Occupational health

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Occupational health discussed at the South American Rural Health Forum in Santa Fe, Argentina

Claudio Colosio (claudio.colosio@unimi.it), Department of Occupational and Environmental Health of the University of Milan, San Paolo Hospital Unit and International Centre for Rural Health, WHO Collaborating Centre for Occupational Health;
Ivan Ivanov (workershealth@who.int), Global Occupational Health Programme, Department for Public Health and Environment, World Health Organization, Geneva.

Increasing the access to health care of disadvantaged population subgroups is an urgent need in all the corners of the world. All work towards universal access to health services and elimination medical deserts, in particular in rural areas where people suffer problems related to remoteness, distance to welfare structures, and lack of health care providers.

The adoption of the Almaty Declaration in 1978 emphasized the need of bringing health care close to the places where people live and work. For some populations, providing health care at the workplace, may be the only option for local people to come in contact with the health system. For example, plantation workers may have access to occupational health service at their workplace, but not to general practitioners. Rural dwellers may have access to primary care provider, but no access at all to occupational health. Therefore, linking occupational health and primary care is a an important avenue towards increasing health coverage in rural areas.

The Forum of the Latin American Network on Rural Health held in Santa Fe, Argentina, from 9 to 10 December 2011, focused on the role of occupational health in rural health practice. Participants included representatives of the national rural health associations from Argentina, Chile, Bolivia, Uruguay, Colombia, Peru, and Brazil, together with experts from the Rural Health Institute of Spain, the International Centre for Rural Health and University of Milano, the International Commission of Occupational Health (ICOH), the WONCA Working Party on Rural Practice, the Australian College of Rural and Remote Medicine, and the World Health Organization.

A special round table discussed the role of rural physicians in occupational health. The discussion revealed that rural physicians see themselves as responsible for total health of their population, including occupational health. Most of them never had contact with occupational health specialists. Rural physicians needed more knowledge and access to information about specific occupational health issues in rural areas, such as new health risks from agriculture and industries and other occupational hazards, new occupational diseases, tools for addressing work-related health problems. Occupational health services in rural areas, where they exist, could be expanded to cover also workers' families and the rural community at large.

Stimulating such developments requires a stronger collaboration between international networks on occupational health, rural health and primary care/family medicine/general practice, particularly regarding the rural physicians and primary care providers in rural health centers in basic occupational health and providing them with access to occupational health information and expertise. The WHO collaborating centres for occupational health at the International Centre for Rural Health in Milano, Italy, maintains a large network on occupational and rural health and is actively involved in collaboration with Wonca Rural Health Party. The centre works with WHO towards increasing the access of rural populations to essential interventions and basic services for occupational health and for strengthening the capacities of primary care services to address the specific health needs of rural workers.

The meeting in Santa Fe adopted a declaration "Rural Health in Extinction" that:

- expressed the support of rural health community to the implementation of Resolution WHA 62.12. Primary health care, including health system strengthening and Resolution WHA60.26 "Workers' Health: Global Plan of Action";
- called upon the policy makers, academic and professional association and social actors to declare a state of alert and to provide solutions to the process of extinction and promote the development of the rural health practice;
- urged authorities should encourage the recruitment of future members of rural health teams;
- encouraged rural health practitioners to further develop their knowledge and practice by creating a speciality in rural medicine;
- stressed on the need to implement measures that contribute to the retention of health teams and their families in rural areas; and
- highlighted the social inequalities in health between rural and urban areas and integrated such considerations into the planning and distribution of resources, as well as the need to support research in this area.

The full text of the Santa Fe Declaration (in Spanish) is available at http://www.ancaloo.com.ar/nota.asp?idnota=5405

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