The United Nations General Assembly (UNGA), the International Labour Organization (ILO), the World Health Organization (WHO), the International Commission on Occupational Health (ICOH), and the ...European Union (EU) have encouraged countries to organize occupational health services (OHS) for all working people irrespective of the sector of economy, size of enterprise or mode of employment of the worker. The objective of this study was to survey the status of OHS in a sample of countries from all continents.
A questionnaire focusing on the main aspects of OHS was developed on the basis of ILO Convention No. 161 and several other questionnaire surveys used in various target groups of OHS. The questionnaire was sent to 58 key informants: ICOH National Secretaries.
A total of 49 National Secretaries responded (response rate 84.5%), from countries that employ 70% of the total world labour force. The majority of the respondent countries, 67%, had drawn up an OHS policy and implement it with the help of national occupational safety and health (OSH) authorities, institutes of occupational health or respective bodies, universities, and professional associations. Multidisciplinary expert OHS resources were available in the majority (82%) of countries, but varied widely in quantitative terms. The average OHS coverage of workers was 24.8%, with wide variation between countries. In over two thirds (69%) of the countries, the content of services was mixed, consisting of preventive and curative services, and in 29% preventive only. OHS financing was organized according to a mixed model among 63% and by employers only among 33% of the respondents.
The majority of countries have drawn up policies, strategies and programmes for OHS. The infrastructures and institutional and human resources for the implementation of strategies, however, remain insufficient in the majority of countries (implementation gap). Qualitatively, the content and multidisciplinary nature of OHS corresponds to international guidance, but the coverage, comprehensiveness and content of services remain largely incomplete due to a lack of infrastructure and shortage of multiprofessional human resources (capacity gap). The estimated coverage of services in the study group was low; only a quarter of the total employed population (coverage gap).
Objectives International organizations have encouraged countries to organize occupational health services (OHS) for all working people. This study surveyed how that objective has been achieved in a ...sample of International Commission on Occupational Health (ICOH) member countries from all continents. Method A structured questionnaire was sent to ICOH national secretaries in 61 countries. The survey focused on (i) policies and strategies; (ii) systems, institutions, and infrastructures; (iii) contents and activities; (iv) human and other resources; (v) financing; and (v) future priorities in the development of national OHS systems. Results Of 47 respondents, 70% had drawn up a policy and strategy for OHS and 79% had a national institute of occupational health or safety. The calculated coverage of workers was 19% among the respondent countries. Sixty percent of respondent countries used multiple channels for service provision and 70% provided mixed contents of OHS with preventive and curative services. Almost all (94%) reported availability of multidisciplinary experts, but not in sufficient numbers. OHS is financed through combined employer plus insurance financing in 62% of respondents and through employer financing only in 38%. The countries identified well the needs for future development of OHS. Conclusions In spite of documented policies for OHS, only slightly over one third of the surveyed countries had organized OHS for more than 50% of workers. The vast majority of workers of the world are underserved due to four gaps in OHS: implementation, coverage, content, and capacity.
An unhealthy lifestyle may contribute to ill health, absence due to sickness, productivity loss at work, and reduced ability to work. Workplace health promotion programs (WHPPs) aim to improve ...lifestyle and consequently improve health, work ability, and work productivity. However, systematic reviews on intervention studies have reported small effects, and the overall evaluation of effectiveness of WHPPs is hampered by a large heterogeneity in interventions and study populations. This systematic review aims to investigate the influence of population, study and intervention characteristics, and study quality on the effectiveness of workplace health promotion programs.
A systematic literature search was conducted identifying RCTs, published before June 2012, evaluating the effect of a WHPP aimed at smoking cessation, physical activity, healthy nutrition, and/or obesity on self-perceived health, work absence due to sickness, work productivity, or work ability. Studies were included in the meta-analyses if quantitative information was present to calculate an effect size (ES). A meta-analysis, stratified meta-analyses, and meta-regression analyses were performed in Spring 2012 using Comprehensive Meta-analysis software 2.0 and PAWS 17.0.2.
In 18 studies describing 21 interventions, the overall effect of a WHPP was small (ES=0.24, 95% CI=0.14, 0.34). The effectiveness of a WHPP was larger in younger populations, in interventions with weekly contacts, and in studies in which the control group received no health promotion. A 2.6-fold lower effectiveness was observed for studies performing an intention-to-treat analysis and a 1.7-fold lower effectiveness for studies controlling for confounders. Studies of poor methodologic quality reported a 2.9-fold higher effect size of the WHPP.
The effectiveness of a WHPP is partly determined by intervention characteristics and statistical analysis. High-quality RCTs reported lower effect sizes. It is important to determine the effectiveness of WHPPs in RCTs of high quality.
Work is an important social determinant of health; unfortunately, work-related injuries remain prevalent, can have devastating impact on worker health, and can impose heavy economic burdens on ...workers and society. Occupational health services research (OHSR) underpins occupational health services policy and practice, focusing on health determinants, health services, healthcare delivery, and health systems affecting workers. The field of OHSR has undergone tremendous expansion in both definition and scope over the past 25 years. In this commentary, focusing on the US, we document the historical development and evolution of OHSR as a research field, describe current doctoral-level OHSR training, and discuss challenges and opportunities for the OHSR field. We also propose an updated definition for the OHSR field: Research and evaluation related to the determinants of worker health and well-being; to occupational injury and illness prevention and surveillance; to healthcare, health programs, and health policy affecting workers; and to the organization, access, quality, outcomes, and costs of occupational health services and related health systems. Researchers trained in OHSR are essential contributors to improvements in healthcare, health systems, and policy and programs to improve worker health and productivity, as well as equity and justice in job and employment conditions. We look forward to the continued growth of OHSR as a field and to the expansion of OHSR academic training opportunities.
Various basic occupational health services (BOHS) are provided, particularly in-plant BOHS; however, it might be necessary to start expanding BOHS. The current study focuses on BOHS model development ...using participatory action research (PAR) at a large-sized enterprise in northeastern Thailand. The PAR began with a situation analysis using ILO Convention C161, problem and cause analysis, the development of an action plan, observation and action, evaluation, and replanning. The research tools included interviews, focus group discussions (FGDs), and participant observations. The participants included managers, human resource staff, safety officers, and workers. Both inductive and deductive thematic analyses were undertaken. The results showed that (1) education and learning experience led to the workers detecting work-related diseases early by themselves and the implementation of medical surveillance programs; (2) the workers' occupational health needs led to return-to-work assessments and first aid room system development; (3) the employer's experience led to appropriate fit-for-work examinations and emergency preparedness; and (4) the feedback from BOHS providers led to a hospital-to-in-plant return-to-work conversion. The study concluded that the enterprise could develop fit-for-work and return-to-work assessments as per the ILO Convention C161 under the policy; however, medical surveillance and the first aid room system need to be developed through counseling at the hospital's occupational medicine clinic.
Introduction
Common mental disorders (CMD) are leading causes of decreased workability in Sweden and worldwide. Effective interventions to prevent or treat such disorders are important for public ...health.
Objective
To synthesize the research literature regarding occupational health service (OHS) interventions targeting prevention or reduction of CMD among employees. The effect on workability (sickness absence, return-to-work and self-reported workability) and on CMD symptoms was evaluated in a narrative analysis.
Data sources
The literature search was performed in four electronic databases in two searches, in 2014 and in 2017.
Eligibility criteria (using PICO)
Population: studies investigating employees at risk or diagnosed with CMD, as well as preventive workplace intervention targeting mental health. Intervention: studies where the recruitment or the intervention was delivered by the OHS or OHS personnel were included. Control: individuals or groups who did not receive the target intervention. Outcome: all types of outcomes concerning sickness absence and psychological health were included.
Study quality was assessed using a Swedish AMSTAR-based checklist, and results from studies with low or medium risk of bias were narratively synthesized based on effect or absence thereof.
Results
Thirty-three studies were included and assessed for risk of bias. Twenty-one studies had low or medium risk of bias. In 18 studies, rehabilitation interventions were evaluated, 11 studies concerned interventions targeting employees at risk for developing CMD and four studies investigated preventive interventions. Work-focused cognitive behavioral therapy and problem-solving skill interventions decreased time to first return-to-work among employees on sick leave for CMD in comparison with treatment-as-usual. However, effect on return to full-time work was not consistent, and these interventions did not consistently improve CMD symptoms. Selective interventions targeting employees at risk of CMD and preventive interventions for employees were heterogeneous, so replication of these studies is necessary to evaluate effect.
Limitations
Other workplace interventions outside the OHS may have been missed by our search. There was considerable heterogeneity in the included studies, and most studies were investigating measures targeting the individual worker. Interventions at the workplace/organizational level were less common.
Conclusions and implication of key findings
Return-to-work and improvement of CMD symptoms are poorly correlated and should be addressed simultaneously in future interventions. Further, interventions for CMD administered through the occupational health service require further study. Rehabilitative and preventive strategies should be evaluated with scientifically robust methods, to examine the effectiveness of such interventions.
To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, ...we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions.
In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40–80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance.
Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0·685 (95% CI 0·629–0·741) to 0·833 (0·783–0·882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40–64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt.
We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide.
World Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research.
The review aimed to synthesise recent evidence on health service use and health outcomes among international migrant workers, compared with non-migrant workers.
A search was carried out in MEDLINE, ...PubMed, Embase, and CINAHL for studies published between Jan 1, 2010, and Feb 29, 2020. Included outcomes were: occupational health service use, fatal occupational injury, HIV, and depression. Two authors independently screened records, extracted data, assessed risk of bias and judged quality of evidence. We meta-analysed estimates and conducted subgroup analyses by sex, geographical origin, geographical destination, and regularity of migration.
Twenty-one studies were included comprising >17 million participants in 16 countries. Most studies investigated regular migrant workers in high-income destination countries. Compared with non-migrant workers, migrant workers were less likely to use health services (relative risk 0·55, 95% confidence interval 0·41 to 0·73, 4 studies, 3,804,131 participants, I2 100%, low quality of evidence). They more commonly had occupational injuries (1·27, 95% confidence interval 1·11 to 1·45, 7 studies, 17,100,626 participants, I2 96%, low quality of evidence). Relative risks differed by geographical origin and/or destination. There is uncertainty (very low quality of evidence) about occupational health service use (0 studies), fatal occupational injuries (5 studies, N = 14,210,820), HIV (3 studies, N = 13,775), and depression (2 studies, N = 7,512).
Migrant workers may be less likely than non-migrant workers to use health services and more likely to have occupational injuries. More research is required on migrant workers from and in low- and middle-income countries, across migration stages, migrating irregularly, and in the informal economy.
The coronavirus (COVID-19) pandemic has resulted in changes to the working arrangements of millions of employees who are now based at home and may continue to work at home, in some capacity, for the ...foreseeable future. Decisions on how to promote employees' health whilst working at home (WAH) need to be based on the best available evidence to optimise worker outcomes. The aim of this rapid review was to review the impact of WAH on individual workers' mental and physical health, and determine any gender difference, to develop recommendations for employers and employees to optimise workers' health.
A search was undertaken in three databases, PsychInfo, ProQuest, and Web of Science, from 2007 to May 2020. Selection criteria included studies which involved employees who regularly worked at home, and specifically reported on physical or mental health-related outcomes. Two review authors independently screened studies for inclusion, one author extracted data and conducted risk of bias assessments with review by a second author.
Twenty-three papers meet the selection criteria for this review. Ten health outcomes were reported: pain, self-reported health, safety, well-being, stress, depression, fatigue, quality of life, strain and happiness. The impact on health outcomes was strongly influenced by the degree of organisational support available to employees, colleague support, social connectedness (outside of work), and levels of work to family conflict. Overall, women were less likely to experience improved health outcomes when WAH.
This review identified several health outcomes affected by WAH. The health/work relationship is complex and requires consideration of broader system factors to optimise the effects of WAH on workers' health. It is likely mandated WAH will continue to some degree for the foreseeable future; organisations will need to implement formalised WAH policies that consider work-home boundary management support, role clarity, workload, performance indicators, technical support, facilitation of co-worker networking, and training for managers.
In 2015, approximately 244 million people were transnational migrants, approximately half of whom were workers, often engaged in jobs that are hazardous to their health. They work for less pay, for ...longer hours, and in worse conditions than do nonmigrants and are often subject to human rights violations, abuse, human trafficking, and violence. Worldwide, immigrant workers have higher rates of adverse occupational exposures and working conditions, which lead to poor health outcomes, workplace injuries, and occupational fatalities. Health disparities of immigrant workers are related to environmental and occupational exposures and are a result of language cultural barriers, access to health care, documentation status, and the political climate of the host country. Recommendations on global and local scales are offered as potential solutions to improving the health of immigrant workers.
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