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Keynote Session 3

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K3.1 THE CONTRIBUTION OF OCCUPATIONAL RISK FACTORS TO THE GLOBAL BURDEN OF DISEASE

T. Driscoll, M. Fingerhut, D. Imel Nelson, M. Concha, L. Punnett, A. Pruess, K. Steenland, J. Leigh, C. Corvalan.School of Public Health, University of Sydney, Australia

The World Health Organization conducted a comparative risk assessment (CRA) to ascertain the contributions of 26 risk factors to the global burden of disease. Age and gender specific global exposure information for all 14 WHO subregions, and risk estimates, were placed into a single model, in order to allow comparisons regarding relative contributions of risk factors. Attributable fractions were based on disability adjusted life years lost, which reflect the burden caused by both mortality and morbidity. Five occupational risk factors, for which adequate global exposure and risk information could be ascertained, were included: carcinogens, airborne particulates, hazards for injuries, ergonomic stressors for low back pain, and noise. Additionally, analysis of needlestick injuries as a risk factor for infectious disease among healthcare workers was conducted. Data limitations, primarily in developing countries, meant we were unable to include major occupational risk factors for some illnesses such as some cancers, reproductive disorders, dermatitis, infectious diseases, ischaemic heart disease, and musculoskeletal disorders of the upper extremities. Exposure was characterised for the economically active population in both formal and informal sectors, aged 15 years and older. Child labour could not be addressed. Exposure was quantified based on the economic sector and on occupation, using economic databases and publications of the International Labor Organization and the World Bank, and workers were grouped into high and low exposure categories. Risk estimates were obtained from the published literature. These five occupational risk factors accounted for an estimated 37% of back pain, 16% of hearing loss, 13% of chronic obstructive pulmonary disease, 11% of asthma, 9% of lung cancer, 8% of injuries and 2% of leukaemia worldwide. Needlesticks accounted for 40% of hepatitis B and C, and 4% of AIDS infections among healthcare workers. These selected occupational risks accounted for nearly 800 000 deaths and more than 22 million years of healthy life lost, and constitute about 40% of the ILO estimate of 2 million deaths worldwide due to work related risks.

K3.2 METHODS FOR AGENCY AND VOICE: COMMUNITY BASED SURVEILLANCE AND ACTION RESEARCH

R. Loewenson.Training and Research Support Centre, Zimbabwe

Poor households in southern Africa have borne an inequitable share of the cost burdens of major public health problems regionally and globally. Working people within these households have also borne an inequitable share of the cost burdens of the restructuring of production under a globalisation process based on unfair global trade relations, dominance of transnational corporation interests, reduced role and authority of the state, and political and economic marginalisation of southern and low income populations. The gap between knowledge and practice in safe work and occupational health is growing increasingly wide for such communities. At the same time, global knowledge is poorly applied in precisely those settings where risks are greatest. Confronting such trends calls for redistribution of the resources for health in an equity and public interest oriented policy agenda supported by the state. Given the intensifying political struggle around health resources, this paper argues that increased attention needs to be given to participatory forms of inquiry, particularly those that strengthen the influence of poor communities, promote accountability of the state and private sector, raise public interest values in health policy, and reduce the gap between knowledge, voice, and agency in acting on health issues in working life. The paper presents a framework for the type of participatory action research that this implies. It outlines the trends, challenges and methodological issues in such research, reflecting on how far those raised in previous EPICOH meetings have been addressed. In the context of the widening economic and social insecurity and inequality noted above, the paper presents a practical example of community based surveillance and action research and examines the role of such research in addressing gaps raised earlier in the paper in: (a) contributing to new knowledge in environments of economic, employment, and social insecurity; (b) strengthening influence of poor communities, promoting public interest, and promoting state and private sector accountability, including on safe work; and (c) overcoming the knowledge–practice gap and strengthening the influence and agency of poor communities in improving their working lives.

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