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The Global and African Occupational Health and
Safety: strategies, trends and role of professionals
Lagos 6 – 10 November 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
2
ss
Contents and overview of this presentation
About ICOH
1906
Milan
1906
Milan
1972
Buenos Aires
1975
Brighton
1963
Madrid
2003
Iguassu Falls
1928
Budapes
t
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
Melbourn
e
1898-1905 – Simplon-Tunnel Construction
Giuseppe Volante
www.ICOHweb.org
Cancer, AFwork=13.8%
CVD,
AFwork=14.4%
Injuries
Deaths in 2016 by age, Nigeria
AF= Attributable
Fraction, re work
GBD= Global Burden
of Disease and Injury
Violence
Communicable
diseases at work,
AFwork= 14.4%
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 and Injury
Violence
Injuries
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, Nigeria Europe
Musculoskeletal, AFwork= 37% AF= Attributable
Fraction, re work
Communicable diseases
AFwork=13.3%
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
• Estimated 2.32 million deaths
• Fatal occupational accidents
341,373
• Non-fatal occupational accidents
302 million (at least 4 days absence)
• Fatal work-related diseases
1.98 million
• Occupational cancer 666,000
Sources: ILO, WHO, Scientific reports
8.0%
27.0%
2.0%
31.0%
17.0%
1.0% 1.0%
14.0%
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 53%. 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%.
% of Work-related Deaths caused by Illness, World
See “Global estimates”: http://goo.gl/0xSHGl
Respiratory
Diseases
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
Work-related Deaths: World, 2015
in WHO Regions
AMRO
AFRO
HIGH EURO
EMRO
SEARO
WPRO
Work-related Deaths: World, 2015
in WHO Regions
Nigeria is located here
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
Singapore estimated all work-related deaths: 1,439
(S’pore 2014, WSH Institute)
ILO- ICOH Global Estimates 2017
ILO-ICOH 2017 Global Estimates: Data on occupational accidents in 2014, on work-related diseases in 2015 , ILO and WHOna
Occupational
injuries reported
to ILO
Global estimates of occupational accidents anf fatal work-related diseases
Fatal
Non-fatal (at least four days absence)
Region Labour force
Total
employment Fatal Non-fatal
Lower limit
(0.14)
Upper limit
(0.08) Average
Fatal work-
related
diseases Total mortality
High * 521 662 897 476 238 830 4 064 1 991 628 10 757 7 683 291 13 193 091 10 845 213 424 083 434 840
Afro 350 749 965 345 598 985 110 8 742 65 145 46 532 038 81 431 066 63 981 552 213 897 279 042
Amro 297 081 063 269 154 947 1 916 966 221 19 388 13 848 697 24 235 220 19 041 958 133 366 152 754
Emro 195 451 073 160 588 073 210 16 692 21 113 15 081 021 26 391 787 20 736 404 131 262 152 375
Euro 227 406 974 204 171 210 2 598 98 904 14 159 10 113 353 17 698 368 13 905 861 209 094 223 253
Searo 824 496 607 763 156 900 77 6 710 124 404 88 859 942 155 504 898 122 182 420 683 301 807 705
Wpro 953 638 990 909 608 518 222 44 638 125 535 89 667 644 156 918 377 123 293 011 608 962 734 497
Total 3 370 487 5703 128 517 463 9 197 3 133 535 380 500 271 785 986 475 372 807 373 986 418 2 403 965 2 784 465
Nigeria 56 222 810 53 089 000 0 0 10 023 7 159 431 12 529 004 9 844 217 32 858 42 881
AMRO
AFRO
HIGH EURO
EMRO
SEARO
WPRO
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%
Nigeria 4.38%
Sources: ILO, WHO, Scientific reports
https://goo.gl/
Global figures
Sources: ILO, WHO, Scientific reports
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
Nigeria: 14% 23% 23.4% 40.2%
Latest 2017 data, EU-OSHA,
WSH-Institute, ICOH
https://osha.europa.eu/en/about-eu-osha/press-room/eu-osha-presents-new-figures-costs-poor-workplace-safety-and-health-world
EU-28 and High Income country proportion (%) of the main causes for
work-related mortality and morbidity in DALYs per 100,000 employees
Nigeria: 14% 23% 23.4% 40.2%
Nigeria: 14%
Nigeria: 16.3%
Nigeria: 12.5%
Nigeria: 15.0%
Nigeria: 50.1%
Changes in the workplace 1
• Economic structure
– Tertiarisation: usually implies fewer accidents but
higher prevalence of psychosocial issues
• Employment structure
– Part-time, seasonal, temporary agency work,
subcontracting, self-employment, telework
• Legislation and best practice
– e.g., to encourage the integration of people with
disabilities at work
– requires more attention to workers’ health status
(incl. chronic diseases)
• Ageing population
– delayed retirement: more important to maintain health
and work ability
– Workers >55 suffer the most serious accidents, and
have the greatest incidence of illnesses such as
occupational cancers
• Increasing number of women at work
– Traditionally under-researched and overlooked:
emphasis on accidents and male-dominated sectors
and occupations
• Increasing number of migrant workers
– Concentrated in high-risk sectors
– Over-represented in hazardous jobs
Changes in the workplace 2
• True rate of work-related death, injury and ill health
underestimated by national official figures
• For example due to:
– Under reporting or non-reporting
– Exclusion of injuries resulting in no absence or 1-3 days
absence
– Lack of knowledge or recognition of work-relatedness
of some ill health, especially if latency period long or
multifactorial causes
– ….
The real OSH situation?
• Exposures and attributable fractions (AF) for work- related mortality
– Work-related cancer AF = 8.4% (13.8 male, 2.2% female) ……………………….
– Asbestos, Europe: first up to ca.-2020 then down; lung cancer and
mesothelioma AF = 15% (Australia), 12.2% (Finland) …………………………….
– External tobacco (passive) smoke, lung cancer and circulatory diseases,
many countries up, some others down, AF lung cancer = 2.0-4.0% …………
– Fatal accidents, stable or slight decrease ………………………………………………
– All accidents, down (target 25%), but baseline unclear for many countries
– Circulatory diseases, AF=12.4% (14.4% m, 6.7% f)……………………………………
– Absenteeism, depending on criteria, trend up, ca.5% ……………………………..
– Work disability pensions increase, in particular, caused by………………….
psychosocial factors and MSDs
OSH exposure trends – Established Market Economies
Work-related
cancer
Work-related
circulatory
diseases
Accidents Infectious and
parasitic diseases
Musculo-skeletal
disorders
Psychosocial
disorders
Asbestos
Shift and night
work, overwork
Lack of company
policy, man.system,
worker/employer
collaborative
mechanism, poor
safety culture
Poor quality
drinking water
Heavy lifting,
loads, shapes of
materials Lack of control
Carcinogenic
substances,
processes, silica
and other dusts
Strain by high
demands, low
decision making
latitude
Lack of knowledge,
solutions and good
practices
Poor sanitation and
sewage system
Repetitive
movements
Poor work-life
balance
Ionizing radiation,
radioactive
materials
High injury risk
Lack of guidance or
poor gvt policies,
poor legislation and
poor enforcement
and tripartite
collaboration
Poor hygiene, lack
of knowledge
Poor design of
seats, tables,
tools, processes
Poor
organisational
culture
UV-radiation Chemicals
Lack of incentive-
based compensation
system
Protection against
animals, insects,
snakes
Low temparatures,
vibration
Role ambiguity or
conflict, unclear or
changing priorities
ETS (passive
smoking at work)
ETS (passive
smoking at
work)
Lack of or poor OH
services
Diesel engine
exhaust
Poor recording and
nofification systems
Major Disease/Injury Groups and Modifiable Factors
Additional Slides
313.000
GBD/IHME 2016
2098
And new ILO data released in 2017
106,307
Source new,
ILO:
goo.gl/hTZaW5
Source:
goo.gl/fuUXsl
Switzerland 1905
GBD/IHME
in 2017
Source new,
GBD/IHME:
goo.gl/isCng3
99,083
Norway 759
17
1481
849
1896
183
2326
1285
303
1163
12,623
18,180
1678
1860
13
968
18
11,057
23
510
710
110
80
23
3879
7874
2457
4498
10
1211
446
10,248
2201
14,082 19,232
Nigeria 5.963
Source: John Cherrie, IOM, ICOH/Takala
CAREX Canada
Not covered by GBD/IHME
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
Austria 769 118 41 12 3 942
Finland 602 103 29 6 20 760
Nigeria 111
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
Survey averageWorld average max.
Coverage gap
• ICOH survey 80%
gap
• Global coverage
estimate 15.5%
• = 2.7 billion people
without services
ICOH 47 Country
survey results
• OHS policy in 70%
of countries
• >50% coverage
in 38% of countries
• Variation 3% - 100%,
average 20%
• Estimated world
goverage at the
maximum 15%
Ref. J.Rantanen
4.Workers
5. Availability 89%
6. Accessibility 88%
7. Acceptability 88%
10. Impact < 50 49% Impact > 50 % 71%
10 types of coverage of OHS (ex. Finland)
8. Content 75%
9. Work environment 48%
3. Companies
1. Policy
2. Legal
85%
100%
100%
~ 70%
Increased need for services in the global world of work
• Demographic changes, ageing, gender, youth, mobility,
migration
• Health promotion and work ability issues > Employability
• World economies benefit no more from old staregic
approaches: The total productivity concept (financial+
material+ environmental + social resources need to be
considered together. (G20 )
• Total sustainability concept( economic, knowledge,
environment, social)
• Competition on skilled workers
• Multifactorial nature of hazards and risks
• SMEs, Micro enterprises and self-employment, solution to
unemployment?
This presentation
WSH Council
& Institute
WSH Council
Campaigns
Enterprises
Workplaces
SC’s, TG’s
ICOH, Ass., Sustaining
and other Members
‘Human health is a precondition for, and an outcome, and
indicator of all three dimensions of sustainable development’
34
Dissemination: what format book/e-format
Sustainable Development Goals – Occupational risks 2016
Finland
Sustainable Development Goals – Occupational risks 2016
Nigeria
Dublin Statement on Occupational Health
The 32nd International Congress on Occupational Health in Dublin on Friday May 4th,
2018, adopted the Dublin Statement on Occupational Health, which expressed the
commitment of ICOH to take action for prevention of occupational cancer and ARDs
in collaboration with other relevant international actors. The statement was signed by
Dr. Martin Hogan, president of the ICOH Congress 2018 and Dr. Jukka Takala,
president of ICOH.
Download the Dublin Statement on Occupational Health
Conclusions and recommendations of the ICOH 2018 Congress
Preamble
UN SDGs particularly 1,3,8
ILO Declaration No 112 on human rights, and key conventions, C 136, 155, 161, 187, and ILO Resolution 1
June 2006 on asbestos
WHA Resolution on Cancer Prevention and Control 2005: “to pay special attention to cancers for
which avoidable exposure is a factor, particularly exposure to chemicals and tobacco smoke in the
workplace and the environment, certain infectious agents, and ionizing and solar radiation”;
WHO Tokyo Declaration on Universal Health Coverage, GPA for Workers’ health and WHO 2020
Conclusions of the 21st World Safety Congress Singapore, WSH2017 on Zero Vision and Global
Coalition
ILO/WHO Joint Committee Recommendation (2003): ”Elimination of Asbestos-Related Diseases”
(ARD’s) endorsed by ILO Governing Body and WHO Governing Council
1. Information and education
a) Elevation of awareness among decision-makers and stakeholders (International organizations, NGOs)
b) Promotion of banning asbestos among non-banning countries, and strict management of asbestos
present in existing infrastructure everywhere
c) Support the non-banning countries and particularly the Low Income Countries (LIC’s) with
education, technical advice, and feasible good practice guidelines in preparation and implementation of
the ban and elimination of ARDs
d) Providing information on economic and health appraisal of cancer prevention and elimination of
ARDs (WHO Euro)
2. Implementation
All countries to strengthen policies, means and practices feasible and effective for implementation:
a) Mapping existing asbestos in infrastructure, marking and labelling the in situ possible exposure
sources (surveys and data sources)
b) Distribution of information and providing technical advise and support for safe alternatives
c) Regulation and its implementation for asbestos demolition work and waste handling & disposal
d) Monitoring and registration of exposures by competent measurements (if not available, JEMs,
CAREX)
e) Enhancement of competence and capacity in diagnosis of ARDs
f) All countries to register effectively ARDs; Advice and Support by International Organizations
g) Surveys of exposed populations for ARDs
h) Good care of the diseased, including secondary and tertiary prevention, cancer treatment,
rehabilitation, immunizations
h) Justice and fairness in compensation of diagnosed occupational cancers and ARDs
j) Intersectoral collaboration: In addition to Labour, Health, Industry, social partners, several other
ministries should be involved (e.g. Social, Education, Defence, etc., i.e. WHO Health in All Policies)
3. International actions
a) International Organizations, WHO, ILO, International NGOs, ISSA and others to organize and
implement the Global Covenant for support of implementation of the SDGs of the UN 2030
Sustainable Development Agenda
b) Draw up a Covenant for global ban of asbestos, including Pan–European ban and
combined with the EU Parliament’s ‘Freeing the EU from asbestos by 2030’ initiative
c) Provide financial, technical and training, education and information support for countries
willing to join the global asbestos ban and implement National Programmes for Elimination of
Asbestos-related Diseases
d) International Organizations, ILO, WHO, UNEP, IMF and the IIB, to follow the example of the
World Bank and set Decent Work Programmes and Prevention of Occuptional Cancer,
including asbestos ban and elimination of ARDs, as conditions for public investments,
loans and development aid
4. ICOH contribution
a) ICOH to join with the UN and International Organizations and, within the limits of its resources,
provide commitment and expertise for all relevant activities for implementation of the UN
Sustainable Development Goals, particularly the SDGs No. 1, 3 and 8
b) ICOH to join and contribute to the organization and activities of the Global Occupational
Safety and Health Coalition
c) ICOH to provide its knowledge and expertise for collaboration with other international
and national actors for prevention of occupational cancer and elimination of ARDs
d) ICOH to draw up an ICOH Programme for Prevention of Occupational Cancer, including the
ICOH Programme element for Global ban of Asbestos and Elimination of Asbestos-
related Diseases, ARDs
e) In the drawing and implementation of the ICOH programmes, all the means, available for ICOH
should be employed; research, information and education and develoment and
dissemination of good practices
doi:10.3390/ijerph15051000
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
www.mdpi.com/1660-4601/15/5/1000/s1

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Lagos 6 10 Nov 2018 Soehpon Conf Global, African, Nigerian Occupational Health and Safety

  • 1. The Global and African Occupational Health and Safety: strategies, trends and role of professionals Lagos 6 – 10 November 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
  • 2. 2 ss Contents and overview of this presentation
  • 3. About ICOH 1906 Milan 1906 Milan 1972 Buenos Aires 1975 Brighton 1963 Madrid 2003 Iguassu Falls 1928 Budapes t 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 Melbourn e 1898-1905 – Simplon-Tunnel Construction Giuseppe Volante www.ICOHweb.org
  • 4. Cancer, AFwork=13.8% CVD, AFwork=14.4% Injuries Deaths in 2016 by age, Nigeria AF= Attributable Fraction, re work GBD= Global Burden of Disease and Injury Violence Communicable diseases at work, AFwork= 14.4%
  • 5. 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 and Injury Violence Injuries
  • 6. 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, Nigeria Europe Musculoskeletal, AFwork= 37% AF= Attributable Fraction, re work Communicable diseases AFwork=13.3%
  • 7. 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%
  • 8. 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 • Estimated 2.32 million deaths • Fatal occupational accidents 341,373 • Non-fatal occupational accidents 302 million (at least 4 days absence) • Fatal work-related diseases 1.98 million • Occupational cancer 666,000 Sources: ILO, WHO, Scientific reports
  • 9. 8.0% 27.0% 2.0% 31.0% 17.0% 1.0% 1.0% 14.0% 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 53%. 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%. % of Work-related Deaths caused by Illness, World See “Global estimates”: http://goo.gl/0xSHGl Respiratory Diseases
  • 10. 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 Work-related Deaths: World, 2015 in WHO Regions AMRO AFRO HIGH EURO EMRO SEARO WPRO Work-related Deaths: World, 2015 in WHO Regions Nigeria is located here
  • 11. 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 Singapore estimated all work-related deaths: 1,439 (S’pore 2014, WSH Institute)
  • 12. ILO- ICOH Global Estimates 2017 ILO-ICOH 2017 Global Estimates: Data on occupational accidents in 2014, on work-related diseases in 2015 , ILO and WHOna Occupational injuries reported to ILO Global estimates of occupational accidents anf fatal work-related diseases Fatal Non-fatal (at least four days absence) Region Labour force Total employment Fatal Non-fatal Lower limit (0.14) Upper limit (0.08) Average Fatal work- related diseases Total mortality High * 521 662 897 476 238 830 4 064 1 991 628 10 757 7 683 291 13 193 091 10 845 213 424 083 434 840 Afro 350 749 965 345 598 985 110 8 742 65 145 46 532 038 81 431 066 63 981 552 213 897 279 042 Amro 297 081 063 269 154 947 1 916 966 221 19 388 13 848 697 24 235 220 19 041 958 133 366 152 754 Emro 195 451 073 160 588 073 210 16 692 21 113 15 081 021 26 391 787 20 736 404 131 262 152 375 Euro 227 406 974 204 171 210 2 598 98 904 14 159 10 113 353 17 698 368 13 905 861 209 094 223 253 Searo 824 496 607 763 156 900 77 6 710 124 404 88 859 942 155 504 898 122 182 420 683 301 807 705 Wpro 953 638 990 909 608 518 222 44 638 125 535 89 667 644 156 918 377 123 293 011 608 962 734 497 Total 3 370 487 5703 128 517 463 9 197 3 133 535 380 500 271 785 986 475 372 807 373 986 418 2 403 965 2 784 465 Nigeria 56 222 810 53 089 000 0 0 10 023 7 159 431 12 529 004 9 844 217 32 858 42 881 AMRO AFRO HIGH EURO EMRO SEARO WPRO
  • 13. 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% Nigeria 4.38%
  • 14. Sources: ILO, WHO, Scientific reports https://goo.gl/ Global figures Sources: ILO, WHO, Scientific reports 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 Nigeria: 14% 23% 23.4% 40.2%
  • 15. Latest 2017 data, EU-OSHA, WSH-Institute, ICOH https://osha.europa.eu/en/about-eu-osha/press-room/eu-osha-presents-new-figures-costs-poor-workplace-safety-and-health-world EU-28 and High Income country proportion (%) of the main causes for work-related mortality and morbidity in DALYs per 100,000 employees Nigeria: 14% 23% 23.4% 40.2% Nigeria: 14% Nigeria: 16.3% Nigeria: 12.5% Nigeria: 15.0% Nigeria: 50.1%
  • 16. Changes in the workplace 1 • Economic structure – Tertiarisation: usually implies fewer accidents but higher prevalence of psychosocial issues • Employment structure – Part-time, seasonal, temporary agency work, subcontracting, self-employment, telework • Legislation and best practice – e.g., to encourage the integration of people with disabilities at work – requires more attention to workers’ health status (incl. chronic diseases)
  • 17. • Ageing population – delayed retirement: more important to maintain health and work ability – Workers >55 suffer the most serious accidents, and have the greatest incidence of illnesses such as occupational cancers • Increasing number of women at work – Traditionally under-researched and overlooked: emphasis on accidents and male-dominated sectors and occupations • Increasing number of migrant workers – Concentrated in high-risk sectors – Over-represented in hazardous jobs Changes in the workplace 2
  • 18. • True rate of work-related death, injury and ill health underestimated by national official figures • For example due to: – Under reporting or non-reporting – Exclusion of injuries resulting in no absence or 1-3 days absence – Lack of knowledge or recognition of work-relatedness of some ill health, especially if latency period long or multifactorial causes – …. The real OSH situation?
  • 19. • Exposures and attributable fractions (AF) for work- related mortality – Work-related cancer AF = 8.4% (13.8 male, 2.2% female) ………………………. – Asbestos, Europe: first up to ca.-2020 then down; lung cancer and mesothelioma AF = 15% (Australia), 12.2% (Finland) ……………………………. – External tobacco (passive) smoke, lung cancer and circulatory diseases, many countries up, some others down, AF lung cancer = 2.0-4.0% ………… – Fatal accidents, stable or slight decrease ……………………………………………… – All accidents, down (target 25%), but baseline unclear for many countries – Circulatory diseases, AF=12.4% (14.4% m, 6.7% f)…………………………………… – Absenteeism, depending on criteria, trend up, ca.5% …………………………….. – Work disability pensions increase, in particular, caused by…………………. psychosocial factors and MSDs OSH exposure trends – Established Market Economies
  • 20. Work-related cancer Work-related circulatory diseases Accidents Infectious and parasitic diseases Musculo-skeletal disorders Psychosocial disorders Asbestos Shift and night work, overwork Lack of company policy, man.system, worker/employer collaborative mechanism, poor safety culture Poor quality drinking water Heavy lifting, loads, shapes of materials Lack of control Carcinogenic substances, processes, silica and other dusts Strain by high demands, low decision making latitude Lack of knowledge, solutions and good practices Poor sanitation and sewage system Repetitive movements Poor work-life balance Ionizing radiation, radioactive materials High injury risk Lack of guidance or poor gvt policies, poor legislation and poor enforcement and tripartite collaboration Poor hygiene, lack of knowledge Poor design of seats, tables, tools, processes Poor organisational culture UV-radiation Chemicals Lack of incentive- based compensation system Protection against animals, insects, snakes Low temparatures, vibration Role ambiguity or conflict, unclear or changing priorities ETS (passive smoking at work) ETS (passive smoking at work) Lack of or poor OH services Diesel engine exhaust Poor recording and nofification systems Major Disease/Injury Groups and Modifiable Factors
  • 22.
  • 23. 2098 And new ILO data released in 2017 106,307 Source new, ILO: goo.gl/hTZaW5 Source: goo.gl/fuUXsl Switzerland 1905 GBD/IHME in 2017 Source new, GBD/IHME: goo.gl/isCng3 99,083 Norway 759 17 1481 849 1896 183 2326 1285 303 1163 12,623 18,180 1678 1860 13 968 18 11,057 23 510 710 110 80 23 3879 7874 2457 4498 10 1211 446 10,248 2201 14,082 19,232 Nigeria 5.963
  • 24. Source: John Cherrie, IOM, ICOH/Takala CAREX Canada Not covered by GBD/IHME
  • 25.
  • 26. 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 Austria 769 118 41 12 3 942 Finland 602 103 29 6 20 760 Nigeria 111 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
  • 27. Survey averageWorld average max. Coverage gap • ICOH survey 80% gap • Global coverage estimate 15.5% • = 2.7 billion people without services ICOH 47 Country survey results • OHS policy in 70% of countries • >50% coverage in 38% of countries • Variation 3% - 100%, average 20% • Estimated world goverage at the maximum 15% Ref. J.Rantanen
  • 28. 4.Workers 5. Availability 89% 6. Accessibility 88% 7. Acceptability 88% 10. Impact < 50 49% Impact > 50 % 71% 10 types of coverage of OHS (ex. Finland) 8. Content 75% 9. Work environment 48% 3. Companies 1. Policy 2. Legal 85% 100% 100% ~ 70%
  • 29. Increased need for services in the global world of work • Demographic changes, ageing, gender, youth, mobility, migration • Health promotion and work ability issues > Employability • World economies benefit no more from old staregic approaches: The total productivity concept (financial+ material+ environmental + social resources need to be considered together. (G20 ) • Total sustainability concept( economic, knowledge, environment, social) • Competition on skilled workers • Multifactorial nature of hazards and risks • SMEs, Micro enterprises and self-employment, solution to unemployment?
  • 30. This presentation WSH Council & Institute WSH Council Campaigns Enterprises Workplaces
  • 31.
  • 32. SC’s, TG’s ICOH, Ass., Sustaining and other Members
  • 33. ‘Human health is a precondition for, and an outcome, and indicator of all three dimensions of sustainable development’
  • 35. Sustainable Development Goals – Occupational risks 2016 Finland
  • 36. Sustainable Development Goals – Occupational risks 2016 Nigeria
  • 37.
  • 38. Dublin Statement on Occupational Health The 32nd International Congress on Occupational Health in Dublin on Friday May 4th, 2018, adopted the Dublin Statement on Occupational Health, which expressed the commitment of ICOH to take action for prevention of occupational cancer and ARDs in collaboration with other relevant international actors. The statement was signed by Dr. Martin Hogan, president of the ICOH Congress 2018 and Dr. Jukka Takala, president of ICOH. Download the Dublin Statement on Occupational Health
  • 39. Conclusions and recommendations of the ICOH 2018 Congress Preamble UN SDGs particularly 1,3,8 ILO Declaration No 112 on human rights, and key conventions, C 136, 155, 161, 187, and ILO Resolution 1 June 2006 on asbestos WHA Resolution on Cancer Prevention and Control 2005: “to pay special attention to cancers for which avoidable exposure is a factor, particularly exposure to chemicals and tobacco smoke in the workplace and the environment, certain infectious agents, and ionizing and solar radiation”; WHO Tokyo Declaration on Universal Health Coverage, GPA for Workers’ health and WHO 2020 Conclusions of the 21st World Safety Congress Singapore, WSH2017 on Zero Vision and Global Coalition ILO/WHO Joint Committee Recommendation (2003): ”Elimination of Asbestos-Related Diseases” (ARD’s) endorsed by ILO Governing Body and WHO Governing Council 1. Information and education a) Elevation of awareness among decision-makers and stakeholders (International organizations, NGOs) b) Promotion of banning asbestos among non-banning countries, and strict management of asbestos present in existing infrastructure everywhere c) Support the non-banning countries and particularly the Low Income Countries (LIC’s) with education, technical advice, and feasible good practice guidelines in preparation and implementation of the ban and elimination of ARDs d) Providing information on economic and health appraisal of cancer prevention and elimination of ARDs (WHO Euro)
  • 40. 2. Implementation All countries to strengthen policies, means and practices feasible and effective for implementation: a) Mapping existing asbestos in infrastructure, marking and labelling the in situ possible exposure sources (surveys and data sources) b) Distribution of information and providing technical advise and support for safe alternatives c) Regulation and its implementation for asbestos demolition work and waste handling & disposal d) Monitoring and registration of exposures by competent measurements (if not available, JEMs, CAREX) e) Enhancement of competence and capacity in diagnosis of ARDs f) All countries to register effectively ARDs; Advice and Support by International Organizations g) Surveys of exposed populations for ARDs h) Good care of the diseased, including secondary and tertiary prevention, cancer treatment, rehabilitation, immunizations h) Justice and fairness in compensation of diagnosed occupational cancers and ARDs j) Intersectoral collaboration: In addition to Labour, Health, Industry, social partners, several other ministries should be involved (e.g. Social, Education, Defence, etc., i.e. WHO Health in All Policies)
  • 41. 3. International actions a) International Organizations, WHO, ILO, International NGOs, ISSA and others to organize and implement the Global Covenant for support of implementation of the SDGs of the UN 2030 Sustainable Development Agenda b) Draw up a Covenant for global ban of asbestos, including Pan–European ban and combined with the EU Parliament’s ‘Freeing the EU from asbestos by 2030’ initiative c) Provide financial, technical and training, education and information support for countries willing to join the global asbestos ban and implement National Programmes for Elimination of Asbestos-related Diseases d) International Organizations, ILO, WHO, UNEP, IMF and the IIB, to follow the example of the World Bank and set Decent Work Programmes and Prevention of Occuptional Cancer, including asbestos ban and elimination of ARDs, as conditions for public investments, loans and development aid
  • 42. 4. ICOH contribution a) ICOH to join with the UN and International Organizations and, within the limits of its resources, provide commitment and expertise for all relevant activities for implementation of the UN Sustainable Development Goals, particularly the SDGs No. 1, 3 and 8 b) ICOH to join and contribute to the organization and activities of the Global Occupational Safety and Health Coalition c) ICOH to provide its knowledge and expertise for collaboration with other international and national actors for prevention of occupational cancer and elimination of ARDs d) ICOH to draw up an ICOH Programme for Prevention of Occupational Cancer, including the ICOH Programme element for Global ban of Asbestos and Elimination of Asbestos- related Diseases, ARDs e) In the drawing and implementation of the ICOH programmes, all the means, available for ICOH should be employed; research, information and education and develoment and dissemination of good practices
  • 44. 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 www.mdpi.com/1660-4601/15/5/1000/s1