Address: Medical Section, Occupational Safety and Health Branch, International Labour Office, 4, route des Morillons, Geneva
Phone: 41 22 799 6710
Fax: 41 22 799 6878
Past position(s): Resident, Emergency Service Hospital des Anglais, Liège, Belgium; Medical Inspector of Labour, Liège, Belgium; Chief Medical Officer, Mines of Bou Azzer and Bou Skour, Morocco; ILO Regional Specialist in the Middle East, Beirut, Lebanon
Education: MD, 1964, University of Liège, Belgium; Dipl Hyg, 1965, University of Liège, Belgium
Areas of interest: Radiation protection; occupational health services; ethics in occupational health
The role of international organizations is essentially to offer an organized framework for international cooperation. Over the centuries people have exchanged information and experiences in many ways. Cooperation between countries, scientists and professional groups developed progressively over time, but by the beginning of the 20th century it had become obvious that some issues could be faced only collectively.
In general, a distinction is made between “intergovernmental” and “non-governmental” international organizations. Intergovernmental organizations (IGOs) include the United Nations and its specialized agencies. There are also many other intergovernmental organizations, such as the Organization for Economic Cooperation and Development (OECD), the Organization of African Unity (OAU), the Organization of American States (OAS), and regional or subregional entities, such as the European Union (formerly the European Communities), MERCOSUR (Southern Market—Mercado Comun del Sur), the Caribbean Community (CARICOM), the European Free Trade Association (EFTA) and the North American Free Trade Agreement (NAFTA) between Canada, the United States and Mexico.
Some international non-governmental organizations, such as the International Commission on Occupational Health (ICOH) and the International Social Security Association (ISSA), cover all aspects of occupational health and safety. Many international non-governmental organizations are interested in occupational health and safety within the frameworks of their broader activities, such as the employers’ and workers’ organizations and the international associations of various professional groups. Some non-governmental organizations, such as the International Organization for Standardization (ISO), deal with standardization, and many other non-governmental organizations deal with specific subject areas or with specific sectors of economic activities.
Many intergovernmental and non-governmental organizations have interests in occupational health and safety, which involves technical, medical, social and legal aspects as well as a variety of disciplines, professions and social groups. There is a comprehensive network of organizations whose knowledge and capabilities can be used to promote exchange of information and experience among countries.
Aims and Purposes of Intergovernmental Organizations
One of the important roles of international organizations is to translate agreed-upon values into rights and obligations. The Charter of the United Nations (United Nations 1994) provides a good example of what the role of an international organization in the UN system should be—that is, “to achieve international cooperation in solving international problems of an economic, social, cultural, or humanitarian character, and in improving and encouraging respect for human rights and for fundamental freedom for all without distinction as to race, sex, language or religion.” The International Covenant on Economic, Social and Cultural Rights refers to the principles proclaimed in the Charter of the United Nations and recognizes the right of everyone to safe and healthy working conditions.
The aims and purposes of international organizations are set out in their Charters, Constitutions, Statutes or Basic Texts. For example, the Constitution of the World Health Organization (WHO) (1978) states that its aim is “the attainment by all people of the highest possible level of health”. Protection of the worker against sickness, disease and injury arising from employment is one of the tasks assigned to the International Labour Organization (ILO) in the words of the Preamble of its Constitution (see below and ILO 1992). The Declaration on the Aims and Purposes of the International Labour Organization, adopted by the International Labour Conference at its 26th Session in Philadelphia in 1944, recognizes the obligation of the ILO to further, among the nations of the world, the implementation of programmes that will achieve “adequate protection for the life and health of workers in all occupations”.
The international community recognizes that there are issues where countries are interdependent. One of the main roles of the intergovernmental organizations is to address such issues. The Preamble of the ILO Constitution adopted in 1919 recognizes that “the failure of any nation to adopt humane conditions of labour is an obstacle in the way of other nations which desire to improve the conditions in their own countries” and considers that “a universal and lasting peace can only be established if it is based on social justice”. The ILO Declaration of Philadelphia states that “poverty anywhere constitutes a danger to prosperity everywhere”. The WHO Constitution states that an “unequal development in different countries in the promotion of health and control of diseases, especially communicable diseases, is a common danger” and that “the achievement of any State in the promotion and protection of health is valuable to all”. The role of international organizations is to ensure a continuity and create a stability over time towards such long-term policy objectives, while short- and medium-term planning often prevails at the national level because of local social and economic conditions and political circumstances.
Each international organization has a mandate assigned by its constituents. It is within their mandates that international organizations address specific issues such as occupational health and safety. Common features of intergovernmental organizations are that they provide guidance, formulate recommendations and develop standards. International instruments created within the United Nations system that can be applicable at the national level may be divided into two categories. Nonbinding instruments usually take the form of recommendations or resolutions and can serve as a basis for national legislation. Binding instruments entail the obligation that national laws and practices will be brought into line with the decisions agreed upon at the international level. Most binding instruments take the form of international Conventions that require an additional international act of ratification, approval or accession whereby a State establishes its consent to be bound by the obligations of the Convention.
International organizations represent a forum where their constituents elaborate and establish their common policies and strategies in a great variety of fields, including occupational safety and health. This is where countries confront their values and their opinions; exchange information and experience; discuss and propose solutions; and determine the ways to work together towards objectives in order to achieve consensus, agreement, or international conventions that define a common understanding of what is right to do and what should not be done.
One of the advantages of an international organization is to provide for international debates a controlled environment that is governed by rules and procedures agreed upon by its constituents, allowing, at the same time, for a multitude of informal and diplomatic contacts much wider than those that can be made at the level of a single country. Various groups and countries having similar problems in common may compare their approaches and improve their strategies. From an international perspective, it is easier to achieve objectivity about difficult but specific problems linked to national institutional arrangements or to particular historical conditions. Social partners who can hardly meet at the national level sit at the same table. The dialogue is renewed, and hope for a consensus may come to light where it might have been impossible at the national level. Pressure groups can play a catalytic role in the process of consensus building without a need for aggressive strategies. Not only can exchanges of information and experience take place at international conferences, but various groups can measure the worldwide acceptability of their ideas, values and policies at these conferences.
In practice, intergovernmental organizations are involved in a wide variety of activities covering exchange of information, transfer of knowledge, harmonization of terminology and concepts, consensus building, codes of conduct and of good practice, and promotion and coordination of research. Most international organizations also have numerous programmes and activities aimed at assisting their member States to achieve objectives relevant to their mandate, including technical cooperation. International organizations have at their disposal a variety of means of action, such as reports and studies, meetings of experts, seminars, workshops, symposia, conferences, technical advisory services, information exchanges, and a clearinghouse role. In the course of time, basic mandates of international organizations have been enlarged and made more specific by resolutions and programmes that have been approved by their constituents on the occasion of their general assemblies, such as the International Labour Conference of the ILO or the World Health Assembly of the WHO.
The United Nations and Its Specialized Agencies
In the United Nations system, two specialized agencies are directly concerned with occupational health and safety taken as a whole: the International Labour Organization (ILO) and the World Health Organization (WHO). Among the specialized agencies of the United Nations, the International Labour Organization has a unique character since it is tripartite (i.e., its constituents are governments, employers and workers). Another characteristic of the ILO is its standard-setting activities (i.e., the International Labour Conference adopts international Conventions and Recommendations). Since the working environment is considered an integral part of the human environment (International Labour Organization/United Nations Environment Programme/World Health Organization 1978) the United Nations Environment Programme (UNEP) also deals with the matter, in particular as regards chemicals. Its International Register of Potentially Toxic Chemicals (IRPTC) cooperates closely with the ILO and the WHO within the framework of the International Program on Chemical Safety (IPCS).
Apart from their headquarters, international organizations have field structures and specialized institutions or bodies, such as the WHO’s International Agency for Research on Cancer (IARC), and the Pan-American Centre for Human Ecology and Health (ECO), which contributes to the implementation of the Regional Workers’ Health Program of the Pan-American Health Organization (PAHO). The ILO International Training Centre in Turin (Italy) carries out training activities in occupational health and safety and develops training materials for various professional groups, and the International Institute for Labour Studies (IILS) addresses from time to time occupational safety and health issues. The WHO and the ILO have regional offices, area offices and national correspondents. Regional ILO and WHO conferences are convened periodically. The PAHO was founded in 1902 and is also the WHO Regional Office for the Americas. In 1990, the Pan-American Sanitary Conference adopted a resolution on workers’ health (PAHO 1990) which established guidelines for PAHO’s programme and designated 1992 the “Year of Workers’ Health in the Americas”.
The ILO headquarters and field structures support the commitment and the activities of its member States in occupational health and safety within the framework of its International Programme for the Improvement of Working Conditions and Environment (PIACT) (ILO 1984). This programme includes a large variety of advisory services and technical cooperation activities all over the world. The ILO has recently adopted an active partnership policy (APP) that brings the organization closer to its tripartite constituents in member States by strengthening its field structures, most notably through the establishment of multidisciplinary teams (MDTs).
Several other UN specialized agencies have an important role concerning specific aspects of occupational health and safety, such as the International Atomic Energy Agency (IAEA), which is concerned with nuclear safety, the protection of workers from radiation, and the safety of radiation sources. The United Nations Industrial Development Organization (UNIDO) is concerned with occupational safety and health in specific sectors of industry, and is engaged together with the UNEP and the World Bank in preparing guidelines for industrial pollution prevention and control that cover occupational health and safety issues as well. The Food and Agriculture Organization of the United Nations (FAO) promotes safety in the use of pesticides (FAO 1985) and occupational health and safety in forestry, including cooperative arrangements with the ILO and the United Nations Economic Commission for Europe.
The Committee of Experts on Transport of Dangerous Goods of the Economic and Social Council of the United Nations prepared the Recommendations on the Transport of Dangerous Goods, which provide guidance in drafting national legislation and achieving some uniformity throughout the world for various modes of transport. The International Civil Aviation Organization (ICAO) has established international standards for the operation of aircraft and has published a manual of civil aviation medicine that covers aspects relating to occupational health for flying personnel. The International Maritime Organization (IMO) has adopted an International Convention on Safety of Life at Sea (SOLAS). The WHO, the ILO, and the IMO have prepared an International Medical Guide for ships that includes distinct parts containing a schedule for the contents of a ship’s medicine chest and a medical section of the International Code of Signals. A medical first aid guide for use in accidents involving dangerous substances was jointly prepared by the IMO, the WHO and the ILO.
Funding organizations such as the United Nations Development Programme (UNDP) have been financially supporting over the last 25 years a large number of occupational health and safety projects in many countries, including the establishment of national occupational safety and health institutes. The executing agencies for these projects have been the ILO, the WHO, and both organizations jointly. In its economic development projects, the World Bank takes into account environmental, health and human ecological considerations (World Bank 1974), including occupational health and safety. In 1987, the World Bank embarked on a major effort to incorporate environmental concerns into all aspects of its activities. This includes a stronger focus on the development of institutional capacity for environmental management at the country level, a greater recognition of the need to embed environmental concerns into sectoral work, and increased emphasis on the social aspects of environmentally sustainable development (World Bank 1993a). Furthermore, the Report Investing in Health, examines the interplay between human health, health policy and economic development (World Bank 1993b).
Other Intergovernmental Organizations
The activities of the Organization for Economic Cooperation and Development (OECD) are particularly important as regards environmental health issues, safety in the use of chemicals, methods for the evaluation of chemical risks, and protection from radiation. The Council of Europe has adopted a number of resolutions relating to occupational safety and health concerning, for example, safety services within enterprises. The European Social Charter, adopted by the Council of Europe in 1961, recognizes the right of workers to safe and healthy working conditions. The Nordic Council is concerned with occupational safety and health and environmental problems and makes recommendations regarding toxic and dangerous substances, nuclear safety, and protection from radiation, as well as programmes of action on the occupational environment. The Arab Labour Organization, chartered in 1965, is a specialized agency within the framework of the Arab League; it undertakes studies and conducts research in industrial safety and occupational health. The countries from MERCOSUR have a special commission for the harmonization of legislation in occupational health and safety.
The European Union adopts directives that are compulsory for its member States and should be translated into national laws. The European directives cover the whole field of occupational health and safety with the aim of harmonizing national legislation, taking into account the principle of subsidiarity. Three levels of directives can be identified (TUTB 1991): the framework directives, such as the Directive on the Introduction of Measures to Encourage Improvement in Safety and Health of Workers at Work (89/391); those that cover the risks to which workers are exposed (lead, asbestos, noise, ionizing radiation and so on); and those that establish the rules governing the design of work equipment. Technical standards are developed by European Commissions for Standardization (CEN, CENELEC). The Commission of the European Union (formerly the Commission of the European Communities) prepares the directives and has an important occupational safety and health programme (Commission of the European Communities 1990). The European Foundation for the Improvement of Living and Working Conditions, in Dublin, has activities in occupational safety and health, including a working group on occupational health strategies in Europe. The year 1992 was designated the “European Year of Safety, Hygiene and Health Protection at Work”, and a large number of occupational safety and health activities have been supported in countries of the European Union. A European Agency for Safety and Health at Work was established in Bilbao (Spain) as a specialized body of the European Union.
International Non-governmental Organizations
Scientific, professional and other groups also felt the need to develop international cooperation and join in international non-governmental organizations. They may be formed of individual specialists, national associations of specialists, or institutions. The International Commission on Occupational Health (ICOH) was founded in 1906 as the Permanent Commission on Occupational Diseases. It is discussed in a separate article in this chapter.
The International Social Security Association (ISSA) is an international organization of official agencies responsible for the administration of social security and has had a programme concerning the prevention of occupational risks since 1954 and is also discussed separately in this chapter.
While the ICOH and the ISSA are concerned with the whole field of occupational health and safety, there are a number of non-governmental organizations that deal with specific sectors of economic activity, such as agriculture, or with specific subject areas as varied as technology, toxicology, psychology, work organization, process safety, human engineering, epidemiology, social medicine, lifting appliances, cargo handling, pressured vessels, transport of containers and of dangerous materials, safety signals, road safety and nuclear safety. Numerous international non-governmental organizations are concerned with the environment and the protection of consumers, including the International Union for Conservation of Nature and Natural Resources—World Conservation Union (IUCN) and the International Organization of Consumers Unions (IOCU). They are interested in environmental health and, to some extent, in occupational health, particularly in chemical safety and pesticides.
In the field of the protection of workers, patients and the public from adverse effects of ionizing radiation, the work of the International Commission on Radiological Protection (ICRP) is authoritative worldwide and serves as a basis for international recommendations by intergovernmental organizations. The International Radiation Protection Association (IRPA) has established an International Commission on Non-Ionizing Radiation Protection (ICNIRP), which issues guidelines on exposure limits and contributes to the ILO and WHO publications on non-ionizing radiation. Many other international non-governmental organizations or associations could be mentioned since they deal with occupational health and safety or are interested in specific aspects of occupational health and safety, including the International Ergonomic Association (IEA), the Ergonomics Society of French-Speaking Countries (SELF), the International Council of Nurses (ICN), the Inter-American Safety Council (IASC), the International Association of Labour Inspection (IALA), the International Occupational Hygiene Association (IOHA), the International Association on Agricultural Medicine and Rural Health (IAAMRH), the International Association of Public and Rural Health, the Latino-American Association of Occupational Safety and Hygiene (ALASEHT), the International Federation of Associations of Specialists in Occupational Safety and Industrial Hygiene, the European Association of Schools of Occupational Medicine, the World Federation of Associations of Clinical Toxicology and Poison Control Centres, and the International Safety Council, a global subsidiary of the US National Safety Council.
Another group of non-governmental organizations consists of those having standardization as their objective, such as the International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC). ISO is discussed in a separate article in this chapter.
International employers’ and workers’ organizations play a significant role in defining occupational health and safety policies and priorities at the international level. Their involvement is important because national labour laws and regulations make employers responsible for protection against occupational hazards, and the most concerned are the workers themselves, since it is their health and safety that are at risk. A number of employers’ and workers’ international organizations are concerned with occupational safety and health taken as a whole, including the International Employers Organization (IOE), the Union of Industrial and Employers Confederations of Europe (UNICE), the International Confederation of Free Trade Unions (ICFTU), the World Confederation of Labour (WCL), and the World Federation of Trade Unions (WFTU). There are many sectoral international trade union organizations that deal with specific aspects, such as the International Confederation of Chemical, Energy, Mine and General Workers’ Union (ICEM), the International Metal Workers Federation (IMF), the International Federation of Building and Wood Workers (IFBWW), the International Federation of Plantation, Agricultural and Allied Workers, and the International Federation of Commercial, Clerical and Technical Employees (FIET). There also exist regional organizations, such as the Organization of African Trade Union Unity (OATUU) and the European Confederation of Trade Unions (ECTU), which has established a European Trade Union Technical Bureau for Occupational Safety and Health (TUTB). These organizations have a wide variety of activities, in particular concerning the dissemination of information, technical advice, and training in occupational health and safety.
Producers, manufacturers, and operators are also active in the field of occupational safety and health, either through their associations or through institutes and bodies that they have established, such as the International Council of Chemical Associations (ICCA), the European Council of Chemical Manufacturers Federations (CEFIC), the International Group of National Associations of Agrochemical Manufacturers (GIFAP), the International Air Transport Association (IATA), the World Association of Nuclear Power Plant Operators (WANO), the Illuminating Engineering Society (IES), the Asbestos International Association (AIA), the International Fiber Safety Group (IFSG), and the Viral Hepatitis Prevention Board (action on hepatitis B as an occupational hazard). In addition, a number of institutions and international bodies established by producers, manufacturers and their organizations develop activities relating to the protection of the environment and environmental health, which may include occupational health to some extent, such as the International Centre for Industry and the Environment (ICIE), the International Council on Metals and the Environment (ICME), the International Primary Aluminum Institute (IPAI), and the Oil Companies International Study Group for Conservation of Clean Air and Water (CONCAWE).
Finally, there are many international non-governmental organizations established by scientists, professional associations or groups having similar scientific, humanitarian or economic interests that do not have direct interests in occupational health but are dealing with scientific, technical, medical or social issues that are relevant to occupational health and safety, such as the World Medical Association (WMA), the Council for International Organizations of Medical Sciences (CIOMS), the International Union of Pure and Applied Chemistry (IUPAC), the International Council for Building Research Studies and Documentation, the International Epidemiological Association, the International Society for Labour Law and Social Security, and the International Bureau for Epilepsy (IBE), which prepared a Code of Principles of Good Practice for Employing People with Epilepsy.
Joint Programmes in International Cooperation
It is interesting to examine how international organizations complement each other and mobilize their various means of action to combat specific occupational hazards. As regards noise and vibration, for example, the IEC provides standards for measuring equipment, the ISO defines methods of measurement, the WHO provides health criteria, the ILO recommends exposure limits in its Code of Practice on Noise and Vibration and defines a general approach and strategy in its Working Environment (Air Pollution, Noise and Vibration) Convention, 1977 (No. 148) and Recommendation (No. 156).
The role of international organizations is increasingly characterized by cooperation within the framework of international programmes or joint ventures on specific subjects involving the countries themselves and inter-governmental and non-governmental organizations. International cooperation in protection against ionizing radiation and in promotion of chemical safety are two examples of such activities.
In the field of protection against ionizing radiation, the International Commission on Radiological Protection (ICRP) and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) provide the scientific input. The ILO adopted in 1960 the Radiation Protection Convention (No. 115) and Recommendation (No. 114), which make specific reference to the guidance issued by the ICRP. More guidance is given in a number of codes of practice prepared by the IAEA, cosponsored by the ILO and the WHO, where appropriate, and in the ILO Code of Practice on Radiation Protection (ionizing radiation), 1987. These are supplemented by guides, manuals, training materials and technical documents published essentially by the IAEA and by the Nuclear Energy Agency of the OECD. Technical cooperation activities in this field are mainly carried out by the IAEA; other organizations are involved when needed.
In 1990, an important step towards international harmonization of radiation safety took place: the Inter-Agency Committee on Radiation Safety (IACRS) was established as a forum for consultation on and collaboration in radiation safety matters between international organizations. A joint secretariat was set up to revise the 1982 edition of the IAEA/ILO/WHO/NEA-OECD Basic Safety Standards for Radiation Protection. Six international organizations—the FAO, the IAEA, the ILO, the Nuclear Energy Agency of the OECD, the PAHO, and the WHO—joined to prepare international standards with the aim of helping their member States in drafting their own laws. Under the leadership of the IAEA, a major process of consultations with countries and among intergovernmental and non-governmental organizations, including employers’ and workers’ organizations, led to the elaboration of the International Standards for Protection against Ionizing Radiation and the Safety of Radiation Sources (IAEA 1994). These international standards can be regarded as unified standards for the UN system.
International cooperation in promoting chemical safety illustrates how international organizations interact in order to respond to concerns of people in the world expressed by the international community, and how general declarations of principles adopted by intergovernmental conferences are translated into programmes of action and practical activities based on scientific knowledge. There is a consensus that the evaluation of chemicals should address concerns about occupational exposures, public exposures, and the environment. To carry out risk assessments in an international framework is an asset for mobilizing limited expertise and resources. This led to the establishment in 1980 of the International Programme on Chemical Safety (IPCS) by the WHO, the United Nations Environment Programme (UNEP) and the ILO. The commitment of the three cooperating organizations to collaborate in the IPCS was expressed through a memorandum of understanding in 1988 that establishes the objectives of the IPCS. The technical work of the IPCS relies on a network of national and international institutions that participate in its activities and are responsible for particular tasks. The programme maintains close and efficient working relations with several other intergovernmental and non-governmental organizations, associations, and professional bodies that have important activities in the field of chemical safety.
The United Nations Conference on Environment and Development (UNCED), held in Rio de Janeiro in 1992, recognized the need to ensure the environmentally sound management of toxic chemicals and identified six programme areas for international cooperation:
This was followed in 1994 by an International Conference on Chemical Safety (Stockholm Conference 1994), which established the Intergovernmental Forum on Chemical Safety, identified a number of priorities for action, and invited intergovernmental organizations to participate in an expanded collaborative programme on chemical safety. An Inter-Organization Programme for the Sound Management of Chemicals (IOMC) was established in which the WHO, ILO, UNEP, FAO, UNIDO and OECD participate. It includes an Inter-Organization Coordinating Committee (IOCC), which ensures the coordination of activities on chemical safety carried out by the participating organizations, individually or jointly, and follows up the implementation of the recommendations of UNCED.
There are signs of an increasing trend to mobilize expertise and resources within the framework of joint activities. Such is the case, for example, in the field of training and information exchange in occupational health and safety. As regards biological safety, cooperation was developed between the UNIDO, the UNEP, the WHO and the FAO, and some activities were carried out within the framework of the IPCS. The UNIDO has been designated to follow up Chapter 16 of Agenda 21 (environmentally sound management of biotechnology) of the Rio Conference, to catalyze joint activities and programmes, and to develop common UN system strategies on biotechnology. The OECD has a programme on environmental aspects of biotechnology. The European Directive concerning the protection of workers against biological agents at work (90/679 and 93/88) was adopted in 1990 and modified in 1993. In 1993, the International Labour Conference of the International Labour Organization adopted a resolution concerning exposure to and safety in the use of biological agents at work that indicates that the issue should be studied, including the need for new international instruments (convention, recommendation, or both) to minimize the risks to workers, the public and the environment.
Two additional examples concern the protection of workers against non-ionizing radiation and the harmonization of chemical classification and labelling systems. Environmental health criteria documents on non-ionizing radiation were prepared by the WHO, the UNEP and the International Commission on Non-Ionizing Radiation Protection (ICNIRP). A broader cooperation on protection against non-ionizing radiation, including occupational exposure, is now developing, which includes the ILO, the Commission of the European Union, the International Electrotechnical Commission (IEC), the International Agency for Research on Cancer (IARC) and the Scientific Committee on Radiation and Work of the ICOH. The harmonization of chemical classification and labelling systems is a field where extensive cooperation is promoted, under the leadership of the ILO, among countries, intergovernmental organizations (e.g., OECD; the European Union), non-governmental organizations (employers’ and workers’ organizations; international consumer and environmental protection associations), the UN Committee of Experts on Transport of Dangerous Goods, the FAO, the UNEP, the WHO, the IMO and the ICAO.
There are many other fields where new, flexible forms of international cooperation among countries and international organizations are emerging or could be developed, such as occupational stress and combating occupational lung diseases, in particular silicosis. International networking for occupational health and safety is developing increasingly with objectives such as coordinating research. It would be an advantage if an international network for occupational health and safety could be developed on the basis of existing structures in international organizations that could be interconnected, such as the Collaborating Centres of WHO, the Scientific Committees of ICOH, the International Sections of ISSA, the National Correspondents of IRPTC, the contact points of the OECD Complementary Information Procedure, the Participating Institutions of IPCS, the National and Collaborating Centres of the ILO International Occupational Safety and Health Information Centre (CIS), and the designated bodies of the ILO International Occupational Safety and Health Hazard Alert System.
Common Goals and Complementary Approaches in Occupational Health
In the field of occupational health, the ultimate goals of the WHO and the ILO are the same: to protect and promote the health of the workers in all occupations. Policy guidance is given by the ILO on the basis of its international Conventions and Recommendations on occupational health and safety and by the WHO through the resolutions adopted by the World Health Assembly concerning workers’ health and the primary health care approach that it advocates.
Since the Primary Health Care Conference in Alma-Ata in 1978, the WHO workers’ health programme has attempted to extend its health protection and health promotion activities to cover all people at work, paying special attention to the underserved and the vulnerable working populations. The 40th World Health Assembly requested the Director-General of the WHO:
In October 1994, the Second Meeting of the Network of Collaborating Centres in Occupational Health (52 research and expert institutions from 35 countries) adopted a “Global Strategy on Occupational Health for All” and recommended that this document be submitted for consideration by the WHO to be converted into the WHO “Global Strategy on Occupational Health for All”. This was done in May 1996, with the support of the ILO.
The ILO Conventions and Recommendations on occupational safety and health define the rights of the workers and allocate duties and responsibilities to the competent authority, the employers and the workers in the field of occupational safety and health. The ILO Conventions and Recommendations adopted by the International Labour Conference, taken as a whole, constitute the International Labour Code, which defines minimum standards in the labour field. The ILO policy on occupational health and safety is essentially contained in two international Conventions and their accompanying Recommendations. The ILO Occupational Safety and Health Convention 1981 (No. 155) and Recommendation (No. 164), provide for the adoption of a national occupational safety and health policy and describe the actions needed at the national level and at the enterprise level to promote occupational safety and health and to improve the working environment. The ILO Occupational Health Services Convention 1985 (No. 161) and Recommendation (No. 171), provide for the establishment of occupational health services which will contribute to the implementation of the occupational safety and health policy and will perform their functions at the enterprise level.
In 1984, the International Labour Conference adopted a Resolution concerning the improvement of working conditions and environment, which recalled that the improvement of the working conditions and environment was an essential element in the promotion of social justice. It stressed that improved working conditions and improved environment are a positive contribution to national development and represent a measure of success of any economic and social policy. It spelled out the three fundamental principles that:
There are many similar features between the ILO strategy for the improvement of the working conditions and environment and the WHO primary health care approach. They rest on similar basic principles and they both:
The current trend of globalization for the world economy, and regional integration, has increased interdependence and the need for cooperation between countries. This overview shows that there are common goals, approaches and policies in occupational health and safety. There is also a structure on which a global cooperation can be built. This is the objective of the Global Programme on Safety, Health and the Environment, to be launched by the ILO in 1998.
Infrastructures, Practice and Approaches in Occupational Health
While much progress has been made since the 1980s towards a comprehensive approach in occupational health where the protection and promotion of workers’ health are pursued together with the maintenance and promotion of their working capacity, with a special emphasis on the establishment and maintenance of a safe and healthy working environment for all, there is much room for discussion as to the manner in which occupational health is actually implemented. The expression occupational health practice is currently used to cover the whole spectrum of activities undertaken by employers, workers and their organizations, designers and architects, manufacturers and suppliers, legislators and parliamentarians, labour and health inspectors, work analysts and work organization specialists, standardization organizations, universities and research institutions to protect health and to promote occupational safety and health.
The expression occupational health practice includes the contribution of occupational health professionals, but it is not limited to their practice of occupational health.
Confusion often occurs because the term occupational health services may be used to denote:
In order to overcome this difficulty and several other common causes of misunderstanding, the following wording was used for the second point on the agenda of the Twelfth Session of the Joint ILO/WHO Committee on Occupational Health: “Infrastructures for occupational health practice: options and models for national policies, primary health care approaches, strategies and programmes, and functions of occupational health services” (1995b) with the following understanding of the terms:
The use of the key words infrastructures, practice and approaches permits the various actors and partners in prevention to play their individual roles in their respective fields of competence and to act jointly, as well.
Occupational health services contribute to the occupational health practice, which is intrinsically multidisciplinary and intersectoral and involves other specialists both in the enterprise and outside in addition to occupational health and safety professionals, as well as the appropriate governmental authorities, employers, workers and their representatives. Functionally, occupational health services must be considered both a part of country-level health infrastructures as well as of the infrastructures that exist for the implementation of relevant legislation on occupational safety and health. It is a national decision to determine whether such services should be under the supervision of the ministry of labour, the ministry of health, the social security institutions, a tripartite national committee or other bodies.
There are a large number of models for occupational health services. One of them enjoys the support of a large consensus at the international level: the model proposed by the ILO Occupational Health Services Convention (No. 161) and Recommendation (No. 171) adopted by the International Labour Conference in 1985. Countries should consider this model as an objective towards which progress should be made, taking into account, of course, local differences and the availability of specialized personnel and financial resources. A national policy should be adopted to develop progressively occupational health services for all workers, taking into account the specific risks of the undertakings. Such policy should be formulated, implemented and periodically reviewed in the light of national conditions and practice in consultation with the most representative organizations of employers and workers. Plans should be established indicating the steps which will be taken when occupational health services cannot be immediately established for all undertakings.
Multidisciplinary Cooperation and Intersectoral Collaboration: An Overall Perspective
The ILO and the WHO have a common definition of occupational health (see box), which was adopted by the Joint ILO/WHO Committee on Occupational Health at its first session (1950) and revised at its twelfth session (1995).
Governments, in collaboration with employers’ and workers’ organizations and professional organizations concerned, should design adequate and appropriate policies, programmes and plans of action for the development of occupational health with multidisciplinary content and comprehensive coverage. In each country, the scope and content of programmes should be adapted to national needs, should take into account local conditions and should be incorporated into national development plans. The Joint ILO/WHO Committee emphasized that the principles embodied in the ILO Conventions No. 155 and No. 161 and their accompanying Recommendations, as well as WHO resolutions, guidelines and approaches related to occupational health, provide a universally accepted guide for design of such policies and programmes (Joint ILO/WHO Committee on Occupational Health 1992).
Definition of occupational health adopted by the Joint
ILO/WHO Committee on Occupational Health (1950)
Occupational health should aim at the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; the prevention amongst workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological capabilities and; to summarize: the adaptation of work to man and of each man to his job.The main focus in occupational health is on three different objectives: (i) the maintenance and promotion of workers’ health and working capacity; (ii) the improvement of working environment and work to become conducive to safety and health and (iii) development of work organizations and working cultures in a direction which supports health and safety at work and in doing so also promotes a positive social climate and smooth operation and may enhance productivity of the undertakings. The concept of working culture is intended in this context to mean a reflection of the essential value systems adopted by the undertaking concerned. Such a culture is reflected in practice in the managerial systems, personnel policy, principles for participation, training policies and quality management of the undertaking.
There are similar features between the ILO strategy for the improvement of the working conditions and environment and the WHO general principle of primary health care. Both rest on similar technical, ethical and social considerations and they both:
The main focus of ILO activity has been on the provision of international guidelines and a legal framework for the development of occupational health policies and infrastructures on a tripartite basis (including governments, employers and workers) and the practical support for improvement actions at the workplace, while the WHO has concentrated on the provision of scientific backgrounds, methodologies, technical support and on the training of health and related manpower for occupational health (Joint ILO/WHO Committee on Occupational Health 1992).
For the WHO, occupational health includes safety at work. Hygiene is conceptualized as directed towards disease prevention while safety is thought of as the discipline that prevents bodily injuries due to accidents. For the ILO, occupational safety and health is considered as a discipline aiming at the prevention of work injuries (both occupational diseases and accidents) and at the improvement of working conditions and the environment. The terms occupational safety, occupational health, occupational medicine, occupational hygiene and occupational health nursing are used to acknowledge the contribution of different professions (e.g., engineers, physicians, nurses, hygienists) and in recognition of the fact that the organization of occupational safety and health at the enterprise level very often comprises separate occupational safety services and occupational health services, as well as safety and health committees.
To some extent, occupational safety and primary prevention are more directly linked to the technology which is used, to the process of production and to daily management than is occupational health, which focuses more on the relationships between work and health, in particular on the surveillance of the working environment and of workers’ health (secondary prevention), as well as on human factors and ergonomic aspects. Further, at the enterprise level, engineers are a necessary presence and are inte-gral to the management line (production engineers, maintenance, technicians and so on), while occupational health and hygiene requires the intervention of specialists in the health field who need not be present for the enterprise to function, but can be consultants or belong to an external occupational health service.
Whatever organizational arrangements and terminology are used, the most important thing is that occupational safety and health professionals work as a team. They need not necessarily be in the same unit or service, although this may be desirable where appropriate. The emphasis should not be on the structure of services but on the execution of their functions at the enterprise level in a sound manner (from a scientific, technical and ethical point of view). The emphasis should be on cooperation and coordination in the elaboration and implementation of a programme of action, as well as on the development of unifying concepts, such as “working cultures” (safety culture, labour protection culture, corporate culture) that are conducive to safety and health at work and “continuing quality improvement” of the working conditions and environment.
In 1992, the Joint ILO/WHO Committee emphasized that the scope of occupational health is very broad (as shown in table 1), encompassing disciplines such as occupational medicine, occupational nursing, occupational hygiene, occupational safety, ergonomics, engineering, toxicology, environmental hygiene, occupational psychology and personnel management. Collaboration and participation of employers and workers in occupational health programmes is an essential prerequisite for successful occupational health practice.
Table 1. Six principles and three levels for a sound occupational health practice
Personal protective equipment
Scientific organization of work
Employee assistance programmes
Groups (exposed groups, special needs)
Safe and healthy working environment
Ergonomics including design
Workers’ health promotion programmes
Emergency planning and preparedness
Society and all workers
Environmental health management
Preventive health care
Health education and promotion programmes
Note: The times (1910, 1920, etc.) are arbitrary. Dates are merely given to provide an idea of the time scale for the progressive development of a comprehensive approach in occupational health. Dates will vary from country to country and may indicate the beginning or the full development of a discipline or the appearance of new terms or approaches for a practice which has been carried out for many years. This table does not intend to delineate exact disciplines involved in the process but to present in a concise manner their relationships within the framework of a mutlidisciplinary approach and intersectoral cooperation, towards a safe and healthy working environment and health for all, with a participatory approach and the objective of new forms of development which should be equitable if they are to be sustainable.
The definition of a common goal is one of the solutions to avoid the trap of an excessive compartmentalization of disciplines. Such compartmentalization of disciplines may sometimes be an asset since it allows for a specialized in-depth analysis of the problems. It may often be a negative factor, because it prevents the development of a multidisciplinary approach. There is a need to develop unifying concepts which open fields of cooperation. The new definition of occupational health adopted by the Joint Committee in 1995 serves this purpose.
Sometimes there can be heated arguments as to whether occupational health is a discipline in itself, or is part of labour protection, of environmental health or of public health. When the issue is more than academic and involves such decisions as which organization or ministry is competent for specific subject areas, the outcome can have significant consequences with regard to the allocation of funds and distribution of resources available in the form of expertise and equipment.
One of the solutions to such a problem is to advocate convergent approaches based on the same values with a common objective. The WHO approach of primary health care and the ILO approach of improving the working conditions and environment can serve this purpose. With common values of equity, solidarity, health and social justice in mind, these approaches can be translated into strategies (the WHO’s strategy of occupational health for all) and programmes (the ILO International Programme for the Improvement of Working Conditions and Environment) as well as into plans of action and activities implemented or carried out at the enterprise, national and international levels by all partners in prevention, protection and promotion of workers’ health, independently or jointly.
There are other possibilities. The International Social Security Association (ISSA) proposes the “concept of prevention” as a golden path to social security to address “safety worldwide” at work and at home, on the road and during leisure time. The International Commission on Occupational Health (ICOH) is developing an approach of ethics in occupational health and catalyses a rapprochement and cross-fertilization between occupational health and environment health. A similar trend can be seen in many countries where, for example, professional associations now get together occupational health and environmental health specialists.
In 1984, the ILO’s annual International Labour Conference adopted a resolution concerning the improvement of working conditions and environment incorporating the concept that the improvement of the working conditions and environment is an element essential to the promotion of social justice. It stressed that improved working conditions and environment are a positive contribution to national development and represent a measure of success of any economic and social policy. It spelled out three fundamental principles:
During the 1980s a shift occurred from the concept of development towards the concept of “sustainable development”, which includes “the right to a healthy and productive life in harmony with nature” as indicated in the first principle of the Rio Declaration (United Nations Conference on Environment and Development—UNCED 1992). The objective of a safe and healthy environment has thus become an integral part of the concept of sustainable development, which also implies balancing environment protection with generation of opportunity for employment, improved livelihoods and health for all. Both environmental health and occupational health contribute to make development sustainable, equitable and sound not only from an economic but also from a human, social and ethical point of view. This paradigm shift is illustrated in figure 1.
Figure 1. A multidisciplinary approach towards a sustainable and equitable development
The purpose of this figure is to illustrate the interaction between occupational health and environmental health and their mutually supportive contribution to a sustainable development. It identifies an area which represents the integration of the economic and social objectives which can be met while at the same time taking account of the environment, employment and health.
The WHO Commission on Health and Environment has further recognized that “the kind of development needed to safeguard health and welfare will depend on many conditions, including respect for the environment, while development without regard for the environment would inevitably result in impairment of human health” (WHO 1992). In the same vein, occupational health should be recognized as an “added value”, that is, a positive contribution to national development and a condition of its sustainability.
Of particular significance to the work of the ILO and the WHO are the Declaration and Programme of Action adopted by the World Summit for Social Development held in Copenhagen in 1995. The Declaration commits the nations of the world to pursuing the goal of full, productive and freely chosen employment as a basic priority of their economic and social policies. The Summit clearly indicated that the goal must not be to create just any sort of jobs, but quality jobs that safeguard the basic rights and interests of workers. It made clear that the creation of good quality jobs must include measures to achieve a healthy and safe working environment, to eliminate environmental health hazards and provide for occupational health and safety. This is an indication that the future of occupational health may well be active partnership in reconciling employment, health and environment towards an equitable and sustainable development.
The primary health care approach emphasizes social equity, affordability and accessibility, participation and community involvement, as noted by the Joint ILO/WHO Committee on Occupational Health in 1995. These basic moral and ethical values are common to the ILO and the WHO. The primary health care approach is innovative because it applies social values to preventive and curative health care. This complementarity has not always been clearly understood; sometimes confusion is due to the interpretation of common words, which has led to a degree of misunderstanding in discussing actual roles and activities to be undertaken by the ILO and the WHO, which are complementary and mutually supportive.
Primary health care can be considered to be based on principles of social equity, self-reliance and community development. It may also be considered to be a strategy for reorienting health systems, in order to promote individual and community involvement and collaboration between all sectors concerned with health. A general principle should be that primary health care should incorporate an occupational health component and specialized occupational health services should apply the general principle of primary health care, regardless of the structural model in place.
There are many partners in prevention, sharing the philosophy of both the ILO and the WHO, who should provide the necessary inputs to implement a good occupational practice. The Joint ILO/WHO Committee has indicated that the ILO and the WHO should promote an inclusive approach to occupational health in their member countries. If such an approach is used, occupational health can be seen as a multidisciplinary and integrated subject. Taken in this light, activities of different organizations and ministries will not be competitive or contradictory but will be complementary and mutually supportive, working towards an equitable and sustainable development. The emphasis should be on common goals, unified concepts and basic values.
As pointed out by the Joint ILO/WHO Committee in 1995, there is a need to develop occupational health indicators for the promotion and monitoring of the progression towards health and sustainable development. Forms of development which jeopardize health cannot claim the quality of being equitable or sustainable. Indicators towards “sustainability” necessarily include health indicators, since UNCED emphasized that the commitment of “protecting and promoting human health” is a fundamental principle for sustainable development (Agenda 21, Chapter 6). The WHO has taken a leading role in developing both the concept and use of environmental health indicators, some of which concern health and the working environment.
The WHO and the ILO are expected to develop occupational health indicators which could help countries in the evaluation, both retrospective and prospective, of their occupational health practice, and assist them in monitoring the progress made towards the objectives set by national policies on occupational safety, occupational health and the working environment. The development of such indicators focusing on the interactions between work and health could also assist occupational health services in evaluating and guiding their programmes and their activities to improve the working conditions and environment (i.e., in monitoring the efficiency and the manner in which they carry out their functions).
Standards and Guidance
The ILO Conventions and Recommendations on occupational safety and health define the rights of the workers and allocate duties and responsibilities to appropriate authorities, to the employers, and to the workers in the field of occupational safety and health. The ILO Conventions and Recommendations adopted by the International Labour Conference, taken as a whole, constitute the International Labour Code which defines minimum standards in the labour field.
The ILO policy on occupational health and safety is essentially contained in two international Conventions and their accompanying Recommendations. The ILO Occupational Safety and Health Convention (No. 155) and its Recommendation (No. 164), 1981, provide for the adoption of a national occupational safety and health policy at the national level and describe the actions needed at the national and at the enterprise levels to promote occupational safety and health and to improve the working environment. The ILO Occupational Health Services Convention (No. 161) and its Recommendation (No. 171), 1985, provide for the establishment of occupational health services which will contribute to the implementation of the occupational safety and health policy and will perform their functions at the enterprise level.
These instruments provide for a comprehensive approach to occupational health that includes primary, secondary and tertiary prevention and is consistent with general principles of primary health care. They indicate the manner in which occupational health care should ideally be delivered to the working populations, and propose a model that channels towards the workplace organized activities which require expert staff in order to catalyse an interaction between various disciplines to promote cooperation between all partners in prevention. These instruments also provide an organizational framework wherein occupational health professionals can deliver efficiently quality services to ensure workers’ health protection and promotion and contribute to the health of enterprises.
Convention No. 161 defines occupational health services as services dedicated to essentially preventive functions and responsible for advising employers, workers and their representatives at the enterprise on the requirements for establishing and maintaining a safe and healthy working environment that will optimize physical and mental health in relation to work and on the adaptation of work to the capabilities of workers, taking into consideration their state of physical and mental health.
The Convention specifies that occupational health services should include those of the following functions that are adequate and appropriate to the occupational risks at the worksite:
The ILO Convention and Recommendation are very flexible with regard to the forms of organization of occupational health services. The establishment of occupational health services may be done by laws or regulations, by collective agreements, or in any other manner approved by the appropriate authority, after consultation with the representative organizations of concerned employers and workers. Occupational health services may be organized as a service for a single enterprise or as a service common to a number of enterprises. As far as possible, the occupational health services should be located near the place of employment or should be organized to ensure their proper functioning at the place of employment. They may be organized by the concerned enterprises, by the public authorities or official services, by social security institutions, by any other bodies authorized by the authorities or, indeed, by combination of any of these. This offers a large degree of flexibility and, even in the same country, several or all of these methods may be used, according to local conditions and practice.
The flexibility of the Convention demonstrates that the spirit of the ILO instruments on occupational health services is to place more emphasis on its objectives rather than on the administrative rules for achieving them. It is important to ensure occupational health to all workers, or at least to make progress towards this objective. Such progress is usually achievable by degrees but it is necessary to make some progress towards achieving these aims and to mobilize resources in the most efficient manner for this purpose.
Various methods of financing occupational health exist. In many countries the obligation of establishing and maintaining occupational health services rests with employers. In other countries they are part of national health schemes or public health services. Staffing, financing and training of personnel are not detailed in the Convention but are individual national approaches.
Many examples exist of occupational health services set up by social security institutions or financed by special workers’ insurance schemes. Sometimes their financing is governed by an arrangement agreed upon by the ministry of labour and the ministry of health or by the social security institutions. In some countries trade unions run occupational health services. There are also special arrangements wherein funds are collected from employers by a central institution or tripartite body and then disbursed to provide occupational health care or distributed to finance the functioning of occupational health services.
The sources of financing occupational health services may also vary according to their activities. For example, when they have curative activities, social security may contribute to their financing. If occupational health services take part in public health programmes and in health promotion or in research activities, other funding sources may be found or become available. Financing will depend not only on the structural model chosen to organize the occupational health services, but also on the value that society concedes to health protection and promotion and its willingness to invest in occupational health and in the prevention of occupational hazards.
Conditions of Operation
A special emphasis is placed on the conditions of operation of occupational health services. It is not only necessary for the occupational health services to execute a number of tasks but it is equally important that these tasks should be performed in an appropriate manner, taking into consideration technical and ethical aspects.
There are some basic requirements as regards the operation of occupational health services which are spelled out in the ILO Convention, and especially in the Recommendation on Occupational Health Services. These may be summarized as follows:
Ethical dimensions of occupational health are increasingly taken into account, and emphasis is placed on the need for both quality and on-going evaluation of occupational health services. It is not only necessary to determine what should be done but also for which purpose and under which conditions. The ILO Recommendation on Occupational Health Services (No. 171) introduced a first set of principles in this respect. Further guidance is given by the International Code of Ethics for Occupational Health Professionals adopted by the International Commission on Occupational Health (ICOH 1992).
In 1995, the Joint ILO/WHO Committee on Occupational Health emphasized that “quality assurance of services must be an integral part of the occupational health services development. It is unethical to give poor quality of service”. The ICOH Code of Ethics prescribes that “occupational health professionals should institute a programme of professional audit of their own activities in order to ensure that appropriate standards have been set, that they are being met and that deficiencies, if any, are detected and corrected”.
Common Goals and Values
The role of institutionalized occupational health services should be seen within the broader framework of health and social policies and infrastructures. The functions of occupational health services contribute to the implementation of the national policies on occupational safety, occupational health and the working environment advocated by the ILO Occupational Safety and Health Convention (No. 155) and Recommendation (No. 164), 1981. Occupational health services contribute also to the attainment of the objectives embodied in the “Health For All” strategy advocated by the WHO as a policy for equity, solidarity and health.
There are signs of an increasing trend to mobilize expertise and resources within the framework of networking arrangements and joint ventures. At the international level, such is already the case for chemical safety, where there is an interorganization me-chanism for chemical safety: the Inter-Organization Programme for the Sound Management of Chemicals (IOMC). There are many other fields where new flexible forms of international cooperation among countries and international organizations are emerging or could be developed, such as radiation protection and biological safety.
Networking arrangements open new fields of cooperation which may be adapted in a flexible manner to the theme which is to be addressed, such as occupational stress, coordinating research or updating this Encyclopaedia. The emphasis is placed on interactions and not any more on vertical compartmentalization of disciplines. The concept of leadership gives way to active partnership. International networking for occupational safety and health is developing rapidly and could be further developed on the basis of existing structures which could be interconnected. The roles of the ILO and the WHO may well be to initiate international networks designed to fulfil the needs and demands of their constituents and to meet the common goal of protecting the people at work.
The social and ethical values agreed upon by the international community are incorporated into the ILO Conventions and Recommendations, as well as in the WHO policy on “Health For All”. Since the 1980s the concept of sustainable development has progressively emerged and, after the Rio Conference and the Social Summit in Copenhagen, now takes into account the interrelationships between employment, health and the environment. The common goal of a safe and healthy working environment for all will reinforce the determination of all those involved in occupational safety and health to better serve the health of workers and to contribute to a sustainable and equitable development for all. One of the main challenges in occupational health may well be to resolve the conflict between values such as the right to health and the right to work at the level both of the individual and all workers, with the aim of protecting health and allowing employment.