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Other than the home environment, the workplace is the
setting in which many people spend the largest proportion of their time. Indeed, for many
people, particularly in developing countries, the boundary between their home and
workplace environments is blurred, since they often undertake agricultural or cottage
industry activities within the home. Growth of the latter has often been spurred by
population growth and rapid urbanization, in combination with economic development, and in
parallel with larger, more conspicuous industrial development.
In favorable circumstances, work contributes to good health and economic
achievements. However, the work environment exposes many workers to health hazards that
contribute to injuries, respiratory diseases, cancer, musculoskeletal disorders,
reproductive disorders, cardiovascular diseases, mental and neurological illnesses, eye
damage and hearing loss, as well as to communicable diseases.
The current global labor force stands at about 2600 million and is growing
continuously. Approximately 75% of these working people are in developing countries. The
officially registered working population constitutes 60–70% of the world's adult
male and 30–60% of the world's adult female population. Each year, another 40
million people join the labor force, most of them in developing countries. Workplace
environmental hazards are therefore a threat to a large proportion of the world
population.
The workplace environment and economic
development
In some of the least developed countries up to 80% of the workforce is employed in
agriculture, mining and other types of primary production. Heavy physical work, often
combined with heat stress, occupational accidents, pesticide poisonings, organic dusts and
biological hazards are thus the main causes of occupational morbidity and mortality in
these countries. Additionally, numerous non-occupational factors such as parasitic and
infectious diseases, poor hygiene and sanitation, poor nutrition, general poverty and
illiteracy aggravate these occupational health effects.
The informal sector and small-scale industries
(SSIs), in particular, are subject to
numerous workplace hazards. Many migrants find work in the informal sector and SSIs since
these offer easy entry for newcomers, and often do not require formal trade skills, or
large amounts of capital or machinery. Estimates suggest over 1000 million people
worldwide are employed by small-scale industries. In some countries, such as Thailand,
SSIs may account for the majority of registered industries. However, SSIs are not subject
to occupational health-and-safety provisions. Even in the advanced economy of the USA, 90%
of all work sites, covering 40% of the countries total workforce of 110 million, are not
inspected regularly and/or do not have access to occupational health services. Many of
those working in SSIs therefore suffer adverse health impacts due to exposure to dusts,
heat stress, toxic substances, noise, vibration and poor hygiene.
In rapidly-industrializing countries occupational health problems often arise due to
use of technologies that are less advanced and more hazardous than those favored by
developed countries. Moreover, managing all aspects of production — for example,
health and safety at work and the health of the work environment, as well as the external
environment— can be difficult when technical and financial resources are limited, as
is often the case. In such circumstances, occupational accidents, traditional physical and
ergonomic hazards, and occupational injuries diseases become major problems. Their true
extent is unknown, however, since many occupational injuries and diseases are neither
notified nor registered.
Evidently, the panorama of workplace hazards varies in accordance with the stage of
economic development that has been reached and approaches to health protection should take
this into account. The basic principles of occupational health remain the same, however,
and are laid out in the Declaration on occupational health for all.
Workplace exposures
Workplace health hazards generally differ from those found in the general environment.
Furthermore, because workers are often exposed in confined spaces, exposure levels to
workplace hazards are often much higher than exposures to hazards in the general
environment. In developing countries, workers may be exposed simultaneously to workplace
hazards, to an unsafe housing environment, and a polluted general environment. The
following summary of major workplace hazards has been extracted from the Global
strategy on occupational health for all, which was adopted by the World Health
Assembly in 1996.
Mechanical hazards, unshielded machinery, unsafe structures in the workplace and
dangerous tools are some of the most prevalent workplace hazards in developed and
developing countries. In Europe, about 10 million occupational accidents happen every year
(some of them commuting accidents). Adoption of safer working practices, improvement of
safety systems and changes in behavioural and management practices could reduce accident
rates, even in high-risk industries, by 50% or more within a relatively short time.
Approximately 30% of the workforce in developed countries and between 50% and 70% in
developing countries may be exposed to a heavy physical workload or ergonomically
poor working conditions, involving much lifting and moving of heavy items, or
repetitive manual tasks. Workers most heavily exposed to heavy physical workloads include
miners, farmers, lumberjacks, fishermen, construction workers, storage workers and
healthcare personnel. Repetitive tasks and static muscular load are also common among many
industrial and service occupations and can lead to injuries and musculoskeletal disorders.
In many developed countries such disorders are the main cause of both short-term and
permanent work disability and lead to economic losses amounting to as much as 5% of GNP.
Exposure to some 200 biological agents, viruses, bacteria, parasites, fungi,
moulds and organic dusts occurs in selected occupational environments. The hepatitis B and hepatitis C
viruses and tuberculosis infections (particularly
among healthcare workers), asthma (among
persons exposed to organic dust) and chronic parasitic diseases (particularly among
agricultural and forestry workers) are the most common occupational diseases resulting
from such exposures. Blood-borne diseases such as HIV/AIDS and hepatitis B are now major
occupational hazards for healthcare workers.
Physical factors in the workplace such as noise,
vibration, ionizing and non-ionizing radiation and
microclimatic conditions can all affect health adversely. Between 10 and 30% of the
workforce in developed countries, and up to 80% of the workforce in developing and
newly-industrializing countries, are exposed to such physical factors. In some high-risk
sectors such as mining, manufacturing and construction, all workers may be affected.
Noise-induced hearing loss is one of the most prevalent occupational health effects in
both developing and developed countries.
About 100 000 different chemical products are in use in modern work environments
and the number is growing. High exposures to chemical
hazards are most prevalent in industries that process chemicals and metals, in the
manufacture of certain consumer goods, in the production of textiles and artificial
fibres, and in the construction industry. Chemicals are also increasingly used in
virtually all types of work, including non-industrial activities such as hospital and
office work, cleaning, and provision of cosmetic and beauty services. Exposure varies
widely. Health effects include metal poisoning, damage to the central nervous system and
liver (caused by exposure to solvents), pesticide poisoning, dermal and respiratory
allergies, dermatoses, cancers and reproductive
disorders. In some developing countries, more than half of the workers exposed to dust-containing
silica in certain high-risk industries (such as mining and metallurgy) are reported to
show clinical signs of silicosis or other types of pneumoconiosis.
Reproductive hazards in the workplace include around 200–300 chemicals
known to be mutagenic or carcinogenic. The reported adverse effects include infertility in
both sexes, spontaneous abortion, fetal death, teratogenesis, fetal cancer, fetotoxicity
and retarded development of the fetus or newborn. Numerous organic solvents and toxic
metals, many biological agents, such as certain bacteria, viruses and zoonoses, as well as
heavy physical work, are also associated with an increased risk of reproductive disorders.
The reproductive hazards of ionizing radiation are now well-established, while hazards
from non-ionizing radiation are under intensive study. Both male and female workers may be
affected by these hazards, but protection of women of fertile age and pregnant women is of
particular concern.
About 300–350 substances have been identified as occupational carcinogens.
They include chemical substances such as benzene,
chromium, nitrosamines and asbestos, physical hazards such as ultraviolet radiation (UVR) and ionizing radiation, and
biological hazards such as viruses. In the European Union alone, approximately 16 million
people are exposed to carcinogenic agents at work. The most common cancers resulting from
these exposures are cancers of the lung, bladder,
skin, mesothelium, liver, haematopoietic tissue, bone and soft connective tissue. Among
certain occupational groups, such as asbestos sprayers, occupational cancer may be the
leading factor in ill-health and mortality. Due to the random character of effect, the
only effective control strategy is primary prevention that eliminates exposure completely,
or that effectively isolates the worker from carcinogenic exposure.
Exposure to the estimated 3000 allergenic agents in the environment is mainly
occupational. In the work environment, such hazardous agents enter the body via the
respiratory tract or the skin. Allergic skin diseases are some of the most prevalent
occupational diseases. Occupational respiratory diseases should therefore be the focus of
any occupational health programme. Occupational asthma, for instance, is caused by
exposure to various organic dusts, microorganisms, bacteria, fungi and moulds, and several
chemicals. The increased number of people who develop an allergic response, coupled with
high numbers of occupational allergenic exposures and improved diagnostic methods, has led
to a steady growth in the registered numbers of occupational asthma cases in several
industrialized countries.
Psychological stress caused by time and work pressures has become more prevalent
during the past decade. Monotonous work, work that requires constant concentration,
irregular working hours, shift-work, work carried out at risk of violence (for example,
police or prison work), isolated work or excessive responsibility for human or economic
concerns, can also have adverse psychological effects. Psychological stress and overload
have been associated with sleep disturbances, burn-out syndromes and depression.
Epidemiological evidence exists of an elevated risk of cardiovascular disorders,
particularly coronary heart disease and hypertension in association with work stress.
Severe psychological conditions (psychotraumas) have been observed among workers involved
in serious catastrophes or major accidents during which human lives have been threatened
or lost.
Social conditions of work such as gender distribution and segregation of jobs
and equality (or lack of) in the workplace, and relationships between managers and
employees, raise concerns about stress in the workplace. Many service and public employees
experience social pressure from customers, clients or the public, which can increase the
psychological workload. Measures for improving the social aspects of work mainly involve
promotion of open and positive contacts in the workplace, support of the individual's
role and identity at work, and encouragement of teamwork.
Occupational
health impacts
The great variety of occupational health hazards makes quantification of their
associated health risks and impacts at the global level very difficult. Some estimates
have been based on the occupational injuries and diseases reported in official statistics.
But a large number of injuries and diseases caused by workplace hazards are not reported.
Adjustment is therefore necessary. Making such adjustment, ILO and WHO estimate that there
may be as many as 250 million occupational injuries each year, resulting in 330 000
fatalities.
Due to the changes in occupational distribution with development, many countries have
experienced a shift from the hazards that characterize work in agriculture, mining and
other primary industries, to those of manufacturing industries or service industries.
Following such a shift, occupational injuries and diseases could be expected to fall in
number and the severity of those that do occur to be less. But, in fact, new occupational
disease problems have emerged, leading to an increased incidence of reported occupational
disease in certain developed countries.
In addition to the specific workplace hazards discussed above, work and health are
associated in other ways, creating possibly even greater impacts on health. Working
conditions, type of work, vocational and professional status, and geographical location of
the workplace and employment also have a profound impact on the social status and social
well-being of workers. Historically, occupational health programmes have developed with
attempts to improve the social conditions of underserved and unprivileged occupations. In
many countries, social policy and social protection are closely linked with employment and
unemployment. As the mobility of workers increases, leading to high numbers of migrant
workers in some countries, their health, well-being and social support will require
special attention. These are key issues for sustainable development.
Extracts from Health
and Environment in Sustainable Development,
Geneva, WHO, 1997
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