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The percentage of children at work—a special subset of informal workers—in LMICs ranges widely from 2. The percentage of working children who do not attend school also varies widely, from around 2 percent to 89 percent, but does not exceed 50 percent in most LMICs. The vast majority of working children are employed in agriculture. Others are employed in a range of industries—fisheries, domestic work, mining and manufacturing, and construction—where adults are also employed, and some are soldiers in war-affected zones. The problem of child workers is waning worldwide but is still alarming in Sub-Saharan Africa, where one in five children is working ILO b.
Child workers are at higher risk for injuries and may suffer greater consequences because their bodies are still growing. Working children often emulate unsafe behaviors of adults, lack adequate safety training, are at higher risk for exploitation, and endure long working hours and minimal pay, often superimposed on a background of deprivation ILO a.
Until child labor has been eliminated, efforts to mitigate hazardous working conditions for children are needed Siddiqi and Patrinos In summary, LMICs bear the brunt of global occupational fatality and disability, yet many lack the resources and infrastructure to tackle them effectively. Challenges related to workforce shortages, compliance of employees and employers with OSH, lack of sound data, and predominance of a vulnerable and hard-to-reach informal workforce preclude the direct transfer of successful interventions from HICs to LMICs.
Therefore, progress in OSH is inseparable from overall progress in many domains: Addressing the problem will require community-based public health initiatives that transcend the traditional well-demarcated workplace, scale up participatory intervention, invest in the local workforce, and improve the quality and use of data.
Over the past three decades, globalization has changed the way goods are manufactured and exchanged internationally. International supply chains offer a flow of materials from natural resource to final product in a manner that is cost-efficient and easily scalable to produce high-quality goods for affordable prices. The supply chain is governed by a focal company, often a multinational, which receives goods and materials from suppliers that use subcontractors to develop raw materials into finished products Ustailieva, Eeckelaery, and Nunes Firms in the EU and the United States have developed global supply chains spanning a variety of industries, ranging from apparel and toys to electronics Locke One advantage of using foreign factories is the unmatched scalability of their labor.
A sense of how globalized the supply chain has become can be gained by considering a Nike cross-trainer shoe: The number of intermediate goods integrated into global supply chains has reached a record high. Their integration into global supply chains has provided LMICs with promising economic opportunities and a prominent place in the world economy, while providing HICs with low-cost labor Rivoli Focal companies have a clear profit incentive to acquire low-cost ready-for-market goods.
In turn, suppliers contracted by the focal company strive to keep costs low and to deliver products quickly and reliably because of volatility in production orders and intense competition with rival firms. Because the contracted factories in LMICs tend to be under intense economic pressure to deliver intermediate products at a low cost, work-related injuries and occupational hazards persist. In order to respond to large fluctuations in the quantity of production in a short span of time, temporary employment has become very common in factories in LMICs Smith, Sonnenfeld, and Pellow The majority of workers integrated into global supply chains are migrants who move from poor rural areas to the rapidly developing and industrializing urban areas within their country seeking employment with higher pay, because rural job opportunities are often sparse and pay below subsistence-level wages Welford and Frost From to , 79 million migrant workers in China alone moved to prominent manufacturing cities in search of higher-paying employment Wang and others Most of these migrant workers are young ages 17—39 years , have little to no formal education, and lack experience in an industrial environment.
Consequently, they tend to have a poor understanding of workplace risks and labor rights. They are placed in the highly hazardous workplaces of construction, mining, and manufacturing often without training, resulting in high rates of injury, sickness, and death at the workplace. The excessive competition for temporary work means that they are reluctant to report minor injuries on the job for fear of losing employment. These subcontracted laborers have one and a half times the occupational accident risk of their full-time counterparts Quinlan This growth of contract work is not a temporary trend.
In China, 80 percent of the recorded on-site deaths were of migrant workers Wang and others Additionally, there is little to no professional OSH oversight to ensure the safety of workers, especially among large manufacturing plants in China, where 15,—20, workers are at risk for injury at any given moment Brown Moreover, these employees are hired and fired on short notice.
Finally, forced overtime in excess of 6-day, hour work weeks is all too common Locke and Romis , resulting in increased risk for accidents and repetitive motion injuries Brown Another issue of concern is the limited availability and accessibility of OSH training and education in source countries undergoing rapid industrialization Ahasan The occupational health services coverage in China, for example, is estimated to be in the 10 percent range, whereas in HICs, the average is in the 20—50 percent range Barboza, Lattman, and Rampell Fragmented production in the global supply chain has resulted in the establishment of a flurry of regulatory bodies meant to control the OSH and labor rights of each supplier.
However, the complexity of the chain often prohibits effective regulation. The ILO and WHO provided similar regulation at the international level, publishing reports on worker conditions and employment demographics for each sector globally. Thus, the advent of the global supply chain left a void in the regulation of OSH and labor rights, because authority was dispersed in a complex web of buyers and sellers.
Compounding this situation are the economic incentives for governments to ignore factory OSH violations in order to keep the cost of production low Locke To bridge the gap in OSH oversight, nongovernmental organizations NGOs —privately owned labor-watch groups—have emerged as so-called regulators of the working conditions of factories by articulating international expectations for OSH conditions, wages, and gender equality. These organizations conduct random audits of factories and publish reports on their performance. NGOs have been unable to regulate suppliers or the focal company itself.
A newer development in global supply chain regulation is the notion of corporate social responsibility; the focal company has a direct responsibility to protect the interests of society by upholding OSH and labor equality standards throughout its supply chain. Many multinational corporations, such as Adidas, Apple, Gap, Nike, and Walmart, have defined criteria that their suppliers must meet and then conducted factory audits as part of a yearly report analyzing current labor conditions in their supply chain Apple ; Burke, Scheuer, and Meredith ; Gap ; Verbeek and Ivanov ; Yu Little research has been conducted on the effectiveness of these initiatives Ustailieva, Eeckelaery, and Nunes The paradoxical demand for both high OSH standards and low-cost labor creates conflicting incentives for recording occupational injuries Brown The distinctive economic incentives and pressures operating in the global supply chain give rise to numerous OSH risks.
Although the specific risks are not unique to the global supply chain, the combination of hazards presents particular challenges. To examine the OSH risks engendered by the global supply chain, this section reviews the common sources of risk in the microelectronics and textile goods workplaces, prominent industries using the supply chain of LMICs. The electronics industry is one of the fastest-growing sectors in the world, with a vast network of suppliers Locke Beginning in the s, prominent multinational firms in Canada and the United States, such as Apple, IBM, Lucent, Maxtor, and 3Com, gradually adapted their supply chain management to a new form of outsourcing that granted licenses to suppliers from factories across the globe, prominently China, Malaysia, Mexico, and Singapore Locke Today, 75 percent of computer products are manufactured by contract manufacturers as opposed to original equipment manufacturers Brown By , the most successful of these companies had production facilities in as many as seven countries, mostly LMICs Locke The magnitude of employment that these contract manufacturers manage can be illustrated by Foxconn: The common structure of a factory in the global supply chain is a large assembly line consisting of hundreds of workers performing a single to second operation repetitively until their shift ends Sandoval and Bjurling This level of repetition is mentally taxing Butollo, Kusch, and Laufer and is accompanied by reports of suicides and attempted suicides Ngai and Chan The common OSH risks in the electronics manufacturing industry include fatigue resulting from long work shifts and physically demanding work with very few or no breaks and no proper safety equipment Sandoval and Bjurling Serious occupational injuries are common in electronics factories.
According to a study that gathered audit reports from factory suppliers of Hewlett-Packard from June to January , 59 percent of the factories were in violation of legal working hours, 40 percent were in violation of emergency preparation, 32 percent were in violation of hazardous material storage, and 22 percent were in violation of occupational safety Locke A similar study published by a coalition of NGOs, referred to as ProcureITfair, found that workers for the Excelsior Electronics plant in Dongguan, China—a computer and digital electronics manufacturing facility for Apple, Intel, and Sony components at the time of investigation—were working for 10—12 hours on a poorly ventilated shop floor and inhaling industrial alcohol, cleaning agents and thinners at the printed circuit board processing area Butollo, Kusch, and Laufer ; ProcureITfair According to statistics gathered from Shenzhen factories that were released by mainland authorities, an average of 13 workers lose a finger or an arm daily, and 1 worker perishes onsite every 4.
Another serious issue is the unsafe handling of flammable materials, leading to deadly factory fires. In Zhejiang Province, a factory fire killed five workers Murdoch and Gould On April 24, , the Rana Plaza factory building collapsed in Dhaka, Bangladesh, killing 1, workers and injuring more than 2,, making it the deadliest industrial disaster to date Adler-Milstein, Champagne, and Haas Between and , 33 major fires occurred in garment factories, as well as smaller fires in Bangladesh alone, injuring more than 5, workers Brown These textile factories—stationed in poorly structured high-rise buildings—lack safety exits and proper electrical wiring Adler-Milstein, Champagne, and Haas A recent study gathered data from audit reports of factories supplying a major global apparel firm that span Bangladesh, China, the Dominican Republic, Honduras, and India Locke The criteria for compliance covered compensation, working conditions, and overtime hours.
The worst compliance was found in the factories in South and East Asia, where 56 and 72 percent of the factories, respectively, were not approved. China has the strongest presence in the supply chain of the footwear industry; 86 percent of all footwear sold in the United States comes from factories in Southern China Locke Guangdong is the hub of the athletic footwear industry because of its well-designed ports, access to large numbers of cheap laborers, and lack of government regulation Frenkel According to recent publications, work in the Chinese shoe manufacturing industry is fraught with excessive overtime, managerial neglect of OSH conditions, and sexual harassment Locke Much like trends in the electronics industry, contracted temporary work in the textile, clothing, and footwear industries has been growing, leading to dangerous OSH conditions for workers Nossar, Johnstone, and Quinlan In a study examining the comparative dangers of contingent work in the clothing and manufacturing industries Mayhew and Quinlan , contracted employees in the clothing industry had three times the number of occupational injuries as did contracted workers in the manufacturing sector.
One possible explanation for this disparity in injury experience is that garment workers are often paid by an incentive system that pushes them to work faster than their manufacturing counterparts, who are paid by the hour, and increases the risk for injury. Because working conditions significantly influence worker performance and productivity, optimizing the conditions for improved health and safety has far-reaching implications for individuals, employers, and economies globally. Identifying and implementing effective health and safety interventions at the policy level and in individual workplaces to foster sustainable and safe work environments are important.
However, there is no one-size-fits-all strategy for reducing the risk for occupational injury. LMICs are especially diverse in their type and amount of resources, strength of their regulatory institutions, industrial profile, and levels of informality, among other relevant features. Therefore, the range of viable options for a country in Sub-Saharan Africa, for example, may not be the same as that for a country in Latin America. Nonetheless, considering comprehensive solutions that integrate multiple strategies for improving not only primary prevention, but also injury care, rehabilitation, workforce training, and data systems is important.
Given the challenges in LMICs, prevention of occupational injury should consider two distinct but related questions: What is known to work? How can it be applied successfully and sustainably? These questions can be rephrased as technical measure effectiveness versus implementation or program effectiveness. Because of resource constraints in LMICs, applying the more effective, but also more expensive, technical measures from the top of the hierarchy of hazard controls—elimination, engineering, administration, or personal protection in order of decreasing effectiveness —may not be feasible except perhaps in large, well-resourced enterprises.
Very few studies have evaluated the effectiveness of technical measures in LMICs. In India, the use of protective eye equipment reduced the incidence of eye injury among agricultural workers Chatterjee and others , while the installation of mirrors above tandoor ovens showed potential for reducing burns among oven operators in Pakistan Nasrullah and Awan These remain very isolated islands of evidence.
Prehospital, hospital, and ambulatory care for occupational injury in some LMICs is part of the general capacity for trauma care. Although basic health units in the workplace or the community can manage minor trauma, a sophisticated prehospital and hospital trauma care system is crucial for saving lives and mitigating the effect of severe occupational injuries. Much room exists for improvement in such systems in LMICs Baker and others ; Dunser, Baelani, and Ganbold ; Goosen and others , but not without resources that could be beyond reach in such settings. In a nonrandom control study, Murad, Larsen, and Husum reported a lower injury mortality rate among patients managed by field-trained first responders than among those not managed by first responders.
Applying a similar approach in workplaces or communities may be an affordable alternative for improving outcomes, particularly in the informal sector. Access to rehabilitation services following injury cannot be dissociated from the general problem of limited access to quality health services in LMICs. Similar to emergency medical services, there is much room for building and improving rehabilitation services in LMICs Haig and others ; Tinney and others Data on the duration of disability after injury in LMICs are very scarce, and such data are critically needed for an evaluation of initiatives that aim to minimize disability and enhance early return to work.
Scaling up training programs to develop a competent occupational health workforce, including primary health care workers, needs to be coupled with simultaneous and serious retention efforts. The disproportionate concentration of the health workforce in urban areas is a global phenomenon Chen and others , but it is accentuated in LMICs by the rural-to-urban influx as a result of poor investment in rural development.
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Adjusting training to local needs—for example, by providing enough training to enable locals to serve their own populations—coupled with efforts to improve working and living conditions, may curb outmigration in LMICs WHO a. To overcome OSH resource scarcity, models have highlighted the use of intermediary organizations designed to bridge the gaps between public health and safety organizations and SMEs and to deliver occupational health and safety services Soares and others Because SMEs are diverse and often insular, straightforward information is needed regarding OSH initiatives that can offer specific, tangible benefits and be readily adapted to their organizational structure.
Through regular interactions with individual SMEs, intermediary organizations may offer the best opportunity to influence OSH decision making, providing short-, medium-, and long-range benefits Gervais and others Effective and targeted prevention efforts are impossible without viable local data. A recent review of an audit of suppliers to Apple revealed that fewer than one in seven recorded any injury or health events in the past year Apramian and Cullen The ILO guidelines for improving national reporting of occupational injuries acknowledge the challenges of expanding reporting to cover small enterprises, migrant workers, the self-employed, and the informal sector Ehnes Among the recommended solutions are legalizing migrant work and creating administrative connections through which small enterprises are obliged to report to a national database, for example, in the same way they report information for tax purposes or social insurance.
However, more pragmatic solutions may be needed for these hard-to-reach groups. One possible solution is ensuring that occupational injury modules are part of periodic household or establishment surveys Taswell and Wingfield-Digby Enhancing routine health information data with identifiers of the relation to work and the occupation and industry of the injured person is a promising approach. Marucci-Wellman and others tested an active surveillance system that builds on the health information system in one commune in Vietnam and compared its outcomes with those from a range of unenhanced and enhanced passive surveillance models also based on the existing system.
Although active surveillance performed better than passive surveillance, such an approach could be expensive and difficult to monitor and sustain. As a middle ground, passive surveillance that is enhanced with data on place and activity during injury, supplemented with active surveillance in high-risk settings, has been suggested. Determining whether prevention programs that rely on participatory approaches, particularly those overseen by primary health care workers, could be a suitable platform for active surveillance will be useful.
Ensuring the quality and completeness of data is crucial for the success of such approaches. Governments in HICs protect workers against health and safety risks through OSH legislation, regulation, and enforcement via workplace inspections that may result in citations and penalties. These approaches are often considered the cornerstone of workplace safety and health risk management Mischke and others ; Tompa, Trevithick, and McLeod However, these policies are lacking or inconsistently applied in many parts of the developing world.
Studies examining the effect of OSH inspections, citations, and penalties have shown varying results Foley and others ; Friedman and Forst ; Levine, Toffel, and Johnson Some evidence shows that inspections resulting in penalties are associated with lower rates of lost workday injuries in the years immediately following inspections Gray and Mendeloff Other evidence suggests that penalty inspections extend their influence beyond the injuries closely related to the specific regulations for which citations and penalties were levied Gray and Mendeloff ; Mendeloff and Gray ; that is, penalties may prompt employers to enhance general safety efforts and to respond to cited deficiencies Haviland and others Verbeek and Ivanov appraised systematic evidence for effectiveness of basic OSH interventions in settings similar to those prevailing in LMICs and found that enforcement of regulations reduced injury rates.
In the most comprehensive report to date, a Cochrane review assessed evidence on the enforcement of OSH regulations and the prevention of occupational diseases and injuries. Mischke and others found that inspections likely reduce the risk for injury in the long term, although the magnitude of effect remains unclear. Further, focused inspections appear to have greater effect than more general inspections, although the current evidence is low quality. Unfortunately, because inspections are costly and resources are limited, the enforcement or threat of enforcement fails to reach all workplaces equally.
Additionally, the changing political, economic, and legal landscape of work is creating new stressors and potential hazards with consequences that not yet understood. Although regulations and enforcement activities are designed to protect worker safety and health, employer obligations have not yet been fully realized Niskanen and others Given the limited number and unequal distribution of labor inspectors worldwide, more effective mechanisms are needed to translate OSH regulations into widespread practice.
Achieving sustainably safe work environments within the organizational structure of supply chains will require both private voluntary and public mandatory regulation. The involvement of local government can be crucial to upholding proper labor standards and, historically, it has underused its own capacity to impose worker standards on foreign investors in global supply chains Amengual However, the fluid, fast-evolving structure of international supply chains means that static governmental law alone cannot sufficiently protect worker rights and health.
Rather, a joint effort with NGOs and government intervention is necessary. An example of such joint regulation involves the protection of the rights of workers in maquiladoras —Mexican manufacturing plants that operate in a free-trade zone Locke Before the Accord, workers were subject to government neglect largely because of a weak union presence in maquiladoras and a general lack of understanding of Mexican law.
Since the advent of the Accord system, workers can file labor violation cases in court and have them resolved within a few months. Training workers as well as managers in hazard recognition and control, safe work practices to reduce risk, proper use of personal protective equipment, safety and health information, and emergency procedures is a widely recognized, essential component of OSH programs Burke, Scheuer, and Meredith ; Redinger and Levine Systematic reviews of research pertaining to the effectiveness of OSH training found strong evidence for positive effects on worker safety and health behaviors, but insufficient evidence that training alone improves health or safety outcomes Amick and others ; Robson and others A review of evidence on the effectiveness of OSH interventions in agriculture, SMEs, and informal sector settings did not find educational interventions to be effective in reducing injury risk Verbeek and Ivanov Given the increasingly diverse workforce and demographic disparities in injury risk, OSH training programs need to target workers with language barriers and low literacy and incorporate cultural and societal aspects to be effective.
Failing to address these aspects can deepen the OSH disparities Steege and others A general belief holds that management commitment plays a fundamental role in developing a strong safety climate and culture and that strong management commitment to and support of safety enhance employee adherence to safe work practices and ultimately reduce workplace injuries. However, evidence showing a direct link between safety culture and climate and injury outcomes is limited. A meta-analysis found support for an association between safety climate and safety performance, but also found a much weaker link between safety climate and injury Clarke Subsequent work examined the effect of government subsidies designed to improve occupational safety by changing safety culture.
Research found that only half of the subsidized interventions evaluated were deemed successful in improving reporting of hazards, reducing unsafe behaviors, or reducing accidents, indicating the challenge of promoting organizational culture change Hale and others Factors associated with successfully improving safety culture included a planned, systematic approach that generates sufficient energy and support for deployment of multiple safety interventions, engagement and empowerment of workers in the learning and change process, and training and motivation of managers at all levels Hale and others Safety incentive programs are popular and widespread, yet little research has been done regarding their effect on the occurrence and reporting of injuries GAO Such rate-based and behavior-based incentive programs are intended to entice workers to work safely, but safety incentive programs may discourage injury reporting.
Studies evaluating incentive programs have reported varying conclusions about their effect on workplace safety. Some have reported that rate-based safety incentive programs have no effect on injury reporting Brown and others Others have concluded that safety incentive programs reduce injuries Alavosius and others ; Gangwar and Goodrum , and still others have shown that workers whose employers enact policies involving discipline as a consequence of injury are less likely to report injuries for fear of punishment than are those whose workplaces have no such programs Lipscomb and others The bulk of evidence is equivocal.
These discrepancies may be due, in part, to the widely varying components of safety incentive programs. Some offer incentives for reporting near-miss incidents, reporting other safety concerns, or wearing protective equipment, and others reward work groups for having fewer injuries. Behavioral interventions such as monetary incentives, praise and feedback, and team competition may reduce injuries in settings similar to those prevailing in LMICs, but the evidence is limited Verbeek and Ivanov Effective implementation of behavioral interventions may require a greater degree of organizational regulation than currently exists in LMICs.
Because ergonomic hazards vary markedly between industries and jobs within specific industries, the optimal means to mitigate those hazards likewise vary. Evidence showing a positive effect of ergonomic hazard control on reducing injury risk across groups of workers and jobs has been rather limited and conflicting Fujishiro and others ; McSweeney and others ; Palmer and others However, several studies have reported an association between reduced risk for MSDs and acute injuries associated with manual handling and ergonomic job modification Carrivick and others ; Marras and others ; van der Molen and others A recent report illustrated the benefits of identifying ergonomic hazards and controlling risk for any type of acute injury or MSD among a population of manufacturing workers, and risk was reduced further with each hazard control implemented Cantley and others Furthermore, the application of an ergonomics process for identifying and mitigating organizational and psychosocial demands that contribute to both injury and MSD risk at work has been the subject of some recent research Bentley The body of scientific evidence supports the financial case for ergonomic programs.
Ergonomic programs have been shown to be cost-effective, particularly in manufacturing, and ergonomics best practices focus on integrated approaches to hazard control rather than on specific ergonomic tools and procedures Amick and others Some countries in Asia are increasingly using action-oriented participatory approaches to deliver OSH interventions, particularly in difficult-to-reach or difficult-to-regulate settings such as small enterprises and the informal economy Kawakami Also widely deployed in HICs, this approach involves the target population in identifying hazards and developing and implementing safety interventions figure 6.
Interventions using a participatory approach could even help eliminate hazards and substitute them with appropriate, low-cost, and safe alternatives. This approach promotes ownership, improving the potential for compliance and sustainability. OSH trainers mobilized by government, worker, and employer organizations assisted participants in identifying practical safety solutions using a simple action checklist Kawakami and others In a slightly different version in Thailand, primary care unit national hospital system staff members were retrained as OSH service providers, assessing OSH risk and giving low-cost improvement advice through participatory group discussions Kawakami In Vietnam, the Worker Improvement in Neighborhood Development program has been extensively applied in agriculture.
Supported by provincial government officials, farmers were trained to use illustrated checklists to propagate examples of good practice among established networks of their peers. The approach could potentially be used to address child labor in hazardous agricultural work ILO d.
A few studies have employed an uncontrolled pre- and post intervention design to test the effectiveness of these approaches. In Thailand, reductions in toluene and carbon monoxide levels were recorded following the application of participatory training in the informal sectors of artificial flower making and batik processing Manothum and others Similar benefits were observed after applying the same approach in the informal weaving, ceramic, and blanket-making industries Manothum and Rukijkanpanich Knowledge, attitude toward occupational safety, and use or provision of personal protective equipment were improved after participatory training of welding workers in 25 SMEs in China.
However, improvements in implementation of engineering controls were inadequate Fu and others Falls from heights are a serious hazard for many workers, especially in the construction sector. Same-level STFs pose a substantial hazard for workers in nearly every sector, but especially in health care, food services, and wholesale and retail trade. Much has been learned about the causes and prevention of injuries resulting from these hazards, and resources have been developed to assist employers and workers in recognizing and controlling them.
However, barriers continue to limit the dissemination of knowledge and use of interventions in the field. Management systems designed to ensure the use of fall protection measures have been shown to reduce falls among construction contractors Becker and others Implementing comprehensive STF prevention programs that include analysis of common causes of STFs, general awareness campaigns, workplace hazard assessments, changes in housekeeping products and procedures, consistent removal of ice and snow, changes in flooring, and provision of slip-resistant footwear for high-risk employees can substantially reduce the risk for STF injuries among hospital workers Bell and others These results should be readily transferable to other sectors at similar risk for STFs.
Mechanical patient-lifting devices have been shown to reduce the back compressive forces on nursing personnel by approximately 60 percent, reduce the lifting required during patient transfers, and improve patient perceptions of comfort Garg and Owen ; Zhuang and others Working with national and international researchers, the National Institute for Occupational Safety and Health in the United States conducted research into comprehensive safe patient-handling policies involving the use of mechanical lifts and repositioning aids, a zero-lift policy, and employee training on the use of lifting devices.
This approach was highly effective in reducing back injury risk among health care workers of all ages and lengths of work experience, regardless of the type of facility Collins and others Additionally, clinical use and scientific studies have documented the effectiveness of blunt-tip suture needles in reducing needlestick injuries, and multiple resources have been developed to disseminate this information to health care workers CDC ; NIOSH Very few controlled studies demonstrate the effectiveness of different measures in preventing sharps injuries in LMICs.
Cross-sectional comparative effectiveness analysis conducted in the Alexandria University hospitals in the Arab Republic of Egypt found that factors such as access to safe injection devices, adherence to infection control guidelines, access to written protocols on prompt reporting, and training on safe injection practice were associated with a lower probability of needlestick injury Hanafi and others Studies on the effectiveness of educational programs elicited inconsistent results.
In contrast to an educational program, an official imperative program with monetary penalty for unsafe practice reduced syringe recapping among nurses in the Islamic Republic of Iran Dianati and others A controlled study in China and an uncontrolled study in Taiwan, China, among student and intern nurses showed improved practices and reporting of sharps injuries following education interventions Wang and others ; Yang and others In Cairo University hospitals, education combined with improved access to safe injection devices in intensive care units was associated with a reduction in the incidence of sharps injuries Zawilla and Ahmed Countries such as the Syrian Arab Republic also report improvements in injection practice and reductions in sharps injuries after implementation of multifaceted strategies combining the provision of safe injection devices, development and circulation of national guidelines, education campaigns, and training of health care workers WHO A great deal has been learned about engineering solutions to address major safety issues, including fall protection equipment, nail gun safety, and protection from contact with overhead power lines.
However, overcoming the barriers to knowledge dissemination is needed to facilitate wider recognition of hazards and implementation of available solutions Committee to Review the NIOSH Construction Research Program Efforts to increase awareness of construction worksite hazards should target vulnerable work groups, including immigrant workers, young workers, and contract workers, who are at substantially higher risk for injuries and fatalities in this sector. Little research has systematically examined the effect of safety culture and OSH management systems on reducing injury and improving working conditions in the construction industry.
However, evidence suggests that when owners, contractors, contractor associations, insurance carriers, and appropriate unions collaborate to establish and promote a safety culture, the risk for injury and fatalities can be reduced. To enhance the uptake of safety training among the many immigrant workers in this sector, using training workers from representative cultural groups to deliver safety training may be more effective than using professional trainers.
To promote effective integration of health and safety management into construction project planning, communication, and control, a project funded by the U. Health and Safety Executive developed several integrated tools for use. These include a responsibility chart, an option evaluation chart, health and safety hazard workshops, drawings presenting safety information, red-amber-green lists, health and safety milestones, and a process for controlling design changes Cameron and Hare ; Hale and others Various safety interventions have been implemented within the agriculture sector in HICs, but their effect remains poorly understood.
Farm safety hazards in LMICs, where the vast majority of agricultural workers are employed, have received much less attention. Results from a meta-analysis found no evidence that educational interventions were effective at reducing injury risk, which is consistent with evidence suggesting that training alone is insufficient to prevent injuries. In contrast to earlier reports, limited evidence was found that rollover protective structures on tractors reduced injuries Lehtola and others However, the dearth of high-quality studies illustrates the continued need to develop and evaluate farm injury interventions, particularly in LMICs.
National coordination of efforts across agriculture sector stakeholders is under development in several countries, including New Zealand, Sweden, and the United States Lundqvist and Svennefelt , In addition, initiatives to address injuries and fatalities associated with tractors and other farm machinery have been developed, including an electronic system to warn farm equipment drivers when someone enters the hazardous zone near their vehicle EU-OSHA n. Pesticide poisoning is a major hazard in the agriculture sector in LMICs. Occupational exposure causes unintentional harm, while easy access is a key factor in intentional self-harm.
In accordance with expert opinion, the WHO recommends a range of promising interventions regarding the safe storage of pesticides in households, communal storage, training of farm workers and schoolchildren, training of pesticide vendors, and use of community leaders to disseminate information on safe handling of pesticides WHO b. The effectiveness of these measures is yet to be demonstrated. Social marketing—the use of commercial marketing strategies to raise awareness and promote safe behavior—has been advocated for tackling unsafe behaviors among young people Lavack and others ; Monaghan and others ; Smith Although they are difficult to evaluate, social marketing campaigns have been associated with a reduction in occupational injuries in Germany Mustard The effectiveness of such campaigns in LMIC settings remains to be seen, but the campaigns are probably suitable as components of participatory programs.
Worker contact with machinery or equipment presents a major risk for severe injury, particularly in the manufacturing and mining sectors. Some recent risk mitigation efforts include the application of capacitance-sensing technology Powers Jr. Although these efforts show promising results for preventing future injuries Ruff , they are less readily transferable to LMICs. Although fatigue is widely accepted as a public and workplace safety concern, critical gaps exist in the understanding of strategies to mitigate its causes and adverse health and safety effects Noy and others ; Williamson and others Because both work and nonwork activities can greatly affect fatigue, fatigue risk management requires the involvement of employers and workers alike.
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Regulatory limits on hours worked are evolving into multidimensional fatigue risk management systems that incorporate additional risk mitigation strategies, such as education and training; regular monitoring of fatigue levels; and systematic assessment of the role of fatigue in accidents and injuries in many sectors, including transportation and health care Gander and others Most of the proposed interventions apply to service organizations such as health care institutions.
Evidence from areas such as government policy and strategy development could apply to other sectors where risks are not clearly defined, such as street vending and domestic work. However, awareness-raising and prevention initiatives still need to be part of participatory occupational health approaches that target all sectors. The association between baseline psychosocial workplace stressors and ill health and injury was documented recently among construction and municipal utility workers before the performance of a random control trial of a workplace safety intervention Bodner and others The results from this trial will be useful for informing future interventions.
An analysis of data from the European Survey of Enterprises on New and Emerging Risks identified six aspects associated with psychosocial risk management. Establishment size, industry, and country predicted the degree of psychosocial risk management. Larger enterprises were associated with better psychosocial risk management.
Manufacturing and construction sectors were associated with the least comprehensive psychosocial risk management, while the education, health, and social work sectors were associated with the most comprehensive. Countries in Northern Europe offered more psychosocial risk management than did countries in Southern and Eastern Europe van Stolk and others Although room exists for improvement globally, this trend toward taking systemic approaches to managing workplace psychosocial risks in Europe is encouraging.
Much effort has been focused on developing OSH management systems for large enterprises, but similar development, implementation, and evaluation have been lacking for smaller enterprises Hale and others ; Robson and others Given the barriers to disseminating OSH information to SMEs across many employment sectors, smaller businesses may require assistance from external organizations and other sources to fulfill their responsibility to protect the health and safety of their workers.
Adequate risk assessment is a key component of OSH, but it can be costly and difficult for small businesses that lack resources for the task. Although some evidence highlighting the economic benefits of OSH interventions has emerged in recent years, substantial gaps remain. Existing analyses focus primarily on benefits achieved via ergonomic interventions in four sectors: Strong evidence supports the financial merits of ergonomic interventions for the manufacturing and warehousing sector, moderate evidence was found for the administrative and support services and health care sectors, and limited evidence was found for the transportation sector Guimaraes, Ribeiro, and Renner ; Tompa and others Studies have found that ergonomic and other musculoskeletal injury prevention interventions in manufacturing and warehousing environments are cost-effective and improve health and safety outcomes, and paybacks are realized over a time period ranging from just over three months to slightly more than two years Tompa and others Implementation of a participatory ergonomics process consisting of both proactive and reactive components yielded a benefit-to-cost ratio of Similarly, economic evaluation of a participatory ergonomics process implemented in a clothing manufacturing plant, which introduced primarily low-cost, low-tech interventions, showed a benefit-to-cost ratio of 5.
Economic evaluations of OSH interventions in SMEs are difficult to find, although SMEs represent a significant force in the global economy and the cost of injuries to these establishments could be catastrophic Targoutzidi and others Economic evaluations may be lacking, in part, because smaller enterprises rarely have a separate budget for OSH and routinely collect only very limited OSH data, which makes complete economic analyses quite a challenge Lahiri, Gold, and Levenstein To identify and address factors relevant to SMEs and encourage investment in OSH interventions, Targoutzidi and others recently developed several case study examples as a tool for SMEs to calculate the costs and consequences of OSH interventions.
SMEs often perceive that performing work more safely would be costly. For this reason, highlighting the business case for OSH could facilitate the broader diffusion of OSH interventions globally. There is a vast literature on the contributions that physical, chemical, and biologic exposures at work may make to the occurrence of acute and chronic medical conditions Rosenstock and others Indeed, almost every pathological condition has one or more possible occupational causes.
Some conditions may have myriad causes, although deciphering the role of workplace exposures in each case is problematic. For others, the consequences of workplace exposures are unique, such as the poisonings caused by lead, mercury, arsenic, and other heavy metals; the pneumoconioses caused by coal, silica, or asbestos; or the rare syndromes caused by dioxins and vinyl chloride. These latter causes can, at least in theory, be diagnosed individually.
Other consequences present as very common, such as chronic obstructive lung disease caused and exacerbated by exposure to irritant dusts, coronary artery disease caused by exposure to particulate matter or workplace stressors, or the more common forms of cancer caused by exposure to several dozen common carcinogens. In individuals with these common ailments, the contribution of work can be assessed only by looking at patterns of disease in the population in aggregate.
However, broad debate continues about the burden of chronic disease that may be attributed to work even in well-studied HICs, ranging from as little as 1—2 percent to perhaps as high as 10 percent Sorensen and others Far fewer data are available on LMICs. Moreover, although acute overexposures to toxins are commonplace WHO , their role in morbidity and mortality is unlikely to approach that of injury, which is the reason this vast subject is relegated to a brief overview.
More than , chemical substances and numerous biologic hazards are found in workplaces around the globe. The control of occupational disease has focused on three major categories of hazard—physical, biological, and chemical:. Although the fraction of chronic diseases to which workplace factors contribute remains unknown, there is compelling reason to believe that some progress on prevention has been made in HICs. All evidence suggests that high-level exposures of the sort historically associated with acute disease have become far less common in the past four to five decades.
This improvement is likely the result of a combination of regulations enforced in all HICs; successful litigation against manufacturers of products known to cause harm, such as asbestos; and a far higher level of awareness of workplace hazards by employers and employees alike, especially in unionized sectors of the workforce. Jurisdictions with reporting laws, including the United Kingdom and many U. Although exposure to noise, heat, and fine particulate matter continues to be very widespread, potentially adding to the still-high burden of cardiovascular disease, average exposures to metals, pesticides, and carcinogens have improved Kauppinen and others ; Symanski, Kupper, and Rappaport The same cannot yet be said for the situation in most LMICs.
The picture is clouded by severe impediments to control, with strong parallels to the issues affecting injury control:. Combined with the dearth of research, the sparseness of strategies for controlling exposure or preventing acute and chronic diseases is not surprising. For this reason, the discussion combines control of these conditions with injury control, for which the need is more immediate, the risks are well documented and recognized, and the available information is at least slightly more tractable.
The most effective means to prevent occupational injuries globally is far from certain, and universally effective intervention strategies are improbable. Nevertheless, sufficient evidence exists to recommend widespread implementation of several approaches. Developing and retaining a competent health care workforce is critical for LMICs. Community-based initiatives to promote OSH in conjunction with public health have the potential for broader reach in regions with few resources for health care workers.
Empowering workers to advance change through wider implementation of participatory approaches could speed the identification and mitigation of hazards across many regions and sectors. Targeted and effectively delivered training for vulnerable workers, such as young workers, inexperienced workers, immigrant workers, and workers in SMEs, is needed to reduce the burden of occupational injury among these subgroups of workers worldwide. Efforts to formalize segments of the informal workforce are also needed to protect these vulnerable workers. This work is available under the Creative Commons Attribution 3.
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Beijing needs to temper its high-handed attitude towards Hong Kong
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Examples of components can include, but are not limited to, tables, figures, or images. Turn recording back on. National Center for Biotechnology Information , U. Introduction The world of work has changed dramatically. Occupational Injury in Hics Several developments have the potential to raise occupational injury rates. Workplace Hazards Research conducted in HICs is the predominant source of information about the contribution of workplace hazards physical, psychosocial, and work organization and individual factors gender, age, and health status to occupational injury risk as well as ways to mitigate risk.
Physical Exposures Physical exposures related to job tasks, workplace environment, use of tools and materials, machine operation, and machine-paced work affect workers in different occupations and employment sectors Chau and others ; Vandergrift and others The following physical workplace exposures are strongly associated with injury risk: Psychosocial Exposures Significant changes in technology and management ideologies, combined with increases in global competition, are responsible for the trend toward more difficult, faster, more productive labor with less control over tasks Green Psychosocial stressors include the following: Work Organization The modern hour society has greatly affected the timing of work hours.
Individual Factors Individuals have varying susceptibilities to workplace injury, and this variability is related to occupational and individual characteristics Clarke ; Schulte and others These findings illustrate the potential benefit to be gained from targeted job training. Gender The gender gap in labor force participation is closing globally. Age Among younger workers, differential distribution by type of job, workplace environment, and organizational structure plays an important role in their elevated risk for injury, because younger workers are more likely to work in more hazardous jobs Breslin and Smith and are overrepresented in small enterprises, which have limited OSH resources Eakin, Champoux, and MacEachen ; Headd Health A few reports have linked chronic health problems to occupational injury, but substantial gaps remain in the evidence.
Employment Sector Globalization has subjected the manufacturing sector in HICs to intense international competition. Agriculture, Forestry, and Fishing Work in the agricultural, forestry and fishing sector is among the most hazardous, and comparatively weaker health and safety regulations, in combination with growing numbers of immigrant workers and a paucity of surveillance data, have resulted in widespread underrecognition of worker injury risk.
Manufacturing Although the manufacturing sector comprises a diverse array of industries worldwide, the majority of manufacturing jobs are labor intensive. Wholesale and Retail Trade Although workers in the wholesale and retail trade sector are generally perceived as having lower risks for injury than are workers in other sectors, many trade jobs are physically demanding, which places workers at risk for back and upper-extremity disorders.
Health Care and Social Services The health care and social services sector is a large employer in HICs, with projections suggesting continued growth as populations age. Transportation and Warehousing The transportation and warehousing sector, which enables the movement of passengers and goods via air, rail, water, and road, is vitally important to the economies in HICs and encompasses a very diverse group of workers, jobs, and job-related hazards.
The Global Supply Chain Over the past three decades, globalization has changed the way goods are manufactured and exchanged internationally. Regulation of Occupational Health Fragmented production in the global supply chain has resulted in the establishment of a flurry of regulatory bodies meant to control the OSH and labor rights of each supplier. Electronics Industry The electronics industry is one of the fastest-growing sectors in the world, with a vast network of suppliers Locke Textile, Clothing, and Footwear Industry On April 24, , the Rana Plaza factory building collapsed in Dhaka, Bangladesh, killing 1, workers and injuring more than 2,, making it the deadliest industrial disaster to date Adler-Milstein, Champagne, and Haas Occupational Injury Interventions Because working conditions significantly influence worker performance and productivity, optimizing the conditions for improved health and safety has far-reaching implications for individuals, employers, and economies globally.
Primary Prevention Given the challenges in LMICs, prevention of occupational injury should consider two distinct but related questions: Injury Care and Return to Work Prehospital, hospital, and ambulatory care for occupational injury in some LMICs is part of the general capacity for trauma care. Capacity Building and Retention Scaling up training programs to develop a competent occupational health workforce, including primary health care workers, needs to be coupled with simultaneous and serious retention efforts.
Data for Planning, Monitoring, and Evaluation Effective and targeted prevention efforts are impossible without viable local data. Regulation and Enforcement Governments in HICs protect workers against health and safety risks through OSH legislation, regulation, and enforcement via workplace inspections that may result in citations and penalties. Worker Training Training workers as well as managers in hazard recognition and control, safe work practices to reduce risk, proper use of personal protective equipment, safety and health information, and emergency procedures is a widely recognized, essential component of OSH programs Burke, Scheuer, and Meredith ; Redinger and Levine Safety Climate and Safety Culture A general belief holds that management commitment plays a fundamental role in developing a strong safety climate and culture and that strong management commitment to and support of safety enhance employee adherence to safe work practices and ultimately reduce workplace injuries.
Safety Incentive Programs Safety incentive programs are popular and widespread, yet little research has been done regarding their effect on the occurrence and reporting of injuries GAO Ergonomic Interventions Because ergonomic hazards vary markedly between industries and jobs within specific industries, the optimal means to mitigate those hazards likewise vary. Other Participatory Approaches Some countries in Asia are increasingly using action-oriented participatory approaches to deliver OSH interventions, particularly in difficult-to-reach or difficult-to-regulate settings such as small enterprises and the informal economy Kawakami Prevention of Falls from Heights and Slips, Trips, and Falls Falls from heights are a serious hazard for many workers, especially in the construction sector.
Health Care Mechanical patient-lifting devices have been shown to reduce the back compressive forces on nursing personnel by approximately 60 percent, reduce the lifting required during patient transfers, and improve patient perceptions of comfort Garg and Owen ; Zhuang and others Construction Worksite Safety A great deal has been learned about engineering solutions to address major safety issues, including fall protection equipment, nail gun safety, and protection from contact with overhead power lines.
Agriculture Various safety interventions have been implemented within the agriculture sector in HICs, but their effect remains poorly understood. Machine Safety Worker contact with machinery or equipment presents a major risk for severe injury, particularly in the manufacturing and mining sectors. Fatigue Although fatigue is widely accepted as a public and workplace safety concern, critical gaps exist in the understanding of strategies to mitigate its causes and adverse health and safety effects Noy and others ; Williamson and others Psychosocial Risk Management The association between baseline psychosocial workplace stressors and ill health and injury was documented recently among construction and municipal utility workers before the performance of a random control trial of a workplace safety intervention Bodner and others Diffusion of OSH Interventions to SMEs Much effort has been focused on developing OSH management systems for large enterprises, but similar development, implementation, and evaluation have been lacking for smaller enterprises Hale and others ; Robson and others Cost-Effectiveness of OSH Interventions Although some evidence highlighting the economic benefits of OSH interventions has emerged in recent years, substantial gaps remain.
Occupation and Risk for Acute and Chronic Medical Diseases There is a vast literature on the contributions that physical, chemical, and biologic exposures at work may make to the occurrence of acute and chronic medical conditions Rosenstock and others Exposure Classes More than , chemical substances and numerous biologic hazards are found in workplaces around the globe. The control of occupational disease has focused on three major categories of hazard—physical, biological, and chemical: Physical hazards include noise, heat and cold, ionizing and nonionizing radiations, and stressors such as vibrations.
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Beijing needs to temper its high-handed attitude towards Hong Kong. Monday, 19 September, , 2: Monday, 19 September, , 7: Related topics Legislative Council elections Politics Hong Kong government scraps plan to shorten voting hours 16 May Politics Independence activist files election ban appeal as deadline passes 27 Apr The pro-establishment camp now looks like another state-owned enterprise whose rate of return is disproportionate to the resources pumped in.
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