The Principles of Occupational Health

Global Occupational Health
Tee L. Guidotti
Print publication date: 2011 Print ISBN-13: 9780195380002 Published to Oxford Scholarship Online: May-11 DOI: 10.1093/acprof:oso/9780195380002.001.0001
The Principles of Occupational Health

Jorma Rantanen
DOI: 10.1093/acprof:oso/9780195380002.003.0001
Abstract and Keywords

Occupational health brings together many sciences and many social disciplines in order to achieve social progress for workers and their families. The field recognizes a social right to work in a safe workplace where due care is given to prevent injury and illness and to protect the health of workers from death, injury and disability, thereby also protecting their families and those who depend on them against loss of income and social support. Occupational health problems are often overlooked as an obstacle to development but they can be a substantial drag on economic development, amounting to at least 4 5 % of the gross domestic product (GDP) of countries. Even so, developing countries often lack effective occupational health protection, even when safeguards exist in the law.
Keywords: occupational health, workplace, injury, illness, health, disability, economic development, safeguards, workers, protection
Occupational health is a multi-dimensional field, encompassing science, social progress, economics, law, employment studies, and issues common to every family. The health and safety of people at work is a critical concern for all societies and all countries. The field of occupational health touches on fundamental aspects of working life: making a living providing for a family staying healthy
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avoiding unnecessary risk of injury protecting oneself and others from harm creating useful products and services for societal benefit anticipating and preventing future problems sharing information the right to knowledge of potential health hazards fairness and justice in the treatment of workers achieving responsibility and accountability in the workplace minimizing the risk of necessary but hazardous work
Because occupational health issues are so fundamental to working life, they have become central social and political issues in countries with progressive policies and a tradition of social responsibility. These countries have developed systems of occupational health protection, social insurance, and medical services that reduce the burden on the worker and reduce the loss to the economy. However, these systems are not perfect, and they are often under stress. Developing countries often lack these systems or have them only in rudimentary forms. Occupational health problems are often overlooked as an obstacle to economic development when wages are low and the cost of health care is low. Occupational injuries and (p.4)
Figure 1.1 Occupational health is influenced by many factors and plays a critical role in shaping many social issues. illness can become a significant drag on the economy, however, by reducing productivity, increasing the burden of disability and illness on people, and causing financial insecurity. Occupational health issues are deeply embedded in society and have a profound but largely unacknowledged effect on economic development. Some of these issues include:
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the health risks that workers take to earn a living the consequences to their families when workers become ill or injured the social contract between workers and employers and the responsibility to keep the workplace safe the financial loss to workers and their families from a prolonged illness or disabling injury the cost of providing medical and rehabilitation care to injured workers the hidden cost to the health-care system of illnesses that are not recognized as occupational, especially those that take a long time to develop the cost of providing benefits and wage replacement to workers who are injured the loss of productivity that results from avoidable injuries and illness the development of new technology, the cost of production, and return on investment the social management of risk spreading, for example, by workers compensation or other insurance plans management of and minimization of the risk of disasters International organizations such as the World Health Organization (WHO) and the International Labour Organization (ILO) have given much attention to worker health and safety, as evidenced by the WHO Global Strategy on Occupational Health for All that was adopted by the 49th World Health Assembly in 1996 (WHO 1995) and by the ILO Convention No. 161 on Occupational Health Services (1985). The European Union includes occupational health as a part of its Employment and Social Policy Programmes. Although much effort has been made toward the worldwide implementation of those authoritative policies, much remains to be done before the WHO objective Occupational Health for All is achieved. In fact, out of the 3 billion workers in the world, only 10% to 15% have access to occupational health services, and these services do not necessarily correspond to the most urgent needs.
(p.5)
At its first session in 1950, the Joint ILO/WHO Committee on Occupational Health defined the purpose of occupational health. It revised the definition at its 12th session in 1995 to read as follows (Alli 2001): Occupational health should aim at the promotion and maintenance of the highest degree of physical, mental and
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social well-being of workers in all occupations; the prevention amongst workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological capabilities and; to summarize: the adaptation of work to man and of each man to his job.
Occupational Health and Development

A healthy and productive workforce is the key factor behind the social and economic development of any country. Originally, occupational health programs were designed during the advent of industrialization to prevent and treat acute and chronic illnesses and injuries among the working population. Gradually, as public health programs were developed, occupational health adopted a more specific role in the prevention and control of occupationally determined outcomesaccidents and diseases directly associated with work or working conditions. Over time, occupational health shifted its emphasis to the overall health and well-being of the working population. Today, occupational health services in their most advanced forms are comprehensive, covering the control of hazardous factors in the work environment, promotion of work ability, and promotion of workers general health and healthy lifestyles. The economic costs of poor safety and health at work amount to 4% to 5% of the gross domestic product (GDP) of countries, and the bill from poor work ability is likely to be 45 times higher. Work ability is defined as the capacity to carry out ones job productively and competently so that the objectives of the work tasks are achieved without exposing the worker to physical or psychological overload. Well-being at work means that the criteria of work ability are met. In addition, the job generates satisfaction and the work and work community provide social support and facilitate the personal development of the worker. Developing countries struggling to improve their standard of living should avoid the enormous loss of work ability of the workers by supporting and sustaining them and their families. Thus, supporting occupational health is an important tool for the elimination of poverty. Industrialized countries face growing problems due to the shortage of young workers and
(p.6) Page 4 of 20
the aging of the working populations. To ensure the availability of a sufficient workforce, unnecessary losses of work ability need to be eliminated. There are many reasons for pointing occupational health in a more comprehensive direction, due to the growing importance of work ability, work motivation, and the well-being of people in modern work life. Traditionally, occupational health was considered a service of value only to those exposed to high physical, chemical, mechanical, biological, or ergonomic exposures (i.e., the factory-level, or blue-collar worker). But healthy and safe working conditions now are seen to include worker well-being, good psychosocial functioning, and issues of work organization, which has expanded occupational health services to all groups of working people, starting from the factory-level blue collars up to middle and top managers (Rantanen 1999).
Equity and Occupational Health

Fairness and impartialityunder the law, in business dealings, and in the opportunity for social relationshipsis the definition of the principle of equity. Equity in work life enables men and women of all backgrounds to obtain employment, to develop their skills at work, to fulfill multiple roles in society, and to earn the resources needed to sustain themselves and their families. It also means that no worker needs to risk health or safety while earning the necessities of life. Equitable societies value such rights as minimum basic salary, social protection, occupational health and safety, employment security, opportunity for training and education, and the right to know and right to participate. Equity as a concept is closely related to ethics and justice. Therefore, prominent ethicists have strongly emphasized the importance of equity as both an instrument and an objective, as both a way to realize ethical principles and as an ethical goal in itself. Distributive justice is the principle that people should be rewarded or compensated proportionate to what they deserve, which for most practical purposes means equity. Equity in occupational health is formally considered to be an outcome of distributive justice (i.e., equal distribution of occupational health services to people without any discrimination, or compensation provided to people fairly on the basis of how badly they were injured and their living expenses). As adverse working conditions and occupational health and safety hazards are in principle preventable, the strategies for preventing such hazards and risks, starting with high-risk occupations and the most adverse conditions,
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will have an equalizing impact on all occupations. Most of the differences in health outcomes are related to social and economic factors and are thus manageable with the help of social policies. This is particularly true with policies concerning occupational injuries and diseases.
(p.7)
Basic Principles of Occupational Health
Occupational health activities vary from country to country due to differences in legislation, national tradition, and medical practices. However, international organizations have identified a basic framework that is generally applicable and that works in practice. The summary of key objectives of ILO Convention No. 161 and the related Recommendation No. 171 are collected in Table 1.1. The respective principles from the WHO Global Strategy on Occupational Health for All are summarized in Table 1.2. Table 1.1 Key Objectives of ILO Convention No. 161 and Recommendation No. 171
1. Principles of national policies concerning occupational health services 2. Functions of occupational health services: a) Surveillance of the working environment b) Surveillance of workers health c) Information, education, and training advice to workers and employers d) First aid treatment and health programs e) Other functions including analyzing surveillance results, reporting on occupational health service activities, and participating in research and with other services in environmental protection activities 3. Organization of occupational health services 4. Operational conditions of occupational health services including provisions for composition and competence of occupational health service teams, protection of confidential health information, and professional independence of occupational health service personnel
Table 1.2 The 10 Objectives of the WHO Global Strategy on Occupational Health for All
1. Strengthening international and national policies for health at work and developing the necessary policy tools
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2. Developing healthy work environments 3. Developing healthy work practices and promotion of health at work 4. Strengthening occupational health services 5. Establishing support services for occupational health 6. Developing occupational health standards based on scientific risk assessment 7. Developing human resources for occupational health 8. Establishing registration and data systems, developing information services for experts, effectively transmitting data, and raising public awareness through public information 9. Strengthening research 10. Developing collaborations between occupational health and other activities and services
Five basic principles have been identified as the basis for successful occupational health systems, as determined in a WHO/EURO survey of legislation in European countries concerning occupational health services (Rantanen 1990). The balance among the five principles in different economic sectors, different countries, and different enterprises may vary substantially depending on the national and local conditions, traditions, laws, and practice. The five principles are as follows. 1. Protection and prevention. This principle is the core of occupational health activities and includes the following:
(p.8)
identification of hazardous exposures and factors causing overload or other adverse work conditions assessment of the distribution and levels of exposures, identification of exposed groups or individuals, and sources of hazards assessment of risks to health and safety from exposures or adverse conditions initiating, instituting, and advising on needs and means for preventive and control actions aimed at protecting workers health and safety 2. Adaptation. Not all workers have equal work ability, health status, or competence. Thus, aging workers, adolescents and young workers, pregnant women, handicapped workers, migrant workers, and workers with chronic diseases may need adaptation of work, working methods, or work environment, including machinery and
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tools, to their special needs and abilities. Occupational health experts need to balance job demands with the special health and safety concerns of such workers, initiate and advise about work adaptations, and monitor the impact of such measures. 3. Promotion and development. Optimally organized work can have a positive effect on workers health and work ability: it can develop physical, mental, and professional capacities, and it can contribute to the development of safe working practices and healthy lifestyles. This principle has become especially important for industrialized countries given their attention to maintaining work ability in aging workers, ensuring their continued participation in the workforce. 4. Cure and rehabilitation. In spite of efforts for prevention and protection as described in principle 1, work-related diseases, accidents, states of physical and mental overload, and acute and chronic illnesses do occur among a substantial proportion of the workforce. An aging working population suffers an increased risk of chronic disease conditions. The curative and rehabilitation principle is important to minimize the consequences of such events, to facilitate a return to original health and work ability, and, if that is not possible, to maintain the remaining work ability as much as possible. 5. Primary health care. Some countries and employers include a role for primary care or general practitioner-level health care as part of occupational health services. In many countries workers may not have access to anything but primary health care. In all countries, certain economic sectors, such as agriculture, smallscale enterprises, informal workers, home workers, and workers in (p.9) remote and sparsely populated areas, usually lack specialized occupational health services and depend on primary care providers. Some countries avoid overlap and have even prohibited the combination of general health services with occupational health services. They do this to emphasize a preventive approach and to keep the management of occupational injuries and illnesses without bias. However, there are many good reasons for integrating occupational health services into primary care: to provide primary health-care services, e.g., injury care, quickly and conveniently at the workplace or nearby to fill possible holes in public primary health services to use public services most efficiently
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to obtain a comprehensive picture of the total health of workers in the community (i.e., occupational health and general health) by capturing information at the primary care level
The Role of Research in Occupational Health

Occupational health practice rests on scientific knowledge, which comes largely from research. Without research, occupational health would still be backward, inefficient, inflexible, and unable to adapt to new technologies or challenges. There is a long tradition of high standards of research in the field of occupational health, oriented toward both practical problem solving and the investigation of occupational hazards to see what new knowledge can be gained for human benefit. Occupational health practice rests on scientific knowledge, drawing from several scientific disciplines in natural sciences (physics, chemistry), biomedical sciences (biology, basic medical sciences, physiology, epidemiology), behavioral sciences (psychology, social sciences), and technology (safety technology). Applying the knowledge and methods from the basic sciences and carrying out research to produce new knowledge on the relationship between workers and the work environment are the main missions of occupational health research. Research is further divided into disciplines such as occupational/industrial hygiene, occupational medicine, occupational psychology, occupational epidemiology, safety, and ergonomics. Research may be undertaken at universities, specialized research institutes, and government agencies. The cumulative knowledge from occupational health research is used to develop methods in occupational health practices, to train and educate occupational health experts and practitioners, and to disseminate information on work and health to numerous target groups: experts, practitioners, managers, workers and their organizations, decision and policy makers, the media, and the public at large.
The Infrastructure of Occupational Health

Occupational health is supported by a worldwide network of practitioners, public and private facilities, and institutions and organizations that are guided by laws, government agencies, and professional standards of practice. The infrastructure for occupational health protection, management
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of occupational (p.10) injuries and illness, and compensation and public policy is called occupational health services. According to international guidance, including ILO Convention 161, and national legislation, all people who take part in the workforce shall have access to occupational health services (WHO 1995). That service should be provided either at the workplace or in a nearby facility, and it should carry out a minimum set of service activities indicated in Table 1.1. The precise content of services may vary according to national law and practice and local conditions and needs, but a certain minimum should be found everywhere. Each worker should be provided with such services. Occupational health services are a special, separate set of health services for workers and workplaces to prevent and control health and safety hazards at work and to promote good practice and guidance in the field of occupational health. Occupational health services should cover all workers in all workplaces, in all sectors of the economy, including industry, private and public services, agriculture, self-employment, and informal work, and cover the work done in all environmentse.g., on land, at sea, in the air (including space), underground, and even underwater. They should be available to all working people, including blue-collar workers, farmers, informal workers, middle managers, top managers, and public-sector civil servants and defense forces. In short, everyone who works should have access to an occupational health service. Occupational health services shall be provided by competent and accredited personnel including occupational health physicians, occupational health nurses, occupational hygienists, occupational psychologists, physiotherapists, ergonomics experts, and others as defined by the national laws and regulations. Occupational health services personnel should have a certified competence in the tasks for which they are responsible. In most countries, occupational health services apply the principle of participationthe workers and employers have a right to participate in the decisions on how the occupational health services are organized and provided. The competent authority (mostly occupational safety and health inspectors) has a right to inspect to make sure the occupational health service regulations are implemented. According to the ILO Convention 161, the employer (where he or she exists) is responsible for financing and organizing occupational health services for his or her employees without any costs to the employee. The
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experts providing occupational health services are guaranteed professional independence in carrying out their activities (i.e., they make their decisions on occupational health, medical, and other services independently according to their professional competence and ethical principles).
Basics of a National System for Occupational Health

The minimum structure for a national system in occupational health can be drawn from international conventions, national regulations, and international and national guidelines provided by international organizations and national legislators (p.11) and authorities. Some countries have much more than this, but all should have at least this minimum structure. The following lists the essential elements that are the minimum necessary for a national system of occupational health. 1. Legislation should set forth the basic requirements, responsibilities, and rights of authorities, employers, and workers in occupational health services. 2. Competent authorities for enforcement of legislation are often assisted and advised by a national occupational health committee appointed on a tripartite basis by the government. In most countries, the authority consists of the Ministry of Labour, Department of Occupational Health and Safety, or the Ministry of Health, Department of Occupational Health, or there may be a shared responsibility of two ministries. The enforcement functions are most often delegated to the National Board of Occupational Safety and Health, the National Board of Health, or the Occupational Safety and Health Commission with its operational units and whatever the local names for these bodies. 3. A national policy program organizes services; develops content, human resources, and conditions of operation; and plans for the development of occupational health services. 4. Infrastructures for providing services at the workplace level may utilize several options such as in-plant services, group services, private health centers, hospital-based occupational health services, or services provided by the public primary health-care units, social security institutions, etc. 5. Human resources personnel (such as personnel managers and hiring agents) should have competence, criteria, and guidelines for qualitative and quantitative aspects of the management of human resources. This includes training in how to deal with issues
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of compensation, insurance, accommodation, employment security, rehabilitation, and retraining. 6. Information systems should be established at several different levels: normative information, laws, standards, guidelines, and instructions official registries of occupational diseases and occupational accidents information for experts concerning scientific and professional expert information (libraries, scientific journals, databanks, search and retrieval services, etc.) practical information concerning occupational health practices, such as good practice guidelines, fact sheets, and expert journals public information concerning the importance, needs, and state of occupational health 7. Support and advisory services are typically second-level services that are needed to provide specialized support to the frontline occupational health service. Such services cover the following: diagnostic services for occupational diseases (usually in polyclinics or departments of occupational medicine in hospitals) analytical and measurement services for toxicology, biological monitoring, physical factors, biological agents, ergonomics, and psychology. Institutions of occupational health, university teams, or private consultancies provide such services.
(p.12)
advice and consultations in work organization and workplace development 8. Occupational health is a specialized activity that requires competence in several disciplines: occupational medicine and occupational health, occupational hygiene, psychology, and others. Such competence requires special training, and many countries have set special competency-based criteria, for example, for specialists in occupational medicine. Specialist training curricula are needed at the national level to produce a sufficient number of experts needed for occupational health activities. Some
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international harmonization of curricula is underway at the WHO, in European Union countries, and among professional associations. 9. In addition to the contributions of experts in occupational health practices, employers, workers (treated as social partners), and their representatives need to be involved to ensure the successful implementation of occupational health at the workplace. This is carried out at the national level in the form of a tripartite (government, employers, and trade unions) national occupational health committee that is an advisory body for government policy making and implementation. Respectively, the workplace-level collaboration is organized through occupational health and safety committees, work councils, or through safety and health representatives of the enterprises. 10. The occupational health service system should be a part of the national general health service system infrastructure.
Occupational Health and Environmental Health

The work environment is a subset of the total environment, like the home and neighborhood. It is characterized by where people work, but workers and their families also live in the general or ambient environment, in urban, suburban, or rural settings. Industrial, municipal, energy, agricultural, and transportation operations and facilities may have a substantial environmental impact on the health of people who live in the community. If the workers in an industry live near industrial sites (as is the case in many traditional industrial areas), they may be exposed to hazardous agents at the workplace and from the general environment, including contaminants from air, water, food, or soil. These community exposures are almost always at lower levels than are encountered in the workplace, but they may be significant for the workers health and are more likely to affect the health of their families and other residents. There is usually a substantial difference (often orders of magnitude) in the levels of exposure between the work environment and the general environment, due to dilution factors in the general environment. Occupational exposures typically occur during the one-fourth to one-third of a day that is usually taken up with work. Exposures from the general environment occur over the other two-thirds of the day. Children spend 100% of their time in the home, at school, or outdoors in the general environment. (p.13) (p.14)
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Box 1.1 A Historical Figure in Occupational Health The year 2000, the Millennial Year, was the third centennial of the founding of occupational medicine, the first professional specialty area to concern itself with occupational health. It began with a single book, written by an Italian physician who already had a reputation as a great teacher and scholar. Bernardino Ramazzinis Diseases of Workers (De Morbis Arteficum) was the text that established the future medical specialty of occupational medicine and the occupational health sciences broadly. Ramazzini accumulated in one book the most relevant facts about occupational disease in his era, mostly from personal observation, and came to insights about medicine and prevention that are completely modern. His insights into the cause of occupational diseases are considered early models not only of scientific observation in occupational health but also of public health in general and pointed the way toward accurate diagnosis, compensation, and, most of all, prevention. He also came to astute conclusions about the social context of employment in his time, the nature of ethnic stereotyping, access to health care, and treatment outcomes. Ramazzini taught at the Italian universities of Modena and Padua. He wrote fluently in Latin, in a style considered a model of elegance, and with great good humor, not hesitating to poke fun at his fellow physicians. His works are considered classics of the medical literature. For a person of wealth and status in his society, Ramazzini was unusually understanding and dedicated toward the poor and working people of low social status. That does not mean that he was perfect: in his work one reads echoes of the prejudices of his era, but he was unusually tolerant considering his class and the times in which he lived. It is very common to hear references to Ramazzinis early descriptions of occupational disorders expressed in terms that make it sound as if he had anticipated modern-day problems. Ramazzini described [this or that] centuries ago and his descriptions are right on target. While Ramazzini had outstanding powers of observation and thought deeply about what he saw, he did not foretell the future. The fact that Ramazzinis observations are relevant today is because many of the problems he described have not been solved. Many of the occupational disorders and working conditions that he described should now
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be eliminated, but yet they persist. The reality is that many workers still face having to choose between loss of income and safe working conditions as they did in Ramazzinis time. His work is a benchmark that tells us that we have not progressed so far as we would like to believe. Figure 1.2 is an original drawing of Ramazzini, wearing the wig typical of his era, by Mr. Anthony Stones, who drew it as a composite sketch from portraits he found in Padua on a trip to Italy. Mr. Stones was born in New Zealand and currently divides his time between the United Kingdom and China. He is perhaps best known as a sculptor. His realistic, life-sized or greater sculptures can be seen in public collections and monuments, mostly in the UK.
Figure 1.2 The Italian physician Bernardino Ramazzini wrote the first comprehensive treatise on occupational health in 1700. (Portrait by Anthony Stones, used with permission of the artist, supplied courtesy of William Ivan Glass, New Zealand.)
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In most instances, exposures in the work environment are similar to exposures in the general environment, only more intense. For example, controlling both occupational and environmental exposures plays an important role in the prevention of chronic lung diseases such as asthma and chronic obstructive pulmonary disease. A substantial part of local environmental pollution can be controlled using the knowledge and actions of occupational health principles within the work environment. Successful examples of such approaches include, for example, successful management of lead exposure, carbon disulphide to the point where over-expsoure is now rare in developed countries, and successful control in many workplaces of solvent emissions, noise abatement, and dust controls. For some occupations, the general environment is also a work environment and, thus, has a direct occupational health impact. Examples include agricultural (p.15) work (water pollution, pesticides, and microbial agents), animal health, forestry work (environmentally active substances such as herbicides), fishery work (water pollution), and outdoor work (air pollution). In such situations, advocates of occupational and environmental health and environmental protection have good opportunities to work toward win-win solutions.
The History of Occupational Health

Occupational health developed in parallel with technology and industrial activities. In the early days of industrialization, the poor social conditions of workers living in urban industrial areas were inhuman and unreasonable. The work was dangerous, full of hazardous exposures and high accident risks that often led to fatal or severe diseases and injuries. Working hours were over 12 hours a day, and child labor, without any special protections, was common. Social and housing conditions of workers were poor, communicable diseases spread epidemics, and the nutritional status of workers was poor. By the middle of the 19th century, these conditions created concern among enlightened industrialists and physicians. Occupational health conditions were first documented in Italy by Bernardino Ramazzini (16331714), then in England by Percival Pott (17131788) and Charles Turner Thackrah (1795 1833), and spread gradually to the whole industrialized world. The main focus was in curative care and curative measures to minimize the effects of occupational hazards. The second wave of occupational health interest started between the 19th and 20th centuries, approximately 100 years ago. In conjunction with
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developments in biomedicine, particularly microbiology and human cellular pathology, scientists and medical practitioners investigated singular causal factors and their relationships with single disease outcomes. Prevention and control became an important priority, particularly in the leading industrialized countries, where occupational safety and health legislation and legislation for workers compensation for occupational injuries and diseases was passed. These activities stimulated specific prevention practices. This second wave lasted approximately 70 to 80 years. The most important focus in the work environment included machine safety, prevention of injuries from falling and slipping, prevention of explosions of pressure vessels and boilers, tool safety, and hazardous materials and explosives safety. Since World War II, occupational or industrial hygiene as a technical field has developed to measure and assess hazardous factors at work, to prioritize targets for preventive and control actions, and to design control technologies and protective equipment. Since the 1950s, occupational health services were directed toward specific preventive activities, preventive health examinations, and measurements for minimizing hazards in the work environment. The third wave of occupational health started in the 1980s when Scandinavian scientists first considered the psychological and psychosocial aspects of work. Occupational stress, psychological hazards, workload, psychosociology at individual and group levels, and work organization became subjects of active discussion and targets for research and preventive control actions. These studies paralleled work (p.16) in occupational psychology on issues of job satisfaction and work motivation. This research led to the improvement of the overall quality of work life and to health promotion, work ability, and the well-being of working people. All three waves of occupational health history have been responses to the needs of work life in its various developmental stages. They also reflect the evolution of human work from physical, muscle-dependent manual work, through the machine power-based technology that was typical in manufacturing industries in the last century, to present-day work life, which is dominated by high information content and computer-based technology. All three approaches are still relevant. However, the current concept of a comprehensive occupational health approach is broader than any one approach. It covers the following: the protection and promotion of health, work ability, and wellbeing of workers
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continuous improvement and development of safe and healthy work environments psychological, psychosocial, and organizational aspects of work, and the adoption of work and management cultures conducive to health and well-being For occupational health services to follow such a comprehensive model requires teams with multidisciplinary expertise to address a wide range of aspects of work, including the health and work ability of workers, a healthy and safe work environment, and the organizational aspects of work. It also requires the full participation of workers and managers at the workplace to implement such practical goals in real life.
International Organizations
The major international occupational health organizations are part of the United Nations system or have a close working relationship to UN agencies. In addition, there are occupational health associations or societies in almost every country, usually representing certain professions and sometimes specific to certain industries.
World Health Organization (WHO)

WHO has a long tradition in occupational health dating back to the design of its constitution in 1948, which references occupational health. The famous Alma Ata Declaration (1978) called for the provision of health services in places where people work and live. The Health for All by the Year 2000 Strategy included concrete objectives for occupational health. In 1996, the 49th World Health Assembly adopted the Global Strategy on Occupational Health for All, which contains comprehensive and ambitious objectives for occupational health that are currently implemented in all WHO regions.
(p.17)
International Labour Organization (ILO)
ILO has worked on occupational health issues for over 80 years. One of the first health-related conventions of the ILO was Convention No. 13 in 1921 on the prohibition of white lead paint that was found to be toxic to both workers and children. In 1985, the International Labour Conference adopted Convention No. 161 and Recommendation No. 171 on occupational health services. The current Safe Work Programme consists of occupational health elements, including the Global Program for Elimination of Silicosis.
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International Commission on Occupational Health (ICOH)

ICOH is a professional association of occupational health experts whose mission is to advance research, training, and information on occupational health. The ICOH has 35 scientific committees active in various fields of occupational health research. The most important ICOH document is the 1993 International Code of Ethics for Occupational Health Professionals. The Code defines the basic ethical principles for occupational health practice, obligations of health professionals, and professional independence of occupational health experts. The Code stipulates 26 different duties and obligations for occupational health professionals, guiding them in various practical activities according to ICOHs ethical principles. These guides cover the following areas of occupational health practice: maintenance and upgrade of competence, including knowledge of conditions of work and scientific and technical knowledge advice on policies and programs for improving occupational health emphasis on preventive and promotion actions follow-up on remedial actions provision of information on safety and health protection and management of company information, healthy surveillance, workers information on health examinations, employers information on health examinations, and protection of confidential health data biological monitoring health promotion protection of community and environment contributions to scientific knowledge, competent scientific judgment, integrity and impartiality, professional independence, and equity ethics clause in employment contracts for occupational health personnel record keeping medical confidentiality collective health relationships with health professionals relationships with social partners ethics promotion professional audits
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(p.18)
Other International Organizations
Other important professional organizations relate to occupational health, such as the International Occupational Hygiene Association (IOHA), the International Ergonomics Association (IEA), which produce scientific material and practical guidelines, and the International Social Security Association, in which national social insurance programs share information.
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