Asian-Pacific Newsletter ON OCCUPATIONAL HEALTH AND SAFETY. Volume 11, number 3, November 2004 OHS. Occupational health services

Asian-Pacific Newsletter ON OCCUPATIONAL HEALTH AND SAFETY Volume 11, number 3, November 2004 OHS Occupational health services

Asian-Pacific Newsletter on Occupational Health and Safety Volume 11, number 3, November 2004 Occupational health services Published by the Finnish Institute of Occupational Health Topeliuksenkatu 41 a A FI-00250 Helsinki, Finland Guest Editor-in-Chief Suvi Lehtinen Guest Editor Inkeri Haataja Linguistic Editor Sheryl Hinkkanen Layout of the cover pages Tuula Solasaari-Pekki The Editorial Board is listed (as of 10 March 2004) on the back page. This publication enjoys copyright under Protocol 2 of the Universal Copyright Convention. Nevertheless, short excerpts of the articles may be reproduced without authorization, on condition that the source is indicated. For rights of reproduction or translation, application should be made to the Finnish Institute of Occupational Health, Office of Information and International Affairs, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland. The electronic version of the Asian- Pacific Newsletter on Occupational Health and Safety on the Internet can be accessed at the following address: h t t p ://www. occuphealth.fi/asian-pacificnewsletter Contents Editorial 47 Jukka Takala Occupational health services 48 An ILO policy perspective Igor A. Fedotov Occupational health services as a part of 51 primary health care Gerry Eijkemans Developing the national occupational safety 54 and health profile in China Tsuyoshi Kawakami, Changyou Zhu, Yuhang Wang Developing basic occupational health services 56 with special reference to China Jorma Rantanen Occupational health services in the Philippines 58 Dulce P. Estrella-Gust ILO News 62 10th International Congress of Toxicology 63 (ICT-X) Ari Hirvonen The issue 1/2005 of the Asian-Pacific Newsletter deals with chemical safety. Photograph on the cover page: International Labour Organisation/ Crozet M. Printed publication: ISSN 1237-0843 On-line publication: ISSN 1458-5944 Finnish Institute of Occupational Health, 2004 The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and publication does not constitute an endorsement by the International Labour Office or the Finnish Institute of Occupational Health of the opinions expressed in them. 46

Global occupational safety and health Occupational health services T he ILO Conference in 2003 decided on a new Global Strategy on Occupational Safety and Health. The fundamental pillars of this strategy include a preventative safety and health culture often called safety culture based on the right to a safe and healthy work environment, principle of prevention, and a systems approach to management of occupational safety and health. The ILO/WHO Joint Committee on Occupational Health in December 2003 built on this strategic approach, providing guidance for the two organizations to collaborate. The Strategy also included an action plan. The first element is the proposed Promotional framework for occupational safety and health to be discussed by the ILO Conference in 2005 and possibly also in 2006. The objective is to place safety and health at work high on the national agenda, organize national systems and structures that are governed by a tripartite mechanism and that include responsible and accountable administrative units, organizations and persons which can provide guidance and management at the national level. One acknowledged way to continually improve the national system ensuring progress at the shop floor level is to establish a national occupational safety and health programme and strategy. Such a time-bound activity plan has clear priorities, targets and ways to report and follow up the activities using a system of indicators. The programme should be based on an initial review of the safety and health circumstances, i.e. a national profile. We expect companies to behave rationally and to establish occupational safety and health management systems. It is perfectly reasonable that governments in collaboration with workers, employers and their organizations do the same. A key tool at the disposal of the countries and companies, and a major component of the system, is the occupational health service. The analysis done for the ILO Conference revealed that although ILO instruments exist and national standards have been enacted in many parts of the world, they are not implemented. The new promotional framework may not prescribe further details on occupational health services, but it should establish, among other things, new methods, programmes, strategies and actions to promote and implement the ILO Convention No. 161 on Occupational Health Services. It is not acceptable that only a few countries in the world have ratified and implemented it properly. Even in many industrialized countries the coverage of occupational health services is below 50%, and in most countries of the world the rate is below 10%. The goal is that all workers, that is 100%, have access to occupational health services. Today most workers of the world have never even heard of such services. This was also the message of the ILO/ WHO Joint Committee in proposing and promoting basic occupational health services to all. Globalization of the world economy has led to considerable changes in work life, resulting from deregulation, liberalization of trade, and a shift towards more market-based economic policies. Increased competition, which is a positive factor in improving the quality of production, has also contributed to higher unemployment rates. When access to health care is linked to a stable job in the formal sector, unemployment leads not only to exclusion from the labour market but also from access to occupational health services, endangering the workers re-employability. Work-related poor health is a background cause for a large part up to 30% of unemployment, and leads to disability pensions, early retirement, absence from work and reduced working capacity. In some countries this accumulated absence from work affects more than 20 25% of the working aged population. Often the end placement is in the informal sector that offers no protective measures. And there are more than 2 million work-related fatalities in the world every year. Investing just a small part of this economic loss in preventive occupational health services would radically reduce the burden of injury and disease at work. The development of occupational health services, both qualitatively and quantitatively, should have a new dimension in the context of national occupational safety and health systems. Being an integral part of the system and related national programmes, the development, financing and provision of occupational health services will be pursued in a coherent manner. Thus, the Global Strategy adopted by the ILO and coordinated with WHO represents a new policy perspective for the development of occupational health services. This means revitalized national efforts in safety and health at work promoting existing national and international tools and instruments. We have the road map and knowledge, let s put them into practice. Jukka Takala, Director InFocus Programme on Safety and Health at Work and the Environment (SafeWork) International Labour Office takala@ilo.org All documents referred to above can be located from www.ilo.org/safework. 47 Asian-Pacific Newslett on Occup Health and Safety 2004;11:47

Occupational health services An ILO policy perspective Igor A. Fedotov, ILO Mandate The raison d être of occupational health services has traditionally been the protection of the health of workers in relation to the work environment. The ILO Occupational Health Services Convention No.161 defines occupational health services as services entrusted with essentially preventive functions and responsible for advising the employer, the workers and their representatives in the undertaking on the requirements for establishing and maintaining a safe and healthy work environment which will facilitate optimal physical and mental health in relation to work and the adaptation of work to the capabilities of workers in the light of their state of physical and mental health. Similar requirements for the provision of the protective and preventive services at the enterprise are defined in many national laws and in relevant legislations of most countries of the European region. Up-to-date, the ILO Convention No. 161 has been ratified by 23 countries. Many countries voluntarily use the Convention No. 161 and its accompanying Recommendation No. 171 as models for establishing requirements for the organization and functioning of occupational health services. Their provisions are sufficiently flexible to make allowances for different national conditions and practices, without losing the essence of the guiding principles. Initially, the provision of occupational health services has been carried out mainly by teams of specialists (occupational health professionals) set up under specialized institutional arrangements mostly at large enterprises in the organized labour sector. Later on, other models of occupational health services have been developed in an attempt to meet varying needs of a very large informal sector of the working population where the model of in-plant health services was not feasible. Despite genuine efforts of governments and legislators to extend occupational health services to the working populations, the average coverage figures are only 5 10% in developing countries and 20 50% (with very few exceptions) in industrialized countries featuring a limited access of workers to them. Occupational health practice The provision of occupational health services entails carrying out occupational health practice with the aim of protecting and promoting workers safety, health and well-being, as well as improving working conditions and the work environment. Occupational health practice may mean different things to different people. For occupational health professionals, it means conducting activities to prevent occupational accidents, injuries and diseases and to improve the work environment. By tradition, it is customarily believed in the society that occupational health practice is the exclusive domain of action of occupational health professionals, functioning individually or as part of special service units of the enterprise or of external services. In its broadest context, however, occupational health practice (which al- ways includes safety) consists not only of the activities performed by occupational health services. It is a multidisciplinary and inter-sectoral activity, involving in addition to occupational health and safety professionals, other specialists both in the enterprise and outside, as well as competent authorities, the employers and workers organizations and their representatives. Such involvement requires a well-developed and well-coordinated system at the workplace. The necessary infrastructure should comprise all the administrative, organizational and operative systems that are needed to conduct the occupational health practice successfully and to ensure its systematic development and continuous improvement. Occupational health practice should be understood as the activities of all those who contribute to the protection and promotion of workers health and to the improvement of working conditions and the work environment. These activities should not be seen as limited only to the practice of occupational health professionals. Infrastructures for occupational health practice should comprise all the organizational arrangements needed to implement a national policy on occupational health services and to ensure action at the enterprise level. They include many bodies other than occupational health services, such as enforcement agencies, research institutions, educational and training institutions, non-governmental organizations, and tripartite bodies having stakeholders interest in occupational health. Obviously, occupational health servic- Asian-Pacific Newslett on Occup Health and Safety 2004;11:48 50 48

International Labour Organisation/Maillard J. Checkup after a work accident es are the core element that dwells in the centre of occupational health practice but the entire infrastructure of the national OSH system is critical and ultimately conducive to their efficient performance. Occupational health services are an essential element of national health care and public health care system. The observed tendency is that more occupational health services units operate nowadays in the private health market, i.e. outside the public health care system. This means that, in the analysis of national health resources, they are not always taken into account. This deregulatory trend, i.e. the operation of occupational health services on a health market basis, has led to competition with other health care providers and consultancy units. Privatization of occupational health services usually requires the establishment of quality systems as an integral part of their management in order to cope with the increasingly diverse and complex service contracts they need to fulfill. Investment in health It is increasingly recognized that a healthy workforce is a prerequisite for the success of economic and social policy and a necessary condition for the achievement of sustainable development. At the same time, it is often observed that enterprises spend incomparably higher amount of funds to compensate losses due to unsafe work environment in comparison with those that would be necessary to create and maintain safe and healthy working conditions and the work environment. The process of globalization and technological advances promise to bring about a more productive and efficient world economy that could deliver faster growth and ultimately give rise to working and living standards. But it has also given rise to serious problems and anxieties. Increased competitive pressures have impelled widespread economic restructuring that has caused increased unemployment, income inequalities and cuts in health-related expenditures. Unemployment and job insecurity have become widespread and long-lasting. Under such conditions, the enterprises tend to lessen activities of occupational health services, some cut them altogether or tend to introduce health promotion programmes instead of occupational health programmes. Health promotion programmes, which aim at changing personal health practices with a view to improving overall health status and reducing absenteeism, are not considered by occupational health professionals as occupational health programmes, but rather as non-occupationally related activities, i.e. as public health services delivered at the workplace. They focus attention and resources on personal health habits, rather than on the protection of workers against occupational health hazards. Although their implementation is important for improving the total health of workers, they should never substitute for occupational health programmes, the implementation of which is the primary task of occupational health services. The investment in health is meaningful from the economic point of view. Investing in health reduces costs due to occupational injuries and diseases. It is estimated that the social cost of occupational diseases is two-threefold higher than the investment that would have been necessary to prevent them. The existing health economics studies and the experience in the field of occupational health confirm this assertion. Common knowledge indicates that prevention is better and less costly than treatment. It is necessary to define most feasible approaches from social-economic point of view in order to involve new patterns in occupational health practice and optimize the efficiency of the institutions and organizations concerned with the protection and promotion of workers health and the maintenance of their working capacity. The province of these organizations should be broadened to aim at the total health of workers covering both preventive and curative health. They should address in a concerted manner disease prevention, workplace health promotion, rehabilitation and workers compensation with the primary objective of a prompt recovery and return to work. The emphasis needs to be placed, on one hand, on the relevance, quality and effectiveness of the services provided to the working population, and, on the other hand, on the evaluation of activities, quality management and coordination between institutions financing and providing occupational health services. To achieve this goal, it is necessary to expand occupational health services emphasizing the importance of their activities in the society in order to help reduce the increasing social costs of work-related ill-health and disabilities. This is a critical socio-economic factor at the national and enterprise levels. The concern is growing about the problem of externalization of costs incurred as a result of work-related injuries and illhealth due to insufficient occupational health activities. Consequently, the externalization of these costs fall on the entire society through increased taxation and/or health and social insurance premium instead of being met by the enterprises with unhealthy and unsafe working conditions. It is believed that internalization of such costs could help reduce this economic burden on the 49 Asian-Pacific Newslett on Occup Health and Safety 2004;11:48 50

society. Indirectly, the internalization of such costs would create the economic incentives to improve occupational health practice and intensify activities of occupational health services. Future Decent Work must be Safe Work repeatedly underlines Mr. Juan Somavia, Director-General of the ILO. But today, despite all efforts by those concerned with workers health, occupational accidents and diseases cause huge human suffering to workers and their families and economic losses, while public awareness of occupational safety and health remains generally low. All too often, occupational health does not get the priority it merits. This must be changed and action needs to be taken to stimulate an accelerated response nationally and internationally. To address this challenge, the International Labour Conference discussed, in June 2003, the ILO s standard-related activities in the area of occupational safety and health. The 2003 discussion attracted a high level of interest among delegates and reflected the importance which ILO constituents continue to attach to the issue of occupational safety and health. The Conference has formulated conclusions that outline a global strategy on occupational safety and health. They call for integrated action that better connects the ILO standards with other means of action, such as advocacy, awareness-raising, knowledge development, management, information dissemination and technical cooperation to maximize impact. The Conclusions pinpoint the need for tripartite national commitment and national action in fostering a preventive approach and a safety culture which are critical to achieving lasting improvements in safety and health at work. The main pillar of the adopted global strategy is the application of a management systems approach to occupational safety and health. A key element in making a management systems approach operational at the national level is the formulation and development of national OSH programmes. These programmes are strategic time-bound programmes that focus on specific national priorities for OSH, based on analyses of the situations in the countries concerned, which should preferably be The above documents on the Internet can be found at : www.ilo.org/safework. summarized as national OSH profiles. Programmes should be developed and implemented following tripartite consultation between government, employers and workers, and endorsed by the highest government authorities. While such programmes need clear objectives, targets and indicators, overall they should also aim to strengthen the national OSH system to ensure sustainability of improvements and to build and maintain a safety culture. The utmost importance for occupational health services is that they become an integral element of the management systems approach which, at the national level, include national policy on OSH, a national OSH system (infrastructure for occupational health practice), and a national OSH programme. As such, the activities and further development of occupational health services will be closely linked to the development of national OSH systems that represent infrastructures in the area of OSH and provide the main framework for the performance of occupational health practice at large through the implementation of national OSH programmes. This new approach advocated by ILO is formulated in the ILO Report IV(1) entitled Promotional Framework for Occupational Safety and Health that will be subject to discussion at the 93rd Session of the International Labour Conference in June 2005. This discussion is to lead to the development of a new international instrument to promote occupational safety and health globally. Bibliography 1. Fedotov I, Saux M, Rantanen J. Chapter 16 on Occupational Health Services, ILO Encyclopaedia of Occupational Health and Safety (Fourth Edition), Vol. I, 1997, ILO, Geneva. 2. Fedotov I. Health Promotion in the Workplace. World Health Forum, Vol. 19, 1998, WHO, Geneva. 3. Global Strategy on Occupational Health for All. WHO/OCH/95.1. Geneva, 1995. 4. Global Strategy on Occupational Safety and Health. Conclusions adopted by the International Labour Conference at its 91st Session, 2003. ILO, Geneva, 2004. 5. Promotional Framework for Occupational Safety and Health. Report IV (1) International Labour Conference, 93rd Session, 2005. ILO, Geneva, 2004. Igor A. Fedotov, M.D., Ph.D. Senior Specialist on Occupational Health In Focus Programme SafeWork International Labour Office (ILO) 4, route des Morillons CH-1211 Geneva 22 Switzerland E-mail: fedotov@ilo.org Asian-Pacific Newslett on Occup Health and Safety 2004;11:48 50 50

Occupational health services as a part of primary health care Gerry Eijkemans Occupational Health, WHO Background About 2.6 billion people belong to the global workforce. While sustaining the economic and material basis of society, workers are exposed to numerous, preventable hazards. Additionally, there are 170 million children ages 5 17 in hazardous work. According to ILO, over 2 million people die each year from occupationally related diseases and injuries. This is only the tip of the iceberg another 160 million nonfatal diseases, and 270 million nonfatal injuries occur annually. In 2002 the World Health Report indicates the importance of the contribution of occupational health risk factors to the global burden of disease. (see Figure 1) Occupational diseases and injuries account for a loss of about 4% of the global gross domestic product. In the field of occupational health, over the last years a double burden of hazards has developed; the old hazards like exposure to high levels of noise and (obsolete) chemicals and carrying heavy loads, go hand in hand with the newly emerged or recognized hazards, such as stress at work and long hours sitting in front of the computer screen. This double burden of hazards translates in a double burden of disease, making the panorama of occupational injuries and diseases complex. The protection of health of workers is intimately related to equity issues: Figure 1. Attributable fraction (%) of global disease and injury due to occupational risk factors. The lack of access to occupational health services (most workers do not have access to any services), therefore becoming vulnerable ; workers in the informal economy (crosscutting all sectors of the economy), include a large proportion of women. Child labour is also predominantly related to the informal economy, including agriculture. These are also generally the groups that are most affected by poverty. Only 15% of the global workforce has access to any kind of occupational health service. Workers that are traditionally involved in the most hazardous jobs, with the highest exposures, are also the ones living in circumstances of poverty. Certain groups of workers are exposed to unacceptably high risk (for example, workers in agriculture, fishing, mining, construction and health care). Occupational health services focus too often on the delivery of medical or curative services and on the provision of personal protective equipment, while the gain in health can be made mainly through (primary) prevention. At the same time, there has been a tendency worldwide to blame the victim, focusing strongly on the change of behaviour of workers, and making them responsible for accidents and diseases. Globally, occupational health is in a difficult position, lacking trained human resources and sufficient finances. 51 Asian-Pacific Newslett on Occup Health and Safety 2004;11:51 53

In many countries, particularly in developing countries, there is a lack of policies and appropriate plans to protect the health and safety of workers. Basic occupational health services: effective interventions to reduce the burden of occupational deaths, injuries and diseases Responding to the brief situation analysis presented above a comprehensive and long-term response is needed. The provision of basic occupational health services will be an important strategy to address the situation. In order to implement basic occupational health services the following is needed. The creation of a supportive policy environment. The policies should be based on evidence, and have to be accompanied by realistic, adequately funded action plans. Existing information on the various risk factors (chemical, physical, ergonomic, psychosocial, biological, accidents) should be available. Channels for getting the information to the people on the ground that will make use of the materials should be in place. Practical tools to assess and manage (risk management toolbox, incl. the chemical toolkit, previously called control banding) should be developed. Databases with solutions should be set up, and instruments for estimating cost-effectiveness of interventions in the workplace should be made available. Some conceptual issues around the basic occupational health services The concept of occupational health for all is by no means new. The Global Strategy on Occupational Health advocates for this. However, Basic Occupational Health Services (BOHS) can be interpreted in different ways. Responding to the unacceptably low coverage of workers with occupational health services, it is important to focus attention on reaching out to those least protected workers. The concept of BOHS is based on the principles of primary health care (equity, universality, etc.). It is also in line with the definition of Occupational Health adopted by the Joint ILO/WHO Committee on Occupational Health. Joint ILO/WHO Committee on Occupational Health in 1950 and revised in 1995. Occupational health should aim at: the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations the prevention amongst workers of departures from health caused by their working conditions the protection of workers in their employment from risks resulting from factors adverse to health the placing and maintenance of workers in an environment adapted to their physiological and psychological capabilities and, to summarise, the adaptation of work to workers and of each worker to his or her job. The health sector, together with the labour sector, are the guiding agencies of this concept. Clear guidance should come from the government. Implementation and funding mechanisms can be different in different settings, but the guiding principles should remain the same. Public health services, providing primary health care are an important implementation mechanism for BOHS. First line health care workers need to be included in the planning and implementation of BOHS. The capacity of the primary health care services is stretched. Another programme, occupational health, might be considered as additional work burden, and might not be welcomed. However, in order to reduce the occupational health burden (the diseases and injuries that seek care in health care facilities) actions aimed at prevention have to be included in the day-to-day activities. It is well known that many non-communicable and communicable diseases are related to working conditions. For example, TB, hypertension, cardiovascular diseases all have occupational determinants. The prevention of occupational risks will reduce the burden for the health care system. In public health it is generally accepted that some services should be subsidized, or even free. Vaccination, access to clean water and decent sanitation are generally accepted on the public agenda. The provision of a safe work environment is, however, usually not considered as a basic right that should be subsidized by the health sector. In order to make BOHS a reality, public funding will definitely be necessary. According to the situation of the country and particular sectors, BOHS can also be implemented through other channels, like, for example, company-based service providers, social security mechanisms, universities, NGOs and others. Providing BOHS for every working citizen is neither easy nor cheap. Even though the government should be the leading and standard setting entity, the public systems should definitely not be expected to fit the bill alone. The development of public-private partnerships for the implementation of BOHS is desirable, and necessary. Although BOHS have a strong focus on (primary) prevention, the concept is comprehensive, and includes prevention, cure and rehabilitation. Workplace health promotion correctly applied should also be part of the concept. In order to implement basic occupational health services, we also need to define a minimum package of occupational health services that each country should establish, with a focus on primary prevention, aiming at expanding coverage to the most vulnerable groups (like, primary health care in occupational health) define innovative mechanisms (system approach) for delivering services to workers in small enterprises and the informal economy. Basic occupational health services have to be adapted to the reality of the countries, taking into account the distribution of the double burden. Special vulnerable groups (in terms of lack of protection and in terms of high risks) should be targeted. BOHS should be multidisciplinary (involving occupational hygienists, safety specialists, as well as occupational health nurses and physicians). Workers should be actively involved in the evaluation and control of the hazards. The risk management tools as mentioned previously should form the basis of the interventions. Asian-Pacific Newslett on Occup Health and Safety 2004;11:51 53 52

Services should be focused according to the hierarchy of interventions, moving, in order of preference, from the elimination of the hazard to engineering controls to administrative controls (policies and training programmes aimed to limit exposure to the hazard) to work practice controls to personal protective equipment (PPE) (barriers and filters between the worker and the hazard). Since many years we have collectively been pointing out that the majority of workers in the world have no access whatsoever to any occupational health services. Research has been carried out, knowledge has been generated, and experience has been gathered on how to prevent occupational injuries and diseases. It is time that we move to a next level of collective action. We need to translate our knowledge into action; we need to close the knowledge-application gap. The implementation of basic universal occupational health services will be a huge challenge and joint commitment and collective efforts are necessary to make this a reality. Themes of the Asian-Pacific Newsletter in 2005 The preliminary themes of the Newsletters to be published in 2005 will be: 1/2005 Chemical safety (manuscripts by 17 January 2005) 2/2005 National occupational health and safety programmes & labour inspection (manuscripts by 2 May 2005) 3/2005 Occupational health in Asia: Practical solutions (manuscripts by 1 September 2005) Readers are encouraged to submit manuscripts addressing the above themes. Articles on other topics in the field of occupational health and safety are also welcome. If you are planning to submit a manuscript, kindly contact the Editorial Office in advance. Submitted articles will be published provided there is space in the Newsletter. For instructions on how to prepare manuscripts, see the Internet: http://www.occuphealth.fi/asian-pacificnewsletter. See heading: Instructions for contributors. Please send your manuscript to: Ms. Suvi Lehtinen, Editor-in-Chief Asian-Pacific Newsletter Finnish Institute of Occupational Health Topeliuksenkatu 41 a A FI-00250 Helsinki, Finland E-mail: inkeri.haataja@occuphealth.fi or inkeri.haataja@ttl.fi Dr. Gerry Eijkemans Scientist Occupational and Environmental Health Programme World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland E-mail: eijkemansg@who.int WHO website New website on occupational health: http://www.who.int/ occupational_health GOHNET Newsletter GOHNET (Global Occupational Health Network) Newsletter is available at the following address: http://www.who.int/ occupational_health/publications/ newsletter/en/ The latest issue No. 7, 2004 deals with health care workers. Instructions for contributors Text The maximum length of the typewritten manuscript is 6 pages, including all the figures, tables and the list of references. Please send your text both in printed and diskette form/by E-mail; if possible, written in Word. Illustrations Number the figures in the order in which they appear in the text and indicate their position in the typescript. In the text, illustrations should be referred to as Figure 1, Figure 2, etc. Each figure should be identified by the figure number. In cases where it is not obvious, the top should be indicated. Diagrams and sketches should be suitable for direct reproduction. Photos and slides Contributors are encouraged to provide their articles with photos. For printing, black and white paper copies or colour slides are preferable. Digital photos of high resolution are accepted (the resolution should be at least 300 dpi). References The author is responsible for the accuracy and completeness of his bibliography. The references cited should be listed in the order in which they appear, numbered consecutively, and referred to in the text by the number in parentheses. The reference list should contain only those references found in the text. No unpublished data should be included in the reference list; it should be referred to in the text itself (e.g. According to the unpublished results of... or In a personal communication from... References to periodicals should include the authors, title, name of periodical, year, volume, and pages. Those for books should include authors or editors, title, publisher, city and year; those for a section of a book should contain the authors, title, editors, book title, publisher, city, year and inclusive pages. 53 Asian-Pacific Newslett on Occup Health and Safety 2004;11:51 53

Developing the national occupational safety and health profile in China Tsuyoshi Kawakami, Subregional Office for East Asia, ILO Changyou Zhu, ILO Beijing Office Yuhang Wang, China New ILO global strategy on occupational safety and health At the 91st Session of the International Labour Conference (ILC) in 2003, the ILO adopted a new global strategy on occupational safety and health (OSH) (1). The building and maintenance of a national preventive safety and health culture and the introduction of a systems approach to OSH management at the national level were considered as the fundamental pillars of the strategy. The 93rd Session (2005) of the International Labour Conference will further discuss a promotional framework in the area of occupational safety and health (2). To implement the strategy, formulating national OSH programmes is a key element at the national level. The national OSH programmes are strategic time-bound programmes that focus on specific national OSH priorities. In Asia, the ILO has been supporting its member countries to develop national OSH programmes. For example, Thailand launched a 5-year OSH Master Plan for the period of 2002 2006 (3), and prioritized national OSH action areas. Profiling national OSH information Developing national OSH profiles is a logical step to formulate national OSH programmes. Once the government, employers and workers reach a consensus to formulate a national OSH programme, the first technical step is to carry out a review of the national OSH situation. A national OSH profile summarizes the existing OSH situation, including OSH legislative frameworks, mechanisms for ensuring compliance with OSH legislation, OSH information and advisory services, training and awareness-raising structures, workmen s compensation schemes, occupational accident and disease statistics, policies and programme of employers and workers organizations, and so forth. National OSH profiles facilitate a systematic review of the improvements in national OSH systems and programmes and enable a country to identify needs for the further OSH development. The process of preparing the profile itself can serve as a starting point for improved coordination among the agencies concerned and an improved understanding of the OSH actions to be taken within the country. OSH development in China In China, occupational safety and health is recognized as an indispensable aspect of employment policy and strategy. The China Employment Forum, which was organized jointly by the Ministry of Labour and Social Security and the ILO in April 2004, confirmed the development of the national occupational safety and health programme as a high priority measure to provide adequate safety and health protection for all workers. The recent developments of safety and health legislation in China have been encouraging. Two major safety and health laws, the Law on Work Safety and the Law on Prevention and Control of Occupational Diseases, came into force in 2002. And a new regulation on Work Safety Permits was issued in 2004 which applies to hazardous work, including specifically in mining, construction, and the production of dangerous chemicals, fireworks, and civil explosives. ILO Chemicals Convention (No. 170) was ratified in 1995 and Safety and Health in Construction Convention (No. 167) was ratified in 2002. China s national standard on safety and health management systems, which was developed reflecting the ILO Guidelines, has been widely applied. However, China is yet facing increasing serious challenges in OSH. Practical safety and health improvement measures need to be widely applied in high-risk workplaces. The development of national OSH programme is expected to strengthen the national OSH systems involving all the agencies concerned. Asian-Pacific Newslett on Occup Health and Safety 2004;11:54 55 54

Steps taken to develop the national OSH profile of China As the first step, an inter-ministerial and tripartite taskforce was formed. The taskforce members were the representatives from the State Administration of Work Safety (SAWS), the Ministries of Health, Labour and Social Security, Agriculture, and Construction, All China Federation of Trade Unions, and China Enterprise Confederation. The taskforce jointly reviewed the existing OSH data, information and policies. The ILO guides on the contents of possible information to be included for national OSH profiles were referred to. In addition, the taskforce members from SAWS and the Ministry of Health jointly visited Fujian and Hunan Provinces to investigate the OSH implementation situation at the provincial level. Fujian Province was selected as a representative of economically-growing coastal provinces and Hunan as a representative of inland provinces. Provincial labour and health offices, trade unions and employers organizations and both large-scale and small-scale factories were visited in the two provinces. The inter-ministerial, tripartite occupational safety and health task force members engaging in active discussion. Outline of the profile The taskforce jointly examined the collected OSH information to develop the national OSH profile. The final draft of the profile composed nine main elements: (1) OSH legislative frameworks; (2) national policy review mechanisms; (3) coordination and collaboration among all the social partners; (4) inspection and enforcement systems; (5) OSH measures and tools; (6) statistics of occupational accidents and diseases; (7) policies and programmes of employers and workers organizations; (8) regular and ongoing activities related to OSH; and (9) general data. Through the process of profiling the existing OSH data and information, strong points and key action areas for OSH in China were understood. For example, the stronger enforcement of the existing laws and regulations is noted as a priority, though the existing OSH legislative frameworks of China is broad. The quality and coherent inspection systems need to be established. Currently, the responsibilities of occupational safety and health are divided into several ministries and agencies. Hazardous industries like small coal mines need special attention to reduce accident risks. The rapidly growing private enterprises, particularly small enterprises, require stronger OSH support. Practical OSH training needs to be provided for them. In the past, the priority of the occupational safety and health management had been given to the state-owned enterprises. Upgrading the level of safety research and technology was considered as another challenge. This is important to strengthen scientific measures taken for preventing major industrial accidents and for effectively identifying potential dangers to cause serious accidents. Though the overall accident and disease reporting systems have been gradually improved, an increased reporting coverage of accidents and diseases particularly from small- and medium-sized undertakings remains as a big challenge. Towards the development of the national OSH programme The first national OSH profile of China was developed as a joint product of the inter-ministerial, tripartite OSH taskforce. The process of the profiling itself provided a unique opportunity to reconfirm the importance of the concerted efforts by the different ministries and agencies towards the common OSH goals. The profile was able to illustrate both strong points and improvement needs of the national OSH systems in China. As the next essential step, the taskforce members plan to jointly analyse the profiled data and information towards the development of a possible national OSH programme. Those who need a copy of the profile, please email to Mr. Tsuyoshi Kawakami <kawakami@ilo.org> or Mr. Zhu Changyou <zhucy@ilobj.org.cn>. References 1. ILO. Global Strategy on Occupational Safety and Health. Conclusions adopted by the International Labour Conference at its 91st Session, 2003. 2. ILO. Promotional Framework for Occupational Safety and Health. Report IV (1), International Labour Conference, 93rd Session, 2005. 3. Department of Labour Protection and Welfare, Ministry of Labour, Thailand. Master Plan, Occupational Safety, Health and Working Environment, Years 2002 2006. Tsuyoshi Kawakami Subregional Office for East Asia, ILO P.O. Box 2-349 Rajdamnern Bangkok 10200, Thailand E-mail: kawakami@ilo.org Changyou Zhu ILO Beijing Office Beijing, China E-mail: zhucy@ilobj.org.cn Yuhang Wang National Centre for Safety Science and Technology Beijing, China E-mail: wangyh@chinasafety.ac.cn 55 Asian-Pacific Newslett on Occup Health and Safety 2004;11:54 55

Developing basic occupational health services with special reference to China Jorma Rantanen, ICOH Introduction The need for OHS is evident in all countries, although the requirements for the qualitative content of the services may vary widely from country to country. Industrialized countries face the problems of the new economy, with a hectic pace of work, continuous change, growing demands for performance and competence, and psychological stress. The developing countries, the countries in transition, and the newly industrialized countries still face, first and foremost, the traditional occupational safety and health hazards, such as occupational accidents, physical overload, and chemical and biological hazards. The ageing of working populations, the growing participation of women in the workforce, the increasing role of small enterprises and of selfemployment as providers of job opportunities, all increase the need for OHS. In the industrialized countries the well-organized part of work life comprises some 70 90% of the workforce, while in the developing and newly industrialized countries the corresponding figure is about 10 30%. Small enterprises, micro-enterprises, and the self-employed, in both urban and agricultural areas, comprise some 70 90% of the working people. Particularly the less organized part of work life, often characterized by the highest safety and health risks, has not been provided with occupational health services (OHS). This results in a great loss of healthy work days, loss or reduction of work ability, and a lowered quality of life of the workers, as well as lowered economic productivity. The WHO Global Strategy on Occupational Health for All, adopted by the 49th World Health Assembly in 1996, also emphasized the provision of occupational health services for all working people. The implementation of the strategy is supported in practice by the Global and Regional Networks of the WHO Collaborating Centres in Occupational Health. The objectives and content of both of these international instruments are still valid. Numerous countries have enacted legislation on OHS as a part of their labour or health legislation. So far only 22 countries have ratified ILO Convention No. 161 on Occupational Health Services. This is a low number, as virtually every country and every workplace needs occupational health services. Some countries, however, use the Convention and the Recommendation to guide their practices, even though they have not ratified them. The provision of occupational health services implies carrying out activities in the workplace with the aim of protecting and promoting the workers health, safety and well-being, as well as improving their working conditions and the work environment. Occupational health services are provided by occupational health professionals who work either in the in-house units of the enterprises or in various types of external units, including primary health care centres. For SMEs, the self-employed and the informal sector, the services need to be provided by external service providers. Specialized OHS are not likely to be available for them, and therefore it may be necessary to delegate the provision of these services to health care centres, which nevertheless need special arrangements and training in order to be able to provide basic occupational health services. The international strategies and instruments aimed at providing OHS to the less organized sectors have not been effective, because often they are not covered by legislation, or enforcement of the legislation has not been effective. New strategies are needed to get the instruments to work for the improvement of health, safety and working conditions of about four fifths of the global workforce. ILO and WHO in a new joint action The Joint ILO/WHO Committee on Occupational Health convened on 8 12 December 2003 in Geneva and agreed to collaborate on giving high priority to the development of basic occupational health services (BOHS) in their efforts to improve health and safety at work globally. The BOHS concept has been developed jointly by the International Commission on Occupational Health and the WHO. This approach aims at the provision of competent occupational health services for all working people in the world. According to the working document of the Joint Committee, occupational health services are not a time-limited project, but rather a continuous activity serving the working people and enterprises and helping them to meet their everyday occupational health needs. The services should be focused especially at coping with changes in enterprise activities and structures. OHS should therefore have a stable and continuous infrastructure as a part of the national health and safety system. Such a system is a prerequisite for the implementation of OHS policy and regulations, and provides support for practical measures at the workplace level. A model for an optimal occupational health service system is given in Figure 1. International organizations and the International Commission on Occupational Health (ICOH) are currently in the process of formulating appropriate guidelines for policies, practical tools and infrastrucutures for basic occupational health services. The objective is to produce a basic set of guidelines which can be used to advise national governments and practical occupational health organizations in building up a system of basic occupational health services. The international guidelines are intended to give the basic structures, content, methods and prerequisites, according to which the Member States Asian-Pacific Newslett on Occup Health and Safety 2004;11:56 57 56

TRAINING RESEARCH can design their own solutions, adapted to national and local conditions. China looking at ways to strengthen OHS The Chinese work life is undergoing rapid change due to the fast growth of economies, transition in economic policies, and rapid change of economic structures. The Government has recently renewed the key legislation on occupational safety and health. These actions are timely, as there are well-recognized occupational health needs, and some signs of the limitation of economic growth in some areas due to a shortage of labour force. The loss of working capacity due to accidents and diseases calls for preventive activities to ensure a healthy workforce for the rapidly developing country. This has raised the priority given to occupational health and safety. The public health care sector has also been substantially enhanced after the SARS outbreak in 2003, and measures have been taken to build up an early warning network for epidemic outbreaks. On the basis of international experience, it is known that the risks tend to show rising trends during periods of rapid economic growth and transitions in economic systems. China has experienced intensive industrial growth. Construction has boomed in urban centres and in a number of mega-projects for infrastructures, for example, in the production and supply of energy, and in transportation. The Chinese industry is critically dependent on coal ener- POLICY & LEGISLATION MINISTRY (MoL or MoH) OH Centre of Excellence SUPPORT SERVICES INSPECTION OH&S INFRASTRUCTURE SOCIAL PARTNERS E E SME SSE ME SE Figure 1. A model for a national OH&S system. (MoL= Ministry of Labour, MoH= Ministry of Health, E= enterprise, SME= small and mediumsized enterprise, SSE = small enterprise, ME= micro-enterprise, SE= self-employed) gy, and there are some 60,000 coal mines, making safety and health in mining a national priority issue. The risk of mining accidents needs a lot of effort, and the prevention of miners silicoses is a serious occupational health challenge. The prevention of chemical poisonings is given high priority in industries, as well as prevention of pesticide hazards in agriculture. The Law on Prevention and Control of Occupational Diseases was passed in 2001 and came into force on 1 May 2002. It deals with prevention, control and elimination of occupational diseases and on protection of workers health at work. According to the Act, occupational diseases are diseases contracted by workers from exposure to dusts, radioactive substances, and other poisonous and hazardous substances. The Ministry of Public Health together with the Ministry of Labour and Social Security is authorized to draw up a list of occupational diseases, and to update it periodically. The challenge for developing occupational health services arises from the country s vast geographical area, and the versatile and rich spectrum of economic activities, very high number of smallscale enterprises, a large agricultural sector, and the on-going rapid urbanization and migration of working people. The big industries are well organized and provide services for their workers, but it is extremely difficult to cover the fragmented small enterprise sector with services. Innovative solutions are needed to ensure occupational health services for all and everywhere, and simultaneously to ensure the proper content and quality of the services. The Ministry of Health has appointed a Task Force to draw up a National Occupational Health Programme for the prevention and control of occupational diseases. It will be a multi-ministry programme aiming at concerted actions for reducing and eliminating the most serious occupational diseases. It is also important to draw up a longerterm development plan for occupational health services that aims at the provision of services to each working individual. In connection with the meeting of the Inter-ministerial Tripartite Task Force in April 2004 (see Kawakami et al. in this issue) the BOHS model proposed by the ILO/WHO Joint Committee was introduced and discussed. The need for strengthening the occupational health service infrastructure was recognized, and the BOHS model was considered an appropriate starting point for further discussions. The core content of such a programme could be the effective enforcement of the new legislation, and the development of mechanisms for prevention, control, diagnosis and treatment of occupational and eventually also work-related diseases. The elimination of the most serious occupational diseases in industry and in agriculture through the development of an occupational health service infrastructure is a major challenge. Other elements could be, for example, the development of surveillance and data systems, the development of registration, notification and statistics on occupational diseases, the development of human resources for BOHS, and a health promotion programme. Both the WHO and ILO will support the development of such a programme. Furthermore, close coordination with the development of the National Occupational Safety and Health (OS&H) programme is foreseen. Reference Basic Occupational Health Services. A Working Document. Joint ILO/WHO Committee on Occupational Health, 8 12 December 2003 Geneva. Jorma Rantanen, President International Commission on Occupational Health (ICOH) E-mail: jorma.rantanen@ttl.fi 57 Asian-Pacific Newslett on Occup Health and Safety 2004;11:56 57

Occupational health services in the Philippines Dulce P. Estrella-Gust, The Philippines Photo by Charlie Solo The staff of the Occupational Safety and Health Center (OSHC); the author in the foreground. Background This report distills into a few pages the varied and numerous activities undertaken by the Occupational Safety and Health Center (OSHC) during the past six years to provide occupational health services to the Filipino worker. It covers the years 1998 to 2004. An ounce of prevention is better than a pound of cure. This is exactly what the OSHC upholds. The Occupational Safety and Health Center came into being through Executive Order No. 307, signed by former President Corazon C. Aquino, on 4 November 1987. Twelve years later, the Philippines is assured of a well prepared expertise on occupational safety and health. The OSHC s main accomplishments in developing occupational health and safety programmes and services thus revolved around the promotion and development of occupational safety and health (OSH) programmes in the country through research, training, information dissemination, and technical support to those who needed assistance from the Center. It placed a heavy emphasis on voluntary efforts by those in the workplace to improve working conditions, strong advocacy and positive action towards safety and health everywhere in the country. The Center has a regular staff of specialists in various OSH fields, and draws on national and international expertise when special needs arise. The Implementing Rules and Regulations of Executive Order 307 signed in 2002 state that it is government policy to upgrade the capability to prevent, eliminate, and reduce work-related injuries, illnesses, and deaths. It is also government policy to implement OSH programmes to: enhance national productivity; promote the health, efficiency and general well-being of the Filipino worker; and maintain an expert intelligence and training centre for occupational disease prevention and control, as well as occupational health and safety. The different divisions of the OSHC Environment Control Division The Environment Control Division works towards eliminating hazards in the work environment and controlling their ill effects on workers. It carries out work environment measurements to evaluate levels of exposure to various agents (such as solvents, heavy metals, toxic gases) and physical agents (for instance, noise, heat, vibration and illumination). It also evaluates existing ventilation systems and recommends control measures to eliminate hazards. Safety Control Division The Safety Control Division conducts safety audits, and technical visits to work sites, the emphasis being on hazardous machines, processes, and operations. This Division renders technical advice to correct unsafe conditions in the workplace. It also undertakes practical testing on the safe use of personal protective equipment and sets standard specifications for the production of personal protective equipment and other safety devices. The Safety Control Division develops technical guidelines and test procedures for safety performance checks. Health Control Division The Health Control Division conducts medical surveillance programmes necessary for early detection of occupational diseases through medical examination and biological monitoring of workers. Special examinations (such as audiometry, pulmonary function testing and analysis of heavy metals and organic solvent metabolites) are routinely conducted by the staff of the Health Control Division. Training and Public Information Division The Training and Public Information Division organizes and conducts OSH training for a broad range of clientele: for government (including those involved in labour standards enforcement), trade unions, employer groups, supervisors and others officers at establishments; for professionals (e.g. nurses, physicians, engineers, human resource officers); and even for workers from underserved sectors, including informal businesses, women workers and child labourers. The Training and Public Information Division coordinates activities related to the design and development of various training modules on OSH. As training is a function of the whole Center, trainers for training programmes are drawn from all the divisions of OSHC. Asian-Pacific Newslett on Occup Health and Safety 2004;11:58 62 58

Strategic plan 1998 2004 In August 1998, the OSHC carried out a strategic planning workshop to strengthen and sustain the Center s organizational gains. The following strategic directions were agreed upon: 1. Establish an effective OSH communication system 2. Improve the provision of OSH services/technical assistance to the under-served sectors 3. Develop a comprehensive, responsive, gender-sensitive and participatory training programme for OSH 4. Establish a rapid response system or mechanism in pre-selected industries 5. Propose and lobby for policy legislation governing OSH 6. Strengthen and enhance manpower and technical capabilities of OSHC 7. Recognize excellence in the field of OSH 8. Rationalize and prioritize an OSH research agenda 9. Institutionalize linkages with multi-sectoral groups 10.Formulate the Implementing Rules and Regulations to Executive Order 307. The four functions of the OSHC Research, technical services, information dissemination and training The training assistance provided by the Occupational Safety and Health Center is based upon a pool of capable trainers on OSH, nationwide in partnership with stakeholders. It takes the lead in developing a training agenda in consultation with its partners and stakeholders, and has developed training programmes ranging from basic to specialized programmes. The long-term goal is to professionalize the OSH training community in the context of the changing world of work. The Center serves as the clearinghouse for information and innovative methods, techniques and approaches in dealing with OSH problems. It develops mechanisms for information dissemination, and exchange among workers, employees, the public, and the stakeholders through mass media, electronic media and other forms of dissemination, such as publications, conferences, or consultations. Information on OSH ranges from prevention through workplace and community efforts, to early detection through prompt and effective interventions and to measures that reduce accidents, illnesses, and impairments, among others. Mass media, undoubtedly, is a potent tool in influencing people s perceptions and opinions on issues like OSH. All Philippine households have a radio and listen to it for news and entertainment; TV is a major source of information and entertainment to 89% of households; while print media are used by 45 50% of households. Technical assistance by the OSHC The Occupational Safety and Health Center provides a range of technical services to private and public establishments to improve the workplaces safety and health policies and programmes. This includes the following: 1. Regular requests from establishments 2. Assistance to specific establishments in imminent danger 3. Work environment measurements and other occupational hygiene concerns 4. Safety audit 5. Performance testing of personal protective equipment 6. Technical services through occupational health 7. Assistance to bills, formulation of implementing rules and regulations, laws and policies on OSH 8. Sharing of knowledge and facilities. The Center coordinates with appropriate Regional Offices when technical assistance is rendered to companies outside of the Center s office premises. The Center makes its findings, recommendations, and services available to authorized requesting clients within the shortest possible time, and in cases of imminent danger, the results are given to requesting parties immediately. OSHC assistance to specific establishments in imminent danger The clients may request technical assistance from the Center in writing, except in cases of imminent danger where an oral request would suffice. Work environment measurements The OSHC conducts regular work environment measurements in workplaces throughout the country. Work environment measurements include the identification, understanding, and evaluation of the various environmental hazards present in the workplace, as well as the recommendation of appropriate control measures to minimize workers exposure to occupational health hazards. As of June 2004, a total of 8,342 parameters had been measured. Evaluation of noise was in the greatest demand, accounting for 19.1 per cent of measurements, followed by ventilation system measurements (18.9%) and illumination (15.1 %). The analytical results showed that the most common problems encountered were excessive noise and inadequate illumination. Most establishment had problems with ventilation; such problems would include poor air movement in the work areas, insufficient air exchange and inadequate control of contaminants generated in the different processes. Safety audit The OSHC conducted safety audits in which experts from the Center evaluate the safety of workplaces, test boilers and pressure valves, and inspect press machines. Performance testing of personal protective equipment Rule 1081.03 of the Occupational Safety and Health Standards mandates that employers shall be responsible for the adequacy and proper maintenance of personal protective equipment used in the workplace. Regular testing and evaluation of personal protective equipment yield valuable information that can help manufacturers design and develop new and better products. Occupational health Medical services are offered to private companies and government agencies that request assistance in the early detection, monitoring, and prevention of occupational and lifestyle-related diseases. The Center also conducts biological determinations, such as determinations of lead concentration and metabolites in the blood of workers in industries with high-risk exposure to lead. These are generally lead smelting and car battery manufacturing companies. 59 Asian-Pacific Newslett on Occup Health and Safety 2004;11:58 62

Assistance with legislation and policies on OSH Assistance is given when bills and policies are drafted. This assistance is provided through comments, attendance at public hearings and consultations; assistance in the development of Implementing Rules and Regulations of OSH-related laws and policies, and in development of programmes to implement draft bills and laws. Assistance is also provided in monitoring and evaluating actions emanating from such laws and policies. Examples are the Comprehensive Workplace Policy on HIV/ AIDS Prevention; Republic Act 8504, also known as the National AIDS Law; Republic Act 9165, also known as the Comprehensive Dangerous Drugs Act of 2002; and Department Order 53 03 Guidelines for a Drug-Free Workplace. Now being drafted is Department Order on Tuberculosis Prevention and Control at the Workplace. Action research Understanding new paradigms for OSH practice The research agenda of the Center was envisioned to advise the partners concerned as to policy review and programme formulation and implementation. The new paradigm shifted focus from a passive, law-driven philosophy to a proactive, partner-shared, and meaningful prevention programme. Special attention was given to women, young workers, informal sector workers and child labourers. The outcome of these studies has included advocacy for policies and laws, the re-design of workplaces, the rethinking of public and even agricultural places where work is done, and the re-alignment of training and development programmes towards a healthy and safe work environment in the near future, especially for the underserved. OSHC reaches out to the underserved This segment of activities concerns the informal sector, children in unsafe work environments, and women workers. Probably one of the main features of any developing country is the ubiquitous presence of workers in the informal sector. They are anywhere and everywhere. Long unrecognized and not counted by government planners Photo by Rey Jose Soriano Industrial hygienists of the OSHC collecting samples to determine the exposure of farmers to pesticides. because they are unrecorded in official statistics, these informal sector workers have little access to organized markets or to public services and amenities that serve formal sector workers. Nevertheless, the informal sector is a reality in the world of work. Its pervasiveness, its potential contributions to the national economy, and the provision of strategies in steering the sector toward formalization all indicate the need to understand the sector clearly and to offer it all the help it may need. To date, about 52 per cent of the total employed Filipino population belongs to the informal sector. This is a very crude estimate sifted from survey data on the labour force. Making the invisible (as informal sector workers are called) visible is now one of the Center s main goals. It is in this light that the Occupational Safety and Health Center carried out case studies in 1999 on the informal sector, i.e. in battery recycling, metal fabrication and woodworking. Organized actions in favour of the informal sector have since been undertaken by the OSHC through training. The result was greater awareness of OSH hazards to the informal sector workers. The Executive Director of the OSHC gave the keynote speech at the first ever session on women and gender issues related to occupational safety and health in the context of the World Congress. The First National Conference on Women Workers Health and Safety was held, bringing together various practitioners and institutions. At the end of the symposium, the participants signed a joint communiqué committing themselves to the uplifting of workplace conditions of women workers, particularly in the area of health, safety and work environment. This communiqué was used as a springboard for developing a comprehensive and forward-looking national action agenda for women workers on OSH. The First National Youth OSH Congress on Young Workers Safety and Health The meeting was held on 30 September 1 October 2003. Organized by the Occupational Safety and Health Center (OSHC) and the Friedrich Ebert Stiftung (FES), the Congress covered a broad range of topics related to occupational safety and health of young workers. There was general consensus that greater attention to the OSH of young workers was long overdue. 57 per cent of the Philippine population is below 24 years of age. Representing a broad spectrum of agencies, firms and practitioners, the participants of the First National Youth Congress on Safety and Health committed themselves, among others, to urgent action in support of the basic rights of working youth and other disadvantaged young workers in the formal and informal sectors, to more and better jobs, to the removal of children Asian-Pacific Newslett on Occup Health and Safety 2004;11:58 62 60

from hazardous work and the worst forms of labour, to effective social protection, and to the full participation of young workers in decision-making on social matters of their concern. Protection and removal of children from dangerous workplaces Health and safety case studies carried out by the OSHC from 1996 to 2002 have demonstrated the poor healthseeking behaviour of children and their families, mostly in consequence of inaccessibility to health care. There are scant resources for buying medicines, for transport, and for hospitalization because the families of child labourers live from day to day. On 19 December 2003, Republic Act 9231, or the Special Protection of Children Against Child Abuse, Exploitation and Discrimination Act, was signed into law. This legislation translates into Philippine national law ILO Convention 182, on the elimination of the Worst Forms of Child Labour. The law entails the creation of a broad base of primary health care services, as well as building the necessary expertise. This would entail improving the competencies in identifying risks caused by children s occupational exposure to multiple hazards, diagnosing work-related illnesses, understanding the synergies between prevalent public health problems such as tuberculosis, malnutrition and workplace exposures, and providing for appropriate intervention. For these reasons, the OSHC in collaboration with its partners have developed a comprehensive project for the National Program on Child Labor and for its Time Bound Program from 2005 to 2010. The zero accident programme The zero accident programme is the end goal of the preventive programme. It uses a multi-pronged approach to the problems of safety and health at work. It relies on five components: advocacy; training; compliance; networking and linkages; and productivity link-ups. This programme recognizes outstanding firms and individuals who champion occupational safety and health in their workplaces. It grants these firms and individuals awards in the annual Gawad Kaligtasan at kalusugan, or the GKK. It is the first national award given to firms and individual champions for excellence in occupational safety and health. The framework highlights the strategies for achieving the zero accident level at the workplace. It emanates from OSH policy and elements of OSH policy, and it involves an OSH programme (including the aspects of safety control and emergency preparedness, occupational hygiene, occupational health, capacity building for OSH) as well as environmental protection, community relations, and social accountability. These elements are among the GKK criteria. Linkages A. The ASEAN OSH-NET is an organization of national centres of occupational safety and health in the ASEAN Member Countries. It has four priority areas: training, research, information, and standards. Programme coordinators are designated for each of these priority areas. The Philippines, through the OSHC, is the coordinator for training priority area. B. The International Labour Organisation (ILO), through the ILO Centre for Information Services (ILO-CIS), works in partnership with the OSHC, supporting the national congresses. C. The Government of Japan supports two programmes through JICA and JISHA: The Japan International Cooperation Agency (JICA) sponsors the Third Country Training Programme on OSH for Small and Medium Enterprises, conducted by the OSHC for the past seven years. Likewise, JICA gives training to OSHC s technical staff ranging from biological monitoring to work environment measurements. The Japan Institute for Safety and Health Association (JISHA) provides training programmes in specialized OSH topics from time to time. D. The Finnish Institute of Occupational Health, in cooperation with the ILO and the WHO, has supported the OSHC expert to participate in the international conference on Work in the Global Village, the International Workshop on Occupational Health and Safety: Profiles and Indicators held on 18 October 2001, and the International Symposium on Youth and Work held in Espoo, Finland, on 20 22 November 2002. E. Active sharing of expertise had been ongoing between the OSHC and the several professional organizations and NGOs. The OSHC has trained most of the members of these professional organizations in training courses for the basic occupational safety and health, the zero accident programme, HIV/AIDS, and the drugs and alcohol abuse. Conclusion Progress in improving workplace conditions over the past decade has been remarkable. Globalization has had its gains; but in its wake, some consequences have to be faced. There are bright spots in the world of work, but there remain some worrisome patches. We still have to extend our assistance to the least and underserved: the informal sector, women workers, and child labourers. In the forthcoming years, we intend to broaden the number of partners and search for more advocates of safety and health among the Filipinos. We will look for more people who share our passion and determination to bring about lasting improvements in the Filipino way of life, not only in the workplace but also in the streets and homes. Technical assistance and outreach are important. Our plan for conducting such outreach programmes will be holistic and convergent. This will allow us to maximize the use of all our assets and resources. Feedback and continuous improvement will be part of our daily routine. Our training programmes will be focused so as to give people the specific skills, concepts, knowledge, and opportunities they need to become advocates in their own right, to make their world a better place to live in, no matter how small that world is. The challenge to the Center to produce tangible results in the interest of a world of work is greater than ever. The world of work is threatened by internal ignorance as well as by the inadequacy of the safety nets of Filipino workers, who number more than 35 million people. Literature 1. A Primer on HIV/AIDS and the Workplace: Based on RA 8504 The Philippine Prevention and Control Act of 1998, by OSHC, Department of Labor and Employment, with support from the ILO. 2. Administrative Order No. 236 (Series of 1996), Creating an Inter-Agency Committee within the DOLE to draft the a plan of action for the Workplace-based Strategies on STD/HIV/AIDS. Department of Labor and Employment (DOLE). 61 Asian-Pacific Newslett on Occup Health and Safety 2004;11:58 62

3. Are our workplaces safe? LABSTAT Update, Bureau of Labor and Employment Statistics, Department of Labor and Employment. 4. Asian-Pacific Newslett on Occup Health and Safety 2003;10(2):25 64. Psychological stress and well-being. 5. Asian-Pacific Newslett on Occup Health and Safety 2000;7(2):25 52. Child Labour. 6. Asian-Pacific Newslett on Occup Health and Safety 1999;6(2):25 56. Women at Work. 7. Department Order No. 53 03 (Series of 2003), Guidelines for the Implementation of a Drug-Free Workplace Policies and Programs for the Private Sector. Department of Labor and Employment (DOLE). 8. Estrella-Gust Dulce P. Globalization and Asian Women: The Philippine Case. Asian-Pacific Newslett on Occup Health and Safety 2001;8:66 70. 9. Estrella-Gust P. Vulnerable and Underserved Groups in Globalization, Plenary Paper, An International Conference on Work Life in the 21st Century, Helsinki, Finland, 15 17 October 2001. 10. Estrella-Gust P. Keynote Speech Session on Women and Gender Issues Related to OSH, 15th World Congress on OSH, Sao Paolo, Brazil, 12 16 April 1999. 11. Estrella-Gust Dulce P, Galang R. (1999) Occupational Injuries in the Philippines, background paper for the Experts Meeting on Occupational Injuries, ILO, Geneva. 12. Gust Gert A. Fundamental Labor Rights and their Relevance for the Philippines, Philippine Journal of Labor and Industrial Relations 1998;XVIII(1&2). 13. Human Capital in the Emerging Economy: Report and Recommendations of the Congressional Commission on Labor, Congress of the Philippines, February 2001. 14. ILO, Geneva: Reducing the Decent Work Deficit: a global challenge, 2001. 15. Keynote Speech: Honorable Patricia Santo Tomas, Secretary. Department of Labor and Employment, to the Gawad Kaligtasan Kalusugan Award, September 2004. 16. Proceedings of 7th National Occupational Safety and Health Congress, OSHC, 26 27 October 2000. 17. Proceedings of First National Conference on Women, OSHC, 14 16 October 1999. 18. Proceedings of 6th National Occupational Safety and Health Congress, OSHC, 11 12 November 1998. 19. Republic Act No. 9231, An Act Providing for the Elimination of the Worst Forms of Child Labor and Affording Stronger Protection for the Working Child. Republic of the Philippines. 20. Republic Act No. 9165, Comprehensive Dangerous Drugs Act of 2002. Republic of the Philippines. 21. Research Abstracts of the Occupational Safety and Health Center from 1998 to 2001 are for publication. 22. The Labor Code of the Philippines, 1998 Edition. 23. The Occupational Health and Safety Standards, Department of Labor and Employment, 1978. 24. Triennial Report of the Occupational Safety and Health Center (OSHC), Department of Labor and Employment (DOLE), 1998 2000. 25. Workshop Report, Occupational Safety and Health Center: Strategic Planning A Workshop to Strengthen and Sustain Organizational Gains, 6 7 August 1998. Associated Resources for Management and Development, Inc. Dr. Dulce P. Estrella-Gust Executive Director Occupational Safety and Health Center, Department of Labor and Employment North Avenue Corner Science Road Diliman, Quezon City The Philippines E-mail: oshcenter@oshc.dole.gov.ph Guidelines in shipbreaking ILO has developed guidelines to provide assistance to ensure safe work in shipbreaking. The practical recommendations in these guidelines are for use of all those who are responsible for occupational health and safety in shipbreaking operations. The ILO publication Safety and health in shipbreaking: Guidelines for Asian countries and Turkey (Geneva, International Labour Office, 2004) is available on the internet at the following address: www.ilo.org/safework/ shipbreaking. The guidelines were adopted by the Interregional Tripartite Meeting of Experts on Safety and Health in Shipbreaking for Selected Asian Countries and Turkey, held in Bangkok in October 2003. The Governing Body of the ILO approved the publication of the guidelines in March 2004. ILO electronic products Two important sources of lifesaving information are now freely available to the public on the ILO s website. The English version of the ILO Encyclopaedia of Occupational Health and Safety and the bilingual (English/French) CIS- DOC database were previously available only on subscription through partner institutions. Internauts are now invited to point their browsers at http://www.ilo.org/encyclopaedia/ and http://www.ilo.org/dyn/cisdoc/ index_html (underscore, not full stop, between index and html ). The ILO s International Occupational Safety and Health Information Centre announced the news in Brussels on 18 September at an meeting of knowledge management specialists from 20 countries. The delegates represented some of the 137 institutions world-wide that contribute time and publications to an active and self-sustaining information exchange network, a network that was an important source of expertise for the Encyclopaedia and continues to provide material for the CISDOC database. ILO News Now in its fourth edition, the Encyclopaedia is a unique and widely respected reference. Its 1,000 articles and copious illustrations have been available on paper, CD-ROM and the World Wide Web since 1998. But always at a price. Responding to calls from International Labour Conference Delegates and the ILO Governing Body to provide free access to more resources, the InFocus Programme on Safety and Health at Work and the Environment (SafeWork) has now made the Encyclopaedia the centrepiece of its SafeWork Bookshelf, which presently also includes the ILO/WHO/UNEP International Chemical Safety Cards. CISDOC is the fruit of 30 years of screening the occupational safety and health literature of the world for interesting and useful books, articles and audiovisual materials that occupational safety and health specialists can use in their fight against workplace accidents and diseases. It already guides users to over 62,000 publications, and 2,000 more references are added every year. The Encyclopaedia and CISDOC are still available from their long-time vendors. The two are searchable together on the World Wide Web at http:// www.ilocis.org, and CISDOC is combined with other important occupational safety and health databases on CD- ROMs from the Croner unit of Wolters-Kluwer (UK) and from the Canadian Centre for Occupational Health and Safety. An important tool is included with the Encyclopaedia and CISDOC: the CIS Thesaurus. This trilingual (English/ French/Spanish) collection of terms is used by the ILO to index CISDOC references, and by a number of occupational safety and health libraries around the world to organize their collections. In the Internet age, it is a valuble source of meta-data for making Web pages easier to find. Asian-Pacific Newslett on Occup Health and Safety 2004;11:58 62 62

10th International Congress of Toxicology (ICT-X) The Finnish Society of Toxicology, in close collaboration with the International Union of Toxicology (IUTOX), organized the 10th International Congress of Toxicology, which was held on 11 15 July 2004 in Tampere, Finland. The magnificent Tampere Hall, which is the largest congress and concert centre in Scandinavia, was a perfect venue for a conference of this size, with open space and many opportunities to sit down and talk. The conference brought together nearly 1,400 participants from 67 countries, who were pampered with a multitude of excellent lectures and interesting posters. The scientific programme consisted of 22 symposia and 13 workshops. The Organizing and Scientific Programme Committees had clearly made every effort to acquire scientifically eminent and geographically representative speakers for the Congress. Crucial issues, such as risk assessment, food safety and food toxicology, mechanisms of cell death and carcinogenesis, pesticide and clinical toxicology, drug safety and drug development, as well as capacity building and training in toxicology were emphasized in the programme. A special goal was to combine cutting-edge toxicological findings with research that is also relevant to solving the many problems faced by individuals in developing countries. In addition to the symposia and workshops, six continuing educational courses on topical issues in toxicological research, such as Bioinformatics and in silico methods in toxicology and Toxicogenomics and metabonomics in risk assessment, were offered. A special Deichman Award Lecture was also given during the Opening Ceremony of the Congress. The Deichman Award Lecture was originated by the family of William B. Deichman, Photo by Solveig Borg Nearly 1,400 participants from 67 countries attented the ICT-X Congress in Tampere, Finland. Her Royal Highness, Princess Chulabhorn, from Thailand was among the attendees. the initiator of the establishment of IU- TOX. The first Deichman Lecture was given at ICT-III meeting in 1983; the tradition then started has persisted, with a Deichman Lecture being delivered at each International Congress of Toxicology. The Deichman lecturer at ICT-X in Tampere was the grand old man of toxicology in Finland, Professor Jouko Tuomisto, whose lecture was entitled Do mechanisms help risk assessment example dioxins. The wide scope of the Congress provided the participants with excellent possibilities to meet colleagues from all over the world. It is more than likely that many of the names familiar only from reference lists of publications have now become friends and colleagues. A special flavour for the meeting was provided by the attendance of Professor Her Royal Highness Princess Chulabhorn from Thailand, who gave an Asian perspective on human resource development in toxicology for developing countries. Ari Hirvonen, PhD Chief of the Biomonitoring Laboratory Finnish Institute of Occupational Health Topeliuksenkatu 41 a A FI-00250 Helsinki, FINLAND E-mail: ari.hirvonen@ttl.fi 63 Asian-Pacific Newslett on Occup Health and Safety 2004;11:63