Injuries and Illnesses at Work ILO Methods and Estimates in Europe, Asia and Globally EPICOH, Barcelona 5-7 September, 2016; Takala J, Hämäläinen P, Tan BK, Yong E…
Dr Jukka Takala Workplace Safety and Health Institute, Singapore and International Commission of Occupational Health,
Real risks and numbers, estimates, or nontransparent evidence
s
2
ILO Global Estimates, Methods We reviewed employment figures, mortality rates, occupational burden of diseases and injuries, reported accidents, surveys on self-reported occupational illnesses and injuries, attributable fractions, economic cost estimates of work related injuries and ill-health, and the most recent information on the problems from published papers, documents, and electronic data sources of international and regional organizations, in particular ILO, WHO, EU and ASEAN, institutions, agencies, and public websites.
Work-related Mortality Fatal Work Injuries (2010)
ILO member State fatality rates/100,000 workers were applied to the whole work force of the country.
If no or poor information were given for the country, then a proxy country rate or average of several countries having closely related economic structure and cultures, were used.
Fatal Work-related Illnesses (2011) WHO mortality data by disease categories
Applied established AFs on work-related conditions Applied inclusion/exclusion conditions by age-groups/ conditions WHO regional Work-related mortality by disease categories
Work –relatedness of common Work-relatedness of common diseases diseases
Overall work-relatedness of mortality, ILO: 6.7% GDP loss, Australian method SG: 3.2% ; AUS: new 4.8 % prev. 5.9% Global Burden of disease and injury in Europe, WHO 5.0%
6
A Leading Institute for WSH Knowledge and Innovations
Population Attributable Fractions
Source: Hämäläinen P, Takala J, Saarela KL
Results We estimated 2.3 million deaths occurred annually across the countries for reasons attributed to work. The biggest mortality burden came from work-related diseases, accounting for 2 million deaths whilst the remainder were due to occupational injuries.
2.3 million deaths
See “Global estimates”: http://goo.gl/0xSHGl
See “Global estimates”: http://goo.gl/0xSHGl
Isle of Man Country
Occupational cancer deaths
Italy
18 10609
17
Jersey
23
Austria
1820
Latvia
491
Belgium
2079
Lithuania
694
Bulgaria
1445
Luxembourg
98
Croatia
742
Malta
75
Cyprus
179
Monaco
21
Andorra
Czech Republic
2238
Netherlands
3721
Denmark
1242
Poland
7501
Estonia
292
Portugal
2371
Finland
1135
Romania
4233
France
12035
San Marino
Germany
17706
Slovakia
1150
Gibraltar
5
Slovenia
442
Greece
2131
Greenland
14
Guernsey
13
Hungary
1808
Ireland
928
0
Spain
9807
Sweden
2103
United Kingdom Total EU
13330 102,517
Economic costs of work-related injury and illness vary between 1.8 – 6 % of GDP in country estimates, averaged at 4 %. Singapore economic costs were estimated to be equivalent to 3.2% of GDP.
6.0% GDP
SG: 3.2%GDP
1.8% GDP
w w
w w
w w Workrelated (w)
w w
w
w
w
w w
w W-r
w w
Apply method in EU: Occupational cancer • Globally, cancer kills 8.2 million people each year and 14 million new cancers are detected every year, according to WHO/IARC. Cancer is a multifactorial disease. • Mortality will increase 78 per cent by 2035 (IARC). • And this is the case also with occupational cancers if we’ll continue with “business as usual” • Epidemiological studies indicate that occupational exposures cause 5.3–8.4 per cent of all cancers and among men 17–29 per cent of all lung cancer deaths, according to best estimates.
IARC/WHO: Cancer cases will increase
• In the EU28, there were a predicted 1.366 million cancer deaths in 2013. • Europe, EU28, is the leading victim of occupational cancer globally, 7.5% of all cancer deaths, or 102,500 deaths based on ILO estimates, EU Commission endorsed, • By 2035 expecting the “business as usual” - approach there will be based 182,500 occupational cancer deaths • Worst hit EU Member States are the Netherlands, United Kingdom and Belgium, followed by Italy - do you agree?
% of Work-related Deaths caused by Illness in EU28 2.4% 0.8%
1.0%
Communicable Diseases
2.5% Malignant neoplasms
6.0%
Neuropsychiatric conditions Circulatory diseases 28.0% 53.0%
Circulatory Diseases
Cancers
Respiratory diseases Digestive diseases
5.7%
Genitourinary diseases Accidents & violence
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%. See “Global estimates”: http://goo.gl/0xSHGl
Source: goo.gl/fuUXsl
Switzerland 1905
United Kingdom
European Union Deaths/ year • 58,682 asbestos (asbestos consumption adjusted)
• • • • •
6,900 silica dust 5,000 diesel exhaust 4,500 mineral oils 4,500 shiftwork 2,000 external tobacco smoke at work • ……… http://www.notimetolose.org.uk/
CAREX Canada
Source: John Cherrie, IOM
U.K. 8,000+ and Globally Cancer at work kills
• 666,000 • • • • • •
including
asbestos silica dust diesel engine exhaust mineral oils, chemicals shift work painting and decorating products and activities • ETS (passive smoking) ……… http://www.notimetolose.org.uk/
Estimated Global Mesothelioma Deaths (Annual N*), based on WHO data. * Reported N in 49 countries (48+ Switzerland) are tallied as is, Takahashi et al17 Extrapolation method
Reported Global
(1) Crude (attr: none), all
Deaths at Work/All
Non-reported Global 68,753
15,035*
53,718
China 11,856 EU28: 9,620
(2) Estimates based on asbestos use,
All Work AFmeso.work = 94.9%26 Rushton
China/EU28
33,744 (IHME) - 39,000 (new) 25,212 (IHME) - 37,000 (new)
(3) Reported/Estimated Global, EU estimates, all
15,035
(GBD/IHME 2013)
18,000- 24,000
EU: 8,294 Takahashi et al EU: 9,620 GBD/IHME 2013 EU: 10,368 Takala 2015
Asbestos related lung cancer deaths (Takala et al, not yet published) Methods of estimated lung cancer deaths using mesothelioma as a proxy for asbestos use, mesothelioma estimate based on asbestos exposure above: 53,390 deaths, and 2,149 for Brazil McCormack, Peto et al.14 average estimate using chrysotile, all
Lung cancer/ mesothelioma rate 6.1
Asbestos related lung cancer deaths World
237,900
China/EU28
72,322/58,682 (based on GBD/IHME 2013)
McCormack, Peto et al., lowest and highest estimate, all
2.0-10
78,000 – 390,000
Nurminen, Karjalainen 8, using mixed fibres, asbestos exposure verified by lung tissue fibre counting, all
3.525
137,475
6.61
244,570work - 257,790all 2,265work 24,087work
IHME based rate on global asbestos-related lung cancer and mesothelioma at work: 166,774/25,212=6.61 16 Ovary and larynx cancers Asbestosis
Global asbestos deaths, work: All asbestos exposed:
218,338 - 308,102 Mid-point 263,000 283,308 - 323,332 global
Singapore 1,439 deaths
Burden or DALY: Work Accidents
1.
2.
3.
Magnitude of problems, injuries and diseases, fatal or non-fatal How many days or years of life lost, YLL, and Years with reduced capacity, if permanent: disability weight, or temporary, YLD
DALY= YLL + YLD Disability Adjusted Life Years
23
Respirable Silica Dust in Asia and Globally estimate of exposed and lung cancer deaths New Estimates based on adjusted numbers of exposed population and global cancer death estimates
%
Exposed
Estimate by share of lung cancer
Estimate by share of all cancers
IHME/GBD
Estimate by share of occupat. cancer, 5% of ILO data
5,285,000 669,000 2,998,000
6,991 964 3,876
7,182 786 2,995
846.64 85.73 513.74
5%
5125
5%
667
USA
2.354 2.256 2,114
5%
3268
China India Indonesia Pakistan Vietnam
1.967 1.391 1.368 1.414 0.975
14,495,281 6,173,877 1,310,898 565,176 400,539
11,155 894 451 248 208
9,443 2,104 453 423 248
10,642.48 1,290.42 727.70 424 426.59
5%
8670
5%
2986
5%
727
5%
405
5%
244
2.142 1.885 2.526 est. 1.6 1.657
1,446,318 418,194 53,551 27,000,000 47,007,000
1763 428 39 15,680 28.277
2,000 426 35
202.43 112.32 11.59 16,381.00 21,374.30
5%
1400
5%
526
EU-28 2013 U.K.(control est.)
Driscoll et.al 2014, Expert Working Group
……
Japan Korea Rep.of Singapore ctrl.est Asia, excl.hi inc. Global
30,477
5%
19
5%
20,200
5%
33,311
28,050
Work-related deaths in Asia and Globally Region
Cancer due to Asbestos Asbestos-related lung cancer, ARLC Asb.use Average
Arab States
1,211
1,435
ARLC+ Mesothelioma Usage
Cancer due to RCS
Total Workrelated Cancers
2011 Work-related Disease Number
Average
1,873
2,270
101
10,060
27,646
83,012 116,360
96,337
14,059
216,407
494,583
Eastern Asia
100,216
Central Asia
1,171
1,148
1,473
1,584
153
8,170
30,379
12,427
13,554
26,868
26,656
1,433
82,405
415,985
Southern Asia South-Eastern Asia Western Asia (Israel) Oceania
Incidencea
66.7 54.9 93.6 64.2 60.3
12,250
11,766
14,799
14,252
1,415
49,174
181,395
77.7 170
170
206
206
50
1,337
2,445
3,080
3,225
3,824
4,035
229
8,780
17,516
Total (Asia and Oceania) 130,355 114,140 165,198 145,134 Total (Global) 37,000
263,000
63.7 59.9
17,390
374,997 1,167,505
61.7 28.277
666,210
1,974,736
Method Testing: Economic Costs Number of cases, DALYs, costs
EU 28
1
All fatal occupational accidents 1)
2
All fatal work-related diseases 2)
3
Non-fatal occupational accidents
4
YLL per case, injuries, years 3)
5
YLL per case, diseases, years
6
Years of Lost Life, YLL from fatal cases, injuries 4)
7
Singapore
Finland
Germany
China
4,692
55
43
674
99,197
187,492
2,400
2,076
32,387
408,475
3,331,380
10,264
38,038
596,231
87,750,997
45.90
44.69
45.61
44.76
47.18
15.80 215,382
13.53 2,458
16.30 1,961
15.66 30,169
21.62 4,680,322
Years of Lost Life, YLL from fatal cases, diseases 5)
2,962,235
32,459
33,827
507,092
8,830,134
8
Years Lived with Disability , YLD caused by non-fatal accidents and diseases 6)
5,069,888
63,191
68,197
1,239,119
21,373,867
9
DALY caused by those above, YLLs and YLDs
7)
8,247,505
98,108
103,986
1,776,381
34,884,323
10
All costs in terms of monetary values, in USD
698.2*109
7.51*109
9.76*109
153,884*109
498,086*109
11
Cost of YLL, (fatal cases) in USD, illnesses and injuries
1.13% 2.67*109 1.46%
6.1*109
1.39%
46.5*109
1.78%
192.9*109
12
Cost of YLD (non-fatal cases) in USD, illnesses and injuries
429.3*109
2.05% 4.83*109 2.79% 11.5*109
3.20%
107.3*109
2.80%
305.2*109
13
· Cost of Occupational Cancer in USD
0.73 % 137.4*109
0.56% 1.32*109 0.74% 2.01*109
0.70%
23.4*109
1.11%
124.3*109
14
· Cost of MSD in USD, from GBD occupational ergonomic factors
0.62 % 115.4*109
0.08% 0.19*109 0.60% 1.63*109
0.76%
25.5*109
0.80%
87.3*109
8)
1.46 % 269.0*109
9)
9)
2.33%
· Cost of disease group C, D… 15
Percentage of GDP based on numbers of cases, 10) YLL of GDP (Deaths) YLD of GDP (Disability)
DALYloss % = TOTAL
of GDP
.
.
.
.
1.457 % 2.325 %
1.13 % 2.05%
1.46 % 2.79%
1.39 % 3.20 %
1.78 % 2.80 %
3.8 %
3.18 %
4.26 %
4.59 %
4.56 %
Conclusion Work accidents and fatalities are felt immediately, and thus requires good safety risk management practices to curb. However, the extent of impact on the workforce by workrelated ill health should not be underestimated, as observed from our estimates.
A new threshold of zero harm must be advocated and practiced across all levels and during the entire working life, in order to eliminate all negative effects of work on health and support sustainable working life.
This study was done for the International Labour Office, ILO.
Additional slides: Method applied in Singapore, EU28 and others settings
29
Apply Methods in Asia: Mortality estimates of injuries and ill- health at work in Singapore Jukka TAKALA, DSc, Eunice YONG, MPH Workplace Safety and Health Institute, Singapore Correspondence: Dr J. Takala, E-mail :
[email protected]
Introduction Occupational deaths can be broadly grouped into those resulting from work-related injuries or from work-related diseases or illnesses. For the former, fatal injuries are well documented and reported at the national level in Singapore. However, the actual work-related mortality due to illnesses is still not as complete. Hence, we aim to estimate the number of deaths that could be workrelated using epidemiological methods. This is so that more awareness could be raised among the stakeholders for better workers' protection and prevention.
Methods To estimate work-related mortality for Singapore residents, we applied disease-specific attributable fractions (AFs) from Nurminen and Karjalainen's 2001 paper to the all-cause mortality data in 2010 from the Ministry of Health. Some of the AFs were adjusted to take into account the local context. Foreign workers' estimated figures was taken as proportional to that of the resident population. For work-related injuries, data from the Ministry of Manpower was used. 30
Work-related Mortality Fatal Work Injuries (2011)
Fatal Work-related Illnesses (2010)
MOM WSH data on fatal injuries at work
MOH mortality data in 2010 by disease categories
Applied established AFs on work-related conditions
Applied inclusion/exclusion conditions by age-groups/ conditions
31
Results Estimated work-related deaths All workrelated diseases
1
115
Communicable Diseases Malignant Neoplasms Mental Disorders
0.4% 0.9% 4.3% 7.0% 6.5%
Suicides
Injuries at work (including traffic accidents)
% Deaths from work-related diseases
1323
33.2%
47.4%
0.4%
Cardiovascular Diseases Respiratory Diseases Digestive Diseases Genitourinary Diseases Intentional Injuries
We estimate 115 fatal occupational injuries, one intentional injury and 1,323 fatal work-related diseases totalling 1,439 fatal work-related injuries and illnesses in 2011. While cancers and cardiovascular diseases kill many more workers than injuries, attention has traditionally been on the lesser number but more acute deaths from 32 injuries. This is reflected in the number of injuries reported as compared to the cases of occupational diseases.
Estimation of No. of fatal work-related diseases using ILO Attributable fraction (AF) method1 Fatal work related injuries and diseases, ALL
Permanent Residents and Citizens
14391
819
Perm Res. Men
Disease
Perm Res. Women
PR- TOTAL
43
Communicable diseases
15
57
327
Malignant neoplasms
61
388
2
Neuropsychiatric conditions
0
3
238
Circulatory diseases
34
272
46
Chronic respiratory diseases
7
53
2
Digestive diseases
1
3
30
Genitourinary diseases
4
35
696
Total
123
819
ALL incl. foreign workers
1,439
1 Fatal work related diseases were estimated based on year 2010 resident labour force published by Ministry Of Manpower (MOM). For foreign workers the ratio of the numbers of Singapore residents to foreign workers was used. The AF was adjusted for Singapore individual disorders from ILO AF’s and was used to compute the number of fatal work related diseases (AF * Deaths) and overall new AF’s for Singapore. There were 115 fatal occupational
injuries, 1 work-related suicide and 7 work-related intentional injuries.
33
Conclusion Whilst the exact figures reported here are not the key focus, we hope that the magnitude of these figures would provide a range for stakeholders to gauge the real scale of the problem, especially to bring greater awareness and control of occupational health hazards. Many work-related diseases, such as occupational cancers can be eliminated by reducing the exposures. Applying a Vision Zero and zero harm at work mindset is needed for eliminating or radically reducing the burden of injuries and illnesses from work. 35
Additional slides: Occupational cancer
36
2035?
2035?
Underestimates are common
+78%
2035 ?
Deaths EU28 in 2013 (AF values by Takala) Communicable AFwork=13.3%
Cancer, AFwork, males =13.8%
CVD AFwork,males=14.4%
Injuries AF= Attributable Fraction, re work GBD= Global Burden of Disease
DALYs EU28 in 2013 Cancer AFwork= 5.5-8 %
CVD,stress AFwork= 7.9 %
Mental health, AFwork= 30+ %
DALY= Disability Adjusted Life Years
AF= Attributable Fraction, re wo
Injuries
http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
Selected Occupational Risks, 2013 (IHME)
GBD/IHME: http://vizhub.healthdata.org/gbd-compare/
Burden of Injury and Illness at Work Globally and in Singapore
DALY= Disability Adjusted Life Years GBD= Global Burden of Disease and Injury
Dr Jukka Takala
Workplace Safety and Health Institute, Singapore http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
EU28 Increase of asbestos –related cancer deaths 1.
47,000 deaths in 2015 (Takala)
2.
48,375 deaths in 2000 (GBD est 2015)
3.
53,718 deaths in 2010 (GBD est 2015)
4.
55,487 deaths in 2016 (GBD est 2015)
5.
58,682 deaths in 2016 (Takala et al.)
6.
???
deaths in 2020-
Mesothelioma in the U.K., Real Numbers
2,538 deaths in 2013
Industrial Injuries Disablement Benefit (IIDB)
Consumption of asbestos in Singapore and in Finland and expected mesothelioma cases some 45-50 years later
New Estimates of silica caused cancer deaths based on adjusted numbers of exposed population and global cancer death estimates % of exposed
N* of Exposed
EU-28 2013
2.354
5,285,000
U.K.(control est.) USA
2.256
2,114
Estimate by share of lung cancer
Estimate by share of all cancers
Estimate by IHME/GBD share of occupat. cancer, 5% of ILO data
7,182
846.64 5%
5125
669,000
6,991 964
786
85.73 5%
667
2,998,000
3,876
2,995
513.74 5%
3268
Source: Cherrie et al.2011
2040
2030
2020
2010
Country lung cancer deaths caused by silica, EU in 2010-2040
Strategies in preventing Occupational Cancer • Evidence science, research, knowledge on work life, sustainability • Ethics socially sustainable solutions, quality of work life, equal treatment , defend the vulnerable in the world of work • Engagement openly engage in dialogue with policy makers, all stakeholders, interested parties, all members • Enforcement based on regulatory measures • Economics, show that prevention pays
Example of costs of fatal occupational cancer cost calculation with existing data 1. 2. 3. 4. 5.
EU: 102,500 fatal cases in (ILO) Average years of life lost 15.13 years (YLL from GBD) GDP in EU 28: 18,460,646 million USD (Wiki); Employed 218,050,300 (ILO) GDP/employed: 84,662 USD/year Calculation: [ (15.13 * 102,500 * 84,662 USD] 18,460,646 *106 USD
=
TOTALGBD
115.2 * 109 EUR, or 0.71 % of GDPEU28
Years Lived with Disability, YLD need to be added to this
Strategies for Preventing Occupational Cancer contnd. • A comprehensive set of recommendations are given in : https://osha.europa.eu/en/tools-andpublications/publications/reports/report-soar-work-related-cancer
Summary • Exposures until today determine future trends, exposure elimination/limitation has been poor and cancer cases go up; • Most changes in future exposures depend on structural changes and new technological processes, not (yet) initiated by preventive measures; • One cannot fight cancer at work in general, it must be based on detailed measures for limiting each individual exposures; • Ramazzini: “May I ask what is your occupation?” • CAREX – Cancer exposure Register - by occupation;
Summary • Priority order is important, 50 exposure limits; • Hierarchy of control is vital, elimination substitution..; • Most people think that the asbestos problem is solved.. Another wave of exposures/cancers may be coming from today’s and near future demolitions, removal and related exposures. Such work is not properly done in most countries in the EU today; • Capacity of Member states; • EU Campaign and programme on occupational cancer
Strategies for Preventing Occupational Cancer contnd. • (i) advocate measurable and continuous reduction of exposures to gradually eliminate occupational cancer. • (ii) An international programme ‘Elimination of occupational cancer’ should be launched • (iii) The EU must be a key driver for such programme, collaborating with ILO and WHO and all relevant organisations, including professional organisations,
Strategies for Preventing Occupational Cancer contnd. • (iv) CAREX should be updated, new major model Burden of Occupational Cancer by Canada
www.occupationalcancer.ca/2011/burden-of-occupational-cancer/
• (v) Exposure limit values should be updated: - USA reduced the exposure limit for silica dust from 0.1 mg/m3 to 0.05 mg/m3. OSHA/USA expects to eliminate 60% of the silica caused fatalities with this measure
Strategies for Preventing Occupational Cancer contnd. - New exposure limits ? Diesel exhaust, Chromium VI… - European Commission new proposal, reduces silica exposures and 100,000 lives saved in 50 years, 2,000 year; - If new USA new limit followed, another 100,000 lives saved - Dutch Expert Committee on Occupational Safety (DECOS) has proposed that the occupational exposure limits (OELs) for asbestos be reduced from 10,000 fibres/m3 (all types) to 420 fibres/m3 for amphibole asbestos, 1,300 fibres/m3 for mixed asbestos fibres, and 2,000 fibres/m3 for chrysotile asbestos.
Strategies for Preventing Occupational Cancer contnd. - The Dutch Expert Committee on Occupational Safety (DECOS) has proposed that the occupational exposure limits (OELs) for asbestos be reduced from 10,000 fibres/m3 (all types) to 420 fibres/m3 for amphibole asbestos, 1,300 fibres/m3 for mixed asbestos fibres, and 2,000 fibres/m3 for chrysotile asbestos.
Concrete steps (i) Establish an international action programme, including regional action – for example, in the EU – to eliminate cancer at work through the identification and elimination of exposures to carcinogenic, mutagenic and teratogenic substances and agents, and modification of related work processes. (ii) Mobilise ILO, WHO and EU member states to set up similar country programmes in collaboration with all relevant stakeholders and, in particular, involving workers and employers and their organisations. (iii) Propose the ILO and the WHO to join the programme using the same models as past ILO/WHO programmes. (iv) The European Agency for Occupational Safety and Health and the European Commission should jointly support such action in the EU.
Concrete steps contnd. (v) Draft scientific papers, guidance and reports on occupational cancer and ways to reduce and eliminate exposures. Rather than relying on individual researchers of institutions a network of collaborators should be established to contribute. (vi) Once reasonable findings are complete, these need to be endorsed by credible research bodies, authorities and organisations to provide sufficient weight for further action. These include key institutes, government administrations, workers and their organisations, including trade unions, employers’ organisations, sectoral industry associations, and international and regional players, environmental NGOs and associations, such as ICOH, IOHA, AIHA, ISSA, IOSH, IALI, Collegium Ramazzini. (vii) A group of focal points and interested bodies and experts will be needed to participate in drafting and/or peer reviewing the outputs. Any interested stakeholder may identify such network members.
Progress of asbestos –related cancer estimates in EU
1. 2. 3. 4. 5.
100,000 deaths in 1998 (ILO) 108,000 deaths in 2000 (WHO) 130,615 deaths in 2005 (GBD) 172,399 deaths in 2010 (GBD 194,252 deaths in 2013 (GBD)
6. 283,308 - 323,332 deaths in 2016(Takala et al.)
7.
???
deaths in 2020-
= 200,000 tons used/year
Mesothelioma deaths Today U.K U.K 2005
U.K. Deaths
1500
U.K. Exposure
*
*
*
http://goo.gl/hnEKnC
Singapore
India
Example of poor emphasis on work exposures Combined effect of exposures to asbestos and smoking on lung cancer
Applicable to selected other carcinogens Age-standardized lung cancer death rates
Death rate (per 100,000)
Nonsmoker
Smoker
No asbestos
11
123
Asbestos
58
602
Attributable Fraction, AF is based on risk ratio, RR
AF = (RR-1)/ RR
AF Principle Compensation, if any Hammond EC, Selikoff IJ, Seidman H. Asbestos exposure, cigarette smoking and death rates. Ann N Y Acad Sci 1979;330:473-90.
Deaths caused by selected risks EU 2013 GBD/IHME
DALY= Disability Adjusted Life Years GBD= Global Burden of Disease and Injury
Deaths, Occupational Carcinogens selected causes
498,604 YLLs re occ. injuries
375,105 YLLs re occ. cancer
Slide source: Tim Driscoll, University of Sydney
Concepts for measuring the Burden Years of Lost Life, N=deaths, L = lost years
+
For cancer (UK): 19.8 years (average age ~60 years) For injuries(UK): 45.3 years (average age ~35 years)
Years Lived with Disability Measure of the burden due to early loss of full function
=
I = Number of incident cases DW = Disability weight (0…1) L = Average number of years affected
Disability Adjusted Life Years Concepts designed and accepted by:
How to calculate the Burdenwork
+
=
-We can easily count the lost years from GBD/IHME from the two numbers per country/region: all deaths and YLLs -Number of fatal cases either from statistics and registers, such as mesothelioma deaths, or -Using Attributable Fraction, AFwork for each disease/ disorder and apply that to best all deaths number to the disorder concerned -Take all YLD’s from GB/IHME - Apply AFwork to these YLD’s, note that AFwork morbidity may be somewhat different from those of AFwork mortality Disability Adjusted Life Years
GBD/IHME: http://www.healthdata.org/data-visualization/gbd-cause-patterns
Complete Summary •
The solid, quantifiable evidence of future impact caused by carcinogens is limited to only a few areas of studies, in particular, those on asbestos, silica, and ETS (passive and smoking),
•
What we know from exposures until today provides some hints of future trends, which is that exposure limitation efforts have been poor and cancer cases go up;
•
Most changes in future exposures depend on structural changes (economic structures) and changes in technological processes not initiated by preventive measures;
•
Shift work and night work – a different animal from others- continue to grow due to society interests and 24/7 service expectations – not always necessary; One cannot fight cancer at work in general, it must be based on detailed measures for limiting each individual exposures; Priority order is important, the six major factors are more important than all the rest combined – asbestos, shift work, mineral oils, solar radiation, silica and diesel exhaust; The GBD slides are useful but to some extent misleading, they cover only a few selected carcinogens (shift work, mineral oils, solar radiation, painters, dioxins, radon, welders not covered), and asbestos covering well over 90% due to underestimation in the IHME GBD process so far. Hierarchy of control is vital, elimination of carcinogen use whenever possible, so far the only fairly successful use of this method is the asbestos ban, a model for many others; For asbestos most people think that the problem is solved. Maybe in the (in particular in the western part of) EU, but more globally far from that, also another wave of exposures/cancers may be coming from today’s and near future demolitions, removal and related exposures. Such
• •
• •
•
work is not properly done in most countries in the EU today.
Additional epidemiology slides: Occupational injuries and illnesses
68
Germany
Singapore 2011
EU 28 average 2011
1 fatal 99 accidents, 30 days+ 663 accidents, 4 days+ 1204 accidents with sick leave 1597 accidents, all
1 fatal 362 accidents, 30 days+ 880 accidents, 4 days+ 1208 accidents with sick leave 1646 accidents , all
Accidents
Illnesses
Multi-mechanism
1 fatal 4.4 illnesses, 30+ days 43 illnesses, 4 days+ 121 illnesses with sick leave 257 illnesses, all
1 death
EU 28 average 2011 1 fatal 30 illnesses, 30 days+ n/a illnesses, 4 days+ 69 illnesses with sick leave 111 illnesses, all
Multi-cause
Singapore 2011- 2014
PERCEIVED AND REAL RISKS PERCEIVED RISK Terrorist attack Mobile phones
Evidence 2 Policy Evidence 2 Practice Violent robbery Avian flu
Workrelated
WORK all
Stock exchange crash Glass of vine
Airline accident
Workrelated
Workrelated
Workrelated
Workrelated
Workrelated
Workrelated
Workrelated
Workrelated
Heat wave
REAL RISK
Workrelated
WAR activities, anywhere
Traffic Accident
Cancer Circulatory diseases
Sources: S. Hertlich, M.Hamilo, S.kuvalehti (FI), WHO/ILO/J.Takala 70
WORK all
