Transcript of "NIOSH CY 2011 award to WHO The hague-summary-040512-a4web"
Connecting Health and Labour Bringing together occupational health and primary care to improve the health of working people Executive Summary Global Conference «Connecting Health and Labour: What Role for Occupational Health in Primary Health Care»,The Hague, the Netherlands, 29 November – 1 December 2011
E X E C U T I V E S U M M A R Y Key messages: l Workers’ health is an integral part of general health and daily life l Health systems should facilitate local strategies to meet workers’ health needs l In moving towards universal coverage, those at greatest risk or having greatest needs should be included first. l When developing policies about workers’ health all relevant stakeholders should be involved. l Training in health and work should be part of all health care professional training l Empowerment of workers and the encouragement of decision-makers are critical for the promotion of the health and safety of workers CONNECTING HEALTH AND LABOUR 1
E X E C U T I V E S U M M A R Y Introduction1. Currently, a number of countries are reforming full coverage of all workers with prevention oftheir health systems based on the values and occupational and work-related diseases andprinciples of primary health care to improve injuries (Resolution WHA 60.26 from 2007) andservice delivery and cost-efficiency and to ensure for implementing vertical health programmes in theequity. National debates on health reforms often context of integrated primary health care (Resolutiontouch upon the insufficient collaboration between WHA 62.12 from 2009).health and labour sectors, the organization ofpreventive and curative health services for working 3. The Hague Conference was part of a globalpopulations, and their relation to primary care. process to improve coverage of and access to occupational health services as requested by2. The Alma Ata Declaration from 1978 called the 60th World Health Assembly in 2007 andfor bringing health care as close as possible to contributes to the debate that many Member Stateswhere people live and work. Recently, the World and WHO are now engaged in.Health Assembly urged countries to work towards Health and labour4. Employment and working conditions have 6. There are many effective interventions forpowerful effects on health equity. When these are primary prevention of occupational hazards, forgood, they can provide social protection, social developing healthy work places and for maintainingstatus, personal development, social relations and restoring functional capability. In spite of this,and self-esteem, protection from physical and coverage of occupational health services remainspsychosocial hazards, and positive health effects. low, and where they do exist they often fail toThe health of workers is an essential prerequisite meet the expectations of workers and to providefor household income, productivity and economic access to the most basic preventive interventionsdevelopment. Therefore, maintaining and restoring and measures for protection against occupationalworking capacity is an important function of health diseases.services. 7. At the same time, the lack of work focus in5. However, hazardous working conditions the provision of health care may have a negativeand substandard forms of employment result in impact on people’s ability to work.considerable burden of ill-health and injuriesrepresenting substantial costs for health systems andfor national economies and perpetuating poverty. Occupational health and primary care8. Occupational health and primary care share b. the interest in communities – be it work-com-common values that are important for the health munities or living communities – to secure equi-of people and populations, but health services ty and the involvement of those with greatestthat adequately addresses work is not universally needs;available for people. In particular relevant are: c. focus on improving individuals functioning (ina. the holistic approach, looking at individuals in work and other aspects of life) and not only on the context of their life; disease outcomes. CONNECTING HEALTH AND LABOUR 3
E X E C U T I V E S U M M A R Y 9. Currently, health services based on these life. This requires moving from a care oriented values are not as widely available as is desirable. on diseases and health problems to care that Closer collaboration between occupational health emphasizes optimizing functional capability of and primary care would enhance the opportunities individuals. to contribute to productivity and to extend working Towards an integrated approach for addressing work by health services 10. A more integrated approach to occupational 11. The following principles should guide further health and primary health care will yield a bigger development in pursuing an integrated approach impact on the health of people, than each can to occupational health and primary care: achieve on their own, to secure work-focused a. Workers health is part of general health and life. health care. How that integration works in practice, depends on national and local circumstances. b. Health systems should facilitate local strategies Substantial global demographic trends (ageing, to meet workers’ health needs. migration etc.), changing health problems and the c. In moving towards universal coverage, those at changing nature of work mean that this integrated greatest risk or having greatest needs should be approach will become even more important in the targeted first. decades to come. This will require more care to be provided, without the certainty of any increase d. When developing policies about workers’ health the professional manpower. Important assets in all relevant stakeholders should be involved. initiating this collaboration are the experiments that e. Training in health and work should be part of all can be found in a number of countries and settings health care professional training around the world. f. Empowerment of workers and the encouragement of decision-makers are critical for the promotion of the health and safety of workers. Delivering occupational health in the context of integrated primary health care 12. The following strategic directions for delivering workers to curative and preventive health care occupational health in the context of integrated that allows for full and productive working life; primary health care were developed by the b. Including essential interventions for occupational conference participants in parallel round tables health and work ability in the delivery of devoted to universal coverage, people-centered comprehensive, integrated primary care, such care, participatory leadership and health in all as advice for improving working conditions and policies: for promoting health at work; early detection of occupational and work-related diseases and 13. workers should have access to essential All support for return to work and preservation of interventions and basic health services for prevention working capacity of occupational and work-related diseases and injuries. This requires: c. Including the financing of basic occupational health care for those most in need or at greatest a. Emphasizing the role of national and local risk, within existing arrangements for financing governments for guaranteeing the access of all4 CONNECTING HEALTH AND LABOUR
E X E C U T I V E S U M M A R Y of basic primary health care. New mechanisms d. Providing clinical guidelines and standards for may need to be developed where existing health care professionals that take into account ones are inadequate to meet priority needs. the impacts of work and employment and These should, as far as possible, be integrated working capacity; into existing national or local health financing e. Empowering and supporting individuals and systems. work communities to take over the control ofd. Developing human resource and technological their own health, to protect themselves against capacities at the primary care level for the occupational hazards and to promote health effective delivery of essential interventions at the workplace, for example by training and and basic health services for prevention of developing programmes for healthy workplaces, occupational and work-related injuries and introducing tools for self-assessment and for diseases through training, consultation, work improvement, supporting workers health information, and supportive tools, including and safety representatives and community health telecare. activists;e. Strengthening and expanding specialized f. Carrying out research on the effect of the tools occupational health services, including the for empowering workers and work communities basic occupational health services and scaling to take control over their health, including the up access to such services and increasing the effectiveness of work improvement techniques number of interventions with priority on primary and community based participatory research. prevention of occupational hazards; 15. Protecting and promoting health at workf. Evaluating the models for service delivery and requires a new, participatory health leadership. This financing for occupational health and primary should include: care, and carrying out research on barriers to access to and coverage with preventive a. An integrated response by all building blocks of interventions. health systems1 to the health needs of workers in the ongoing health care reforms with priority14. People in their environment, including work, being given to the needs in the informal sector,should be in the center of health care. This requires: migrant and self-employed workers and small enterprises;a. Strengthening the role and responsibilities of the primary care providers for all health- b. Involving labour stakeholders, such as employers, related aspects of personal life, including early trade unions, governments, civil society, and the recognition of occupational and work-related private sector in the debates about health care ill-health, as well as preserving and restoring reforms and the development of national and working capacity of individuals; regional (preclinical, district) health strategies and plans;b. Building the capacities of primary care centers to respond effectively to the general and specific c. Developing and maintaining national profiles health needs and expectations of working for workers health, including measuring health populations in the catchment area, including outcomes and the performance of health training in basic occupational health and systems regarding the health of workers, basic supportive tools for interventions ; information on working conditions, workers lifestyle, education, as well as interventions andc. Linking occupational health services and services. primary care centers under local primary health care networks, including joint training, referral d. Strengthening the collaboration between systems, information on occupational hazards health and labour sectors for the ratification and other mechanisms for collaboration and and implementation of core international continuity of care; instruments for occupational safety and health,1 According to WHO health systems consist of the following building blocks: leadership and governance; essential medical products and technologies; health information; health financing; health workforce; and health services CONNECTING HEALTH AND LABOUR 5
E X E C U T I V E S U M M A R Y such as Occupational Safety and Health b. Development of national plans of action on Convention 155, Occupational Health Services workers health involving all stakeholders and Convention 161 and Promotional Framework sectors, creating common grounds as whole- for Occupational Safety and Health Convention of-government health initiatives, and identifying 187, establishing connections between labour the non-health benefits from action on workers Inspections and occupational health services and health; promotion of good practices on occupational c. Ensuring input from primary care to the health and safety and primary care. development and implementation of national public programmes for occupational health and 16. The health of workers should be taken into safety, identifying, measuring and highlighting account in designing and implementing policies in the benefits of such programmes for the delivery all sectors. This requires: of integrated, comprehensive primary care. a. Identification of workers health impacts and d. Addressing the health needs of workers and co-benefits of national policies and strategies hazardous working conditions in the policies in the area of labour, environment, education, dealing with the informal economy, rural agriculture, economic development, trade etc. development, and labour migration, including as well as capitalization of benefits and risks, and the provision of health services to such enabling healthy public policies as a common populations, ground for dialogue across sectors.; Next steps 17. WHO, and its networks of collaborating technicians and community health workers, for centres for occupational health and primary care facilitating the inclusion of occupational health will collaborate with ILO, the non-governmental into under graduate and post-graduate training organizations in official relations with WHO and and education in medicine, nursing and allied with the other international stakeholders, such as health; the World Bank and the International Social Security d. Collecting, evaluating and disseminating case Association, on the following actions: studies and examples of delivery of essential a. Developing policy options, methodologies and interventions and basic services for occupatio- case studies and integrated financing mecha- nal health in the context of integrated primary nisms, including costing of the delivery of essen- health care and setting up an agenda for inter- tial interventions for occupational health at the disciplinary research on the occupational health primary care level aspects of health systems and health services delivery b. Encouraging collaboration between the profes- sional associations of occupational health and e. Supporting governments to adopt policies based primary care, such as the International Commis- on the outcomes of research on occupational sion on Occupational Health (ICOH) and the hazards, to promote healthy environment at the World Federation of Family Physicians (Wonca) workplace and to minimize the sickness ab- sence, working incapacity and the related costs. c. Establishing a global repository of training ma- terials and information for building human re- source capacities for basic occupational health among primary care teams - doctors, nurses,6 CONNECTING HEALTH AND LABOUR
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