Eurotox sep 2018 takala brussels new v2

Successful implementation of toxicology in occupational
health
EUROTOX 2018 Session 26, Brussels 3-5 Sep. 2018
Dr Jukka Takala (Adjunct Prof), DSc MSc BSc, FFOM (Hon)
Executive Director emeritus
President
International Commission on Occupational Health
Commission Internationale de la Santé au Travail
Comisión Internacional de Salud en el Trabajo

About ICOH
1906
Milan
1906
Milan
1972
Buenos Aires
1975
Brighton
1963
Madrid
2003
Iguassu Falls
1928
Budapest
1931
Geneva
1987
Sydney
1984
Dublin
1960
New York
1954
Naples
1948
London
1938
Frankfurt
1935
Brussels
1978
Dubrovnik
1910
Brussels
1925
Amsterdam
1969
Tokyo
1966
Vienna
1957
Helsinki
1951
Lisbon
1981
Cairo
1996
Stockholm
1990
Montreal
1993
Nice
2000
Singapore
2009
Cape Town2006
Milan
2012
Cancun
2015
Seoul
2015
Seoul
SUSTANING MEMBERSAFFILIATE MEMBERS
The International Commission on
Occupational Health (ICOH) is an
international non-governmental
professional society whose aims
are to foster the scientific
progress, knowledge and
development of occupational
health and safety in all its
aspects.
COLLABORATION WITH INTERNATIONAL NGO’s
PARTNERS
2018
Dublin
2018
Dublin
2021
Melbourne
2021
Melbourne
1898-1905 – Simplon-Tunnel Construction
Giuseppe Volante
www.ICOHweb.org

Cancer, AFwork=13.8%
CVD, AFwork=14.4%
Injuries
Deaths in 2016 by age, Western Europe
AF= Attributable
Fraction, re work
Communicable AFwork=13.3%
GBD= Global Burden
of Disease
Violence

DALYs in women in 2010 by age, high-income Asia-Pacif.
Injuries
Mental health,
AFwork= 30+ %
Cancer
AFwork= 5.5-8 %
CVD,stress
AFwork= 7.9 %
DALY= Disability
Adjusted Life Years
DALYs in 2016 by age, Western Europe
AF= Attributable Fraction, re work
Communicable AFwork=13.3%

Global figures
2017
• Estimated 2.78 million
deaths
• Fatal occupational accidents
380,500
• Non-fatal occupational
accidents 374 million (at
least 4 days absence)
• Fatal work-related diseases
2.4 million
• Occupational cancer
742,000
2014
deaths
341,373
1.98 million
666,000
Sources: ILO, WHO, Scientific reports
Global figures
2014
deaths
341,373
1.98 million
666,000

Work-related Deaths, Costs, EU 28 and Global
Eur.Union
• Work-related circulatory diseases - 48,500
• Occupational cancer + 106,300
• Work-related communicable dis. (5,000)
• Respiratory diseases ++ (12,100)
• All work-related diseases ++ 200,209
• Fatal occupational injuries 3,739
• Total occupational mortality 203,946
• GLOBAL ++ 2.78 mill.
============
Cost %
of GDP
0.81%
3.20%
0.06%
3.26%
3.94%
===========

2.5%52.1%
EU cancer deaths:
106,000 of which
asbestos 85,900
(ILO 2017 and GBD2016)
USA cancer deaths:
70,600 of which
asbestos: 38,700
( GBD2016)
5.7%
28.0%
6.0%
0.8% 1.0%
2.4%
Communicable Diseases
Malignant neoplasms
Neuropsychiatric
conditions
Circulatory diseases
Respiratory diseases
Digestive diseases
Genitourinary diseases
Accidents & violence
Circulatory
Diseases
Cancers
In EU28, cardiovascular and circulatory diseases accounts for 28%
and cancers at 52%. They were the top illnesses responsible for 4/5
of deaths from work-related diseases. Occupational injuries and
infectious diseases together amount accounts for less than 5%.
Work-related Deaths caused by Illness and Injury, High Income countries
See “Global estimates”: https://goo.gl/hTZaW5
Belgium cancer deaths:
2098 ILO 2017

Work-
related
(w)
w
w
w
w
w
w
W-r
w
w
w
w
w
w
w
w
w
w
w
Disability Adjusted Life Years, DALYs in Global Burden of Disease

Examples of attributable fractions

In 2017 WHO, ILO and ICOH reached out to experts for systematic
reviews of evidence to support estimation of burden for each pair
Pair Risk factor Health outcome
1 Occupational ergonomic factors Musculoskeletal disorders
(except low back pain)
2 Occupational exposure to dusts and fibres Pneumoconiosis
3 Occupational exposure to ultraviolet radiation Cataracts
Melanoma and non-melanoma
skin cancer
4
5 Occupational noise Deaths from cardiovascular
disease
6 Occupational violence Inter-personal violence
(intentional injuries)
7 Psychosocial risk factors (i.e., one of: job strain, job
control, effort-reward imbalance, job insecurity, long
working hours or shift work)
Ischemic Heart Disease
Stroke
8 Depression
9 Alcohol use (intermediary
Outcome)
10
Slide source: Marilyn Fingerhut, ICOH

225,939
37,198
50,038 29,036 56,277
110,662
233,085
103,863
60,151
48,580
50,597
129,992
246,885
223,105
51,363
21,419
18,834 27,123
13,714
215,118
128,018
10,757
65,145
19,388 21,113
14,159
124,404
125,535
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
High Afro Amro Emro Euro Searo Wpro
Occupational injuries
Genitourinary diseases
Digestive diseases
Respiratory diseases
Circulatory diseases
Neuropsychiatric conditions
Malignant neoplasms
Communicable disease
Occupational Deaths: World, 2015
in WHO Regions
AMRO
AFRO
HIGH EURO
EMRO
SEARO
WPRO

Death rate (per
100,000)
Non-
smoker
Smoker
No asbestos 11 123
Asbestos 58 602
Age-standardized lung cancer death rates
Hammond EC, Selikoff IJ, Seidman H. Asbestos exposure, cigarette smoking and death rates.
Ann N Y Acad Sci 1979;330:473-90.
Example of poor emphasis on work exposures
Combined effect of exposures to asbestos and smoking on lung cancer
Applicable to selected other carcinogens
Attributable Fraction, AF is
based on risk ratio, RR
AF = (RR-1)/ RR
GBD/IHME
AF Principle

Latest 2017 data, EU-OSHA,
ICOH and WSH-Institute
Latin America (L.A.) numbers compared
https://osha.europa.eu/en/about-eu-osha/press-room/eu-osha-presents-new-figures-costs-poor-workplace-safety-and-health-world
EU-28 proportion (%) of the main causes for work-related mortality and morbidity
in DALYs per 100,000 employees
L.A. 32.8 %
L.A. 10.5%
L.A. 31.7%
L.A. 13.4 %
L.A. 21.1%
L.A. 12.5%
L.A. 11.8%
L.A. 12.0%
L.A. 22.8%
Morbidity, DALYs
Mortality, deaths

Ireland patterns follow the EU fairly
closely
Consequences of psychosocial factors
at work have not been properly
estimated
See:
https://visualization.osha.europa.eu/osh-costs#!/eu-analysis-illness

2098
And new data released in 2017
106,307
Source new
https://goo.gl/hTZaW5
Source:
goo.gl/fuUXsl
Switzerland 1905

https://goo.gl/
Global figures
Comparative analysis
based on past 2014 country data
Latest 2017 data, EU and High-Income Countr.
https://osha.europa.eu/en/about-eu-osha/press-room/eu-osha-presents-new-figures-costs-poor-workplace-safety-and-health-world
http://www.omfi.hu/cejoem/accident.htm
https://goo.gl/hTZaW5
http://www.efbww.org/pdfs/CEJOEM%20Comparative%20analysis.pdf

Cost Comparison with selected countries
As a proportion of GDP, cost of work-related injuries and ill-health
Korea, 3.58%
Australia, 3.00%
Singapore, 3.46% (3.46-4.06%. Singapore’s est. 3.8% )
Global, 3.94%
New Zealand, 3.19%
United States, 3.25%
United Kingdom, 2.90%
Finland, 3.34%
Germany, 3.33%
Netherlands, 3.12%
Japan, 2.65%
9
WHO Western Pacific 3.98%
WHO South East Asia 4.40%
EU 28 3.26%
Source: ILO/ICOH/EU
Cost Estimates of
Occupational Accidents
and Work-related
Diseases, 2015
ASEAN 4.12%
L.America, 3.71%
(3.47-4.33%) Ireland, 3.47%
Bulgaria, 3.65%
WHO Africa, 4.00%

Deaths at Work/All
Estimated Global Mesothelioma Deaths (annual, based on WHO data
* Reported N* in 59 countries, estimated M* in 172 countries, Odgerel,Takahashi et al17
Asbestos related lung cancer and other asbestos related deaths (Takala et al, modified from CEJOEM)
Methods of estimated lung cancer deaths using
mesothelioma as a proxy for asbestos use
Lung cancer/
mesotheliom
a rate
Asbestos related lung, other cancer (and other asbestosis) deaths
World China
McCormack, Peto et al. (2013) average estimate using
chrysotile, lung cancer, all , GBD 2015 Study
6.1 197,475
McCormack, Peto et al. (2013), low - high estimates, lung
cancer, all, GBD
2.0-10 64,746 – 323,730
GBD2016 based rate between (global asbestos-related
lung cancer, ovary and larynx cancers, asbestosis),and
mesothelioma death numbers at work, GBD2016,
6.92 222,322work – 247,363work
based on GBD/IHME 2016work
Area Meso/ARLC/Ova/Lary,Asbestosis
China 2,178/17,971/270/198/323
Earth 27,612/181,450/6022/3743/3495
Global asbestos deaths, work: 222,321 - 242,802 Mid-point 232,562
All asbestos exposed, global: 243,223 - 260,029 Mid-point 251,626
www.mdpi.com/1660-4601/15/5/1000

Asbestos deaths at work, GBD2016
detailed table located at the end of this presentation
Lung Mesothelioma Ovary Larynx Asbestosis TOTAL
cancer +Chronic
USA 34,270 3,161 787 443 613 39,275
EU28 85,914
China 17,971 2,178 270 198 323 20,940
UK 14,056 2,837 760 174 209 18,036
Belgium 2,391 278 65 34 25 2,794
Finland 602 103 29 6 20 760
Earth 181,450 27,620 6,062 3,743 3,495 222,321
Sources: GBD 2016 https://vizhub.healthdata.org/gbd-compare/ The Lancet 2017; 390: 1345–422
Global asbestos disaster Int. J. Environ. Res. Public Health 2018, 15(5), 1000; https://doi.org/10.3390/ijerph15051000
And Supplementary tables ZIP document from the website http://www.mdpi.com/1660-4601/15/5/1000

This article is incomplete. Please help to improve it, or
discuss the issue on the talk page. (May 2010)
The International Programme on Chemical Safety (IPCS) was formed in 1980
and is a collaboration between three United Nations bodies, the
World Health Organization, the International Labour Organization and the
United Nations Environment Programme, to establish a scientific basis
for safe use of chemicals and to strengthen national capabilities and capacities
for chemical safety.[1]
A related joint project with the same aim, IPCS INCHEM, is a collaboration between
IPCS and the Canadian Centre for Occupational Health and Safety (CCOHS).[2]
The IPCS identifies following as "chemicals of major public health concern“
•Air pollution
•Arsenic
•Asbestos
•Benzene
•Cadmium
•Dioxin and dioxin-like substances
•Inadequate or excess Fluoride
•Lead
•Mercury
•Highly hazardous pesticides [3]
See also:
•Acceptable daily intake
•International Chemical Safety Card
IPCS of ILO/WHO/UNEP

‘Human health is a precondition for, and an outcome, and
indicator of all three dimensions of sustainable development’

34
Significance of health at work in sustainability
Health and work ability of the working population is a key asset
to sustainability.
The ultimate outcome of the input of the global workforce is a
total global gross domestic product (GDP) of USD 75 trillion per
year (some 22,000 USD per worker). This GDP provides the
economic and material resources, which sustain all other
societal activities, including health and social services, training
and education, research and cultural services. In addition to
these material and tangible values, human labour is also behind
the most intangible assets of society such as sustainability of the
social fabric, level of education, general knowledge and social
cohesion.

36
SDG 3: Ensure healthy lives and promote well-being for
all at all ages
Targets Indicators1 Public health interventions
3.4 by 2030 reduce by one-third pre-
mature mortality from non-
communicable diseases (NCDs)
through prevention and treatment, and
promote mental health and wellbeing
3.4.1 Mortality of
cardiovascular
disease, cancer,
diabetes, or chronic
respiratory disease
Managing OH Risks
•Substitute occupational carcinogens
•Dust control
•Improve work organization
•Prevent and manage stress
•Workplace health promotion
•Smoke free workplaces
3.8 achieve universal health
coverage (UHC), including financial
risk protection, access to quality
essential health care services, and
access to safe, effective, quality, and
affordable essential medicines and
vaccines for all.
t.b.d.
• Build capacities of primary care to
deliver essential interventions for
workers' health
• Scale up coverage with basic and
specialized occupational health
services
• Provide health coverage to all
workers, including in the informal
sector
3.9 by 2030 substantially reduce the
number of deaths and illnesses from
hazardous chemicals and air, water,
and soil pollution and contamination
3.9.2 Mortality rate
attributed to
hazardous,
chemicals, water and
soil pollution and
• Safe management of chemicals at
the workplace
• Pesticide safety

SDG 8. Promote sustained, inclusive and sustainable
economic growth, full and productive employment and decent
work for all
Targets Indicators1 Public health interventions
8.7 take immediate and effective
measures to secure the prohibition and
elimination of the worst forms of child
labour, eradicate forced labour, and by
2025 end child labour in all its forms
including recruitment and use of child
soldiers
8.7.1 Percentage
and number of
children aged 5-17
engaged in child
labour, by sex and
age group
• Detection and prevention of
hazardous child labour
• Prohibition of hazardous child labour
8.8 protect labour rights and promote
safe and secure working environments
of all workers, including migrant workers,
particularly women migrants, and those in
precarious employment
8.8.1 Frequency
rates of fatal and
non-fatal
occupational
injuries and
diseases, by sex
and migrant status
• Regulations and enforcement for
occupational safety and health
Hazard mitigation and
substitution
• Engineering and administrative
controls
• Health education of workers
• Personal protection
• Health surveillance

38
Sustainable Development Objectives – Progress 1990-2030

GBD DALYs/100,000 rate – Improvement in occupational risks
1990 - 2016 World, Belgium circled
Source: https://vizhub.healthdata.org/sdg/

“1. Everyone has the right to just and favourable conditions of work. Every worker has a right to
dignity, to be treated ethically, with respect and without being subjected to conditions of work that are
dehumanizing or degrading. States have undertaken an ambitious goal under the Sustainable
Development Goals: to ensure decent work for all by 2030.
2. Despite clear obligations relating to the protection of workers’ health, workers around the world find
themselves in the midst of a public health crisis due to their exposures to hazardous substances at work.
While the World Health Organization (WHO), the International Labour Organization (ILO) and others
have called for action on this public health crisis for decades, the global problem of workers’ exposure
to hazardous substances remains poorly addressed.
3. It is estimated that one worker dies every 15 seconds from toxic exposures at work, while over
2,780,000 workers globally die from unsafe or unhealthy conditions of work each year. Occupational
diseases account for 2.4 million (over 86 per cent) of total premature deaths. An “occupational disease”
is any disease contracted primarily as a result of an exposure to risk factors arising from work activity,
including chronic exposure to toxic industrial chemicals, pesticides or other agricultural chemicals,
radiation and dust, among other hazards. Approximately 160 million cases of occupational disease are
reported annually. Inaction by States and businesses on this global public health crisis is estimated to
cost nearly 4 per cent of global gross domestic product, or virtually $3 trillion.” …
“The exposure of workers to toxic substances can and should be considered a form of exploitation and
is a global challenge…”
Report of the Special Rapporteur on the implications for human rights of the
environmentally sound management and disposal of hazardous substances and wastes
(United Nations Human Rights Council, Sep 2018)

Summary
Rank Country Total Occupational exposure to asbestos Mesothelioma
(observed)
%
Occupat
ARLC/
Meso
Asbestosis
(observed)Total Mesothelioma Lung cancer Ovarian cancer Larynx cancer Asbestosis
B+C+D+F+G A+B+C+D+E A B C D E F A/F B/A G
1 United States 39,395 39,275 3,161 34,270 787 443 613 3,282 96.3% 10,84 613
2 China 21,510 20,940 2,178 17,971 270 198 323 2,747 79.3% 8,25 323
3 United Kingdom 18,063 18,036 2,837 14,056 760 174 209 2,864 99.1% 4,96 209
4 Japan 16,648 16,591 1,449 14,529 189 105 320 1,506 96.2% 10,03 320
5 Italy 15,422 15,394 1,699 12,810 488 297 101 1,727 98.4% 7,54 101
6 Germany 15,278 15,242 1,729 12,613 509 193 199 1,765 98.0% 7,29 199
7 France 12,508 12,481 1,546 10,083 379 215 257 1,573 98.3% 6,52 257
8 India 7,565 7,136 1,976 4,018 144 517 482 2,405 82.2% 2,03 482
9 Canada 5,911 5,896 648 5,031 89 67 61 663 97.8% 7,76 61
10 Spain 4,952 4,932 494 4,137 108 121 71 515 96.0% 8,37 71
11 Russia 4,843 4,776 624 3,716 294 113 29 691 90.2% 5,96 29
12 Netherlands 4,671 4,664 639 3,845 122 45 13 647 98.9% 6,02 13
13 Turkey 4,282 4,250 507 3,573 65 83 22 539 94.1% 7,04 22
14 Australia 4,058 4,048 766 3,017 140 48 77 776 98.7% 3,94 77
15 Brazil 3,528 3,441 691 2,417 129 139 64 778 88.8% 3,5 64
16 Poland 2,930 2,913 234 2,510 95 61 12 251 93.2% 10,74 12
17 Belgium 2,799 2,794 278 2,391 65 34 25 283 98.3% 8,6 25
18 Vietnam 2,038 2,000 127 1,834 11 23 5 165 77.3% 14,4 5
19 South Africa 1,839 1,823 280 1,338 35 54 117 296 94.6% 4,78 117
20 South Korea 1,780 1,760 117 1,586 18 15 24 138 85.0% 13,5 24
21 Iran 1,666 1,630 363 1,162 10 84 11 399 91.0% 3,2 11
22 Argentina 1,597 1,580 202 1,255 58 39 26 219 92.3% 6,22 26
23 Bangladesh 1,572 1,525 137 1,319 5 37 27 183 74.7% 9,64 27
24 Thailand 1,556 1,522 222 1,255 10 31 4 255 86.8% 5,66 4
25 Ukraine 1,364 1,344 309 825 178 25 7 329 93.9% 2,67 7
26 Switzerland 1,276 1,273 203 1,015 36 16 3 206 98.3% 5,01 3
27 Denmark 1,265 1,263 131 1,061 47 13 10 134 98.2% 8,07 10
28 Mexico 1,167 1,123 323 690 53 33 24 366 88.1% 2,14 24
29 Sweden 1,161 1,157 173 898 63 10 13 177 97.7% 5,2 13
30 Myanmar 1,131 1,108 166 798 117 25 3 188 87.9% 4,81 3
31 Greece 1,098 1,093 79 967 27 19 2 83 94.5% 12,25 2
32 Indonesia 1,088 984 337 556 47 29 15 440 76.5% 1,65 15
33 Austria 946 942 118 769 41 12 3 121 96.9% 6,54 3
34 Pakistan 873 819 158 537 32 60 31 212 74.6% 3,4 31
35 Taiwan 766 756 52 677 5 8 14 62 83.8% 13 14
36 Finland 763 760 103 602 29 6 20 106 97.9% 5,83 20
37 Croatia 747 745 67 637 16 19 6 69 97.3% 9,55 6
38 Norway 645 643 80 527 23 5 8 82 97.7% 6,6 8
39 Philippines 643 605 105 471 13 9 7 142 73.5% 4,5 7
40 New Zealand 610 609 97 478 16 7 10 99 98.3% 4,91 10
41 Portugal 560 556 63 460 13 14 6 67 93.4% 7,32 6
42 Romania 545 536 62 436 22 14 2 71 87.4% 7,03 2
43 Hungary 510 506 35 444 16 9 1 40 88.9% 12,51 1
44 Czech Republic 494 489 47 414 21 6 2 51 91.1% 8,84 2
45 Ireland 454 453 44 389 10 6 4 46 96.5% 8,82 4
46 North Korea 414 404 34 354 5 3 8 45 77.2% 10,29 8
47 Colombia 397 380 83 265 13 12 7 100 83.1% 3,18 7
48 Serbia 391 388 32 338 8 9 1 36 88.9% 10,71 1
49 Israel 381 378 45 310 16 5 2 48 94.2% 6,89 2
50 Chile 363 355 58 279 9 6 3 66 89.1% 4,77 3
51…
…195
Global 224,918 222,321 27,612 181,450 6,022 3,743 3,495 30,208 91.4% 6,57 3,495

45
Dissemination: what format book/e-format

Sustainable Development Goals – Occupational risks 2016
Singapore

Sustainable Development Goals – Occupational risks 2016
Finland

Eurotox sep 2018 takala brussels new v2

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