Workers’ Health in the Americas
Regional Plan

1. Introduction

2. Background: PAHO/WHO and Other International Actors

3. Current Situation of Workers’ Health in the Region

1. Composition of the Work Force and Work Profiles
2. Risk Profiles
3. Profiles of Morbidity and Mortality
4. Cost of Occupational Injuries and Diseases

4. Approach and Guiding Principles of the Plan

1. Guiding Principles

5. Purpose and General Objectives of the Plan

6. Programming Areas: Specific Objectives, Lines of Action, Expected Results, and Activities

6.1. Quality of the Work Environment

1. Objectives
2. Plan of Action
3. Expected Results

6.2. Policies and Legislation within the Regulatory Framework

1. Objective
2. Plan of Action
3. Expected Results and Activities

6.3. Workers’ Health Promotion

1. Objective
2. Plan of Action
3. Expected Results and Activities

6.4. Comprehensive Health Services for Workers

1. Objective
2. Plan of Action
3. Expected Results and Activities

7. Key Agents and Actors

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REGIONAL PLAN ON WORKERS’ HEALTH

 

1. INTRODUCTION

In recent decades, the majority of the countries have pursued development models oriented mainly toward economic growth: these have been modified to a greater or lesser extent by the incorporation of a variety of approaches, such as globalization of the economy, regional integration processes, privatization processes, rapid technological progress, and more recently, changes in social policy, and a more flexible labor market. All these factors have modified occupational structures, sometimes positively and sometimes negatively, in ways that contribute to the maintenance or exacerbation of existing inequities in the labor sector.

As the twenty-first century dawns, the countries of the Region of the Americas, like other countries around the world, face the urgent need to modify their styles of development to avoid perpetuating the disparities between and within nations and procure a safer, more prosperous future that satisfies basic needs and raises the standard of living for all.

The 1992 United Nations Conference on the Environment and Development (UNCED), held in Rio de Janeiro, Brazil, adopted sustainable development as its central theme and focused on the concept of satisfying the basic needs of present and future generations. The UNCED Declaration of Principles sets forth these concepts in the following terms: "Human beings constitute the center of concerns related to sustainable development. They have the right to a healthy and productive life in harmony with nature", and "the right to development should be exercised in such a way as to respond equitably to the development and environmental needs of present and future generations."

Recognition of the idea of sustainable development has shaped our traditional concepts of development. A global consensus has arisen on the importance of workers’ health as a key aspect of development and the equitable social and economic well-being of human beings. The subject has awakened renewed concern, and has been raised in international, regional, and country forums, where it is recognized that a work force that enjoys health and well-being is an efficient contributor to economic and social development.

This new interest has led to situation analyses of workers’ health in the countries of the Region, which reveal the existence of large economic and social inequities in the labor sector. Moreover, at the international and national levels alike, a major institutional vacuum can be seen with regard to attention to the problem of workers’ health, particularly in the informal sector.

The Pan American Health Organization (PAHO) is aware of its mission to promote preventive measures in order to protect the health of all the inhabitants of the Region of the Americas. In response to the situation of workers’ health it has seized the initiative and structured its technical cooperation actions in this area with a comprehensive approach that is preventive, multisectoral, and participatory. This led to the preparation of a Regional Plan on Workers’ Health.

The complexity of the problem of workers’ health requires the collaboration and participation of a variety of actors, at both the national and international level. With this in mind, the Plan has been visualized as a framework for the countries and for international cooperation efforts. This framework allows the various actors to operate with a common perspective, and to conduct synchronized interventions (countries and international cooperation) thus optimizing the available resources on behalf of workers’ health. The hope is that this will lead to results that are greater than the sum of many separate efforts.

It is hoped that this instrument ---with the collaboration of all actors, national and international alike--- will contribute effectively and efficiently to significant improvement in equity in the various factors that affect the labor sector, and particularly the health of workers.

 

2. BACKGROUND: PAHO/WHO and Other International Actors

The problem of workers’ health, in its varied aspects, has caused growing concern in many international organizations, including PAHO/WHO.

During the 1990s, this concern intensified due to changes in development models, and their impact on living conditions, working conditions, and risk factors in the workplace and work environment, all of which affect the health of the working population.

The Governing Bodies of PAHO, cognizant of these problems and of the importance of workers’ health, have included actions in this area in its programs directed at cooperation with the countries. Resolution XIV of 1990, adopted measures and modes of cooperation on workers’ health, and recommended the principal programming lines for the Member Governments.

Resolution XIV: Resolution XIV establishes the following as specific programming lines: policy formulation and evaluation; coordination among national institutions; development of different institutional worker’s health care arrangements (with special emphasis on health education, health promotion, primary health care, and the inclusion of primary health care at all levels of health services, including local health care systems); community participation (employers and workers); training of human resources needed for the expansion of coverage; incorporation of occupational health activities in health programs; establishment of information and epidemiological surveillance systems; and workers’ participation in the adoption of healthy lifestyles.

The Strategic and Programmatic Orientations for PAHO 1999-2002, concerning environmental development and protection, include priority aspects of workers’ health stated in the following terms:

"To encourage the countries to take action on physical, biological, chemical, and psychosocial factors, as well as organizational factors and dangerous production processes that adversely affect workers’ health in both the formal and informal sectors, the technical cooperation of the Bureau will focus on:

• Strengthening the countries’ capabilities to anticipate, identify, evaluate, and control or eliminate risks and dangers in the workplace;
• Promoting the updating workers’ health legislation and regulations and the establishment of programs designed to improve the quality of the workplace environment;
• Fostering programs for health promotion and disease prevention in occupational health;
• Promote better health services for the working population;
• Supporting programs aimed at protecting child workers exposed to environmental and occupational risks.

In 1994 the Declaration of Occupational Health for All was adopted at the second meeting of the World Health Organization (WHO), jointly with collaborating centers in occupational health. This served to support the preparation of the Global Strategy on Occupational Health For All, endorsed in Resolution WHA 49.12, and adopted by the World Health Assembly in May 1996. The Assembly further urged Member States to prepare national programs of occupational health for all, based on the global strategy, while paying special attention to the creation of comprehensive occupational health services for the economically active population, including migrant workers, light industry workers, and those in unstructured sectors, as well as other groups with high occupational risks and special needs, including working children.

The International Labor Organization (ILO) has produced a series of conventions and specific recommendations on occupational safety and health, as well as other related items, in order to establish occupational safety and health standards that are duly complemented by codes of practical recommendations. This organization has deployed multidisciplinary technical teams in the Region, which include experts on labor environments and conditions. The ILO conducts the Program for Improvement of Working Conditions and the Environment (PIACT), adopted in 1984, and the Program for the Eradication of Child Labor (IPEC). Furthermore, it is preparing the Global Program on Occupational Safety, Health, and Environment, to be launched in 1999.

The Earth Summit, UNCED 1992, as indicated above, emphasized the need to safeguard health and safety in the workplace. Likewise, the Pan American Conference on Health and Environment in Sustainable Human Development (1995), advanced the concept of sustainable development, which should include the avoidance and minimization of exposure to occupational, transportation, and domestic risks.

The Summit of Americas I (1994) supports a basic package of preventive and public health services consistent with WHO/PAHO recommendations, universal, and nondiscriminatory access to health services, and protection of the human rights of migrant workers, indigenous workers, and their families. The Summit of Americas II (1997) emphasizes the safeguarding of the rights of migrant workers and their families through access to the health services for the least protected populations and through protection of the environment.

The XIII Meeting of the Health Commission of the Latin American Parliament (1998) dealt specifically with Workers’ Health, and recommended that the topic be incorporated into the political agendas of the Summits of the Americas.

The Inter-American Conference on Social Security (CISS), through the Inter-American Commission on Prevention of Occupational Risks and the Inter-American Center for Social Security Studies has promoted and sponsored various courses, congresses, debate forums, and annual workshops on occupational safety and health, ergonomics, epidemiology of the workplace, occupational health, etc.

The International Standardization Organization (ISO) is the worldwide federation of national standardization agencies. Its purpose is to promote the establishment of standards for products and services, and to foster mutual cooperation in intellectual, scientific, technological, and economic activities. It developed the ISO standards, such as ISO 9000 and ISO 14000, which are international standards used to manage and assure product quality, and directives on how to choose and use such standards.

The 1998 Annual Meetings of the World Bank and the International Monetary Fund addressed the topic "the social responsibility of multinational corporations" and noted that the comparative advantages of the developing countries remain favorable even when acceptable parameters for environmental and occupational health are adopted. This creates an opening for factor workers’ health into development projects.

At the regional level, there are free trade areas and other integration processes, such as those covered by the North American Free Trade Agreement (NAFTA), MERCOSUR, CARICOM, and the Andean Union. The World Trade Organization (WTO) has the role of promoting free trade among countries. These free trade agreements offer possibilities to advance and promote workers’ health in corporations.

The mandates, resolutions, and actions of international organizations stress the ever-increasing importance of workers’ health in the interrelated complex of health, sustainable human environment and development.

 

3. CURRENT SITUATION OF WORKERS’ HEALTH IN THE REGION

During the last few decades the widespread adoption of development models oriented toward economic restructuring, reorganization of production, technological innovation, and economic growth based on consumption and the exchange of goods and services, have induced changes in the structure and composition of the work force, in the organization of labor, and in labor relations. These have led to a new international division of labor.

3.1 Composition of the Work Force and Work Profiles

Estimates for 1996 put the population of the Region of the Americas at 781 million. Of this, the estimated EAP* was 351 million--that is, 44.9% of the total population, with 201 million (57.3%) corresponding to Latin America and the Caribbean and 150 million (42.7%) to the United States of America and Canada. The EAP will continue to grow in Latin America and the Caribbean, reaching an estimated 270 million by the year 2025 (a 34% increase).

Since mid-century, at different rates and to differing degrees, the countries of the Region have shifted from primarily agricultural and mining economies to relatively industrialized economies with trade and service activities, a shift that has modified work profiles. The developing countries are consequently dealing with the dual work pattern of transitional economies, marked by an increasingly differentiated work force among and within them. This work force ranges from the employees of the multinational corporations to workers in the informal sector who barely earn a living, a situation that accentuates the social and health inequities.

 

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* The EAP does not include workers under 15 or people over 65.

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In Latin America policies to promote labor flexibility in commercial enterprises, facilitated by reforms in the labor laws and in hiring regulations, have affected job stability, the work day, working hours, vacation time, and wages.

Unemployment in Latin American declined in 1997 for the first time since 1989, when it was around 5.4%. It gradually rose to 8.8% in 1996, falling to 8.3% in 1997 as a result of the economic recovery.

ECLAC estimates that the percentage of the population employed in the informal sector out of total nonagricultural employment in Latin America increased from 51.6% in 1990 to more than 56.7% in 1996, with the figure ranging from 38% to 64% among the countries. The new employment generated is of poor quality. Eighty-five out of every 100 new jobs are in the informal sector. Moreover, outsourcing and the informalization of the employment structure are seriously undermining the quality of jobs and equity in terms of access to services and the social distribution of wealth.

Employment in the informal sector is growing chiefly among traditional economic activities, consisting of small businesses (sometimes linked with medium-sized and large companies) and independent occupations that generally entail higher risks and more unstable working conditions. Added to the biopsychosocial risk factors for workers in the informal sector are the conditions of personal insecurity to which they are exposed on the street and in the home. Work in the informal sector, moreover, exposes family members directly or indirectly employed in the sector to occupational risks.

With regard to wages, it is estimated that some 20% to 40% of the employed population in Latin America receives an income lower than the minimum necessary to cover the basic market basket. The drop in real household income as a result of the decline in the purchasing power of wages, added to inflation, open unemployment, and other factors, obliges many women and children to accept low-paying jobs that are often unstable and unsafe. The indigenous population of the Andean Area typically earns less than other workers in the same economies.

It was estimated that 56 million women would join the work force by 1995. Women's participation in the work force rose from a rate 37% to 45% between the 1980s and mid-1990s, while men’s participation held steady at 78% to 79%. Women generally work in more precarious conditions than men and receive only 71% of the wages that men receive. Like the rest of the working population, women are exposed to chemical substances (pesticides) and adverse physical conditions (heat and cold, heavy loads), as well as the problems deriving from temporary work. Women usually have a double workload (paid work, plus household chores), which exposes them to greater health risks.^, 

Some 15 million children work in Latin America. One out of every five people under the age of 18 is employed, half of them between the ages of 6 and 14. In the United States the number of child workers is estimated at 4 million. In addition to the usual problems connected with poverty, malnutrition, anemia, and fatigue, children who work run the risks associated with unsafe and unhealthy conditions in the workplace. ^,  Among the most intolerable forms of child labor are jobs in mining, agriculture, the informal tanning industry, street vending, and domestic service.

3.2 Risk Profiles

Technology development has produced major transformations in the means of production, resulting in new and varied forms of hazards in the workplace. A study by Leigh et al. demonstrates the importance of occupation as a risk factor in mortality and potential disability-adjusted life years. The study concludes that in 1990, of the principal risk factors for mortality in Latin America and the Caribbean "occupational risks" ranked seventh in terms of years of life with disability and fourth in terms of years of potential life lost. It is also interesting to note that in 1990, occupational mortality was almost equal to mortality from tobacco use (Figure 1).

In its recent publication, Health, Environment, and Sustainable Development: Five Years After the Earth Summit, WHO calls attention to exposure to risk factors in the workplace, highlighting among the principal risk factors physical and ergonomic overload, which affects 30% of the work force in the developed countries and from 50% to 70% in the developing countries; biohazards (more than 200 agents); physical hazards (which affect 80% of the work force in the developing and newly industrialized countries); and chemical hazards (more than 100,000 different substances used in the majority of economic activities; these include teratogenic or mutagenic chemical substances, which are particularly harmful to maternal health and reproductive health).

Social conditions and psychological stress are increasingly indicated as occupational risk factors, affecting virtually the entire economically active population. The differential risks to which workers are exposed imply major inequities that disproportionately endanger the health of the poorest and most vulnerable population groups, since these are the people who hold down the most hazardous, lowest-paying jobs with the least surveillance.

3.3 Profiles of Morbidity and Mortality

The social conditions surrounding employment, risks, growing social inequities, and other similar factors make the working population more susceptible to disease, more vulnerable to injuries, and more subject to burnout and physical exhaustion.

The impact of these multiple factors on workers' health gives rise to an epidemiological profile characterized by the problems typical of the traditional occupational pathologies (occupational hearing loss, acute pesticide and heavy metals poisoning, skin and respiratory diseases), side by side with others recently associated with the workplace (cancer, occupational asthma, occupational stress, cardiovascular and musculoskeletal diseases, immunological conditions, and diseases of the nervous system). Also important are reemerging diseases (dengue fever, leptospirosis, malaria, and tuberculosis). Improvements in data collection of occupational morbidity and mortality will make it possible to describe the magnitude and nature of the problem.

In California, U. S., information on 10 reportable diseases has been consolidated and compared to 10 occupational diseases and injuries (Figure 2). Especially noteworthy is the magnitude of the most frequent occupational diseases compared to the diseases requiring compulsory notification.

The ILO has estimated that 36 occupational accidents occur every minute in Latin America and the Caribbean, and that approximately 300 workers die each day as a result of these accidents. It also notes that nearly 5 million accidents occur annually, and that of these, 90,000 are fatal.

 

With regard to occupational diseases, WHO estimates that barely 1% to 5% of cases are reported in Latin America and the Caribbean, since only cases resulting in disability subject to indemnification are recorded. The traditional occupational diseases most reported in Latin American and the Caribbean are occupational hearing loss, acute pesticide and heavy metals poisoning, skin diseases, and respiratory diseases.

Studies on occupational mortality and morbidity in the United States conducted by Leigh, estimate that roughly 2% to 8% of all cancers are of occupational origin and that 10% to 30% of all types of lung cancer in men can be attributed to occupational exposure. In addition, some 5% to 10% of morbidity from cancer, cardiovascular, cerebrovascular, and chronic obstructive pulmonary diseases in working males aged 25 to 64 are work-related. In Latin America and the Caribbean, chronic work-related diseases (such as cancer, cardiovascular and musculoskeletal diseases, and neurobehavioral disorders) are not registered as such.

 

3.4. Cost of Occupational Injuries and Diseases

The available information on the cost of occupational injuries and diseases usually comes from Social Security and includes the cost of health care and pensions and compensation for disabilities or death. The cost of occupational injuries and diseases in the sectors not covered by Social Security is not known; this burden falls on workers and their families and increases demand in the health services.

In Costa Rica, where the National Insurance Institute alone is responsible for managing occupational hazards and covers 56% of the country's work force and 84.3% of the salaried population, the direct cost (care and indemnification for occupational injuries and diseases) and the administrative cost for 1995 was US$ 50 million. This amounts to nearly 0.6% of the gross domestic product (GDP), not counting the indirect costs or the costs for the workers not covered.

Estimates in Bolivia and Panama for 1995 yield figures of 9.8% and 11% of GDP, respectively, for occupational injuries and diseases. The ILO estimates the cost of occupational injuries at as much as 10% of the GDP of the developing countries and has calculated that if the countries reduced this figure by half, they could pay their foreign debt. In the United States it was estimated that in 1992 the direct cost (US$ 65,000 million) plus the indirect cost amounted to US$ 171,000 million, with the cost of occupational accidents US$ 145,000 million and the cost of occupational diseases US$ 26,000 million. These latter two figures are considered to be underestimated.

 

4. APPROACH AND GUIDING PRINCIPLES OF THE PLAN

In light of all these considerations, as well as the complexity of workers’ health, the above-mentioned trends, current needs, and governing mandates, the Pan American Health Organization is promoting a comprehensive, fully-integrated approach through the Regional Plan on Workers’ Health. The goal is to strengthen cooperation with and among the countries, in order to accelerate prevention and control of dangerous processes and occupational hazards, and to promote and protect workers’ health.

Given this context, the Pan American Health Organization is aware of the need for multisectoral interdisciplinary actions in order to turn the Plan into concrete reality. Thus PAHO invites other international technical cooperation agencies to join in a dialogue based on four strategic areas: the quality of the work environment (primary prevention); policy and legislation within the framework of regulatory policy; workers’ health promotion; and the delivery of comprehensive health services, in order to obtain and formulate a concerted strategy.

This Plan recognizes that national leadership (government and civil society) is the core of the effort for sustainable development in Workers’ Health, since it occupies the middle ground between regional actions, on the one hand, and local implementation, on the other.

4.1 Guiding Principles

The guiding principles of the Plan are:

Universality: Greater coverage of comprehensive health services (prevention, promotion, care, and rehabilitation), for the Economically Active Population (EAP), and workers in general.

Equity: Improvement in unfair living and work conditions. Equality of opportunities and access of quality work, regardless of sex, age, ethnic group, or other considerations.

Participation: Active participation of workers in the crafting and implementation of plans and programs to protect their health and well-being in the workplace.

Consensus-building: Discussion and cooperation among all the sectors involved.

Comprehensiveness: Holistic approach to public health, including promotion, prevention, care, rehabilitation, and return-to-work programs.

Coherence: All efforts of the various entities committed to solving the situations presented should be geared toward a single focus, and have a preestablished, articulated objective.

Timeliness: Precise solutions at the right time.

It follows that the plan’s epicenter hinges on improving working conditions and work environments within a context of productivity, with social equity, in which the theory and practice of work grant people the human dimension they need for effective performance.

 

5. PURPOSE AND GENERAL OBJECTIVE OF THE PLAN

The purpose of the Plan is:

"To contribute to an improvement in work environment, living conditions, health status and general well-being of workers, in order to advance toward sustainable human development with equity and social justice."

The general purpose of the Workers’ Health Plan is: "to strengthen the technical and institutional capacity of the countries, in order to develop effective prevention and protection policies for workers’ health, to regulate and control the working conditions, in order to reduce risks and exposure to dangerous substances and agents, and to monitor and control compliance with established provisions for prevention and protection."

 

6. PROGRAMMING AREAS: Specific Objectives, Plans of Action, Expected Results, and Activities

Taking the strategic areas into account, and in order to consolidate a preventive approach, the Plan envisages four closely interrelated program areas. Table 1 summarizes the results and activities for each program area. Each consists of a specific objective, a plan of action, and a group of expected results and activities. The four program areas are:

• Quality of the work environment
• Policies and legislation within the regulatory framework
• Promotion of workers’ health
• Comprehensive workers’ health services

 

6.1 Quality of the Work Environments

6.1.1 Objective

Based on a primary prevention approach (elimination and/or control of risk) and responding to the multiplicity of risks and working conditions adverse to workers’ health, the objective of this area has been established as follows:

Strengthening of the capacity of the countries to anticipate, identify, evaluate, and control risks in different work environments.

Successful primary prevention requires scientific knowledge of the sources, mechanisms for generation and transmission, and the magnitude of occupational risks. It also requires technical knowledge and practical application of this knowledge in order to identify and control risks. This implies creating groups of multidisciplinary experts who can contribute the insights of many different disciplines to problem solving, without detracting from the participation of employers and workers.

Given that reliable information is scarce and sparsely disseminated, the Regional Plan submits a proposal for developing a strategy and systems to make existing information more accessible for the comprehensive analysis of workers’ health and environments. It emphasizes the development of analytical tools to correlate socioeconomic, environmental, and health indicators, in order to monitor working conditions and define priorities for selection of the most effective programs.

The Plan also promotes the usage and development of appropriate instruments and methodologies for prevention and control of occupational health hazards and adverse conditions. As basic elements for sustainable economic development, it emphasizes the adoption of clean production processes, assessment of appropriate technologies for control of risks, hazardous waste minimization, and the reduction of risks in the use and production of chemicals in the workplace.

Within the above, applied research is geared toward reducing the gap between current knowledge and the application of methodologies, instruments, and clean production processes.

 

6.1.2 Plan of Action

• Train employers and workers in risk prevention and control.

• Improve systems for surveillance, registry, and reporting; craft instruments, methodologies, standards, and policies with the coordinated support of all pertinent entities.

• Disseminate existing technical information in and among the countries, through the establishment and support of information systems, with inputs from the various international agencies and professional associations. The informative systems thus implemented will need to intensify coordination of their activities through the Global Program of Health, Safety, and Occupational Environment of the ILO, and the Global Strategy for Occupational Health of WHO, and the International Program on Chemical Safety (IPCS).

• Train human resources, including review and updating of curricula, support for graduate-level programs, review of teaching materials, and the application of new educational methods (remote courses, etc.) in the fields of Industrial Hygiene, Occupational Safety, Ergonomics, and Epidemiology, with the collaboration of the network of Collaborating Centers of WHO/PAHO.

• Promote and support initiatives aimed at development and implementation of instruments and methodologies to control risk in the workplace, such as PACE and other intervention programs, supported by international institutions and by financial and technical cooperation agencies.

• Develop study and research protocols directed toward preventive interventions, reducing exposure to dangerous substances and agents in the work environment, and the deployment of clean production technologies. These initiatives can benefit from the experience and knowledge of PAHO and its specialized centers, the ILO and other agencies of the United Nations system, WHO Collaborating Centers, and development financing agencies.

 

6.1.3 Expected Results and Activities

(a) Sensitize and train employers and workers in risk prevention and control

Sensitization and training of employers and workers should make it possible to adopt measures for risk prevention and control. The strategic orientation to this end is to obtain high visibility for the positive impact of adopting such measures for workers and employers, as well as the training of these actors.

The strategy for achieving this result is built on multipartite groups, to be composed of representatives of the employers, workers, and government, and with the participation of specialized national technicians; there must be functions and capabilities for research, education and mass communication, organized in a concerted and participatory fashion.

PAHO will provide technical support to these groups through the experience of preparing conceptual and methodological instruments, consultancies, and missions, and by promoting the sharing of knowledge gathered from experiences. To this end it will identify a network of specialists and institutions.

The national groups, with the support of PAHO, the Region, and the countries, will develop:

• Research, through the surveys assessing the problem, or the quality of the work environments, with particular emphasis on occupational hazards, and on the social, economic, productive, and environmental impact of hazards on workers, firms, and countries. The perceived needs and psychosocial profiles of each group will be also studied.

• Process this information for its proper dissemination, seeking sensitization and commitment on three levels:

• Employers and business circles, adapting information materials according to the size of the firm and productive sector.
• Government officials and political leaders, adapting the material by sector and geographical area.
• Workers, adapting the material in accordance with level of responsibility and activity of the workers’ organizations.

• Programs, operational strategies, methodologies, and appropriate educational materials will be prepared in accordance with the levels indicated, in order to provide training on how to improve the quality of the work environment.

The systematization of the experience, methodologies, and specialized human resources at the country and Region levels in education, grass-roots communication, and management of improvement of work environments. These will be the human resources charged with the future sustainability of the project.

Formulation of projects to ensure financing of the process.

Intervention models that work through occupational health, ergonomics, occupational safety and organization of work.

Forms of work organization, that promote the well-being of the workers.

(b) Incorporate a registration, notification and surveillance system in workers’ health, into the existing systems at the different levels

The incorporation of a registration, notification and surveillance systems in workers’ health, into the existing systems (at the firm, local, and national levels in the ministries of health and social security institutes) is the most feasible way to extend coverage to new and unprotected labor sectors. The strategic orientation is the validation of the advantages of taking these national systems into account.

The operational strategy for achieving this result is based on the creation or stimulation of specialized technical groups at country level, with functions and capacities for organization and management of a system for health and safety surveillance in the workplace at different levels, and the capacity to lobby higher levels of authority on behalf of these proposals, with the participation of the employers and workers.

PAHO will provide technical support to these groups through its experiences, by preparing conceptual and methodological instruments, consultancies, and missions, and by promoting shared knowledge of experiences. To this end it will identify a network of specialists and institutions in the subject. Among PAHO’s principal functions will be to:

• Prepare research protocols (hazard/harm) with specialists from countries of the Region and the Collaborating Centers
• Formulate instruments for promoting modes of work organization that are consistent with the well-being of workers and their families
• Support technicians in the countries
• Support specialized human resources education in the countries
• Support the formulation of national plans and projects in surveillance in workers’ health (and also at the regional and subregional level) and in the management of technical/financial cooperation
• Support the lobbying of responsible parties in the countries for incorporating the workers’ health surveillance system into all the levels.

The national groups, with the support of PAHO, the Region, and the countries, will develop:

A diagnosis of the national situation in surveillance systems

• Practical and simple proposals for surveillance systems in health and safety, sentinel indicators, and warning systems
• Adaptation of instruments for promoting modes of work organization consistent with the well-being of workers and their families
• Adaptation of protocols and guidelines prepared in the context of horizontal collaboration
• Dissemination and actual lobbying (of parties responsible for the different levels) with regard to the importance and positive impact of including the safety and health surveillance system in the workplace, in established systems, or in levels where there is no system
• Specialized human resources education in the management of surveillance systems in occupational safety and health at the different levels. These will be the human resources charged with the future sustainability of the project
• Organization of a specialized network to promote systematization, feedback, and circulation of knowledge of experiences at all levels

(c) Systematization and dissemination of information at all levels

A regional network of specialists in occupational safety and health, a regional network for sharing the fruits of experience, and active, sustained research in the countries, are all part of advancing occupational health science and technology in ways that respond to the special characteristics and potential of Latin America. The strategic orientation is to encourage young researchers, grassroots organizations, institutions, workers, employers and business circles, government officials, etc., to share their knowledge and their experiences. It is important that they overcome their timidity and become desirous of presenting completed works.

The operational strategy for achieving this is through the development of a regional network, through a specialized Web Page and list of relevant topics that allow for feedback and information exchange. This project will be executed in a country with the appropriate technical conditions, resources, logistics, and institutions. Once established, its management will be rotated. It will be organized and administered by an interinstitutional team.

PAHO will provide technical and financial support for this project. In due course it will formulate and arrange financial technical cooperation resources or human resources in order to guarantee its success and sustainability.

The components and basic activities of this network will be to:

• Update an Internet-accessible directory of institutions, specialists, and actors in workers’ health in the countries of the Region
• Encourage active participation in the discussion lists so as to elicit information on experiences, questions, and contributions regarding the activities of participants, in order to identify and ultimately settle on topics for discussion
• Promote specialized participation in energizing and managing the discussions of the PAHO Collaborating Centers on given topics. In order to promote systematization, feedback, and dissemination of the knowledge gained from experiences at all levels
• Create and manage a Web Page on workers’ health, based at CEPIS, which will be accessible and continuously updated with contributions from the network of institutions and specialists
• Train specialized human resources in the management of information systems, in workers’ health, at the different levels. These will be the human resources for the future sustainability of the project
• Direct the human and financial resources of the actors and participating agents at each level, assuring the required financing

(d) Appropriate and clean technologies for prevention and control of occupational risks

The identification, validation, and dissemination of appropriate and clean technologies should be the technological basis for risk prevention and control activities in companies and workplaces. The strategic orientation to ensure the prevention and control of risks in the workplace involves getting business and management to adopt these technologies and internalize their advantages.

The operational strategy for achieving this result seeks to create and strengthen a national and regional network of databases on appropriate and clean technologies for prevention and control of occupational risks. This network should be easily accessible and should include employers, workers, public officials, PAHO/ILO, UNIDO, universities, and the PAHO Collaborating Centers.

This network will operate in the following areas: (a) to systematize a database of appropriate and clean technologies in occupational risk prevention and control, and (b) to disseminate these technologies by diverse means, promoting their adoption and incorporation into the technology-based firms that advise businesses.

 

6.2 Policies and Legislation within the Regulatory Framework

6.2.1 Objective

Responding to the current situation, which is characterized by insufficient knowledge of the nature, magnitude, and severity of problems in the health and well-being of working populations, the limited effectiveness of legal protections, and the lack of implementation of policies and explicit plans, the following objective has been formulated for this area:

The countries should strengthen their capacity to establish policy and laws in the area of workers’ health, based on an ongoing situation analysis set within the context of the processes of reform, integration, and globalization. At the same time, they should strengthen their capacity to develop legal instruments to support the technical standards for surveillance and integrate these lines of work into the national plans for health, social security, and occupational safety.

 

6.2.2 Lines of Action:

• Carry out activities to improve the level of public awareness about the importance of workers’ health. This requires crafting and implementing a communication and information strategy that complements regulatory policies and programs.

• Develop participatory strategies in order to set the subject of workers’ health in the context of the countries’ public policies for the social sector; these should emphasize the media, in order to increase the awareness of workers, businessmen, and decisionmakers. These will help to place the subject on the political agenda.

• Training human resources on how to inform and train workers and employers poses a fundamental challenge; it is a major way of sensitizing political and social leaders to the troubling features in the workers’ health profiles.

• In order for the countries to work in the area of workers’ health in a strategic, consistent way, they must be prepared, and they must have implemented policies and plans in this area. This includes the national plans of workers’ health, which should be incorporated within the national health and overall development plans. Furthermore, subregional and regional initiatives should be developed within the context of the intensifying processes of integration, the establishment of shared markets, economic blocks, and the general process of globalization.

• Update and increase the effectiveness of laws to protect workers’ health. The Plan supports the enactment of national and international legislation for the prevention of occupational risks, as well as effective mechanisms to ensure compliance. Both the legislation and the standards that complement international agreements and instruments to support harmonization and standardization processes are priority aspects within the Plan. In order to achieve the foregoing it is very important to establish close relations with the legislative branches of the countries, in order to develop a technically grounded lobbying process. The establishment of professional education and training programs for worker leaders and members of worker organizations is also pertinent.

• Strengthen research, and steer it toward priority issues for the Region, such as improvement in situations of inequity, protection of vulnerable populations (children, women, workers of the informal sector, migrants, refugees, national ethnic groups, and others), and economic and social assessments of the impact of accidents and occupational diseases for the countries. Applied research, and multicenter studies should be encouraged.

 

6.2.3 Expected Results and Activities

(a) Workers’ health incorporated into national, regional, and subregional plans and development policies

PAHO will promote the incorporation of the topic of workers health into plans and policies at the regional, subregional, and national levels. It will seek to increase the awareness of the public and civil society about its importance. PAHO seeks to promote the creation of participatory strategies that will make it possible to include worker health as a component of health reform and social security, within the framework of human and sustainable development. Placing the subject on the political agenda will require an emphasis on reaching the media with good information and suitable scientific support, in order to sensitize workers, entrepreneurs, and political decision-makers. Capabilities for proactive, consensus-building, and the integral inclusion of workers’ health into the various policy proposals to be promoted will be a fundamental strategic orientation.

The operational strategy for achieving these results consists of promoting policy guidelines that should be systematized by technical-political teams at the various levels, in order to make a national level diagnosis possible and turn the guidelines into opportunities for consensus-building. Political decisionmakers will ideally find it indispensable to refer to them when they seek to design innovative approaches at the local or national level.

There should be special emphasis on disseminating and promoting the knowledge gathered in successful local and national experiences, as a way of validating the proposals. In terms of political impact, this should be built on an appropriate technical profile of the proposals, in order to establish strategic partnerships between technical entities or institutions and political decisionmakers.

(b) Harmonize legal framework and instruments in social security and occupational health

To attain this result, there will have to be adequate coordination between two institutions of the United Nations system: PAHO/WHO and the ILO. The strategy of the WHO/ILO Joint Committee considers it crucial to promote compilation of the existing legal instruments; a proposal for regulatory instruments should be designed that can be harmonized at the regional, subregional, and national levels. This entity--which would be of a technical nature--would provide due support for the national initiatives promoted by various sectors, ranging from political decisionmakers to local governments to civil society. It would also facilitate the design of regulatory frameworks for harmonization within the various approaches to integration. Drafting laws and regulations that complement international agreements and conventions (the product of the integration processes) is a priority.

Within the national arena, Technical Committees should be created or established. These should be multinstitutional and interdisciplinary. One of their functions should be the ongoing task of monitoring and follow-up of the process of updating regulations on occupational health and safety. Moreover, mechanisms for the exchange of information on regulatory matters should be established at the level of these national committees, so that all recent laws or regulations can be used as references for other regulatory preparation processes in the various countries.

The core of this modernization and regulatory updating process should be to vest occupational health and safety with greater effectiveness and protection under law, recognizing it as a fundamental human right, and emphasizing the prevention and control of occupational risk. Likewise, special attention should be placed on establishing mechanisms to ensure efficient, effective compliance with regulations.

(c) Capacity to apply concerted workers’ health policy and legislation to workers and employers

With regard to this expected result, one of the strategic orientations is the establishment of a Pan American Congress on Workers’ Health, drawing on all the countries of the Americas and the various agencies of the United Nations system. The Congress could also enlist the support of governments, the various Ministries and sectors involved, employer and worker organizations, academic institutions, and NGOs. The central focus of the Congress will be to advance the Declaration of Occupational Health 2008. This strategy includes the definition of this supranational entity, which should strengthen and provide feedback for the national committees (which are technical/political consensus-building entities at the national level), thus obtaining an ongoing intervention in the crafting of policy and law.

Once critical aspect is to incorporate guidelines on occupational health policy in the different plans and processes of health sector reform and the modernization of social security. This will generate consensus-building possibilities among employer, worker, and State organizations for the adoption of workers’ health policies. In this orientation, it is essential to establish closer relationships with the legislative branches of the States, and to develop what should be properly called technically-grounded lobbying activities, with special emphasis on education and training activities directed at the representatives of workers’ organizations, and events or seminars for representatives from the employer organizations.

 

6.3 Workers’ Health Promotion

Most of the protection and social security measures are related to permanent, formal, and full-time employment. Increasing job insecurity, occupational stress, and high rates of unemployment pose major social challenges in today’s world and require new strategies consistent with the change and modernization taking place in the countries.

Global changes are determining new modalities of work, such as temporary, part-time, and independent jobs, telecommuting, and working from the home. Informal work, small businesses, and microenterprises are increasingly important as new modes of work within the economic growth equation.

6.3.1 Objective

"The countries will apply the strategy of health promotion with a healthy workplace and healthy spaces approach, emphasizing the positive aspects of the social work relations, the individual and collective development of workers, and the strengthening of their organizational capacity for individual and community action in order to improve the physical, economic, and psychosocial work environment."

The healthy workplace and healthy spaces approach gives an opportunity to resolve basic health problems through comprehensive activities based on the principles of occupational health and safety, sustainable human development, health promotion, human resources management, and environmental protection and conservation. Other key elements of this approach are: the creation of workplace contexts that foster well-being, the empowerment of individuals and communities, intersectoral cooperation, and the active participation of key actors, emphasizing the worker’s role as an active partner throughout the planning, development, and evaluation of the process.

This approach regards health as a positive concept, emphasizing social and personal resources, as well the physical and spiritual faculties. Investing in the health, education, and welfare of workers is the cornerstone of building human capital for economic production that is consistent with social justice.

The local, regional, and national health systems, along with the specific occupational health services, are essential social structures which, by the same token, are strategic areas for the application of the above approach, which cannot be based on the responsibility of the health services alone. This approach requires, above all, the commitment and consensus of various interest groups, such as the employers and, of course, the workers themselves.

In order to cover the enormous variety of sectors and modes of production, including informal, rural, and migrant work, it is necessary to address aspects such as the organizational and corporate work environment, the social areas outside and inside of the physical work site, the political context regarding public and private environmental and trade policies, economic aspects such as wages and the distribution of wealth, and social aspects of the community, such as the quality of housing, infrastructures, access to information services, etc. All this requires a consensus-building process involving key actors, as well as coordination with other strategies and approaches such as primary environmental care, the Healthy Cities and Healthy Communities strategy, and the like.

6.3.2 Plan of Action

Implementing the strategy of workers’ health promotion, along with the previously outlined considerations, requires a coordinated effort in the local, national, regional, and global arenas, geared toward the following activities:

• Development and application of the concept of healthy workplaces and healthy spaces within the reality of the Americas, drawing on the experiences of healthy communities, cities, schools, and markets and other health promotion projects, and in direct collaboration with the managers of economic activities, workers associations, government agencies, scientific and technical institutions, and the community, with the support of the PAHO/WHO Collaborating Centers, the health promotion programs of PAHO and WHO, and the specialized Centers of the Organization.

• Creation of a regional network on healthy workplaces and healthy environments as part of the system of global networks promoted by WHO (and integrated in the networks of the ILO and the European Foundation for the Improvement of Living and Working Conditions) with the dynamic involvement of the key actors promoting workers’ health. This is to be the hub for dissemination of these concepts.

• Incorporation of the healthy workplaces and healthy spaces approach into national and local health systems, scientific and technical institutions, centers for the training of human resources, the ministries, and other service providers, with the support of technical and financing agencies for development.

• Development of models and methodologies for operationalization of the healthy workplaces and healthy spaces approach in the Region, through the commitment and participation of interested groups from the private sector, universities, WHO/PAHO Collaborating Centers, cooperation agencies, the PAHO/WHO Division of Health Promotion and Protection, and the specialized centers of the Organization. This is one of the most important logistical points of support for achieving this objective.

• Training workers, employers, and managers to participate effectively in executing the approach, with the support of scientific and technical institutions, employer and worker associations, national and international unions, chambers of industry and trade, and NGOs.

• Dissemination of information and sensitization of the community in promoting workers’ health with this approach, together with the coordination of the educational system, local governments, and nongovernmental organizations. This will make it possible to develop strategic opportunities for policy design, legislation, quality in the work environment, and improvement in the health services.

6.3.3 Expected Results and Activities

(a) Concerted system to sensitize decisionmakers/leaders in politics, business, labor, and public opinion on the economic/social importance of workers’ health

Incorporating the topic of workers’ health in the local and national policies of the countries will require raising awareness of political decisionmakers. The strategic orientation to this end is to demonstrate the positive impact of this result in political terms (governance, consensus, economic development, social equity, etc.) by creating tools for dissemination and training; these shall be prepared by tripartite groups in the countries.

PAHO will support the human resources education of these groups and the basic design of the pertinent instruments.

In the countries, the groups will be jointly organized with two orientations:

• To achieve a multiplier effect (training of trainers etc.)
• The strategy of health promotion and the concept of workers’ health (quality of life, work and health conditions) will be the instrument that will make it possible to show at all levels the relationship between workers’ health and social/economic development.

(b) Workers’ health incorporated at the different levels of education

Workers’ health education is the keystone to building a safety culture, ranging from production and respect for the producer, to our own personal self-esteem. Education at the initial, primary, and secondary levels will provide this training and philosophy of life. Higher education would, moreover, provide scientific and technical knowledge for the management of workers’ health problems. The strategic orientation to this end is to educate those who train the educators and to persuade the countries’ educational policymakers.

PAHO will support human resources training for specialized groups and the basic design of the pertinent instruments.

In the countries, the groups will be organized in a coordinated manner, with two orientations:

• To develop educational curricula in workers’ health, which would be incorporated at all levels of formal education
• To promote education for work as a basis for labor productivity, based on the healthy workplace and healthy environments approach.

(c) Joint commissions of occupational safety and health functioning in promotion, surveillance, training, and communication activities related to risk prevention and control, and current regulations

The active participation of the workers, their organizations for promotion, surveillance, training, and effective application of occupational safety and health standards, is a fundamental tool for success in the prevention and control of risks. The strategic orientation to this end is worker empowerment, with regard to their right to life and to safe, healthy work.

The operational strategy to this end is the training of human resources (specialists, promoters, etc.), drawing on the day-to-day experiences of groups that have been working on the issue in the countries of the Region. PAHO’s work will be oriented toward international technical/financial support, promoting the capacity for communication between unions and business (consensus-building for workers’ health), and links between Latin American unions and other unions and international union organizations in Europe, the United States, and Canada.

(d) Workers’ health activities implemented in workers’ organizations

The Plan considers it timely for the national groups, with the support of PAHO, to promote the following actions in workers’ organizations:

• Prepare their own instruments for the identification, assessment, and control of environmental risks and the organization of work
• Adopt technologies for comprehensive improvement of working conditions and environment
• Design socioepidemiological surveys based on the workers themselves
• Promote worker validation, consensus, and participation in solving their own problems
• Promote the creation of occupational health and safety committees or other forms of worker involvement
• Real and effective worker participation in the planning, organization, supervision, and control of programs for risk prevention and control

(e) Strengthen empowerment of workers and the community

The fundamental activities to be promoted by the national groups, with the support of PAHO, are:

• Raise the level of awareness of workers and communities regarding workers’ health and its linkage with environmental conditions and the quality of life
• Worker and community participation in national activities to promote workers’ health, in general policies on health and the environment, and in specific programs for the prevention and control of risks and the organization of work
• Systematize and disseminate preventive, safe, and healthy practices drawing on the knowledge generated by experience with workers and community activities
• Design national and sectoral programs for the education of promoters, and methodologies for preventive intervention
• Promote the sharing of experience-based knowledge with and between unions and the community

(f) Management of the enterprise with healthy workplace and healthy spaces approach

The participation of business in the prevention and control of risks, and in the execution of healthy workplaces and spaces is still incipient in the Region. Thus, it is necessary to engage in this field with a comprehensive concept of workers’ health. Although workers’ health can never be subjected to the laws of the market, nor to the loss of fundamental human rights, occupational safety and health nevertheless provide a firm foundation for improving labor productivity and social equity.

Business management can promote the following actions:

• Assessment of the impact of occupational risks on the firm’s productivity, and production costs
• Preparation of efficiency, cost/benefit, and cost/effectiveness indicators
• Preparation of indicators of prevention in the workplace
• Analysis of investment in and the cost-effectiveness of prevention measures
• Structuring a system for managing occupational risks for use by firms,
• Adoption of safe and healthy production technologies
• Preparation of self-evaluation instruments, such as audits, verification lists, etc.
• Drafting a code of ethics in workers’ health

In addition to the participation of international, bilateral, and other agencies, achievement of expected results (d), (e), and (f) requires the national political will to seek technical, methodological, and participatory orientations to ensure that the interested parties themselves are the ones who direct and lead the actions (employers, workers, and community). In this regard, PAHO assumes the role of catalyst, facilitator, and provider of technical support.

 

6.4 Comprehensive Health Services for Workers

It is estimated that in the developing countries, only 5% to 10% of the working population has access to full, efficient occupational health services. Existing services tend to employ a curative, rather than a preventive or promotional, approach. This occurs despite the evident need for such approaches, and despite the principles of Health for All of WHO and the occupational health services agreements of the ILO. These establish that every worker has the right to safety and occupational health services, regardless of the economic sector in which he is employed, the size of his company, or the type of work he performs.

The Declaration of Alma-Alta (WHO) emphasizes the need to have primary care services located as close as possible to the places where people live and work, with priority assigned to high-risk populations.

6.4.1 Objective

Strengthen the countries’ capacity for expanding comprehensive workers’ health services (promotion, prevention, care, and physical and social rehabilitation) in or coordinated with national and local health systems and implemented by multidisciplinary teams

Occupational health services can be organized in different modes and levels, depending on the size of the firm, the type of productive process, the occupational risks, the organization of the work, etc. In accordance with Convention #161 of the ILO, health services in the workplace can be organized as services for a single firm, or as services common to several firms, so that, in keeping with national practice, they can be organized by:

• firms or groups of firms
• branches of government or official services
• Social Security Institutions
• any other agency empowered by the responsible authority
• a combination of any of the above formulas

Recommendation #171 of the ILO regarding this purpose points out that the function of these health services in the context of work is essentially preventive, and relies on:

• Monitoring the work environment
• Monitoring workers’ health
• Information, education, training, guidance
• First aid, treatment, and health programs

Effective workers’ health services require a holistic approach to public health. This should include: primary prevention in order to eliminate or control occupational risk factors; secondary prevention, for early detection and reversibility of health alterations induced by occupational exposure, and comprehensive rehabilitation, which should include the rehabilitation (retraining, reeducation, and return-to-work) of disabled workers into a safe and healthy work environment. Accordingly, these services require the intervention of several disciplines from the biomedical, environmental, and social sciences, such as: medicine, nursing, occupational health and safety, ergonomics, physiotherapy, psychology, sociology, epidemiology, toxicology, etc., integrated within a multidisciplinary concept that includes participation and feedback from workers and employers. Service delivery should be characterized by care that is timely, universal, of optimal quality, and based on principles of equity and accessibility.

6.4.2 Plan of Action

• Identification, development, and dissemination of guidelines for the organization of comprehensive services, geared toward obtaining greater access and coverage for unprotected workers, such as those in the informal sector, small business, independent and rural work, and other similar modalities, in direct collaboration with the Division of Health Systems and Services Development of PAHO/WHO, the ILO, and the ISSA in the regional and international area.

• Incorporation of workers’ health services into existing primary care services in the countries, drawing on the current reform and modernization of the health sector and social security and of the institutional development policies supported by international financing agencies such as the World Bank and the IDB.

• Human resources training in the disciplines required for adequate delivery of occupational health services, in direct collaboration with the Program on Human Resources Education of PAHO/WHO, the government sector linked to education and health, the Collaborating Centers in human resources education, higher education institutions, and the authorities responsible for workers’ health services.

• Establishment of collaboration networks at the international and regional levels, drawing on experts in providing support services for workers’ health, and utilizing the specialized centers of PAHO, international programs such as INTOX and IPCS, and the databases of organizations of the United Nations system.

6.4.3 Expected Results and Activities

(a) The systems will have been incorporated in the Primary Health Care (PHC) of the existing health systems (Ministry of Health, SS), with universal coverage and full access for workers

The strategy of incorporating the workers’ health services into the primary health care services is set within the context of the current reform and modernization of the health sector, social security, and institutional development policies. The strategy for achieving the expected result seeks to validate experiences that demonstrate the technical, social, and economic viability of the proposal through increased coverage and access, especially for the unstructured or informal sector. In this regard, the institutions providing health care should establish procedures and standards at the different levels of care that make it possible to rise to the challenge of providing services delivery characterized by care that is universal, timely, and of optimal quality.

According to these scenarios, PAHO will join the national institutions in the processes of:

• Incorporating the primary health care of workers into the health services network, through appropriate mechanisms for expanding coverage and access, in terms of their relation to work, with special emphasis on the informal sector
• Safe guarding the financing and Programming autonomy of these services
• Establishing procedures and standards that facilitate treatment of workers at the different levels of care
• Establishment of rehabilitation programs for work (includes return-to-work)

(b) Primary care and/or the specialized services of public and/or private health care enterprises will have incorporated systems for registry and reporting that are endowed with adequate human and technology resources

At the center of the strategy for achieving this expected result is the training of professionals who contribute to workers’ health from the different disciplines. Simultaneously, a strategy should be devised for ongoing in-service training of specialized staff, in public and private health firms alike, and developing model programs or innovative curriculum plans, especially in the areas of registry systems for reporting injuries. In this regard, programs should be established for collaboration with WHO/PAHO, government sectors linked to education and health, private promoters, and initiatives from the firms and specialized entities.

(c) The firms will have comprehensive workers’ health systems involving employers and workers

PAHO promotes the implementation of participatory experiences in creating opportunities for consensus-building between employers and workers, in both small business and microenterprises at the local, national, and regional levels. The promotion of participation mechanisms that involve workers and employers, such as health and safety committees in the firms, should be strengthened by linking them to processes for improving productivity and quality in the firms.

One element that should be developed is orientation on the use of appropriate and low-cost methods and technologies in production processes, which small and medium size firms would be inclined to adopt and transfer.

Mechanisms should be established for the rehabilitation and return to work of disabled workers.

(d) Expansion of coverage to groups of less-protected workers

The growing presence of work in the informal or unstructured sector, of small business, independent work, and other modalities, suggests the need to develop approaches and models of care that offer guidelines for organizing comprehensive services to permit broader access and coverage for such workers. In this regard, the protection of vulnerable populations must be a priority, in order to overcome inequities in the access to the services. The top priorities should be children and adolescent workers, workers in the informal sector, migrants and refugees, indigenous and rural populations.

Achievements of successful strategies that can be validated in the local arena should be promoted and disseminated at the level of the workers’ health network to begin building cumulative processes and a multiplier effect of the experiences at a local level. They should be presented and systematized in order to provide orientations for national or subregional interventions with regard to particularly vulnerable sectors.

 

7. KEY AGENTS AND ACTORS

The scope of workers’ health, its importance in protecting people, and for producing the goods and services that people require to live, determine the dual process whereby human beings create the conditions both to sustain their society and reproduce as a species. In short, workers’ health involves a process both of creation and self-creation.

Workers’ health makes all people their own actors and agents; they are a part of both the problem and the solution. Hence, the responsible parties are represented by:

• Civil society: which needs to avoid the existence of occupational hazards
• Employer organizations: who are responsible for balancing economic values with the human values related to workers, environment, and the community
• Worker organizations: who are responsible for making workers’ health a strategic objective of their daily activities
• Academic and scientific institutions: which have a responsibility to conduct research on technological, economic, and social problems as determining factors in the characterization of health and work processes
• The State: which has the responsibility of crafting policy and the regulatory framework, and of enforcing laws and regulations.
• International organizations: which are responsible for providing and facilitating technical, financial, and human resources support.

 

TABLE 1

PROGRAMMING AREAS: RESULTS AND ACTIVITIES

 

SUMMARY

 

 

EXPECTED RESULTS	ACTIVITIES
1. Quality of Work Environments
1. 1 Capacities for the prevention and control of adverse conditions and occupational risks, strengthened at all levels	Strengthen teaching of the basic disciplines at all levels for the identification and control of risks Strengthen training for entrepreneurs and workers’ organizations Strengthen technical and institutional capacity in occupational safety and health Promote the use of inspection and intervention methods that are practical, simple, and effective Develop intervention models that attach special importance to comprehensive control of risks Promote the establishment of mixed occupational safety and health committees for surveillance in the workplace.
1.2 Information systems in place for the reporting, registry, surveillance, and control of workers’ health risks	Prepare diagnoses of the national situation with regard to surveillance systems in occupational health and safety Develop practical, simple proposals for notification, registry, and surveillance systems on workers’ health (in national, local, sectoral and company surveillance systems) Design protocols for investigating risk/harm; to identify and prioritize sentinel indicator and warning systems
1.3 Systems installed to permit systematization and dissemination of the existing information	Install and maintain an Internet discussion list on workers’ health in the Region Promote systematization, information dissemination, and feedback on experiences at all levels Maintain an up-to-date Web page in CEPIS on workers’ health Train specialized human resources in the management of information systems on the workers’ health in the different levels Develop documentary information networks. Maintain a directory of institutions, specialists, and actors involved in workers’ health in the countries of the Region
1.4 Appropriate and clean technology developed and in place to ensure risk prevention and control in the workplace	Identify, validate, and disseminate appropriate and clean technology for risk prevention and control in enterprises and workplaces Form and strengthen a national and regional network of databanks on appropriate and clean technologies in risk prevention and control in the workplace that can be accessed for the dissemination of these technologies Adopt and apply standards leading to clean and safe technologies Train specialists in clean and safe technology to advise enterprises
2. Policies and Legislation on the Regulatory Policy Framework
2.1 Workers’ health incorporated in the plans and policies for national, subregional, and regional development	Identify policy guidelines regarding the living and working conditions of the economically active population Promote the approval and application of international work standards as well as environmental quality standards Advise the agencies with the responsibility for drafting national policies and legislation in a concerted manner Prepare diagnoses of policies and legislation that outline the individual and collective rights of workers; to calculate the cost of the harm to the work force and the environment produced by work processes
2.2 Harmonization of the legal framework and legal instruments on occupational safety and health	Formulate and implement laws, regulations, and technical standards on workers’ health Develop, promote, and disseminate instruments for standardization and implementation
2.3 Agreement on policies and legislation in workers’ health among workers, employers, and the State and their application	Promote the establishment of the Standing Commission on Workers’ Health, organized by subregion Form national technical commissions on workers’ health Develop instruments and indicators for the generation of policies and legislation Include the topic in all forums on economic globalization and integration Strengthen regional and subregional parliamentary entities with their specific areas of discussion and intervention Establish consensus-building entities among the representatives of workers, employers, and the State with the capacity for decision-making
3. Promotion of Workers’ Health
3.1 Awareness raising of decisionmakers, policymakers, business executives, labor, and public opinion to the economic and social importance of workers’ health	Develop instruments for information dissemination and training that utilize specialized groups in the countries Train the human resources of these specialized groups and develop the basic design of the corresponding instruments Develop and implement strategies on communicating for health among workers
3.2 Inclusion of workers’ health in the different levels of formal education	Include workers’ health in the different educational levels and in formal and nonformal training Train the instructors of the direct educators and convince decisionmakers about the educational policy of the countries Produce educational materials on workers’ health for the different levels
3.3 Employers and their business representatives sensitized and trained in prevention and control of occupational risks and its importance to productivity	Disseminate indicators of social and economic costs in connection with workers’ health to the business sector Develop communicating for workers’ health campaigns to foster the effective participation of employers Develop technical assistance programs for adapting workplaces to international quality standards Develop programs for strengthening managerial capacity using the healthy workplaces approach Strengthen the technical capacity of human resources in methodologies for health promotion and negotiation with the business sector Prepare entrepreneurs to reincorporate disabled workers in the work force
3.4 The conditions for the empowerment of workers and the community to permit social participation in risk control have been ensured	Increase the level of awareness among workers and the community about workers’ health and its association with the quality of living conditions Promote worker and community participation in risk identification, evaluation, and control, and in control of the organization of the work Systematize and disseminate healthy and safe practices based on the knowledge generated by worker and community participation Mobilize education and communication technologies Prepare guidelines and manuals
3.5 Strengthening of workers’ activities to improve working conditions and the working and living environment	Prepare an instrument for assessing working conditions and the work environment. To promote the formation of workers’ health committees and other forms of intervention in workers’ organizations Prepare workers’ organizations to identify, evaluate, monitor, and apply techniques for improving working conditions and the work environment Develop socioepidemiological surveys geared to workers and the community Promote the validation, consensus, and protagonism of workers and the community for the solution of their problems
4. Comprehensive Workers’ Health Services
4.1 The comprehensive worker’s health systems have been incorporated at the primary care (PHC) level of the existing health systems (ministry of health, SS) with universal coverage and full access for workers	Develop the frame of reference for primary health care for workers Promote the establishment of appropriate mechanisms to increase coverage and access in terms of their relation to work, with special emphasis on the informal sector Encourage health institutions (public or private) to establish procedures and standards that facilitate care for workers at the different levels of care, as well as others related to health promotion and rehabilitation Guarantee the programming and financial autonomy of the services Establish programs for professional rehabilitation and the reincorporation of disabled workers into the work force
4.2 The specialized services of public and/or private health enterprises and the public health system have the necessary human resources and technology	Include training in workers’ health in the models or curriculum plans for the health professions (college and graduate-level), with emphasis on public health and epidemiology Include basic programs on the relationship between productive processes, work, and health in the education and training of other disciplines. Strengthening of continuing education for health workers in areas related to workers’ health Incorporate the activities of the comprehensive workers’ health services into the health care delivery network and to incorporate appropriate technologies by levels of care
4.3 Enterprises have comprehensive workers’ health systems involving the participation of workers and employers	Search for opportunities for consensus-building between employers and workers Develop mechanisms to promote the participation of both workers and employers and establish health services in the workplace (Agreement 161, ILO) Develop and promote the use of low-cost methods and prevention technologies Develop mechanisms for rehabilitating disabled workers
4.4 Expansion of coverage to less protected groups of workers	Identify and quantify the most vulnerable and unprotected working population Develop coverage models inside and outside of the formal health and social security system that have their own financing scheme