The nurse was able to establish a close rapport with IIIIUl¥ of her patients. 'lhis contact with employees and their families was of fUndamental importance and provided opportWl1t1es to discover situations that ot'ten threw l1&ht on specific occupational health problems. Because of her detailed knowledge she was a suitable person to compile statistics for reports; however, abe might at first require expert
guidance as to the most suitable presentation. The nurse must co-operate closely with the hygienist, safety officer and factory inspector. She could plEq a part in public health prograames and in mass inoculation campa1gna, in addition to doing general health education work. The use of the public health nurse to perform occupational health work, such as in-plant follow-up investigations of notifiable 1 nations of diseases and in,)ur1es, and of the results of medical e:....m juveniles, was discussed. Such activities provided a suitable entry into industry and led to opportWlities tor wider preventive activities.
5.
PLENARi SESSIW,
21
October 1967 (morning)
.
Undergraduate and. postgraduate medical edUcation in occupational health Dr Q. SMmi said that most educators agreed that doctors should. have some knowledge of occupational health and bygiene; however, there was some controversy as to the stage of the student' s curriculum at which lectures should be given, and the contents and method of instruction. Occupational health waS a part of public health and should therefore be inclUded in lectures on public health or on p-eventive or social medicine. It was reasonable, moreover, tor a university occupational health Wl1t to be established in a department or school ot public health. Because of the clinical aspects involved, an occupational health Wl1t might not be out ot place in a department of medicine or even in a hospital.
- 19 (a) Undergraduate educaUOIl
In Australia occupational health leotures were gene~ given. in the penUltimate undergraduate year, the time allotted. varying t'rom five to seven hours. In addition, industrial excursions were sometimes made. The Occupational Heal.th Unit at the School of Public Heal.th and Tropical. Medicine of the University of Sydney was the only fUll-time university unit of its kind in Austral.ia. In undergraduate courses there should be scope for more than d1dactic instl'\.lCtion; for example, suitable references to occupational heal.th abould be made in the curriculum both in the pre-clinical. and in the clinical. years.
(b)
Postgraduate education
Such instl'\.lCtion might take ~ form either of abort refresher I courses or more special.1zed ones, leading toa diploma. In Sydney the three week's occupational health portion of the D.P.H. course was given; other medical. graduates could attend. In addition to comprehensive lectures, visits were made to a variety of industries. There was not yet any diploma course in occupational health in Australia. I
In conclusion, the speaker stressed. the point that industrial physicians (USing the term in its widest sense) ought to continua self-education activities.
5.2
The education and. training of industrial hygienists in developing countries Mr A.T. JONES said that, in view, of the complexity of the
problems encountered, the industrial hygienist should preferably . be a university graduate in a technical !ield such as chemistry,
physics, or physiology. It was, however, possible to give persons with a lower eduoational baokground a satisfaotory training in a limited number of oocupational hygiene aotivities such as dust counting. Training in industrial hygiene must essentially be practioal, includ1ng numerous industrial inspeotions. Due attention must be given to the use of instruments, in the !1eld and elsewhere, and to analytical procedures. The trainee should do in-plant evaluation work under oapable supervision. He must also be taught how to interpret his results and to relate them both to the medioal t:Lnd1ngs and to phySical standards. His approach to specific problems must be unbiased. !
.. - 20 I
Tbe uses and 11m1tations of personal protective equipment IIIU8t be demonstrated and the baSic methods and des1gns of effective eng1neering oontrol IIIU8t be tausht. The induatr1al Jv~ JIIWIt realiZe the necesslty for continUed self-tra1n1ng. He IWSt aleo be instructed in legislation and industrial safety. Only i f be understood the respeotive roles and responslbUities of all others engaged in occupational health and safety could he assure liaison with them when necessar.y. 5.3 The tra1ning of occupational health nurses
Miss R. sl{YNXJXRvI said she would only deal with one of the four basic education needs defined at the joint TlIJ/WHo Seminar on "Nurses in Industry" held in London in 1957, i.e. specialized training. To practise occupational nursing effectively, the nurse must reoeive specialized training and have detailed information about certain aspects of industry. An incomplete list of sUbjects to b(I taught would include health education, the techniques of interviewing and counselling, the effects of the env1ronment on health, toxicology, sociology' and certain general medical subJects. The nurse must also be shown how to adapt her nursing sk1lls to the requirements of indUstry. The opportunity to obtain practical field experience under the skilled guidance of her teacher would be a fUndamental part of her training. In certain countries, some of the above sUbjects were included in public health nursing training though not given detailed treatment. In countries wltbout such oomprehensive courses short or part-time instruction based on the general outline given above should if possible be introduced into pUblic health nursing oourses and should also be provided for nurses working in industry. Nurses should also continue selt-education and attend refresher courses.
'&
5.4
Is there a need for regional occypational health training oeatres and co-operation?
Dr A. BEIL said he wished, first, to emphasize the need for self-training. A university graduate should be able to succeed reasonably well in such an effort and even to progress to some extent beyond his undergraduate subject matter. For example a medical man with access to engineering textbooks and journals should be able to learn enough about ventllation to solve lIIost of the practical field probl.s encountered. This would be particularly-valuable -When trained manpower was scarce.
-21Within departments, certain pro.tessional staff should add to their broad knowledge by specializing 10 one or more aspeots of oocupational safety and health; difficult field problems should be channelled to them af'ter preliminary enquiry by colleagues. Each departmental "specialist" should then "educate" his colleagues as much as possible. Much had been accomplished, the speaker said, by fellowships granted by n.o or WHO. However, more might be achieved if it were possible to set up suitable local training facilities which at first would have to utilize overseas experts. Such a scheme might be cheaper and more effeotive, despite initial difficulties. There would always be a need for personnel to go overseas to obtain specialized experience but, in the speaker's opirUon, not for generalized occupational health and hygiene work. If 1t were possible to establish a training centre in the region, co-operation would be strengthened, tra1ning eventually 1mproved and made cheaper, and ad hoo advice more easily obtained. He was, he said, not necessarily being critical of all tra!n1ng given in some of the highly industrialized countriesJ many excellent results had already been achieved. If a regional centre were to be established, the question of its lQcation arose. Should it be all in one country or should different sections be placed in two or three countries? The latter could offer many advantages. There were major cultural, social and economic differences between groups of nations and the practice of occupational health in many developing countries differed cons1d.erably from that in highly industrialized countries. It was important for teachers to be thoroughly familiar with local environmental and social conditions and pUblic health problems. Therefore fullest use should be made of well-trained local graduates. Many who had attended oourses overseas found, for numerous reasons, that much of what they had learnt was not applicable .in their own countries. There was likewise no point in teaching a man how to use an expensive 1nstl'l.lllleI'lt if he could not obtain or maintain it upon return home. During tuition some emphasis should be given to 1mprovisation and the ability to use comparatively inexpensive instrumentation.
Some questions which Dr Bell thought to need. considering were: Is it better to send one man overseas for one year or two men tor four months each? Is there a need for inexpensive correspondence courses?
5.5 (a)
Report on discussion Doctors, Undergraduate and post-graduate
The following pOints were made: Careful cons1d.era~ion should be given as to when occupational health was taught; if too early. students might not have adequate clinioal knowledge
- 22 -
and 11' too late, it might not have the same appeal as clinical
subjects. It was reported that a post-graduate diploma course in indUatr1al health was avaUable at JJuDed1n, New Zealand; th1a occupied a t'Ull academic year except for those already hold1ng the D.P.H., in which case it was for the last term only. There was also a D.I.H., course at the All-India Institute of Hygiene, calcutta. Courses should be planned. to take account of the urgent need for appl1edresearch into the maanitude of local occupational health problems. (b) Industrial hygienists
Details of available courses could be found in the n..o "Directory of Courses in Occupational Safety and Health". Some knowledge ot certain aspects of medicine was necessary to enable hygienists to apply their scientifio f1ndings to work situations. (c) Occupational health nurses
In-service practical training was essential and nurses should be taught audiometry and certain simple pathology laboratory techniques. (d) The need for regional train1ng oentres and regional co-operation in occupational health . II
It was considered that there was a definite need for regional training centres because training facilities were inadequate in III8lIy of the countries represented, and because the instruction received in highly 1ndustrialized oountries was not necessarily pertinent to local conditions. In addition, it was stressed that most oountries served by such oentres would have similar conditions of life and work, similar values and standards, and similar resources for developing an occupational health service. This idea was not new. Centres had been set up in India, with financial assistance from the UNDP Special FUnd; four institutes had been establ1shed one of which, the Bomba.Y Central Labour Inst1tute, oould now provide regional training courses in occupat1onal health. It was emphasized. that in developing such centres, the greatest possible use should be made of well-trained personnel ~ in the region or in neighbouring countries. Among the services that should be available in such centres was the provision of standard analytical solut1ons.
II I ,
, I II
-~.Dr Hil'S'hman eJCpressed the :interest of WHO in the ideas put
El Batawi stated that regional co-operation in training, other aspects of occupational health had alW8¥S been of special :interest to the ItO, and cited the example of the Reg1ona1 Project of Occupational Health and Safety 1n Asia. The latter had started four years before to assist Asian countries to develop occupational health services, including training. The recOlJlllendations put forward by the Seminar following the above discussions are repl'Oduceci as Section 2 of Annex I.
fo~. Dr ~e~ and
6.
Pr..ENAm' SESSI~, 30 October 1967 (morning) The role of the doctor in an occupational health institute
6.l
Dr M. YAMAGUCHI said that one of the main functions of an occupational health insti;tute was to solve difficult safety and health problems that were referred to it; simpler issues could be investigated by the local labour or health officials or by a local occupational health service centre. When asked for his help, the institute doctor should go 1nto the field, investigate and interview everybody concerned. If necessary he should check the results of previous medical examinations and perhaps even carry out clinical examinations himself. Together with the industrial hygienist he should survey the working enVironment. Such studies also served as a source of information to the institute on current practical problems. There was a danger that too heavy a demand for the institute's services might leave it insuffic1ent time for other major functions such as research and teaching. A proper balance should be maintained.
..
The institute's doctors were there to provide the scientific background required by labour administrators when drafting legislation. They were also consulted when certain enforcement difficulties arose. 6.2 The role of industrial health centres
Dr C.F. KUO said that a Division of Industrial Health had been set up in the Provinc1al Department of Health, China (Taiwan), in Ma¥ 1964. Three industrial health centres, under the administrative supervision of the Division, had sUbsequently been establ.1shed in different parts of the country to enabl.e field activities to be carri¢ out more effectively than !'rom a central division. Each centre contained a laboratory and was staffed with a doctor in charge,
!
• - 24 a hygienist. one or two techn1clan8. a health educator. one or two publ1c health nUrses and a clerk. The Division acted as the planning andsupel'Y'isory organization; every two months a meeting of all key staff was held for purposes of co-ordinatlon and exchange 01' teohn1cal 1deu. The centre I s work lay ma1nJ.y:Ln large factories and CaJlPrieed the promotion of medioal services, :Lncluding medical facil1tles and examinations. health ecbloation, surveys, drawing up recOlllll8Ildations for the control of hazards and organizing tra1n1ng prograames.
Why oooupational medioal sel'Y'ices are not alWayS sucoessfUl Dr K.S. ClIO said it must be remembered that occupational conditions were related to levels of economic and sooial development. Even when there was sound. legislation, .progre88 would be slow unless the employers understood. the reasons behind it. Many unfortunately considered that the medical staff should only perfo:mJ curative work, whereas preventive activities were of fundamental importance. Greater attention should be given to occupational health tra1n1ng for undergraduates and medioal staff on the plant, as well as for senior engineering college students and others. Numerous difficulties arose from the shortage of medical and technical personnel~ whether goverrwental or otherwise. An improvement in their status would in some instances help to render their work more effective. Improvements in legislation were ~ frequently required.
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In conclusion. Dr Kuo reminded his hearers that all problems must be considered in the light of limited financial resources and that the first need was to find W8¥S of financing and developing
occupational health services.
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6.4
Legislation and enforcement
Dr A. BELL said that in some countries it might be poSSible, when economic conditions were favourable, to achieve IIIOre by persuasion than by the use of statutory powers. There was still a need, however, for effective enforcement procedures. In some countries that had been visited. health recommendations were completely ignored despite the existence of legal enforcement provisions. Because the inspectors employed were untrained, and for a variety of other reasons, It was often impossible to obtain worthldlUe results. Sometimes d1!f1ault1es arose because· of poor co-ol'd.1nation between departments.
Sometimes also enforcement mecbaniems were weak because governments did not wish to hamper 1ndustrial development. Although this lllisht be understandable in part, it was no excuse for certain
- 25 -
of the large factories visited to do little or nothing with regard to numerous severe hazards. Skilled labour was very scarce in many developing countries, and everything possible Should be done to protect workers from the risk· of injuries due to unguarded mach1nes~ to take only one sample. On the other hand it was true that lack of capital and the need for economy were vital considerations in· small industries. Senior administrators were often aware of enforcement difficulties but, Dr Bell said, unfortWlately often failed to have the matter thorol,lghly enquired into.
6.5
The industrial hygienist and enforcement
Mr A.T. JCNES said that the hygienist must have the facilities to give a realistic and practical service and to assist the government departments that had responsibil1ties in matters of safety, occupational health planning, etc.
In the field of legislation, the industrial hygienist could recoJllllend requirements and standards based on h1s field experience. An example given by the speaker was standards for face inlet velocities of exhaust hoods for spray painting. It was however preferable for the hygienist not to be direotly involved in enforoement as his freedom to carry out industrial investigations would be limited thereby. Although his status was that of an adviser, he should have the statutory right to enter industrial premises and take samples. His recOllll1endations .should be made to the legislative authority, to industry, and in some instances to unions.
6.6
Co-operation between the departments of labour and health
Mr P. BnNO outlined a problem that arose in some developing countries where the health, safety and welfare legislation was administered by the department of labour. The latter found itself unable to enforce certain provisions because it could not appoint its own medical officers. In other countries, it was the department of health that had the responsibility for providing occupational health services. Departmental resources should be pooled and co-operation developed where necessary to avoid costly duplicat1on.
Services dealing with general health, environmental hygiene and occupational hazards were inter-connected and it was often difficult to draw a sharp line between them. Frequently the reports of labour departments might be of use to the health authorities and vice-versa. Mr Jones also mentioned that an indUstrial health unit was being estab11shed in Singapore as a Joint enterprise of the Departments of Labour and Health.
-266.7 Report on d1soussion
•
Several W8¥S were mentioned. of' f1nanoing occupational healtb 1nat:f.tutes or centres. '!'hey m1gbt be wholly govel'ftll8llt-supporte4 through the department of health (as :f.n Ch:f.na (Taiwan» or tbzoouF the workera I compensat:f.on scheme fund (e.g.. the Japanese National Institute of Industr1al Health). others were privately f1nanoed.. :f.n whole or :f.n part; J examples were the centre at Slough. England. and the Hels:f.nld. Institute of Occupat:f.onal Health, Finland. However. when f':f.nancing depended. ent:f.rely on the econom:f.c climate of the contributing industries. the serv:f.ce would be exposed to undesirable fluctuations. SOIDe :f.nst:f.tutes obta:f.ned. extra :f.ncome from services d:f.reo.tly rendered. When th1.s was the only souroe of revenue. however, serious d:f.tticult1es might ar1se as. for :f.nst.anoe, when small factories found tbaaselves unable to P8¥. When the un:f.t was part of a university department, competition for fUnds might result :f.n f1nanoial l1m1tations. The proportion of time devoted by institutes to service. teaoh1ng and research varied both from oountry to country and fraD time to time. In developing countries it was generally oonsidered . that about three quarters of the available time and manpower should be devoted to field servioe and teaoh:f.ng, and the rema:f.n:f.ng quarter to applied research, preferably short-term. Invest1gat:f.ons :f.nto the 1nfluence of local conditions such as temperature and nutrit:f.onal status could probably be pursued to advantage, bUt many projects of basic or fundamental research were very expensive.
.
Considerat:f.on was given to the question of how long unsatisfactory cond:f.tions :f.n factories should be "tolerated". 'lbe point was made that d:f.ffioult:f.es might become WlBUnDOUlltable :f.n speo:f.fic situations if, because of industr1al considerat:f.ons, oorrective action was too long del8¥ed. It was agreed that med:f.oal and 1ndustr1a1 l1¥giene personnel should preferably be advisory, and that the enforoement of legislation. otten a consequence of their f:f.nd1ngs, should rather be ~ by non~cal :f.nspectors. Another po:f.nt made was that caution was necessary in 1ncluding detailed Randards. such as levels of lighting •.:f.n legislation since certa:f.n of tbem might not be applicable to particular Situations. Factory owners were otten antagonized when a series of :f.nveatigations, perhaps dealing nth the same problem. were carried out by d:f.fferent types of :f.nspeotors.
.to
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of the large factories visited to do l1ttleor not!I:tng-with regard • . ' to~l'O\JS ~ev~re haz~.,SWle<i.l~\U;' ~as,V.W SCllNe ,~ many developing countr1es, aid eve~ possib;Lj should t>e dOne to" protect, workers fX'Olll the ~~Sk Qf ~Ur1esdue to ~~JS, to ~ only one sampl,.·Ck) the ot,berbOnc11t was trUe t~t lack ' of . capital ~ ~ n.e4fQ~·eCoDQID,Vwe";V1t~ QoUs14erat~ons'1ii " ,'. smaJ.i 'indUst r1es .'SeQ!ojo ~rat~~·we~o.~~ awar. ot: '~~~e';; ment difficulties but, Dr Boll ea1d. lW'ort'uQatCi1r otten fa4ec1 t.o ' have 'the Jll8.tter thoro~9iiqu1rec11nto. " ., ". " " ' , :-c . '.
<,
6.5
The industrial hygienist and enforcement
Mr A.T. JCJ$'3~a1d that the h¥g1~t.~t,haVet.be 'f/WW,tip ~o give a realistic and practic~ ,serv.1oe atldto ~s1si ,:til,e .gov.~t departments that had re~1blliti~ in, matter.s of. 'afetf... ocQ~",·, . tio~ heali;h P~~ etc. ' '. , . , ,', , .< In the field of legislation, the industr1al hygienist cciuld' recolllll8tl4 requirements ,alxl ,st8ll4ards. paseci, on ~a ,f1e,l,d expeI11ence. An ~leg~ven by the spe.r was 'st~ to:r,f'aceWet 've~o~,~ties 0.1' ChAust 11o,~ ,for GPrOi pd.nt~. It was ho.~.r,prefef~".t~ thebygieii1st not to be .~re~tl.y1nv.oived1n ent';o.rQ/itlllent .'~'l;I,1s ,
free4QaJ to 'o~ out 1l1dustrial ~1nV~1p.tioQS ~ ~~mi~ ',., .' thereby.' AlthouSh h1B'stat~ was that of aO,v1ser,.. M. ,~u;L4 .l1a,ve t1\e $tat\ltory risht to eni;~r~ IU'OIII1ses and take ~slUpPle8"., .. His recOlllllenliations $hould ,btl, .eto ,1;he,.leg~lat1ve a.~thor1ty., to, . 1ndu8try~ and in SOlll& 1rist~o.es, to unions: . " ..
an
wollld
,
"
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6~6
countrleswherethe he&l.Ui,satety &nd weitare ~e~s~tion was ~' " adm1n1stered by the department of labour •. '!'he latter found itself unable to enforce oerta,1rlprodsi9PS ~~use ,1t could not appoint its oWn m8d1c&lof'f':lcers. In '0the.i-.o9)lrit:r:l,es~ 'it' wa., thedep8.rt,aaent of health that. nz;d ,tn." reSPQns.!QU1~y,·for IlfqyWng Qcq.t1onal . health8."i~es. DepartmentliJ.' resources' ShO~' be pooled ,8lld" ~ co-operation developed where necessary to avoid "costly duplication. Services dealing w1tbgeneral heal1;lH ,~v~ ~~ &rid occupational n:az'~ we:re 1nter-o~t~ 'an&iit .,as .otten:. ., d.1f'f'icult" to' draw a sharp'l!ne between·'them. 'Frequently ~"~~~ of labour departments might be of use to the health authorit1esand vice-versa. ltJrJ~el;l also, -.ntipMdthat, ~, ~~ l\e'\},th unit W&S; .~ing e~~l.1.aM,d ~~iIlsap.c>re as a J;o~ ent~!l:'Pr18e, ot .the ". ' Departments of lAbour and Health. . .' _, ,,- _ .; _,' _ _ • .~;.
'. HI' p .Bi'mo outlined a probl.eai that .arO~e in,
some .d.evei~1ll6
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6.7
Report on QlScussion
several wa.ys were ~nUoned of financing oocupatioilal be61:th institutes or centres. They might be wholly government-sUpported thrOugh the department of health (as in China (Taiwan» or ~ the workers' compensatiQn scheme fund (e.g., the Japanese National Institute Of Industrial Health). others were privatelY' financed, in whole or in part; examples were the centre at Slough, England, and the HelS1nld. Institute of Occupational Health, Finland. However, when financing depended entirely on the economic climate of the oontributing industries, the service would be exposed to undesirable fluctuations. Some institutes obtained extra inoome from. servioes direo.tly rendered. When this was the only source of revenue, however, serious difficulties m1Sbt arise as, for instanoe, when small factories found themselves unable to P8¥. When the unit was part of a univers~ty de~ent, competition for funds might result in financial limitatibns. The proportion of time devoted by institutes to service, teaoh1ng and research varied both from oountry to country and from t1Jlle to t1Jlle. In developing countries it was generally considered. that about three quarters of the available time and manpower shO\lld be devoted to field service and teaching, and the rema1n1ng quarter to applied research, preferably short-term. Investigations into the influence of local oonditions such as temperature and nutritional status could probably be pursued to advantage, bUt many projects of basic or fundamental research were very expensive. Consideration was given to the question of how long unsatisfactory conditions in factories should. be "tolerated". '!'he point was made that difficulties m1gb.t become unsurmountable in speCific situations if, because of indUstrial considerations, corrective action was too long del8¥ed. It was agreed that medical and industrial hygiene personnel should preferablT be advisory, and that the enforcement of legislation, often a consequence of their f1nd1ngs, should rather be done bY' non~oal inspectors. Another point made was that caution was neceSsat7 in inclUding detailed 8tand.ards,such as levels of lighting, in legislation since oertain of them might not be applicable to particular situations. Factory owners were often antagonized when a series of investigations, perhaps deal1ng with the same problem, were carried out bY' different tTP8s of inspectors.
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II II
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,
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I I
II
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- zr . The question of standards for maximum permissible conoentrations was also discussed and the differences between national values were pointed out. Experimentation on animals was said to be the main source of specific values, but the opinion was expressed '\.bat experience was a more reliable source if baIIe on prolonged. obaervations. The occupational health team required good laboratories if it was to carry out effective field investigations; it was an aclvantage for them to be under the d1rect control of the division or institute of occupational health •. I f use must be made of other laboratories, the service they provided must be adequate. PLENARlC SESSIW, 31 October
1967
7.1
Occupational health, productivity and production
To illustrate the relationatU.p between occupational health, . productivity and production, Miss R. sXYN1\JXRvI and Dr A. BELL presented a number of case histories \1Ih1ch, they cons1c1ered, would be usefUl to all occupational medioal personnel. Some had oocurred in factories \1Ih1oh, at first sight, had appeared excellent. Many might have been avoided by a good medical service, thus preventing disease and absenteeism. The owner of a Jewellery manufacturing factory decided to sell, as he considered business worries were severly affecting him mentally. In fact, he was suffering from oocupational mercury poisoning. (1)
t
(2) In a lead smelting works, numerous po1son1ngs ocourred amongst skilled production staff; the situation was aggravated by: the use of unsuitable respirators. (3) A large textile factory was fUmigated; one hundred and sixty cases of hysteria SUbsequently occurred, oausing a prolonged shut down. A:f'ter a reassuranoe was given that there was no further danger, normal. production resUlDElC1.
(4) One factory had a;,oo per oent. sldlled labour turnover due to epOJlY resin dermatitis resulting from poor handling tech1U.ques. (5) The owner of a very large sheep farm developed dieldrin poisoning and had to sell. Simple hygienic precautions \1Ih1lst dipping sheep would have prevented this. (6) Rapid. but incorrect methods of hand-packing cigarettes caused numerous oases of tenosynovitis and thus reduced outPllt. Although the work was apparently light, the girls actually l1:f'ted many tons a day.
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- 28 (7) Waterside workers often refuse to unJ.oad ships because of the presence-of strong-smelling spilt substances that are subsequently proved. to be harmless. (8) Pilots of aircraft used. to spray toxic pesticides have crashed. because their vision was adversely affected. by excessive absorbtion of certain insecticides; this can be prevented. by ~gular blood cholinesterase estimations. t
When a radioactive isotope is used. in industry for the first time, production is sometimes stopped. because of the workers' unjustified fears. This situation could be avoided. by prior assurances that adequate safety precautions had been taken. (9)
(10) The consultants had seen a factory where up to 20 foot injuries occurred per day; the basic cause was bad housekeeping. another, large numbers of minor injuries became septic.
• In
In conclusion, the speakers emphasized. that health counselling could reduce absenteeism due to menstrual disorders, minor illnesses and certain psycho-social conditions, and that medical examinations could detect early conditions such as occupational dermatitis, defective vision, unsatisfactory work postures and poor canteen food handling techniques.
7.2
Environmental aspects in productivity Mr A.T. JONES presented. the following case histories:
(1) Intense reflection from the argon welding of rail wagons affected. the eyes of 30 men working some distance away and caused. them to lose time. Production was stopped. for one week. (2) Urethane foam insulation being applied in a large workshop affected. 12 persons not connected. with the process. Three months' production was lost. (3) When reclaiming styrene foam by heating, workmen developed. severe irritative symptoms after only one day's exposure. This led to absenteeism among irreplaceable skilled. labour.
...
(4) In the manufacture of batteries, lead-containing dust passed through inefficient filters into the factory and caused. poisoning; production ceased for three months. Paints containing toluene were used. in the process of rustproofing ships' tanks. High concentrations caused. narcosis in fifteen persons and the subsequent mass hysteria severely disrupted production. (5)
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- 29 (6) Twenty-eight oases of asbestosis occurred in the course of the manufacture of insulation sheets. It was expensive to train replacements and output temporarily dropped.
7.}
Report on disoussion
Dr Batawi stated that occupational health was an essential factor in reducing the cost of production. Ill-health was not compatible with effective work, nor was machine disorder compatible with effioienoy. Environmental measures such as heat oontrol and noise suppression directly improved productivity, as did techniques of preventive industrial medicine such as preplacement and periodical medical examinations. Industrial accidents caused absenteeism, required treatment and rehabilitation, led to costly compensation and socio-administrative burdens and often ruined products and production tools. Dr Batawi went on to describe how in one factory improved lighting led to a 40 per cent. increase in the efficiency of letter sorting, and how in a haematite plant the introduction of dust control meant that the miners no longer needed to stop working for fifteen minutes every hour. He gave figures showing the staggering cost of workers' compensation in many Asian countries.
Mr Quinn said that figures released in Britain showed that industrial accidents caused a greater financial burden than strikes. He gave instances of accidents due to the deliberate neglect of safety precautions that were thoUght to slow down work.
!
Participants gave the following examples: (1) A plant employing }5 persons' disregarded safety requirements. Numerous injuries occurred and union pressure resulted in operations being closed down for several uionths. (2) In a large sugar mill a combination of sulphur dioxide gas and when ventilation was improved production
h1sh humidity was responsible for many cases of conjunctivitis requiring hospitalization; increased by one third. ,"
(}) In six factories using isotopes the health of several employees was affected and operations had to cease.
As a result of exposure to manganese dioxide dust in dry cell battery factories and in mines. 51 persons were permanently disabled. Control measures were expensive. but the compensation costs constituted a continuing burden •
(4)
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• A cement plant lost 15 per cent. of its production via the stack and in leakages. The installation of efficient electrostatic precipitators at a cost of M$ 1 million brought a permanent financial advantage to the firm.
(5)
(6) In Korea in 1966 there were 13 000 cases of occupational accidents and diseases including 295 deaths; compensation costs were us$ 1.5 million. Finally, stress was laid on the possible adverse effects of industry on the neighbouring population. In one instance mentioned, the disposal of waste products through storm drains affected the public, with the result that operations had to cease for several months.
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8. 8.1
GROOP DLSCUSSICN I, 26 October 1967 (afternoon) Public health problems in occupational health Dr Abdul KHALlD BIN BAHAN made the following points;
Particular public health problems were of special importance to some occupational groups; for example, malaria in West Malaysia represented a special hazard for rubber estate workers. Then again, some occupational hazards such as noise extended beyond the factory precincts and. might affect the surrounding community. Because public health problems were encountered in occupational health practice, liaison was necessary between the two services, and. particularly so in countries where trained personnel and money were both in short supply. Public health services could help to ensure proper factory construction, the control of nuisances and the proviSion of adequate sanitary facilities, to take only a few examples. For some of these problems legislative and executive machinery had been entrusted to the local health authorities. With regard to many agricultural workers, e.g., rubber workers, the public health service was already undertaking occupational health types of activity by dealing with malaria control, housing and sanitary facilities, and ensuring that adequate medical services were provided. The possibility of enlarging such activities should be further looked into. 8.2 Health edUcat10n
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Mr D.C. J<liNSON said that health education involved participation of government officials at various levels, management, supervisory staff, workers and. medical personnel. It could best be carried out when opportunities were made for the consideration of problems and
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• sol.1.tt1ons; through the nutual exchange of situational and teQhnical information in a climate fostering easy interchange of ideas. The members of the occupational health team must interpret technical knowledge in terms that could be understood by both ma.n&8e ment and labour. The assistance of a health education specialist could be helpful in planning and developing such aspects of occupational health programmes. Health education needed the combined techniques and skills' of the behavioural and communication soiences and of education, represented by specia11sts such as those from ergonomics, psychology and sociology. Training in health education methods and techniques should be incorporated in courses on occupational and community health.
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8.3
Health education and the occupational health nurse
Miss R S~I stated three fundamental principles that nurses should remember when participating in health education: (a) health education should be regarded as an int.egral part of every health progranme; (b) in the industrial setting health and safety education should be practised as a single entity. rather than separately; (c) the accepted basic concepts and techniques of education in public health should be used as a guide in undertaking occupational health education. It was important, the speaker went on, that occupational nurses should seize every opportunity to engage in health education activities, for the benefit either of individual employees or of industrial groups; such opportunities might occur during examinations, treatment and counselling. The nurse must take care that the principles had been thoroughly understood, and that up-to-date concepts were imparted. During her in-plant activities, the nurse was often able to advise on the main principles of accident prevention and on the necessity to provide and to use personal safety equipment.
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It was also the nurse's responsibility to instruct in first-aid procedures.
8.4
Report on discussion
There was agreement on the fUndamental importance of health education. without which no measures could be effective. All members of the team should therefore be trained in the combined techniques and skills of the behavioural and communication sciences and education.
- 32 . As factory OI8ll8gEIrs, supervisory staff and workers saw the world in different ways. the health educator must mow what 18 important to the particular people he is working with. Resistanoe to health education was met with in a hard core of perhaps six to e1shtper oent. of people in all social strata; it could of'ten be overcome by personal involvement of this minority on working committees or in some other way. Several participants mentioned the value of personal oontact. Each individual should be made to feel that the subject matter was of 1Dmed1ate ooncern to his own life and in the actual circumstances. In the absence of an ocoupational health service. consideration should be given to util1zing public health service personnel. such
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as public health nurses and sanitary inspectors. Some countries used social workers, health supervisors and officers; one oountry had an in-plant training scheme for supervisors. The part which independent organizations, such as safety associations and insurance companies. oould play in promoting health educat10n was outlined as was the place of the radio. cinema. television and press. A planned progr8.llllle in teacher training oolleges and schools was suggested as a long-term polioy.
9.
GROOP DISCUSSICN II. 26 October 1961 (af'ternoon) Industrial safety in developing countries
9.1
Mr A.E. QUINN said that inspectors in most developing oountries were too few in number. were of'ten neither technically qualified nor suitably trained and had few facilities. Because of lack of training, some safety committees and officers had no impact on accident rates. Many too readily blamed the worker instead of instituting control measures. Few countries had adequate safety regulations to combat the high rate of fatal and other accidents in building oonstruction work. Night work on sites was of'ten carried on in very poor lighting.
•
Dangerous power press machines operated by women or young persons were in most cases unguarded. Of'ten because of unsatisfactory environmental conditions, it was diffioult for the operators to be constantly alert against accidents. Some presses oould. be easily guarded; others required expensive and intricate interlock guards which were not available in most developing oountries. It should not. be forgotten that a number of aocidents had ocourred to children living on faotory premises. Cautionary notioes, etc. should be in langUages understood by all. Some safety posters were valueless because the messages were not clear or the required safety precautions were not stated.
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• ~e Asiarl rubber tyre and footwear industries presented. a number of problems, such as, the fencing of rubber rolls, fire hazards, and the use of certain toxic materials (e.g., leaded petrol).
In cotton mills two special problems were the use of old, second-hand machinery, often unguarded and imported from abroad, and uncontrolled byssinosis-causing dust. In addition, employees often worked. excessively long hours, often in conditions of unnecessarily high hl.lD1d1ty.
9.2
The role of ergonomics in develOPing countries
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Dr A. BELL said. that somebody in every occupational health team should have a special1;ed knowledge of ergonomics, which was the scientific study of theman/ma.ch1ne/work environment. This speCiality often made use, as yardsticks, of performance rates, the incidence of spoUt work, power consumption and job training times. It could help increase productiv:Lty.
From circulatory and respiratory responses it was often possible to define limiting values for heavy work. Some knowledge of functional anatomy was requ1red to advise on work-place lIqouts. Because of the importance of factors involving human jUdgements, individual differences and selection techniques, some understanding of applied experimental and occupational psychology was necessary. Attention should be concentrated on production-ergonomics rather than on products-ergonomics. Management should be educated by practical and simple examples as to the contributions which ergonomics could make towards improving the work environment; it could be pointed out, for instance, that anthropometric ally unsUitable work benches, incorrectly placed machine controls or poor visual presentation of information could adversely affect health and production. Occupational medical officers and ergonomists must co-operate to study certain specifiC s.ituations. Ergonomics should be an integral part of an occupational health programme.
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9.3
Report on discussion
The important roles of national safety organizations and councils and of safety committees were tliscussed. Safety comnittees, guided by a well-trained safety officer, should play a major educational role and assist in the control of hazards. The safety officer's regular duties were to inSpect, investigate and report on in-plant conditions and acoidents. He must
- }4 have a pleasant personality and try to develop safety-cor..scious behaviour .and attitudes. He should have an aotive training programme. With respect to the humidification of textile plants, it was suggested that· same of the very high levels deteoted might not be required for the industrial prooess. The hazards in the use of imported second-hand machinery were stressed. In Malaysia, industries which normal.ly enjoyed tax concessions were required to use new machinery. Some partic1pants thought that legislation should be a second line of approach; others believed that it was the prime factor in enforcement. It was pointed out that no Act was ever completely comprehensive, and incomplete statutory provis10ns in themselves might therefore be of comparatively little use and even constitute a hindrance to effective action. ~e right approach was always in the first place to &ive advice, to educate, counsel and convince management rather than to stress statutory enforcement powers. The change from agricultural work, and even from coamercial work, to industry often involved major psychological and physical adJustments; education and training were needed to prevent a high incidence of related accidents and diseases. An ergonomically-designed machine or industrial process was the ideal that should be insisted upon. An unsatisfactory work
c
,
environment created safety problems and reduced productivity. A closer study was needed of the question whether modifications were not required in oertain ergonomicS data obtained fram countries where race, culture and anthropology differed tram those of the region, in order to make them applicable to Asia. Sometimes overseas findings were clearly not applicable and required modifioation. Many examples were given of differences in work postures between races; not all were necessarily detrimental to health. 10. 10.1
, , ~
I
GROOP DISCUSSICN III,
?l October 1967 (afternoon)
Occupational health as a component of labour develOpment projects
Dr M.A. EL BATAWI spoke of the effects of labour problems on ocoupational health and safety. The economic conditions of factories innuenoed in-plant health services and environmental conditions. Employment stability, wages, hours of work, industrial relations and reoognition of effort were all important factors affectiog the weU-being Of workers.
,.
- 35 Labour development projects should be utllllzed- to promote ocaupa~~ healtll. and: ;~ety; . for example, education and tra1n1ng in both -sho'-1ld ~ a. part of vocatlonal.:. tra~ progr8111118s. Such was the case in m8.nY 'coWltriea, and it was tlle IIDls policy to , encourage activlt"ies of that . kind. Not~ons of ergonanlcs should be introduced '1Ilto all .productivity projects. '. . , . ' . . .' . Qocupational health progranmea. bro\lgh~ benefits to IJI&ll8S8IIIent such as. loweJ'absentee1sm and iiii::reaaed production., That fact must be stresaed arx\ example!!! given.·.' .... , .
•
Co-operative sChemes. wh1~ rui:J.ped ,8IIlall owners to impX'OVe thelr production and. d,i,s1:\ribute ~elr 'products, and,laboW,' proje.cts engag8d.in the-education of workers could bOth be utU1zed,t.o provide sel'l7ices otherwiae WlObta1nable. 10.2,
"~~
rrile .ofPllbiic, b~th
~~~ ·w
occupational
hWth
t
Dr Abdul KHALlD am BAHAN said that in Malaysia the basic t:ra1,ni.Qg of Public. health. ;tnspectors. cORlPrised eighteen .IIIOn1;hs of fleid. work arld,rifue ot'int&ruiive intr~ tUition, inCluding occ~t1,oDal health, , inte~persed wi:t;h field. visits, Afewsu.bseqUeirtl:y' a1:tendeci post,..~uate coursesabro~. They.could be val~:l.e. partnerS ,iIi .~occUpatl~ health team by assisting 1ri imProving the workerivi'ronment ari9.rel1derinS it. 88.t'er arid more ; comfortable; . they had. a role to pla¥1n the contrOl ofatr, w.ater and soU pollutlon and of occupatlonAl. infectious diseases suc,h as tuberculosis and the zoonoses. They also carrled out he8J.th education, .' were concerned in. the provision .. of proper s~tar;y facilities at work.;.plflces, and ensured that 'the houses provided tor the workerCi were of an adequate sanltarY standard. . '. . . .- . " '
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10.'
T@1BI5 of non;m,e<lical factoIT W2ectors and other 2!rsonnel connected with health !Pd. safetJ • J . . . . ___ . :
DrK.S. CijO PO:1nted out that the stevelopment' qf occupatlonal health services required.many types of t~personnel aiuong whom non;"lII~cal factQry ~pectors played an lmportant role. !rileY should preferably be gr~uatesand might tl?ere~o~ be, d1fflcult torecnut 1f th.:r:'$!'were n(i' ~teethat they would obtain speoialized posts atterwards. The1rtra1Il1rlg Should be praotiCal ~ applied. in character, should lead to a certificate and should include some general public health subjects. Regulat1~U,-i)erbe.1n ~riee·requ1.red· t'actorles to appoint phySicians, nurses and assistant health offlcers. Doctors and nurses should periodioally be given specialized training by means of courses, seminars and field visits. ,,', . ..
,
- 36 10.4 Report on discussion
It was agreed that education and training were the chief needs in occupational health. 1he training of factory inspectors was often unsatisfactory even in developed countries. A university qualification was desirable but not sufficient, for inspectors also needed to have a number of favourable personal qualities. There was considerable discussion on the respective roles of factory and public health inspectors in thel~ own and in each other's fields. Team work and effective intercommunication ~ere essential, each cross-referring certain problems. Public health inspectors could play an important ~ol. in small factories; in some countries their in-plant generAl emlrcrimental health duties were defined by statute. Reference was made to the 8IIIployment of health supervisors in Japan. Although not factory inspectors, they received some training and spent time in the factory carrying out health edUcation work and making control recOlllllendations. Details Were given of various educational schemes for workers and management J programmes could not be fully successful unless well-planned and repeated. In some places employers were required to inform workers about hazards and to advise them on safety. Employees should keep each other informed about hazards and protective methods; unions had an important part to play in that regard..
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Reference was made to the activities in safety educatiOn undertaken by workers' universities in some countries. It w~ pointed out that management should take all possible safety measures before insisting on the workers playing their full part. Penalties should be inflicted on law-breakers whether employees or in management. In the control of cOlllllWlity air pollution, there was a simple technical solution for many problems; health inspectors could deal with them after taking appropriate lecture courses. Effective liaison should be established between industrial hygienists and factory inspectors since both were concerned with air pollution either outside or inside the factory, and there were s1mUarities in the methods used by both for investigation and control. 1he recOlllDended in-plant threshold limit values were not however applicable to ambient air pollution.
11. 11.1
GROOP DISCUSSIOO "N,
27
October 1967 (afternoon)
The role of voluntary agencies
•
Mr SUK CHOW YOW said that voluntary agencies such as national safety associations could make important contributions to the solution of occupational health problems. Administrations should therefore not
-"77-
.. ~Ould to some extent compensate for shortages of professional staff. On occasion, also, V'oluntary agencies could draw attention to weaknesses 10 government policies and actiVities. They could define probleDIS, make recOlllll8nd.ations concerninS the development of industrial health activities and the need tor legislation, and influence official policies.· They oould also playa major educational role and undertake specifio activities intended to stimulate overall interest in occupational health matters.
he8J.tate to ..nliat their assistaz?ce, _as,in so doing they
•
The. speaker went on to desoribe the Korean Industrial Health Assooiation which was a voluntary organization grouping about 240 industrial ~ioiaris. It had olose links with the Seoul Industrial Health Institute and was able to utilize its faoilities. It worked closely with the Goverriment and. frequently undertook investigations on its behalf. It also oonducted training oourses. Two other organizations that worked. olosely with the Government in 1ncluatr1al andpublio health matters were the Korean Anti-tuberculosis Association and the Korean Fam:1l.y Planning Association. 11.2 The role of non-medical university departments
Mr A.T. JCHEB stressed the value of the assistance and 1ntonnat1.ontbat could be obtained from non-med.ical university departments on matters such as aPOh1:tecture and ventilation or pharmaoology and toxicology. Liaison with them should therefore be encouraged. In the speaker's own experienoe~ entomologists had .advised. on certain agricultural health problems and chemical engineers had lnv'estigated the nature ot fumes·· produced during certain types of welding. Moreover, university departments had on ocoasion undertaken important .research activities leading to effective in-plant control measures •
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11.,
Training of non-medioal inspectors
Mr Abdul AZIZ Bm AHMAD said that, in view of the nature of their work, s~ non-medical inspectors must be trained engineers and some techrdcians but all should have a certain amount of legal tr&1n1ng and a good background in incluatrial, if' not oooupational health. In the 10terests of effioienoy and economy, three grades had been evolved 10 Mal~sia:
- 38 Grade 1.
t
Qual1fication Mechan1ca1 Engineering
Training
Inspectors of Factory and Machinery ( to cover factories.and places with very dangerous machinery and processes)
2 years t post-graduate practice in design, operation and inspection of steam boilers, pressure vessels and lifts. 1 year departmental training in legal aspects, industrial health and allied subjects including short overseas courses and industrial administration.
2.
Assistant Inspectors of Factory and Machinery (covers factor1es and places with less dangerous machinery and processes)
Technical college graduate
1 year post college prac-
tical work, shop training and design of pressure vessels. 1 year departmental traininglegal aspects, industrial hygiene and allied subjects and officeadm1n1strative procedures.
3.
Junior Inspectors of Factory and Machinery (to cover the smaller factories and places with or without general machinery) • 11.4
School leaving certificate
1 year workshop training. 1 year departmental training legal aspects, industrial hygiene and allied subjects and office administrative procedures.
•
Report on discussion
There was general agreement on the important role of nonmedical university departments and the need to train Don-medical factory inspectors. It was noted that some countries had not given due recognition to the advantages to be gained in such ways. When few factory inspectors were available, governments should try to utilize less qualified inspectors for duties that did not require graduate qualifications. It was agreed that voluntary agencies, i f they had adequate financial resources, could also do excellent work and that close cooperation between government departments and others working in occupational health was essential in order to avoid mistakes and duplication of effort.
II
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- J9 12. 12.1 GHWPDISCUSSION V, 30 October 1967 (afternoon) Occupational health in agricUlture
•
Dr M.A. EL &TAWI said that there were many categories of agricUltural workers and all must be protected. Despite the considerable differences between industrial and agricUltural health problems, the basic principles were the same when it came to studying cause and effect, and the types of exposure leading to diseases and injuries.
•
The agricUltural environment differed. in many ways from the man-made industrial environment. Health problems were determined by . various factors such as poor water supplies and contact with animals. Social and economic conditions were also important; indeed it was necessary to consider the ~ole environment. Among more specific problems of agricUltural health the
speaker mentioned the following: (a) Infectious and parasitic diseases that might be contracted during work as well as in ordinary life. The zoonoses were in most cases specifically occupational; a classification had been put fonrard by the Joint JJ.JJ/WHo Expert Committee on Occupational Health (fourth report). A few, such as psittacosis, were sometimes occupational in nature. In addition to the diseases caught from en1mals there were those transmitted by water and soil. Acute or chronic poisoning, sometimes fatal, due to insecticides and other chemicals. Exposures occurred principally on rubber, rice and tea plantations. Dermatitis was common • Physical i'actors including climatic conditions, noise and exposure to certain dusts. Many farmers had to work in uncanfortable postures. Accidents caused by tractors, harvesting machines etc., or occurring as a resUlt of contact with wild life or with certain plants. Falls were common.
(b)
. (c) (d)
Many of the problems were difficUlt to deal with. AgricUltural workers were o:f'ten scattered over vast areas and in general the only available services were those of the public hea:lth department. The speaker suggested several possible l~s of action. One was for governments to control the use of toXic substances, ensure correct labelling, and require the employment of safe spraying techniques and of personal protective devices. Sound general public health
-40measures in the fields of san1tation, nutrition and health eclucation were also important. Specific occupational health action, 1nclud1ng periodic medical examination of those exposed. to toxic substances, work environment valuations and first aid were also essential. 12.2 Agricultural. field invest1pt1ons
Mr A.T. JONES said that among the numerous potent1al.ly barm:f'ul agricultural. exposures, many hazards SUCh as noiae and :fUmes f'rOIII
tractors, welding and heavy lifting were s1m1]ar to those occurring in factories. However evaluation techniques had frequently to be modified, and control depended largely on the use of personal protective devices. The asastence of farmers' associations or co-operatives was essential in order to deal effectively with hazards in agriculture. The speaker then drew partioular attention to the wide use of insecticides in agriculture and the need. to investigate the danger they represented. for workers. Breathing zone samples should be taken in factories formulating insecticides; it might also be necessary to evaluate skin contact. Sometimes the extent of factory contamination could be determined by taking samples fran ledges, etc. On farms. exposure oocurred. during spraying operations and it was therefore necessary to assess skin contamination as well as absorption by 1nhal.ation. In cases where breathing zone sampling was not possible, a new respirator cartridge should be used by the sprayer and later analysed for its insecticide content. By analysing fUter papers fixed at various bod¥ positions, spray contamination could be estimated by analysing fUter papers that had been fixed a various bod¥ positions. In cases of exposure to organophosphorus and carbamate insecticides, it was necessary to measure their effect on the blood cholinesterase, serum or red. cells. Simple field methods were available for suah tests. Pre-exposure cholinesterase levels /llU8t also be known; they could be obtained from surveys made during nonexposure periods. Certain other insectic:ldes such as dieldrin required. complicated biological tests.
..
..
When aircraf't were used for spraying insecticides, the consequent dangers to pUots, loaders and workers had to be investigated. There were also numerous gaseous hazards i examples were the possible lack of oxygen and the high levels of oarbon d1.ox1de in confined food storage bins, and the exposure to gases SUCh as cyanide and phosphine used for fumigation. Another risk arose f'rOIII the c2'JlPal'l1tively recent use of ~us 8IJIIIOnia as a soU fertilizer. StUl other hazards might be encountered in the oourse of treatments for preserving timber and in sheep dipping.
•
•
- 41 l!epor!e on cl1acU8a1on '. . The problema d1acussed included those of distances, seasonal work· and, the lack of medJ.cal services. Participants were advised of the existence of two nD manuals dealing respectively with occupational health and safety in.agriculture and in forestry. It was con$:I.de.red that each country must decide its CMn method of prov1d1ng an aaz'J;cultural health service. Among the d1ffe:rent systems described were those utilizing the genere.l. health services of the state, and the comprebensive services developed privately on larse plantations. It was agreed that in less developed countries, and spec1al.ly where industrial health serviees were· poor, recourse should be had to the public health services available. Sanitary and other inspectore could do valuable work by inspecting farms; public health measures could be taken against d eases such as leptosp1roais and " for a veterinary public health hook-worm. There was also a place servioe.
•
•
..
Participants learnt that one country w1th a quarter of a m1ll10n rubber workers had leg18lated w1th regard to m1n1mum housing standards, certain medical facUit1es, the licensing of importers of sodium arsenite and the oontrol of its use. The importance of dusts from flax, animal dung, etc. was discussed, and 1t was suggested that coconut and tea dusts required fwwther investigation. stress was la1d on the dangers of relyins on dust counts when dealins with Vegetable dusts producing allerg1es. There were also explosion hazards as when, for example, methane was produced by the fermentation of cattle 1/IIUl\1N. .
l}.
OROOP DISWSSION VI, 30 OCtober
1967
(afternoon)
'&be place .......,;. "
ot· -research in developins countries
Dr A. BELL sa1d that ideas d1itered from oountry to country as to wbat was meant by research and what its priorities should be. It was 1mportap~:to ~ve cl~~-,.1deaa..-'Qo.no..em1ng these points • • 1 • ': " •
the ~ tUk was to improve, as quiokly as possible, the. 1f~rk1ng oonditions of the greatest· possible nQmber of employees. In. IIJ(my cases all that was needed. was the applioation of existins knowledge. In others, applied field research.. was essential to assess specific situations. Investigations should be carefUlly planned, with due regard to statistioal. requirements, in order to avoid. wmeoessary work and make eft1cient use of scarce !S1lled manpower. In1.t1al.ly, and as far as possible, preference should be given to investigations that were likely to produce an appreciable and reasonably quick "pay-off". An added. paycholog1cal advantage was the resulting improvement in the unit I S status as good results In
develop1ng-coUll~1~
- 42 were. appreciated. both by industry and by senJ.or administrators .. Much oould be ~ea.rnt from the reSUlt.s of overseas re~. Not all were applicable, however, and local effort was stW ueded.
•
Dr Bell said he had known unfortunate examples where f1pd1ngs pl'eSented. to management had been based. on inadequate medioal diagnoses and environmental assessments. Such deficiencies were usually easy to remedy, and the time so spent was better employed than it would be on matters of no 1mmecUate practical value.
1}.2
Teamwork in occupational health
Dr G.O. SMml said that the occupational health unit might be .quite small or might be composed of members from several
professional groups. Staff must work with inspectors ~ their own and other departments. In universities a similar approach was necessary for the successful conduct of lecture courses and research. In private industry also, there must be exchange of infoxmation between the medical and safety departments. The speaker urged each team member to increase his technica.l knowledge to the best of his ability, acquaint himself with the work of other members, exhibit interest in their activities and appreciate their points of view. l}.} The health and safety aspects of the emPloyer/employee relationship
•
Mr R. SANTOS said that health and safety came into consideration at three stages of the relationship between employer and employees: pre-employment or pre-placement, on-employment and post-employment. Health and safety aspects were important even before finalizing an employment contract, especially in the face of union security !Qeasur8S such as a closed shop, and even after severance of the employer/ employee relationship. Many factors affected the relationship: government regulations, capitalization of the business undertaking, the social complexion of the colllllUIl1.ty and the availability of educational facilities. The health and safety aspects of the relationship, as defined either by legislation or by contractual stipulations, found their justification in the health, eft'1ciency and general. well-being of the worker.
..
The speaker suggested the following possible approaches towards an effective health and safety scheme: (a) meaningful or purposive organization and utilization of safety colllllittees where both labour and management were represented.; (b) encouragement of labour
•
-4, orgarlizations to. undertake their own health and safety tra1ning procranmes; (c) the prov1sion by management of good environmental oonditions. and incentives or motivations for the workers: (d) 8.lf~ senerated and self-impOsed sanctions for.m1n1maJ.. acoident frequency: and <e> the establ1shment of a health and safety machinery to serve·as a communioation link between the.lowliest worker and the top management. ~.4
•
Report on discussion
Dr YAMAGUCHI in opening the discussion stated that occupational health research work could be either applied or basic in character. In one country the need for applied research m1sht conoern a quite s1mple subJeot whereas in another it might arue from more complioated problems. Research was also useful in prociua1ng the background information needed for the promotion of health prograames as well as for solving practical problems. Bas:Lo research_ on the other band. should preferably be a few years ahead of the development of production methods and materials. Epidemiological stud1es, Wlder proper statistical control, were necessary toident1f'y local occupational andnon-oocupational disease patterns resulting from rapid 1ndus1tr1al1zation.
In the diSCUSsion on team work, stress was laid on the possible role of the general practitioner in occupational medicine, particularly if he had received some short-tem tra1n1Dg.
•
As an example of how basic information might be obtained without expensive facilities, a participant mentioned that in Hong-Kong the overall incidence of sickness causing absenteeism in industry, and its relation to sickneSS among the general population, had been determined by using questionnaireS and a s1JDple punch-card system. It was pointed out, however, that questionnaire procedures entaUed certain difficulties. The best results were obtained by a simple approach and a m1n1mum of questions which should be oarefully chosen. Sometimes the only way to obtain reliable information was by personal interview. 14. 14.1 Dr A. BELL, after thanking the participants and all others connected with the Seminar, stated that, in his opinion, the Second Joint IlJ)/WHO Regional Seminar on Oooupational Health had been a success. He hoped that the recommendations made would be sympathetically received and that the knowledge gained would enable participants to approach their problems with renewed vigour.
-44Reviewing tl'.e various Bem1nar themes, Dr Bell stressed the importance of team work and the roles of the doctor, the nurse and the hygienist. 'J!he question of safety had l'IDt been IIIWlh disoussed b\It was of fundamental importance. W1th regard to the problems of small industries, he said that leg1sl.ation andefieotive oontrol measures were needed to oorrect defeots l'ID matter what the size of the factory. An efiio1ent serv10e to investigate field progNllllleS was also necessary for any progress. There should be at least one occupational health institute in every country. 14.2 Dr EL BATAWI stressed the need for urgent action in undertaldns field investigations in small factories and also the magnitude of the eoonomio losses resulting from unsatisfactory working oonditions. After thanking, on behalf of the ILO, all those oonnected with the Seminar. he expressed the hope that the ManUa seminar would be Ha beg1nning of further future oo-operation". 14.} Before Dr PlWlCISCO J. I7l olosed the Seminar he referred to the Region's increasing industrializat10n and the need for a concomitaot development of ocoupational health serv1ces. The Seminar reoOlllllelldat1ons would be olosely studied and he hoped that as a result of these and the wide-ranging disoussions further progress would be made.
•
•
•
•
• SD1INAR COJ«;WSIONB
ANNEX I
1.
Small industries (Plenary session:
Wednesday, 25 October)
'!he Seminar lays particular stress on the importance of the following conclusions on subjects that are all of fUndamental concern in developing countries: (a) Governments should play a major role in tackling the many occupational heal~ and safety problems of small
industries. In some instances, their direot intervention and action will be necessary; in otllers, their influence need only be indirect, for example, through the provision of means to enable certain organizations to carry out effective action. (b) '!here is a great need to undertake field surveys and investigations specifically directed to small industries so that the problems, and their magnitude, can be clearly identified and remedial act10n adequately planned.
2.
Additional training facilities (Plenary session: Friday, Zl October) '!he Seminar notes the existence in the maJority of countries in
•
the Western Pacifio Region, and in some neighbouring countries, of certain similarities in ethnology, culture, sociology, anthropometry, language, eo.nolllY, oOlllllUIli ty and worleing oonditions, avallab111ty of technical resources and other characteristics. It recognizes the value of the worle which has already been done, for example by the present ILO Regional Project 1n Occupational Health and Safety in Asia, WHO's present programme, and those activities planned by the ILO and WHO for the future development and extension of occupational health and safety services in many countries in the Region. It believes that practical benefit can be gained and improvement made by the mutual help and co-operation of those with knowledge, skills and experience related to the Region, and without minimizing the value of overseas training given by highly skilled personnel in more Industrialized countries. It considers that a regional centre, or centres, for occupational health and safety should be established, or existIng centres should be further developed in order to provide training facil1 ties, technical information and assistance, to establish common applicable standards, to promote the further expansion of skills, and to stimulate and. carry out applied research and other activ1ties to meet the needs of the countries concerned.
- 46 It oonsiders further that governments presenting candidates for fellowships should be advised of the existenoe of the excellent oooupational health training faoilities in Australia, Japan and New Zealand, and that available training faoilities or Pl"Ogralllll8s in other oountries, suoh as Korea, should be g1yen encouragement and support to enable them to carry out their fUnotions more effeotively. It also suggests that expert assistance in oooupational health to oountries of the Region and, where neoessary, to ne1ghbour1ng oountries should be increased.
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- 47 -
•
ANNEX 2 LIST OP PARrICIPANTS
• AUSTRALIA
Dr Gordon c. Sm1th Principal Medioal Officer Occupational Health Unit School of Publio Health and Tropical Medioine Un! versi ty ot Sydney Sydney. NSW. Australia Dr Chung-feng Kuo Chief'. Division of Industrial Health Taiwan ProVincial Governnent Wu-feng. Ta1cbung. Taiwan llepublic· of China MrHsing-ch1 Chang Section Chief (Industrial Hygienist) Division of Industrial Health Departmentof'Health Taiwan ProVincial Govennent ~f'eng. Ta1chung. Taiwan Republic ot China
Dr George Y. MoCrtrtak Divisional Medical Officer. Western 0/0 Health Office Lautoka. P1Ji HONG KONG, Dr 'lhomas Taylor Prim1pal MeMcal Offioer of Health New Terr:l. tories Medical and Health Department 4th Floor, Lee Gardens Hysan Avenue Hong Kong Dr &uD1ko Ishizu Chief Toxicological Service Center ShinJuku-ku. Tokyo c/o Chief' Liaison Officer International Affairs Ministry of' Health and Welfare Kasumigaseki, Chiyoda-ku Tokyo, Japan . Dr Kun1h1ro Miura Chief Industrial Health Section Osaka Labor Standards atreau c/o Chief Liaison Offioer International Attairs Minis1>ry· ot Health and Welfare Kasumigaseki. Ch1yoda-ku To]qo. Japan
JAPAN
•
- 48 KOREA Dr Kyu Sang Cho
.. •
Professor and Ddrector Institute of Industrial ~ed1cine Catholic Medical College Myong Dong Seoul, Korea
Mr Suk Choon Yoon Chief Industrial Health Sub-Section Office of Labour Affairs Myong Dong Seoul, Korea LAOS
Dr Chantho Medecin Traitant Chef de Service de gastro-enterologie Hapi tal Mahosot Vientiane, Laos Dr Abdul Khalid bin Bahan Medical Officer of Health Health Offioe (Kuala Lumpur Ddstrict) Young Road Kuala Lumpur, Malaysia
MALAYSIA
Mr Abdul Aziz bin Ahmad Chief Inspeotor of MachineryMaohinery- Department Ministry- of Labour Jalan Raja Kuala Lumpur, Malaysia NEW ZEALAND Dr Alan H. Paul Medical Officer of Health Ddstriot Health Offioe Department of Health Private Bag, C.P.O. Wellington, New Zealand Dr Antonio G. Hernandez Chief Occupational Health Seotion Health and Safety Ddvision Bureau of Labor Standards Department of Labor Manila, Philippines Dr Jose E. Anselmo Medical Specialist II (Industrial Tbxicology) Dd vision of Industrial Hygiene Bureau of Health Services Department of Health Manila, Philippines »
~
PHILIPPINES
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"
• ~
- 49-
(continued)
Dr Teofilo V. Gonzales Medical Specialist II (Occupational Diseases) Di vision of Industrial HYgiene lUreau of Health Services Department of Health Manila, Philippines Dr Shigeo Iha Direotor Ishikawa Health Center Goverraent of the JGrulryu Islands 433 Aza-Ishikawa, Ishikawa City Okinawa, JGrulryu Islands
SINGAPORE
Dr Chew Pin Kee
Senior Registrar Environmental Health Branch Publio Health Division Ministry of Health Palmer Road, Singapore 2 Mr Pang lUtno Chief Inspector of Factories Factory Inspeotorate Ministry of labour Havelock Road Singapore 1
'tHAIIAND
Dr Erb Na Bangxang
Deputy Director General Department of Health Bangkok, 'lbailand VlE'l'-NAM Dr Nguyen Tan Chuc Inspecteur de l'HYgiene industrielle Service de l'HYgiene industrielle Ministere du Travail
459 Ed Tran-hung-Iao Saigon, Viet-Nam Dr Pharo Tu Chinh Chef de Service des Aff'aires sani taires Ministere de la Sante
59
Hong-'lhap-Tu
Saigon, Viet-Nam
•
- 50 • OBSERVERS
Dr Jose P. H. Ibarra Medical Specialist I Division of Industrial ~ene Bureau of Health Services Department of Heuth Manila, Phil1ppices Mrs ~ia R. Perocho
Public Heuth Nurse Operational Staff' - Industrial ~ene Service Regional Heuth Office No. , West Avenue, Quezon City Philippines Dr Wis C8IItro Chi,ef, Industriu Hygiene Unit Regional Health Office No. , West Avenue, Quezon City Philippines Miss AgusUna Guerrero
Public Heuth Nurse Region.u Heuth Office No. , Quezon City, PhU1pp1nes Dr Gregorio D. Dizon Philippine Association of Occupation.u Medicine Dr Jose S. Santillan Philippine Association of Occupational Medicine Dr Angel R. L. Reyes Philippine Association of Occupational Medicine Dr Mercia C. Abrenica Seniar Labar Regulation Officer Health and Safety DiT1sion Bureau of Labor standards Department of Labor Manila, Phil1ppines Mr Re1nal.do D. Manzo
Industrial Safety Engineer Health and Safety D:l.vision Bureau of Labor stan,dards Department of Labor Manila, Phil1ppines
• II
- 51 OBmRVERS (cant. ) Mr Faustino B. Zuiiiga Industrial Safety Engineer .Health and Safety Division 11lreau of Labor standards Department of Labor Manila, Philippines
•
Dr Jose Y. Navarro Industrial .Hygienist (Environmental Sanitat1on) Regional Health Off1ce No. , Delta :&rl.lding West Avenue, Quezon City Philippines Dr Arsenio Regala Chairman and Professor Department of Preventive Medicine University of Santo TOmas Manila. Philippines Dr Herminia Botto Assistant Chief Eaaluation Division 1breau of Worlanen' s Compensation Department of Labor Manila, Philippines
COlBJLTANTB
Mr A.T. Jones Officer-in-Charge Industrial Hygiene Bre.nch Division of Occupational Health New Bouth Wales Department of Public Health 86-88 George Street North Sydney, NSW. Australia (Consultant in Industrial Hygiene) Miss Ruth SliynKJKrvi Occupational Health Nursing Consultant Ins'ti tute of Occupational Health Helsinki, Finland (Consultant in Ocoupational Health Nursing)
•
Dr Jesus V. Almonte Chief D1 vision of Industrial Hygiene Bureau of Health Services Manila, Philippinea
- 52 TlOO'ORARY ADVISERS (oont. )
Dr Masayoshi yamaguchi Director National Institute of Industrial Health Ministry of Labour 2051 Kizukisumiyoshi-cho Kawasaki, Kanagawa Prefecture Japan Mr Ruben F. Santos Direotor S1reau of Labor Standards Department of Labor Manila, Philippines
!
ILO
Dr M.A. El Eataw! Regional Adviser on Occupational Health ILO Bangkok, '!balland Mr A.E. ~nn Regional Adviser on Occupational Safety ILO Bangkok, '!balland.
WHO
DrA.Bell Chief, Social and. Ocoupational Health WHO Geneva, SWitzerland
Director of the Seminar
Dr J.H. Hirshman Assistant Director of Health Servioes WHO Regional Office for the Western Pacific Manila, Philippines (Operational Offioer)
Dr G.J.A. Ferrand Regional Adviser on Community Health Services Miss H. Fillmore Aoting Regional Nursing Offioer
Mr D.C. Johnson Hegional Adviser on Health Eduoation Miss M. de L. Verderese Regional Nursing Officer
•
•
,.
- 53 -
GENERAL ca.tMENTB ON PRE-SEMINAR VISITS BY mE 'IHREE CONSULTANl'S
'!he three oonsul tants visited Malaysia, Singapore, Japan, the Philippines, Korea and China (Taiwan) to study oooupational health prograumes. It was observed in some countries that diffioulties arose because of inadequate legislation, poor enforcement prooedures, insuffioient instrumentation, staff shortages, lack of teChnical knowledge and inadequate library facilities.
A.
Medioal oonsiden.tions
In all the countries visited doctors played a ma,pr role; in some there were several with post-graduate oocupational health qualifications but few were praotising this speoiality. Sometimes universities advised on speoifio problems, undertook general surveys and conduoted training oourses. In one oountry valuable work was performed by an industrial health assooiation.
Researoh, pure and applied, was oarried out. Sometimes this was purely medioal in oharaoter; in other instanoes the medioal staff co-operated olosely with their soientifio oolleagues. In most faotories the medioal staff had little opportunity to praotise preventive oocupational medicine; curative medioine occupied most of their energies. Many dootors did not understand the scope of preventive inplant medicine.
i
Better training and guided practical experienoe of field personnel is a major priority. While much oan be aohieved by overseas fellowships and consultant Visits, these are not enough. Staff must carry out selfeducational programmes. Much can be learned from scientifio journals and textbooks; sufficient expertise can be so gained to solve many field problems. In some of the countries visited it would seem advisable for dootors, apart from their broad oocupational training, to obtain detailed knowledge of certain non-medical matters, such as local ventilation systems, and subsequently instruot their departmental colleagues and non-medical factoryinspeotors. There may also be a place for oorrespondenoe oourses. Doctors should liaise with non-medioal university departments; in oertain oomplex problems the advioe of chemical engineers, eto., is needed. Many environmentally unsatisfaotory faotories had no medical ooverage, despite legislative requirements. On the other hand, several exoellent
- 54 faotories ~re seen where there was really l1ttle purpose in having a dootor. Manpower should be used to ma.x:iIm.In advantage. Medical staff must discuss their tindings with senior plant exeouti ves; where poss1ble, practioal demonstrations ot reoamnended proteot1ve measures should be given. General advioe is often insuf'f'icient. If' in a f'actory it is possible to have an ef'f'eotive oontrol device installed, then this should be demonstrated to looal managers ot s1m1lar industries. In some oountries oocupational legislation is being cons1dered;
there would be advantages if drafts were ref'erred to overseas authorities, inoludlng WHO and ILO, f'or .speoitiooamnent. may
Examples were seen where inoorreot advioe had been glven. ~s be embarraSSing, espeoially during the early days of develop!lent when no oontrol authority can afford to be proved wrong. Similarly, investigatiOns should be as oomplete as possible; instanoes were seen where speoific oooupational diseases were &&gnOsed without Wllng simple pathological tests. An oocupational medioal service can only be ef'feotive if it has eanled the oonfidenoe of' industry; one way is to provide evidence ot the eUeot of poor working oond1 tions on productivity.
•
B.
Industrial hygiene oonsideratlons
Some countries deSire to develop an industrial hygiene servioe f'ram the productivity and health viewpoints; others do not, as yet. utilize suoh eXPertise and wrongly oonsider that such a development might hinder further industrial1zatlon.
Sometimes control legislation has been drawn up based on overseas statutes which trequently are not appropriate and result in unneoessary expense to industry. In general, national training f'aoil1 ties, with the exception of Japan, are not available. '!here is need for regional f'aclllties. A oonsiderably large amount of industrial hygiene equipment is available in some countries; unfortunately this is sometimes not available to those working ln the field. An inventory should be made in each oountry and the availability of' instrumentation regularized. nut analytical f'aoillties in other government departments should also be listed. An inventory should also be made of' available textbooks and Journals. Regular reappraisals are essentlal. Generally, liaison needs to be improved between govel'Illlent departments, such as Labour, Mines and Health, and Departments ln Universltles such as the Chemistry Department. In only one country did there appear
•
• 55 to be full co-operation between officials concerned predominantly with safety and those with health. Many of the problems seen could be overcome simply, without great expense ;.this is partly a refleot1-on on the lack of basic training within the authorities oonoerned.
A general feeling exists that, to make an effective start in this area, additional overseas consultant services are necessary. However, this Is not neoessarily so as details of control measures can be found In the l1terature. t
Many examples of toxic hazards were seen.
Unfortunately, hardly any investigations, or control by legislation, have been carried out in agriculture. While some awareness exists as to the toxio properties of many insecticides, the total problem is very much wider than this. Promulgated legislation tends too often to neglect conditions of work in small factories. The latter predominate in most communities and working conditions are often bad. An instance was seen where legislation was being drawn up without consultation with the governmental occupational health team. Frequently, there was a stated desire to set up research facilities but often no clear reasoning could be given and the expense involved had not been thoroughly considered. However, the most urgent requirements are effective woridng env1roment investigations and control, effective training, education and develolXDent of good industrial hygiene services. C. Occupational health nurSing considerations
Legislation often requires nurses or "Health supervisors" to be employed in the clinics of factories with more than a oertain number of employees, the employees ranging from 16 to 100. However, because there is a very severe shortage of nurses, it is not always possible to comply with the legal requirements. Some countries have introduced short courses, for those girls wi th a high school standard of education, to act as medical assistants in industrial health services. '!here are obviously certain limitations in this connection. Some of the trained nurses do not, unfortunately, carry out occupational health nursing, as generally accepted in more developed countries. For several reasons, including the lack of training, the potential of many is ourrently limited. However, it is clear that there is a growing recognition of the need for specific training. In some public health nursing courses a few occupational health lectures
- 56 are inoluded. Aooording to the opinion of several senior nursing authorit1es, in general, there is, unfortunately, little possibility at present of stimulating nurses to leave general publio health for oocupational nursing. Nevertheless, it is still considered important to have at least one qua,l1t1ed experienced nurse in each country who should oarry out oocupational health nursing training, st1mul.ate interest and assist the nurses to get practical industrial experience. Faotories were seen where injuries were occurring to which nurses oould make a significant preventive oontribution. More extensive oounselling should be carried out.
I
t
- 57 -
QUFSl'IONNAIRE COta:RNING
OCCUPATIONAL HEALTH SERVICES
Participants were asked to present the following information:
•
(a) Brief general country infonnation (population, type of industries, gross national product, number of workers in industry and agriculture); the organization of occupational health and safety services in the participant I s country, in particular the responsible m1nistry and co-ordination with other relevant government bodies, available staff' in the occupational health and safety fields (physicians, hygienists. safety staff, nurses, laboratory staff, etc.), staff needs; available training facilities and requirements; laboratory and equipment facilities; status of legislation including safety provisions and financial provisions for insured workers j evaluation of the position and a summary of particular problems. (b) Tabulated summary of information contained in the submitted country report •
..
• ... •
, a
I ---I
-~
1-1i~1.i:n.,er-Of
General Activities
• 1 I
I
Cocatry
" In order of Impor~ I • rallce _'___ l..I1'3e I
I
Num:,er or Factodes ,
- ,- ~HIiiilber or t
I 'I I I
I Industrial Health ServiJ:e1 " I
• SraffiDg (Govenunent) I I H}'gf.enist, : I
I n ultr.a
I d
'1
Aft.lcultura' 1>'"
!
L I
,-:lorl:en _Srnall~~il!iOI1')
I
'dor1!ed
Tecbnlcal
I I
I
(mil!lOlll) 0,44
• NatiOnal ,l\'OVlncia~ I ,
Private
uJ Medlca: I
AtII#IGt.. 23 I I I •
AUlllllia
I I I
Manufacturing , Agrlcu:tnre t Mining I , , I
I 2 000 I I (over 100) , I t I
57 000
2.0 , I I '..
I
1
I I I I I I I
6 I I I ,
100, I
20
2S, I I
I
I ~. 'I
. ,
I 2 I t I I
Azricult1lre Manda~r.:nng
Ii 000
: &
China (Tai'ilan) I
Mining
22 000. + family indUltry
1.75 I I ' I
I
1 Provincial: 3 District
No Jerailr
I
5
• :
2, I
8
I
I .
3 , , t
Fiji
' I I " I A;lriaultt:te I I
Nil
400: I
0.03
I
No
I I details I
" ' I • Nli I ,
I
t
2
I ,
4.
NU
I I
Nil
I I ,
Manufacr.:nn3 I I ,
J ,
I
, ; , I
I
I
" I
•
4 , I , I
Hong Kong I I
Manufaoturil13: 420 I :020e: I O.-GS I A;lricultlile I . . Mining I " "
0.02
I!
I I
Nil
I
40 dOC1Cn
I
2
1
I
• I • ,
I I "
I . I . • I I
'& I
5
I
I
I
I
I
"
•
I I I
]apan
, AZricultuae I Manufacturing I Construction I Mining
I 140000
I 2660000
• I
:2.0
:
13.1 I
1 I
I
46
I I
I : I I
I I I
I
,
I Cb!ef Health : Supervisor 69 OO~ I Medlaa: Health I I Supervisor 61 000, I Non-Medical : 87 000
IS "
65
I I
10
I I •
I I
I C
I
:
• • I .
I ,
6
.
Korea
'
I
• I I
•
I Agrleult'.:te I MIInufacUlrin3 I Mining I t I
I I
534
,
,
5 0:3
O. 9
I
:
4.7
I
I
1
I I
I I , I • I
I . I
r I :
• I I &
I
I
I
• Health offioea • 800: I Health . .lstanlS I I rna nagers (nUDeS a : & sanitarians) I Industria, Hellth I • A.octltion 240 I ,&
I
NU
I I •
I
Ni:
I
I
Nil
• •
I
I
a I I
. . ,
I •
13000 1
I
I •
I I ,
I ,
I
•
I I "
I I
•
I
I
t I
, • •
c.
f).
'"
•
.
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'
..
Or,
. I
... Legllladve Authar1ty I
•
..
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• Nunes TiaiDed Occupa- • tim" 1fM1Ih I •
"
.. • I
,"
...
I
Training Pacf.l1rfes
Laboratory Services
In
r....... uy I
......
MfacellaneOUl Staffing
• t
Graduate 1
Pmt GladIAte
COnDlned Public
Health NurJ1Di Nil
PrJv' ' am t
I I
Tralnf~ NUnes
I
I 11
3 weeki
I •
D. P.H. &
,Labour, Mines and Health DepartmenU
V.Good
Eug1aeen (Ihort)
7 t + 28 in Govern- I ment fsctorie. I I
I
,700
I I
I 400 factory inapectal t College NSW I 40 mines inlpectal 3
" I I
r I I
mmtha t
I
t
Nll
I ' Nll I
2
De ,pII.
of Health
I
I
Recons~cdon
I I , I
I week
, , I ' I Sweekl I Department
AffallS, Bureau of He.altti 'Prav'llDd'l Mining ComJ • willeS I of Labcur I
·
. &" Social
• Not adelJlste
I
4
I I
No detaill
c I
No detaDl
I ahcrt COUISe I
12 'days
No detaill ,
• I I I '
I
! I
" I ' I I
--1 •
Nil. I I
r I I
Nil
, I
Nil
I I
I
, I
Nil
• 8 fsctory InIpectaS I f
3 • (local qualtI •
I
C.P.H.
1 t
flcatlm 0II1y) I 1 week I ,Nil
r I
: I
I I
• I
" I
,
I
,. • , •
• •
I Department eX LabaJr
I I I
Good
I ' I I
I I' I
3
f:
100 I I &
N i l , 50
• ~
4I
'
I
I I I
• • 5 • , C
L-
A' I
20
• I
I
I
1 year
I I I
Dep8nment ci Labour
Smndards
. I I
I
V.Good
I
J I I I J I ,
Nil
I I' I' I
800 :
I I
" "900 I
I'week
I ~ 200 1IIIII1tar)r engineers I 2 549 faotlEY inlpect.lla
I
•
" I I I
1 1 I
I !
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• I ,
t
I
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:
f I
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1..2 weeka
I
1-2 weeki
I 0HIce Of LabCUr
I
Inadequate
Nil
I
I I
AffallS
r I
• I I
Exiat but Dumben not known
t 6• I I
· r • I I
:
I Exfat but Dum- 1 1 ben not 1 I detailed I
• •
, • I
I
, I
I (Heald! All..;' I I I
r
I I' f
tant Managen>. I
, I I
t I Fsctay iIlIpectCD (lIIIiliy • houn & wages) 42 • I I I
I
, I
•
, I
1 r
I
I
•
, I
I
I
I
•
---
~---------
• • a ~ •
' . ' I Genera•..AocMtiea I Cooolry: In Ckder Ii Il41!'01'"t I tlnce , I
Numller of Fectoriea r LIIl'8e I
I NUII0er of I Nun"»er of I , tndUatrtal I Agrlcultura: '~ I ::lcr!:en I \'Iorkea ,t I (milUCIII) I (mIlUCIII) I 0.0002
IDcbtllal Hoallh Service. I :
l'teftI~ (Goveml11l DC) t
I
:
.J I I ,
t
,Small 70
N.dcoal I &OYiDC;Jal.l :
PriYlte 7 doctoll
I
I I MedlQll , HJg1en1tC l I I
Tecbolcal AtdauInc'
I . . .
a • :
7
I Llloa I
• ASricullQft I Mio1ng I
I !
None
I I
1.5
NIl
I I
Nil
• I • t t
NU
• I
NIl
• I I
Nil
• • I
.pprox.
I •
L' 500 I I
1 "
• lI-ialaysla
6, , I
• Agrl=tture C:!eltem put I MlDafa:lUdqJ onl7) . iMininS I
I I
10 000
1 I
1 I
0.3 I . I
I I
I t .
I
1.5
NIl. •
No deCIllI :
1 . ·N i l . I I
Nil
• I I
. , .
"
1 ' 1 . ,
I I
' "
" -
9 • Ne~" Zealand •
I
I
• ManufacIIIrl1l3 I Agricul~
• • I No detail. t I
(1. ao~
* over • I
detaf~.
I .
• • •
I
0.19
I
0.13
1 13 •
pm dIM
• •
'4 pbya1claQl I ,
I I
I Co..aucdllD '
I I
'100)
teer~ under I I , 100) I 1
I • 1'1
1 I + 18 pIn-~ • I
2
I 1 t
2
• I
I
I . :
dme: I . I
I I
I '
I
,
10 I Pb1tipplnel f I
•
I Agriculture I Maauflcturfns I Mining I .'. I
1
I' 225 I IK 400 I 1.5 I • (ewer 200) I ('under 200) I excludlng 1 I " I _ I
I
12.0
'.
• :
2 • 1
1
.101 phylialalla a451 perc dOlt I I
I I
5
• ,. '"6 I I
I I I
4
•
• • •
I g
I senlcea I •
I I t
physlctaiJI 5
r 11
r . .
, .
• Ryu!qu lllandl • t·
I
f I
t
I J.gdcultme I Mlnufaclllrlng I
, I I
288
I I I I
U 300
I I I
O. OS,
I
0.15
• :1 1
I I
I
' !
1
I
(tncludiug t
M1n1ng
aentces) • 1
I I
-
• I ,309 Re.lm ..per-,
Nil
t
r I
Nfl
I I
14
•
v!soa'
I
•
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t2
I ' t' •
Sm3_Pale
I Mlnufa::Ulne I
1 I
142
, ; t ~05 I I
' ! I 1
•
• Ni! I
:
I
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• • • I
·
I 1
0.2
1 •
0.001
I I I
1
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• 80 full or put I r I
I I
I I I
NIl
• • •
COQIQUcdOil
Cover 100)
• •
'dme pbJd- I 011111'.
• -
t I
Quaa:yfnz
I
, 1.5 I I I I.
I t
Thlll.nd
I Agdclllture t I
MeaufaOUldng
, I
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•
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: I I
, t I
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'I
• a,
I
1 I
1
t
• MlniDg
a •
I' . r •
t
I ;
• t
• I I
I I I ,
8
I
2
I
I
• I
I
• • I
• .J I
• •
Republic at Viet-HIm
' . . ' I AgIlcullllf1t
I
,
,
"
I
_ . .
,MaDufaccudug
• ot
• Mtlll1l8 I
(over 100) I (tell than 1.25 I 1M I 100) I • I 86 422. "
I
5.4
,t
, 1
'"
0.
"
..
,140 doctcn I , • 36 bellch i I vilaa CK/ venfSI t t comeniea) I I • 24
"per...
2
• I
1
• I
2
r • •
I ~
.
I !
no
eo,
," I
f " ,
. ..! f Leglalati ve Autharlty
.. i , I I Trained Occupa- I I l10nal Health I I
,.",.
,,. I "tI ~
.v
• I I
Trainlllg PacU1de.. I Pelt Gnclulte. ggeate
I I -, I I I
Llbarat<qt Serv1cea
In IndutUy Coml:tned Public 1 Nunes Health
\ . • M1JcellaneoUl I ~ fB. I •
NUIIin§
Mvate I
Trlinlng NIl
• I
• Nfl
-7
• , I
I
Nn
• 1 I
I
1
NIl
I Dept. of Labour In I Mlni.ay cI Jntetic:n
N11 I
N11 I I I I
1 I
NIl
• : I I I
NU
• I
I
I
s &: SCY.:l1l MaiD Nil • Depertment of Labour I
i
• 8 • • I I
I, V. Good I I (Depanment 01 Chemistry) I I I
I i
i
• I I I I
i
• I
I -•
• • •
Nll
I I
No details I I
No detail.
Nodetllll
Nfl
I
I
I I I I
Teclmical Slfety JnapecUII • 40 pelt available I 30 I pelt filled I I
I
t
9 '
I No lecEUJeI I DJH 3 mOlltha r Depallll1eot cI Labour I Depamnent of Health I I I I
Good
I I
Nil
: : I I
200 ,,-
, I I
• • I I
'15 full time 'I plrc til11e I
3 days
I I I
l4ll Factory IDfpect<ll
I '
t
J '
I ,
12 ~reelG
' I , 5 weeks I Deplltmeot d Labour ;
I I I
: Fair I
Nil I
S I I
Ii
31'1
I I I
Ii '"feeD
10
I
I I t I
I
I
1
I I : Nil I Department I I I
I I
:
I I
I 1
I 8'1 deotllD. 1'1'1 part time , deotilll. I) ccmpeDlltioo • I phytlclalll, 10 ..fety educa- I I tea. Ii ..fety inlpectea. I 2 chemical eoglOeerl • I • I I I
'.t:::.
0\ ~
I I
& "
, I
I
Nll
cI Labour
I Not adequa1le , I
I I I I
Nil I "
Nil, ,
Nil
, t
Nfl
11'15 ..fety aupervbc:n I I
11,
I 5
I
'
I
I I : I
"
I
,
Nil
,D.P. H. -, &
12
I
Department rI Labella, v. Good Depaltn-enc of Health Depattmeot of
Nil
I
Nil
I
10
I I I
N i l ' 10 gracmate fact«)' l111pectoal I 2 publl'l health ID1pecton I I I
, : I
CbenlfJtry I I
I !
, I
I
I
I
aOhflUll
I
D.P.R.
I
13 : I I
Mlnfatry cI InduJtry I Minfsuy of Health I Deplrtmeot of LabOUl
Fair
I
ND
I I
4 I
2&0 I '
I I I
, PIlbUc HIlIlth I 3Ii fIaIEI7 hiq»OUI r Nun10g - lOme 1100 IID1tary inspecun I I
" ,
I
• I •
:
I l
d
COtfte I
I
,
I
I
I I I •
N1l I I ,
Nil
I Depmmenc rI Labour I I J
I I I
Fair
I I I
3 I
Nil I I
200 I
4 mOlldll
I 2 faclUy l11Ipectoli I
I I I
-t
•
•
- 63 ANNEX 5 SUMMARY OF mE REPLIES TO A ~ONNAlRE
ON SMALL INOOSTRIES
'!be following is a brief resume of the responses received from the partioipants to a questionnaire prepared by Dr M. El Batawi on small industries, inoluding their definition, importanoe as shown by the numbers of workers employed in them, the situation in regard to proteotive ooverage by legislatIon, the prevailing oonditions of' work and the proposed lines of approaoh in solving their problems. 1. 1.
lEFINITIONS
Australia
A legal definition is not required in Australia beoause of the very large number of plants below 100 workers. '!be average size of a faotory in Australia is approximately 20 workers. 2. China (Taiwan)
A small faotory is one that employs less than 30 workers, has a oapital of less than u8$2500 or utilizes maahines less than 5 horse power.
•
-
There is no legal definition of "small industries". 4. Hong Kong
Small plants have between 10-100 workers and exolude work- plaoes empleying less than 20 workers where power-driven maoh1nes are not .used.
5.
Japan
Small plants in Japan are olassified acoording to the number of workers as follows: 1-9, 10-29. 30-49, 50-99. Eaoh has a speoial oonsideration statistioally and admin1strati veIl'. "Small" and "medium" manufaoturing plants employ less than 300 workers. 6. Korea Small plants employ less than 16 workers.
• • Work plaoes employing less than 15 workers are considered small.
- 64 -
8. Malaysia There is no legal. definition of "small plants".
9. New Zealand A factory is any work-place where two or more are employed or where one paid worker is engaged. There is no classification by size. 10. Philippines Small plants are those employing less than .30 employees.
11.
R.yulsvu Islands (Okinawa)
There is no legal definition, but in practice small indUstries employ less than 10 workers, medium industry 10-99 and. large plants more than 99. 12. Singapore A small factory is one that employs less than
50 workers.
u. 14.
Thailand There is no formal definition of small industries. Viet-Nam Those
Small industries are those having less than 20 workers. employing from 20-100 are considered. medium industries.
2.
BrATISTICS Number of Manufacturing Establishments Number of Workers 1 217 520 159791 422 017 not available not available 652000 1
Australia (1964) Total* 1-10 workers 11-100 workers China (Taiwan) (1967) Total* 1-.30 workers Over .30 workers Fiji (1965) Total* 1-100 workers Over 100 workers 223W
59 375 42683 14746
zr 437
5UO 400 397
28 745 not available not available Many are approx1.mated
3
*
Is the grand total of manufacturing industry. figures.
- 65 Number .of Manufacturing
Number of
Establishments HOng-Kong (196'7)
. Workers
Tota1* .
1-10 workers 11-100 woricers
10635 4 129
4467
4}1 20 1}2
TT6
585
m
Japan
(1966) 2 264 118 1
Tota1*
1-9 woricers 10-99 woricers Korea
759 924 473 535
~406m
6 551 }}4 11 754 8}1
(1966)
Total* 1-100 woricers Over 100 workers
5 546 5 Ol} 534
}11 466 1}8 920
172
546
Tota1*
1-15 woricers Ma~s1a
104674
lrJ7 206
- not available (1966)
New Zealand
Total* Ii
.
1-5 woricers 6-10 workers 11-100 workers 101+ workers PhilippineS Total* (1966)
20 475 12 }25
~8 }5
771 914
} 604 41'R 349 ,. ! .....
12 }26
248rJ7 2} 172 1 229 225 181
1-29 workers }O-200 workers 200-.'500 workers 300- and over Ryuk;yu Islands (Okinawa) Tota1*
11588
1-9 woricers 10-99 workers 100+
9349 2 151
288
*
Is the grand total of manufacturing industry.
Many are approximated.
figures.
- 66 Number of Manufacturing Establishments Singapore Total* 1-100 workers Over 100 worl!:ers 'lbailand Total Viet-Ham Totab Less than 100 workers Over 100 worl!:ers 21 026 20 963 63 35000 1 500 000
Number of Worl!:ers
3 547 3405 142
79562 48 035 315Z7
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3. Australia
LEGISLATION
Inspectors are empowered to inspect all work~places which are registered as factories, irrespective of the number of workers. There are no specific indications for inplant services apart from the provision of first-aid facilities, which depends on the size of the establishment> and periodic medical examination of those exposed to certain hazards such as radiation and lead. Workers under 16 or 18 years ot age are required to pass a fitness test before appointment and also those exposed to radioactivity. This applies to all factories. Workmen's Compensation Laws cover all workers in all establishments even those that are not classified as factories. Fbr Australia as a whole, a factory is any work-place employing 4 or more persons or where power is used. 'Ihis definition varies from one state to another. China (Taiwan) Factories employing more than 30 \'1Orkers are required to conduct periodic medical examinations. Pre-employment medical examinations are not required except for the young. 'Ihe provision of first-aid, nurses, physicians depends on the number of employees. Inspection applies to all establishments except small plants. Labour Insurance Act provides for Woril:men's Compensation for all worl!:ers apart from those in factories employing less than 10. 'Ihe
* Is
the grand total of manufacturing industry. figures.
Many are approximated.
- 67 Fiji
IA!gislation applies to all worlq..plaoes regard1ess of size. 'lhere are no requirements in regard to the provision of medical and safety facilities. Workmen's Compensation covers all workers regardless of the size of the factories •. Hong-Kong According tb the laws, factory inspections should be made of all registered work;-places. '!here are no requirements in regard to meclical facilities, nurses and safety officers. Periodic meclical examin4tion is carried out by the Industrial Health D1 vision of the Labour Department. '!his is limited to woriters exposed to ionizing racliation and lead; Workmen's Compensation and Sickness allowances cover certain categories of workers (e.g., Government). '1h1s does not depend on size. Japan
Factory inspection should be made of all work!-places regardless of size. Factories employing more than 30 workers are required to appoint a safety and health supervisor. Woricmen's Compensation and health insurance cover all the workers regardless of the size of establishment. Korea Factory inspection applies only to the plants employing more than
16 workers. Pre-placement and periodic meclical examinations are required in plants which have more than 16 workers. No medical care is required unless more than 100 workers are employed. Specific tests required by law must be included in the pre-employment meclical examination. Workmen's Compensation does not apply to wotitl-J)laces tav1ng less than 15 woriters. In workplaces with 16-100 Worlanen's Compensation is the employers' liab1l1 ty. In workl-places .emplort r.g lIIore than 100 persons, it is obligatory by law. laos
Very recently, a new labour law has been in! tiated. It has safety and health acts that apply to all work-places regardless of size. Malaysia Factory inspection applies to all worit-places where power-driven machinery is used. Irlplant servioes are not incl10ated by law. Workmen's Compensation covers all work-places regardless of size.
- 68 New Zealand Safety and health provisions apply to all factories. '!'here are certain provisions depending on size, e.g., rest-room for women where more than six are employed, meal rooms for more than six persons and first-aid faoilities (depending on size). Medioal examinations are not required exoept for the young. Periodic medical examinations are limited to lead and chrom1um womers. WoriaDen's Compensation applies to all womers. Philippines Establishments employing 1 - 29 employees are not inoluded in the law requiring the employment of a nurse or a physician on part or f'ul.1-time basis. Recently, under the Industrial Safety Law, whioh authorizes the Secretary of Labor to promulgate and enforce rules and regulations, an order was issued requiring establishments with 1-29 employees to keep a stock of medicine under a graduate first-aider.
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l\yuklU Islands (Okinawa) '!be Factories' Act covers safety, health and labour standards in all wom-plaoes. '!'here are acts establishing health insurance. unemployment and Worianen' s Compensation.
Singapore 'lbe laws g1 ve the faotory inspeotorate the power of inspection of faotories employing more than 10 JIIOmers, or where mechanical power is used. 'lbe law requires a firat-aider 1n factories employing more than It does not require pre-emp1oyment or periodio examinations.
50 persons.
,
WoriaDen's Compensation is the employer's liability in all JIIOmplaces. 'lballand '!'he "Factory Control" law supervises all wom-places in the process
of ereotion. No regular safety and health inspections have yet started. Medical and nursing servioes depend on size, starting from 200 and more. There is a Workmen' a Compensation Act that has not yet been fully enforced. Viet-Nam Laws require the inspection of all work-places.
- 69 Periodio examinations and medioal care at the plant level are required only in large factories. Workmen's Compensation covers all workers.
4. Australia
CONDrI'IONS OF WORK
Accidents are generally higher in small-sized plants. Infectious diseases such as leptospirosis, brucellosis, ~fever, occur among workers in ~battoirs and meat processing in some areas. - The socio-economic standards of small plants are generally similar to those in larger plants. - Inplant medical services are less often available in small plants. - Small plant workers enjoy similar holiday rights and facilities as those in large factories. China (Taiwan) - Small factory workers suffer from inadequate conditions of work, lower educational levels and lower incomes. - Small factories lack medical care and safety services. - '!hey generally lack personal protection, foot-wear, unifonn, etc. - They have fewer facilities for rest, recreation and feeding in the majority of cases •
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:
. - Unsatisfactory conditiOns of safety and health prevail in small plants because of inadequate enforcement of these requirements (only 3 factory inspectors). Hong Kong - The safety conditions in small plants are generally of a lower standard and there is less awareness among managelllent and workers of needs. - Socio-economically they may not be different from large factories. - The precautions against aocidents and fire are generally inadequate in small enterprises. Japan
- Generally, the standards of working conditions in small factories are less than those in large factories.
- 70 Korea A comparative study showed that: - the working conditions are poorer in small industries; - ocoupational and non-occupational diseases are more prevalent among the workers of small plants; - the accident rates (4.11%) are three times higher than those in large plants (l.J.%); - welfare facilities are generally lacking.
,
-
Correlations of work are generally lower in small industries.
Malaysia No special information is available on small industries.
New Zealand A survey of first-aid faoilities showed relatively unsatisfactory oond1 tions in small industries. - A lower level of aooident awareness exists. are seldom instituted. Philippines - Small plants suffer from poor and inadequate sanitary faoilities and inadequate lighting and ventilation. There are no first-aid faoilities or emergenoy stocks of medioine, and no personal proteotive equipment.
Safety programmes
R.yukYu Islands (Okinawa) and
,
There is a lower standard of safety and lower wages in small plants fewer services are available.
Singapore '!he working conditions in small plants are "definitely' poorer" than in large factories and. safety. precautions are generally negleoted.
'lhalland A survey was made. It showed that: '"-'
safety oonditions are greatly inferior to those in large establishments;
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- 71 - lower BOc1o-economic standards of workers 1n small factories. - h1gher rates of d1sease and accidents and oomplete iltsence ot med1cal and safety services. Viet-NaIll - Safety and health conditions in small plants are much lowr. the socio-economic standards are also lower. - '!here are many diff1culties 1n surveying or contro1l1ng small plants.
5.
APPRlACH
Australia - employers co-operative schemes - support from local public health services - increased adVisory and 1nspectorial services - statutory requirements for medical e.xam1nation in speoified 1ndustries or prooesses. China (Taiwan) - strengthen inspeotion and adm1n1strat1 ve supervision - support from the Governnent 1n establ1shing health and safety servioes 1s required - pr1 vate health centres should be enoouraged by' loans from the Government .:
strengthen 1nspeotion tra1n1ng of management
Hong Kong _. co-operat1 ve schemes encouraged by the Government - 1nspect10n and enforcement
Japan - should enoourage privately owned servioe oentres 1n 8111&11 industries - tra1ning ot woriters and employers should be encouraged _ parent companies can help by supporting the programnes of small 1ndustries _ finano1al ass1stanoe has been tr1ed out 1n Japan and some 510 faotories have benefited from it.
- 72 -
,. Korea - there is need for the establishment of industrial health service oentres. - utilize the funds of Workmen I s Compensation to support these servioes - develop inspection IAos public health services provide some help to small plants
Malaysia - Government role in legislation and enforcement as well as consultant services - private efforts on a co-operative basis. New Zealand supplement the inspeotorate and advisory. services. - co-operative schemes may not sucoeed unless applied. and supported by Government due to lack of recognition and interest in this kind of servioe among employers Philippines - frequent routine inspection is necessary to implement the provisions of the existing laws covering those establishments. - physical oheck-ups should be perfonned by the physioians on the staff of the Regional Industrial Hygiene Operation Unit. They can also provide consultative and advisory funotions to both management and wor.kers. Byukyu Islands (Okinawa)
- physicians may undertake periodic medioal examinaton on a co-operative basis. - public health nurses can play an important role in providing services. SingaPore pri vate proJeots should be enoouraged inspection should be strengthened as well as the organization of health and safety servioes in flatted factories. Thailand - the Government has established a centre of services for small industries and there are plans for more - co-operative sohemes should be enoouraged and also health insurance.
-
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- ." Viet-Nam - worlters' unions can help in starting a programme of services legislation should be extended to protect small plant workers.
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