WORLD HEALTH ORGANIZATION
.yWI~14'
~JlI ~J, 'IJ;J ~ JI'.,..:.CJ, , ' REGIONAL OFFICE FOR THE
EASTERN MEDITERRANEAN
nEGIONAL COMMITTEE FOR THE EASTERN MEDI'rERRANEAN
~wenty-e1qhth Sess~on
Agenda ;item 10
OCCUPATIONAL HEALTH
ORGANISATION MONDIALE DE LA SANT~
BUREAU REGIONAL DE LA
MEDITERRANEE ORIENTALE
EM/RC28/8 July 1978
ORIGINAL: ENGLISH
TABLE OF CONTCNTS
I INTRODUCTION
CM/RC28/8
Page
1
II SITUATIONAL ANALYSIS: OCCUPATIONAL HEALTH IN THE EASTERN MEDITERRANEAN RE(aO!l
1. Struc cure of economically ae tive popula t ion 2. ::lational occupational health and safety service$ 3. Heal th manpower 4<: Occupational health and safety personnel (Table 2) ')c Activities carried out by health personnel at plant level 6c Health services for the workers 7. Traininr, in occupational health de Health problems of the workers '.J. Occupational hazards and diseases ll>. Industrial accidents 11 c ~'!orkmenl 5 compensation 12. Research in occupational health and safety 1)0 Obstacles in tile occupational health and s~fety progranuue
lIr Rh(;JU;;AL PROGRA!1~IE REVIEW
OCCUPATWNAL HEALTH PROGRA.'1t-1ES (DOCUMENT EN/I(C21/6)
RESOLUTIOll AUOPTEIl AT THE n.'ENTY-FIRST SESSION O~' Tilt. KEGIONAL CONMl1'TEE IN 1971 - OCCUPATIONAL HEALTH I'!\OG~IES (EM/RC21A/R,12)
1
2 2 4 4 6 6 6 6 8 8 8 9 9
9
13
RESOLUTION ADOPTED AT tilE SIXTEENTH SESSION OF THE REGIONAL CONHlTTEE
IN 1966 - HEALTH ASPECTS OF INDUSTRIALI~Al'lON \iIrk SPECIAL REFERENCE TO AIR POLLUTION (E~I/RC16 !R •. ~)
I IN'I'RODUCTION
EM/RC28/8 page 1
1. In 1971, the Twenty-fourth World Health Assembly adopted a r.esolution, Wl1A24.30,
on occupational health programmes, which recommended that the Regional Committees at
their meetings that year discuss means of developing occupational health services.
A paper on the subject prepared by the Regional Director was presented and discussed
at the Twenty-first Session of the Regional Committee for the Eastern Mediterranean
(Annex I) and a resolution was adopted EM/Re21A/R.12 (Annex II) which intep aZia
recommended that countries of the Region should give a high priority to the provision
of occupational health services.
2. The Twenty-ninth World Health Assembly, in 1976, adopted resolution \~29.57
also stressing the high priority to be accorded to the development of occupational
health services as an integral part of national health programmes. The Twenty-ninth
Assembly also requested the Regional Committees to discuss the subject of occupational
health at their 1977 or 1978 meeting with a view to active implementation of regional
programmes in occupational health at both the country and intercountry levels based
on the needs of each country. It is in response to this request that this paper is
being presented to the Regional Committee.
3. In this connexion, it should be recalled that the Fifteenth Session of the Re
gional Committee for the Eastern Mediterranean had selected the subject for technical
discussions during its Sixteenth Session "Health Aspects of Industrialization with
Special Reference to Air Pollution"o A paper prepared by the Regional Director was
presented and discussed during the Sixteenth Session which adopted resolution EM/
RC16/R. P (Annex Ill).
II SITUATIONAL ANALYSIS: OCCUPATIONAL HEALTH IN THE EASTERN MEDITERRANEAN REGION
In 1974, WHO cond~cted a world-wide questionnaire enquiry with a view to compiling
national inventories on occupational health. Replies were received from sixteen
Member countries in this Region. Despite the incomplete and often sketchy nature of
data submitted, due to the prevailing lack of a proper infrastructure of statistical
services, a fair idea of the state of occupational health and safety services in the
Region can be obtained from what is presented below.
BH/RC28/8 page 2
1. Structure of economically active population
A profile of the structure of the economically active population in Hember
countries, drawn from the replies to the questionnaire, and from data given in
various issues of the UN Demographic Yearbook, is as follows:
The economically active population ranged between 20 - 40 per cent, being
25 per cent to 30 per cent of the total population in the majority of Member coun
tries. This indicates a high dependency ratio in the population, n~inly due to
the non-participation of women in economic activit yo The figures are low compared
to those in Western countries (usually in the range 45 per cent to 50 per cent)o
There is extreme polarization in the Region in the role of agriculture as an
employer of men. Whereas agriculture accounted for the employment of 40 to 60 per
cent of men in the majority of Member countries, it provided employment to less
than 10 per cent of the population in a very few countries. Industry, public serv-
ices, commerce and transport employ other sizeable proportions.
2. National occupational health and safety services
Data on the administration of these services in Member countries are presented
in Table 1 .. The questionnaires listed 17 specific functions (or service activities),
and the institutions responsible for these activities were grouped into four cate
gories:
H .. Hinistry of Health or equivalent
L ~ Ministries of Labour, Industry, Universities, etc.
S = Social Security Services (as a separate ministry Or otherwise)
P = Private (non-governmental) institutions,. including regional institutions, companies, etco
The commonest activities undertaken are:
(a) Inspection and enforcement, mainly by the Ministry of Health and other Mi
nistries;
(b) Advisory ervices: mainly by the Ministry of Health and other Ministries;
(c) Sanitary supervision: also mainly by the Ministry of Health and other Mi-
nistries;
(d) Medical care: mainly by the Ministry of Health, then social security serv
ices and private institutions;
COUNTRY
Bahrain
Cyprus
Democratic Yemen
Egypt
Iran
Iraq
Jordan
Kuwait
Libya
Oman
Pakistan
Qatar
Saudi Arabia
Sudan
Tunisia
Yemen
No.of countries by institutions
Total sum-mary
Responsible institurion
H L S P
Table 1
Administration of National Occupational Health and Safety Services
(Institutions responsible for various services)
.., I .. " " " ~
... u 0 " ... .. .. " ...
~ ... '" " " 0 0 ... .... .0 ... " ... .... . .. " 0 " " " ....
" '" '" '" " .... " 0 .. " " .... " " " .... ." '" • u
U > " .. '" .,.,4 .. e ." ... .. 0. ~ ... ... u " " " > " e '" " o U 0. " '" " .. "- " 0 " ~ " " " " " ~ .. u " ..... .... ."
" '" '" " u .... '" 0 ... .... 0 u '" ... 0 o .... " ~ .... >- >- ... ... ." 1l' u bO ... .. .. ... " " ~ • ... U'" 0 " .. ] .c u ... • .... "8 . • " " '" ... u ... " " '" "- " '" u "-" .... ... ... ...... I ... ~ .... .... e ... '" e ~ " ." .. " 0. " bOU " .. .. " " " .. ~ " .. " U .. .. 0
"' '" :>: '" 0. '" 0
... 0. Z
H H H H L H L
HI. HI. S HL HL H HL S S
I S
HL HL H H L H L HL H H P P
L H HL HP S HL P HL HL HP L S P
L HL HL S L L L L
HL HL H S H L L
H H H H H H H
HL HL H H H H H H HL
H H L S S L HS S
HL HL H HL S L H H HL
L L S L L L L
HL HL HP HP HL LP HP HP LP HP HL P P P
HL HL HS S H L H HL
HL Hr. H HP HL H HS HL HL HS H S S
H H P H H L HP H
H II
15 13 13 13 12 12 11 II 10 10 10
12 13 II 9 3 8 9 6 5 9 7 II 9 4 1 5 6 1 7 8 1 8
1 1 0 4 7 0 2 2 1 1 1 1 2 1 4 0 1 2 1 4 2 1
'" ... " .., ... 0 ;. .... 0
" 0 ... ... " u ~ ."
'" HI.
HL
HL P
LP
L
HL
HL
L
HL
9
6 9 0 2
EM/RC28/8 page 3
" '" '" .. .... " " >-" 0 ... ... " 0.
'" ~ '" .0
" " .... U 0
" .... " 0 " ... .c 0 ... . u .... .... ... .. ... " '" " " > ... " u ... "" '" ~ ~ " " ."
'" '" '" '" H H
HL! HI. S
H L H H
LP L
H L L L
H
H
S
HL
HL P P
HL L
HL H HL HL
L H
9 7 7 5
8 1 5 4 6 4 3 3 1 1 0 0 2 1 0 0
" 0 ... ... " ... ... ... .... .0
" .c " '"
S
H
115
liS
4
3 ()
3 ()
H • Ministry of Health L • Ministry of Labour, of Industry, Uni-versities, etc.
S • Social security services P = Private (non-governmental) (as a Ministry or otherwise) institutions including regional
lnstltut10ns
EM/RC28/8 page 4
(e) Uorkmen's compensation: mainly by the social security services, less by
the ~1inistry of Health and other Ministries;
(f) Health licensure of workplaces: mainly by the Ministry of Health and other
Ministries;
(g) Pre-employment examinations: mainly carried out by the Ministry of Health,
where they do exist.
At the other end of the scale, certain activities were very infrequent, in parti
cular:
(a) Rehabilitation for those victims of occupationally related disabilities;
(b) Education of employers in principles of occupational health;
(c) Research;
(d) Registration of absenteeism.
From a different angle, it, may be mentioned that social security services are
mainly dealing with workers compensation, medical care and rehabilitation; and that
it is private institutions which provide most of the medical care and the training of
personnel available.
3. Health manpower
As the objective of occupational health is to provide comprehensive and total
health care to the working population, the programme has to draw upon the total health
manpower available in any given country. It may be recalled that the population per
physicians ratio exceeds 5 000 in a number of countries and that, in all sectors, in
all countries, there are much greater shortages, however defined, among other catego
ries of. health workers~
Information regarding the health personnel actually working within industry was
very inadequate. However, they were mainly physicians and nurses, usually on a full
time basis.
4. occupational health and safety personnel (Table 2)
The distribution of various categories of occupational health and aafety personnel
employed in the different institutions reflects the activities undertaken as detailed
in the previous chapter. Thus physicians are the commonest category employed. Physi
cians and technicians at:e mainly employed by ministries of health, engineers and
Table 2
Occupational Health and Safety Personnel employed in'various In.t~tuti,ons
Category Country
Physician. Engineers Scientists Nurses Safety 'Personnel
Bahrain HP P P P
Cyprus L L HL L
Democratic Yemen H P
Egypt HLP '4P HLP lIP LP
Iran IILP HLp L LP L
Iraq ilL HL L
Jordan P P
Kuwait II ilL II II
Libya ilLS L L LS L
Oman P H II P
Qatar liP liP P
Sudan II II II II II
Syria S S s s s
Tunisia ilL II ilL L
Total No.of countries 4 10 10 10 11 Sum- by institution:H a 6 5 4 2 mary L 6 6 5 3 5
S 2 1 1 2 1 p 6 2 2 6 4
Employing institution: H m Ministrv of Health
EM/RC28/8 pageS
-Techni- Others cians
liP liP
Ii L
II
'IILP. IILP
HLP ilL
ilL
ilLS L
H
lIP liP
II II
S S
ilL
11 9 10 6
4 5 2 1 4 3
'L":::Ii Ministry of 'Labour, of Industry, Universities, etc.
S • Social Security Services (as a_Ministry or otherwise)
P • Private (non-governmental) institutions, including Regional institutions.
EM/RC28/8 page 6
scientists by other ministries, and nurses and safety personnel by the social secu
rity services and private institutions. In many countries private institutions are
quit~ active in employing occupational health and safety personnel.
5. Activities carried out by health personnel at plant level
Of the seven categories of activity mentioned in Table 3, first-aid and medical
care are the main activities implemented at the plant level. Next in order come
diagnostic and referral activities as well as the pre-employment examination. Moni
toring of the working environment, periodical health examinations and health educa
tion of the workers are the least cOmmQn 4ctiv~tieso
6. Health services for the workers
The percentage of work establishments employing more than 100 personnel that
provide health services at the plant level range between 25 per ~ent to 35 per cent ..
This is a lOlJ figure. Furthermore the services provided are mainly curative with
little or no attention to the preventive aspect$ of oc~upational health ..
7. Training in occupational health
Training in occupational health is provided in all medical and nursing schools
wherever they exist but it enjoys a very low priority, as does the safety training
provided in engineering schools.
Facilities for post-graduate training are available in a number of countries
including Egypt, Iran, Pakistan and Sudan.
8. Health problems of the workers
Qqite apart from the hazards and diseases specifically related to occupation,
mentioned in the next paragraph, the main health problems of the workers in the Re
gion are:
(a) Oeficiency ma~nutrition including anaemia and protein-energy malnutrition;
(b) P~rasitic and other endemic diseases, including malaria and schistosomiasis;
(c) Respiratory infections, including tuberculosis;
(d) Trachoma and related vision problems;
(e) Insanitary and unsafe living and worki'lg eonditions;
(f) Psychological stress etc.
Table 3
l!ealth Service Activities carried out by Health Personnel in Work Establishments at Plant Level
., Country on ... u .. .., .... u .... .....
< on .. .... o ... .. .. " ... u .. """ .... ... ...... ." .... .... " ~ '"' Q.'"
BahrainI A A A
Cyprus A S S
J)emocra tic Yt;!:men A A A
Egypt A M M
Iran S N N
Iraq A S A
Kuwait A M M
Libya S S S
Oman A A A
Qatar A S M
Saudi Arabia A N S
Sudan A A A
Syria M M M
tunisia S S S
Yemen S S S
A 10 4 5 Total sUIIDBry M 1 3 4
S 4 6 5 N - 2 1
A • in All ) M • in Most ) S - in Some ) N - in None )
of the work establishments
I. . 1 In pT1vate compan1es on y.
.... 0
" 0 .. . ... " ... " " ~6 c u
- 0 " o .... ...... .., ... .. u .. '" ~;! ...... on ." " .:: ... "' .... 0 .... .. ., , IS • ... iii .... ... .... ... .. .. ...
... " " " " 0 "'''' "'''' "'~
A A A
S S S
S S N
A S M
N N N
S S M
S S N
S N S
S N S
M S M
S S S
S S N
M S S
A A S
S S S
3 2 1 2 - 3 9 10 7 1 3 4
EH/RC28/8 page 7
" -" ... ... .... ... 0· ...
.,,~
""' .... ... "" o " ... .... . ...... c ... ~~
A
S
S
S
N
... N
N
M
S
S
N
S
S
S
1 1 8 4
EM/RC28/8 page 8
These problems are the same as those affecting the majority of the other popu
lation in the countries and are responsible for a large proportion of the total
absenteeism.
9. Occupational hazargs and diseases
The major industries in the Region (after agriculture) are those connected with
petroleum drilling, refining and other processes related to petrochemicals, fertilizer
production, iron and other heavy metal industries. The main occupational hazards and
diseases encountered follow patterns similar to those occurring in other parts of the
world and, according to the replies received, include:
(a) Fires and burns;
(b) Industrial accidents (machinery, traffic, falla, etc.);
(c) Inhalation of fumes, acute gas poisoning and asphyxia (S02, CO, H2S, NH3,
Cl2);
(d) Chemical poisoning (pesticides, lead, chrome, etc,);
(e) Pneumoconioses (silicosis, asbestosis, by •• inosis, wood dust, etc.);
(f) Chronic bronchitis, asthma, respiratory infections:
(g) Physical (heat stroke, noise deafne.a, vibration, radiation, caisson disease);
(h) Dermatitis, chemical allergies;
(i) Conjunctivitis, iritis, and eye injuries;
(j) Snake and scorpion bites, anthrax, etc.
It is not possib~e to quantify these in any truly realistic manner: they are
listed in no confirmed order of priority.
10. Industrial accidents •
The statistics of accidents in the industrial establishments are not available.
11. Workmen l s compensation
Even though accurate data in many countries are lacking, it is evident that the
existing legiSlation and the workers unions have been effective to at least some extent
in securing compensation for workers in case of accidents.
12. Research in occupational health and safety
EM/RC28/8 page 9
Little systematic investigational research or survey work has been done in the
Region to define the true nature and the magnitude of the problem. However, some
surveys of the risk to workers in a number of occupations have been carried out in
Egypt, Iran and Sudan.
13. Obstacles in the occupational health and safety prograflUlle
The main obstacles are:
(a) Lack of infrastructure for collection, compilation and presentation of
data;
(b) Shortage of suitably trained personnel in the field of occupational health,
especially among categories other than doctors;
(c) Deficiency of equipment to monitor the environment and to carry out work;
(d) Inadequate leeislation;
(e) The division of responsibility of occupational health between the various
ministries of the governments and the lack of co-ordination between them.
III REGIONAL PROGRAl-1ME REVIE~1
Almost all countries in the Region could be considered to be in a developing
stage as far as the provision of organized services for worke~' health is concerned.
Rapid urbanization and industrialization have given impetus to the development of oc
cupational health services and have stimulated governments to seek international col
laboration in this important field, but there is still a long way to go.
The scope of occupational health services has widened and is aimed at not only
preventing occupational hazards but also promoting the worker's health in general.
However, at the same time, such data as are available suggest that much more needs
to be done especially in the preventive aspects. The services which do exist at-
tempt to go beyond industrial undertakings and to embrace all places of work includ
ing offices, agriculture and other. In this connexion it should be mentioned that
although the process of industrialization is under way, the rural population employed
in agricultural pursuits still constitutmthe majority. More often than not, social
insurance schemes in the Member countries of the Region, as elsewhere in the world,
do not cover agricultural workers.
EM/RC28/8 page 10
The basic problems of workers' health are somewhat similar in the various coun
tries of the Region, but practical solutions may differ depending largely on the de
velopment of general public health services in each country. Basic problems include:
deficient legislation; shortage of professional and technical staff especially of the
middle and lower levels; lack of training and research facilities to carry out re
search in specific areas, such as studies related to safety devices and protective
equipment as required for local conditions; and inadequate dissemination of informa
tion, with consequent lack of understanding concerning the valuable contribution that
occupational health services can bring to the community in general.
The approaches taken by WHO in face of this situation, as outlined in the Sixth
General Programme of Work for the period 1978-1983 are as follows:
(a) In collaboration with ItO in areas of common interest, WHO will formulate
or revise standards and prepare guidelines for protection against occupational
hazards and will promote co-ordination of activities for strengthening the
legal, administrative and occupational framework to ensure health and safety
in work places.
(b) WhO will collaborate with countries in developing comprehensive occupation
al health programmes and services that are co-ordinated, and preferably inte
grated, with the general public health services.
(c) WHO will promote the development of methods for the early detection of
health impairment of workers and the collection and dissemination of in~ormation
on specific occupational health problems and their solution, and on occupational
hazards.
(d) WHO will co-ordinate and stimulate research.
In the context of the approaches outlined above the Eastern Mediterranean Re
gional Office will continue to collaborate with countries of the Region, on request,
in the further developm£lt of ways and means to strengthen existing occupational
health services, to foster the location of suitably designed services where none
exist, and to help increase understanding of the true needs in this field. In doing
so, WHO will work closely with the agencies coneerned including ILO, UNEP and others.
It is envisaged that by the end of the coming biennium there will be specific colla
boration in this field in the following countries: Bahrain, Democratic Yemen, Egypt,
Iran, Iraq, Jordan, Lebanon, Pakistan, Sudan and the Yemen Arab Republic.
EM!RC28/8 page 11
The main emphasis of this collaboration so far has been directed towards two
main objectives: (a) the development of the necessary manpower for the development
and manning these services; (b) the development of an occupational health unit or
units, in each country, appropriately located in a teaching institution or otherwise,
which is adequately equipped and staffed for the technical assessment and control of
the working environment. Such a unit would have service, training and research func
tions.
In addition the following activities may deserve special mention:
1. As mentioned repeatedly lack or shortage of trained personnel in the manifold dis
ciplines with which occupational health is associated has been and will continue for
sometime to be the major difficulty facing Member States when developing their pro
grammes o However, one can safely assume that. as a result of the fellowship programme
in this field over the years and of the few regional training courses and seminars
organized by WHO, there is in fact a nucleus of trained staff in a number of countries
in the Regiono Over the last six years 38 WHO fellowships have been awarded in occu
pational health. 25 of them were long-term, one leading to Ph.D., 14 leading to MGSco
and 10 leading to the Diploma in Occupational Health; the remaining 13 were short
fellowships for study tours and observations.
As a result of the continuing reorientation of WHO's programme towards increasing
relevance to national needs and self-reliance on the part of Member countries, it is
planned to organize two training courses for teachers of occupational health~ one in
1979 for industrial hygienists and the other in 1981 for occupational physicians. It
is anticipated that the graduates of these courses will be in a position to organize,
in collaboration with WHO, national training courses to train more staff of the right
calibre and competence in their respective countries. Such training courses should
be carefully designed to prepare an appropriate balance of occupational health workers,
including doctors, industrial hygienists and others, providing the most efficient and
effective manpower structure in accordance with the resources and needs of the coun
tries.
2. The Eastern Mediterranean Regional Office has collaborated for many years with
the departments of occupational health both at the High Institute of Public Health,
Alexandria and the School of Public Health, Teheran. Both departments are now ade
quately staffed and equipped and have reached the stage of being able to aSsume the
functions of regional centres. It is intended to negotiate with these institutions
EM/RC28/8 page 12
to assume this responsibility officially so that they can collaborate with neighbour-
ing countries towards establishing their own occupational health units. To use the
Departments referred to in this way would be in accordance with the desire of w110 to
do all possible to foster technical co-operation among developing countries.
3. WHO will collaborate with other countries for the further development' of their
occupational health services, including Bahrain, Lebanon, Pakistan, Sudan and the
Yemen Arab Republic, by provision of consultants, fellowships and supplies and equip-
ment ..
4. A WHO/ILO Multidisciplinary Team of the International Programme for the Improve
ment of Working Conditions and Environment (PLACT) is expected to visit Iraq, at the
Government's request, during the last quarter of 19780 The terms of reference of the
team include, among other objectives:
To assist in the analysis of findings On health problems prevailing in dif
ferent occupational sectors of the country, with a view to identifying priori
ties and to developing more effective services in occupational health at the
national level.
To assist in preparing training curricula on occupational health at the under
graduate and post-graduate levels.
To study existing labour and related health legislation, especially factory
inspection requirements and to make recommendations on its development.
It is envisaged that WHO collaboration will continue in 1980/1981, jointly with
ILO and the Government of Iraq, to implement a programme of action likely to emerge
from the team's visit in the last quarter of 1978.
5. Negotiations are presently at an advanced stage between the Government of the
Arab Republic of Egypt, UNEP and EMRO for a tripartite project entitled "Development
and Integration of Environmental and Occupational Health in Egypt". This project
represents a vivid example of both technical co-operation and inter-agency collabo
ration. The project will be partly funded by UNEP; the Government implementing
agency is the Ministry of Health of Egypt, and WHO is the co-operating executing
agencyo The project, which extends for twenty-four months (and possibly longer)
beginning June 1978, has the following overall objectives:
To develop a nationwide programme of environmental monitoring in relation to
health particularly of the popUlation at riSk.
EM/RC28/8 page 13
To institute a programme of environmental impact assessment of all developme.nt
programmes including industry, construction, agricultural and water resources
development projects.
To investigate and control all sources of pollution of air, water, soil, food
and of the work enviro~nt.
To evaluate the effects on health of exposure to a variety of pollutants, sug
gest health measures and assess the effectiveness of these measures.
To develop a system of early identification of health problems associated with
pollution in the general environment and at work.
To develop norms, guidelines and criteria adapted to conditions in Egypt in
connexion with safe exposure limits; means of detection and control of health
hazards; and to establish biomedical monitoring of exposed populations ..
It is envisaged that the outcome of these two projects in Iraq and Egypt may open
the path for similar collaborative efforts with other countries of the Regiono
IV CONCLUDING REMARKS
Members of the Committee will certainly appreciate that this paper is not intended
to propose any single pattern of occupational health services that could be adopted by
all Member States of the Region. There does not in fact exist any such pattern, and,
as repeatedly mentioned, each country will therefore have to decide, in the light of
prevailing circumstances, how far it can go in providing for the health needs of the
gainfully employed segment of its population. Nor is the paper intended to recommend
specific ways and meanS to overcome the many difficulties encountered when initiating
or expanding occupational health services. This requires much more detailed study
on the spot, going well beyond the scope of a paper such as this one.
However~ the paper is intended to solicit from the members of the Committee their
comments, views and guidance as to how WHO can best reorient its programme in order to
enSure more relevance, and to reshape it to meet the specific and better defined needs
of our Member Stateso Moreover, the paper is also intended to reaffirm certain points
that were highlighted and agreed upon when the Committee last discussed this subject,
in depth, during its Twenty-first Session~ as well as in past discussions in the World
Health Assembly!
EM/RC28/8 page 14
10 The time is opportune for countries of the Region to initiate and expand
their services for the protection and promotion of the health of the gainfully
employed segment of the population to cope with the challenge imposed by rapid
social and economic develoPment.. This will prove in the long ··run to be more
effective and less expensive than the initiation of salvage corrective measures
at a later stage.
2. Experience in
for the protection
developed countries has clearly demonstrated
and promotion of the health of the gainfully
that services
employed can
best be planned effectively and efficiently when they are integrated into the
health programme of the community in which they are working. Countries of
the Region should therefore give serious consideration to the development of
existing public health programmes by extending them into the field of occupation
al health, rather than trying to build up a complete new structure which might
well produce duplication, overlapping of efforts and confusion of responsibility.
30 There is a marked need for better co-ordination at the national level bet
ween all government departments and administrations dealing with occupational
health as well as at the international level between various international organi
zations and agencies.
4. There is a particular need to promote and carry out field investigations of
the health problems of workers. Only through such research can countries obtain
the best guidance as to how to plan and implement effective programmes. In oc
cupational health, as in other parts of the health sector. there is need for
much more of a research and development approach, and WHO will foster this when
ever possible.
5. Likewise there is a real need to give particular attention to specially
vulnerable groups among the working population, such as the young, female,
elderly and handicapped workers and those exposed to special hazards such as
migrant workers, miners and transport workers and especially seafarers. It is
logical and appropriate that, where resources of manpower and materials are still
in short supply, priorities should be set in such a way that the needs of the
most vulnerable are tackled first.
As will be seen in the Proposed Programme and Budget for the biennium 1980-1981
a steady expansion of WHO's work in occupational health is proposed, and expenditures
in this programme area are proposed to be doubled. It is hoped that this paper will
be of value as a contribution to the evolution of the programme and its effective re
alization.
P.EGIONAL Cm1!lITTEE FOR THE EASTERN MEDITERMtll:i/\N
'l'wenty.first Ses$l,on
Agenda item 10 (e)
ANNEX I
OCCUPATlPNAL HEALTH PROGRA~~S
~M/RC28/8
EM/RC21/b August 1971
ORIGINAL: ENGLISH
TABLE OF CONTENTS
INTRODUCTION
I
II
Ol:)JECTIVES AND SCOPE OF OCCUPATIONAL IfEALTH
OCCUPATIONAL HEALTH SERVICES IN THE REGION
1. L~bour authoriti~s
2. H0nlth c.uthoritics 3. l~ •
5. 6.
Teaching institutions Social insuro.ncc Lnbour and dmployors I organizations Plant lovel
III INTEGRATING OCCUPATIONi,L HEALTH IN THE PUBLIC HEALTH SERVICES
A. B. C. D. E.
Rolo of health "uthoriti<.:s Rcnsons bohind non-integration Indications for integration Initiation or dcv810pment of the programme pp.ttcrn r.nd scope of tho s0rvice
IV TIiE PROGRAMME IN OCCUPATIONAL HEALTH FOR THE EASTERN MEDI'l'EllRhNEAN REGION
(a) Consultants (b) F8110wships ( c ) Scmine.rs and Tro.ining Courses (d) Assistnnc<; to divisions of occupntion"l hcnlth
iil national honlth o.dministrc.tion (c) Assistn!lCC to departments of occupation"l ho"l th
in t""ci1ing institutions
EM/RC21/6
1
')
5
7
7 8 -)
10 12
14
14 15 15
16
16
INTRODUCTION
»MjRC2lj6 page 1
The Tt1enty-fourth liorld Health Assembly adopted a Resolutionl on
Occupational Health Programmes recowmending that Regional Co~nittees discuss
in 1971 means of developing oCGupational health services.
This paper is prepa,3d to serve as background information for discus
sions by the Tt1enty-fir.,t Se8sion of the Regional Co~i ttee for the Eastern
Mediterranean Region.
I OBJECTIVES AND SCOPE OF CCCUPATIONAL HEALTH
The Second Meeting of "he Joint IL0/l'iHO Committee on Occupational
Health2
defined the objective~ of occupational he?-lth as follows: "the
pror.1otion and maintenance of the highGst d"BTee of physical, mental, and
social well-being of i-wrker.s in all occupations; the prevent,ion among
workers of departures from health caused by their ,"orking 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 occu
pational environment adapted to his physiological and psychological equipment,
and, to s~arize: the adaptation of work to man and of each man to his job".
Such a definition of oojectives ?-ppears to envisage occup?-tional health
as dealing not only with the health problems related to work and the working
environment but ?-lso with the tot?-l health rroblems of the gainfully employed
segment of the population. Although this interpretation is increasingly
becoming accepted, some quarters continue to have a limited ?-pproach and
envisage occupational health as dealing only with the health problems related
to work and the workir.g environment, Le. occupational diseases and accidents.
Regardless of how this definition is interpreted, there is really only
one basic objective, namely, to protect and promote the health of gainfully
employed persons. This basic objective, however, has several components
which would constitute the scope of occupational health. Of course, there
~1HA2~.30 2\'/1d Hlth Org. Techn. Rep. Ser., 1953, 66.
EMjRC2lj6 page 2
is no blue-print for the content of an occupational health programme for
uni vers~l E'.pplication. Clearly the problcms to be tackled will vary from
onE.: country to another £'..Yld even in tho same cOillltry from time to time;.
Ench country will have, therefore,to decide for itself in the light of the
prcvc..iling circumstances, pr(;ciscly hO\'l f2.r it can go in aiming at providing
C!. comprehensive occup.::tioDC!.l hcntth progr2.l1lme. However, th(; fcllowing
points may be of 2.ssistcncc in makinc; such a decision;
1. The working population in the countries of tho Region represents an
important segment of thc countries' population. They are the breadwinners
of thc families and the backbone of economic e~d social progress. Thcir
health is an important factor in productivity. It is important, therefore,
that countries of the Region should give a high priority to tho provision of
occupational health services, at this stGge of thcir development, to avoid
the risks that may gradually evolve from uncontrolled and unhealthy indus
trial expansion; such risks can be more difficult and costly to control Gt
n later stage.
2. The health of the working population is influenced by many factors -
working environment being only one - and it has been frequently noticed that
not more than 5 to 10 per cent of the working days lost in industry are due
to occupational causes while the remaining 'Xl to 95 per cent arc caused by
pathological conditions not specifically related to the job.
3. It is difficult to separate the prevention of occupational disease from
that of general diseases in developing countries. There is no line of de-
marcntion possible in view of th.;, many typ"s~f ill-hoalth that affect workers
en" are' added to, and complicated by occupati'_onal diseases, and reflect upon
work performance and exposures. Mc.n's h<onlth is indivisible and the npproach
to it should nccount for [\11 cpidemiologic~l end environmental factors includ
ing the working environment.
4. In many developed countries, the health noeds of the g~infully employed
m~y or could be taken caro of by the authorities or institutions outside the
place of work.
EMjRC21/6 page 3
Whereas the condi.tions in many countries of the Region, due
to lack of health and medical resources, will often leave all or most of the
health needs of workers to be. organized and provided for through the place
of employment.
5. Experience in developed countries has demonstrated that measures for
the protection and promotion of th~ bealth of the worker can only be planned
effectively and economically when they are integrated within the health
programme of the community where he is working. Similarly, it haS been
found that many of the public health techniques could be morc effectively
applied to workers at their place of employment, where easy contact can be
made with the working adult, just as children can be easily reached through
health services at schoel.
6. It has now been realized within the occupational health circles in
institutes, centres, academies, universities and societies, that occupational
health should go beyend the. prevention of occupational diseases and accidents,
although this should continue to develop in vic_w of the ever increasing
specific problems resulting lrom the introduction of new chemicals and indus-
trial processes. In everyday health practice, among workers, diseases arc
discovered whose causes mayor may not be related to work but in all cases
affect or get affected by work. With the success of control of physical
and chemical hazards in some advanced modern industries, occupational health
gives a different emphasis; medical placement of workers with chronic
diseases, study of the effecta pf night-shifts on health, the problem of
hard physical performance in-forestry and heavy industry, the adaptation of
machine to man, the practice .of· mental heal,th in industry , etc. Occupational
health has, therefore, developed many .sub-specialties but the overall practice
has become more oriented to a total health approach without at all affecting
its definite profile ,as iii spccialized field of public health, practiced by
a team of several disciplines including preventive medicine, occupational
hygiene engineering, occupational hygiene ;sciences, nursing, psychiatry,
psychology and sociology.
EMft\C21/6 page !f
II OCCUPATIONAL HEALTH SERVICES IN THE REGION
1. Labour authorities
Following the historical develoPl1lent of occupational health in highly
industrialized countries, the occupational health services in many countries
of tho Region concentrate on factory inspection by the Labour Administration.
These labour inspection services are mostly concerned with general labour
conditions, wages, hours of work, employment of WOmen and Children, and
simple occupational safety. The labOur legislations in force, though cumpre-
hensive, are usually not properly adapted to local, social and cultural
conditions. The enforcing ~aehinery is often weak and untrained. They
usually lack the supporting technical laboratory facilities and field equip
ment necessary for the assessment and control oi; the working environment
whic;1 constitutes the scientific base for de~.ling effecti vcly with the health
problems of work"rs, or with the cnvironmentr.l haZards in the great number
of medium-sized and small es-cc,blishments which cr.lplo~r the· "",jari ty of tile
working population. The labour legislations in few countries of the Region
require the provision of modi cal services covering all or some specific types
of est"blishmcmts "ccording to the size and nature of occupationel hazards.
2. Heal th authorities
The pre-occupation of the health services with the formidable henlth
problems they have to face, coupled with the lack of human material resources,
has made the national heelth authorities in a number of countries of the
Region unaware of their leading role in occupational health. In others,
due to the competition~etween the various administrations, the role of
health services has been ill-ctefined, and limited to curative services with
out due consideration to the causes of illness, or the taking of preventive
action. In some countries, however, the health administration has developed
a unit or division of occupational health for the training of health person
nel, standard-setting, research and day-to-ctc.y preventive services, particu
larly for groups of small industries, leaving the enforcement of labour
EM;RC21/6 page 5
legislation to the labour administration, but maintaining a close co
operation and co-ordination.
3. Teaching institutions
A few teaching institutions in the Region have established well-developed
departments of occupational health for training and research, as well as
advisory services. The impact of these departments is not yet felt, as they
are relatively new. However, it is hoped that they will assume a leading
role in developing sound oecupational health programmes in their respective
countriGs.
4. Social insurance
A number of countries of the Region have organiZed social insurance
sch~mes for workers, providing medical care, sick benefits for temporary
disability, pensions for pcrman"nt disability, and cash benefits to surviv-
ing dependents. In some instancos, a parallel systc:m of workmen's compen-
sation is also in existence. Nost of thl;;so .schemeS are spending large sums
of money on cash benents and curative medical services, with littlo or no
intcrest in preventive services and occupational health. HOWBvcr, there is
some indication that a few of these schemes are becoming interested in occu
pational health.
5. Labour and employers' organi~at~ons
Labour organizations are relatively developed in most countries of the
Ragion. So far, they arc mainly conoerned with wages, hours of work and
cash bene fi ts . For understandable reasons, they have not as yet assumed an
important role in promoting comprehepaive occupational health programmes.
Employers' organizations do exist in most countr~es of the Region but,
so far, they do not seem to be fully aware of the economic benefit of compre
hensive occupational health programmes.
6. Plant level
Apart from a number of large e:;;tabl1Shments, j>al'ticularly in the oil
industry and railways, which have developed eXCellent occupational health
E~1;RC21/6 page 6
services, the practice of occupational health at the plant level in the
R~gion leaves much to be desired, particularly in medium-sized and small
estabiishments. The following would help to give a picture of the dif-
ficulties encountered:
(e.) The plants nrc built without due consideration to site or
prevailing climatic conditions.
(b) Overcrowding is common, house-keeping, mnint,enance and s:mitary
conditions tend'to be 'on the poor side, there is a marked need for
potable sources of drinking water, and a safe method for the disposal
of refuse, sewage and industrial wastes.
(c) Machines and equipment are installed without attention to safety
rules, and there is a notable lack of machine guarding. Safety
committees when prcsen~, lack technical support and supervision.
(d) Dust, fumes, gases and vapours are produced without proper use of
exhaust ventilation at the source; noise is excessive; monitoring of
the working tOnvironment is rarely donG.
(e) Personal protective equipment is deficient, and whon available, is
either of poor quality or improperly used.
(f) First-aid equipment is often of a rather low standard and there is
a marked scarcity of trc.ined first-aid workers.
(g) Health education programmes are lacking, or when present are limited
to a few pesters.
(11) Industrial feeding is often lacking, and, when provided, is usually
of poor quality, both from the nutritional and sanitary points of view.
Some excellent feeding programmes do exist, but are not usually patron
ized by workers to the full extent due to lack of supporting nutrition
educational programmes.
(i) Plant health services, when present, are usually poorly housed and
staffed. The Health Officers in charge may work on a full- or part-time
basis, nnd may be engaged in largQ numbers of establishment".
EM/RC21/6 page 7
They core
rarely qualified in occupational health. They seldom visit the work
places. Emphasis is placed,on curative services cot the expense' of
preventive programmes. Pre-placement end periodic medical examin~tions
ocre only cD.rried out occc.sionally. Medical records kept are usually
poor and inadequate. The occurrence of occupational diseD.ses anci
D.ccidentsis usu6lly not investigated nnd poorly reported.
Certainly, there D.rG exceptions to th0 above picture, since well-built,
hcoclthy plents and excellent services do exist, but they arc not c.s common
as OnG would like ,to sec.
III INTEGRATING OCCUPATIONAL HEALTH IN THE PUBLIC HEALTli SB;RVICES
A. Role of he:11th i'.utnoritics
If it is accepted ·that human beings arc ti1C, most import,:mt sinGle
development re50urc(.:
it is ",ssenti",l th"t
(:.ne. tIle c.;:.'n tr~l fnctor in ':-.11 development probrC'.mrncs,
c:ountry wishing to uchi:"':'V0 i;rIdU$tri~lizt.t.ion _w,i thQut
paying an (;xccssi ve pric\... in humq,n vp.lu~s sno,u.ld J'.ecord 0. very high priority
to mec.sureS for the protection and promotion of the hcr.lth oJ th" working
populc.tion. "hen it is recognized thc.t the h<:al,th of the worker's fomily
hc.s c. complementary effect on the hcc.lth ~nd productivity of the worker him
self, it becomes cle,"r thnt occupc.tionc.). heocH!'! services cun b"st be plmmed
effectively 2nd oconomicc.lly "hen thcy "rc intO£,'rated into the hcnlth pro-
gramme of the community where industry is situ"tcd. These services o.re
especic.lly importnnt in developing countries where the bulk of thG l:1bour
force is drawn from the rur:11 populc.tion who arc unfo.milic.r with the hD.z,,"rds
of machinery, toxic processes "-TId the disciplinell of factory life. Conse-
quently, health ,<'-uthoriti8s rove the respoqsibility o~' participating actively
in the planning=d imPl,e{llcnttl.tion of ,CllC.llpccts of the occupationc.l health
Health authorities Should, therefore, participate in:
EMtRC21/ 6 page 8
1. The development and enforcement of labour coaes designed to protect
the health and safety of workers.
2. The preparation of factory legislation.
3. The control of the working envfronment includfng air quality,
humidity, air movement, light, noise levels, the provision of safety
devices, personal protective equipment and sanitary facilities.
4. The determination of which work is suitable for females and young
employees and of the age requirements for workers.
5. The placement of workers in relation to phyeical capacity through
a system of pre-placement and periodic physical examination.
6. The development of social insurance schemes.
7. The trainfng of all types of personnel necessary for the imple
mentation of the programme.
B. Reasons behind non-integration
All countries of the Region have an orgn.nized public; health service to
look after the health of the people. In some countrie3 the public health
services are more than 100 years old, in others they are relatively young.
The majority, however, have not as yot assumed their role in occupational
health due to a combination of the following reasons:
1. The historical evolution of occupational health and safety acts as
a part of overall labour protective acts and the adoption of this pattern
from industrialized countries.
2. The miSinterpretation .and faulty definition of the scope and
objectives of occupational health and the long-standing limitation of
its activities to the contr.ol 01: environmental hazards at work to
prevent occupational diseases and accidents without regard to the
workers' total health.
EH;ltc2lj6 po.ge 9
3. The remarlcablo pre-occup"tion of Public hea.lth services with the
prevention and cOntrol of co~vnicablo diseases coupled with the limited
ava.ilable resources.
l~. The absencD of information cs to the ml1~i tude of the problem of
hcc.lth of the working popull;'.tion and its reflection on economic
developmElnt.
C. Indicntions forinto5£~tion
The indica.tions for including occupa.tionel health programmes within tho
framework of public health servioes oan again be ~ari~ed as follows,
1. The working population is the most important sector of the community
in size and in respect of the economy. It is also a high risk group
~d public heclth services cannot i~ore this vital responsibility.
2. Industrial enterprises not only ·narbaur hezarcts that ma.y nff~ct
tho health of tho workor but also influence th~ tot~l human environment
by the effluents and pollution which t~y produce,
3. Basic houlth services are About the only meanS by which the masses
of workers engaged in small ind~trie8 can bo served. In most indus
tri~li:z:cd countries, thore are !i.S yet no schemes developed to dea.l with
this larGe group.
4. In v10w of the limited number of qu~11f1ed personnel available it
.is to the best advonta.ge of publio henlth services to group health
nctivities under one roof. All types of health programmes including
jl,ml th el1uc('.tion, COntrol of cOrm)\lI'Iico.ble d:lse~clI, nutrition and
0pid~miological rQscnrch have proved to be more effective when performed
among thG working populntion.
5. Adm1rlistrati ve and financiQ.l burdens lire already being borne by the
health services in an ~ ~ and ~cogn!zed mannor. lolorkers seck
medicnl caro in state.run clinics, put·patients' clinics and hospitals.
EM;RC21/6 page 10
Since this is th'.: cas~., it would be better to handle· tho h':;alth proble,"s
of workers in " more constNctive and positive we.Y.bY a properly pl=
ned occupOltion,,1 he"lth progr~mmc.
D. Initiation .or developmpnt· oj;. the. pt'.ogr=e
It should be reOllized from the beginhing thtl.t the organiz"tion of such
a programme in mony cotmtries of the Region would encotUlter n number of
difficulties due to short"ge of tr"incd persormel, materiell and money. It
is important to reOllize, therefore,. tlw.t some sort of organized progrnmme
is better than nothing"t ~ll =d that it is often easier to build up from
a sm~ll begirming than to try to start with an elaborate programme.
Hhen considering the initic.tion or development of an occupational health
programme within the fr=ework of public hoalth services, it is important
for countries of the Region to bear in mind thOlt:
1. Their major hCOllth probloms almost entirely Olrise from inOldGquato
basic health sorvices.
2. The he,:,lth probloms or' industry, although important, form only a
relatively sm,:,ll proportion of the.whole.
3. The occup[\tiqnc.l hG~l th programme should be d8vGloped together with
thi.::! d<JvelopmC'nt of industry to c.void the need for expensive salvage
services at c. l~yt.(;r S-l,.:'.gc.
4. The experienc.e of. developed· countries has exposed tho weakness of
setting up ad ~ occupational health services.
Countries of thc !legion should the:t'.:;fore give serious consideration to
the development of existing publiche~lth progr=mes by extending these into
the field of occupational health rather than by trying to build up a comple
tely new structure whicn might well'p:t'od],lce duplication, overlapping of
effort and confusion of responsillilitios.
It should also be remembered that no practical approach to the solution
of a problem can be made unless the nature and extent of the problem has be on
Ei~/RC21/6 page 11
defined. Therefore, an expert evaluation of the present situation of
occupational health in a country should be first carried out.
include:
This should
1. study of ti,e existing labour laws and codes as well as the extent
of their enforcement.
2. Analysis of other programmes and activities that relate to
occupational health.
3. A nation-Wide survey of all industrial and other enterprises to
determine the extent of occupational health problem.
4. A cenSUS of all available medical, paramedical and auxiliary
personnel and those with speci"l training in occupational health and
related fields.
5. Investigation of ~ll possible souroes of financial and technical
assistance.
The initiation of such a programme docs not necessarily need a large
corps of highly trained and experienced personnel because, as pointed out
before, it is possible and often necessary to start in a modest way with
only a nucleus of trained personnol. In addition, careful consideration
should be given to tho proper usc of auxiliarY personnel to relieve profes
sional workers from unskilled tasks.
A number of countries in the Region have in the ve~ious professions
individuals who have been trained in occupationnl health. Such persons
might be physicians, chemists, engineers and nurses. Whenever possible,
these qualified staff should be assigned ot induced to accept positions in
the occupational health services.
It should also be mentioned" here that II8Z'1cultull'e is increasingly
becoming an industty and from the standpoint of cap! tal investment and the
number of persons employed may be termed Obis ~1ness·. However, agricul-
tural workers though they represent a large $egment of the working force,
E!~/Rc2l/6 page 12
do not E'.S yet receivG the ['vttcntion accorded to \'lorkers in othor occupc..tion2.1
pursuits. While occup"tiom:l health in agriculture is a very speci"l
problem because of the unique cheracterlstics of "griculturc as = occulhticn,
it is felt, however, thnt en occup"tiorierl health service in agri-chlt-ure should
b"sically have tho some functions as that for industrial WOrkers, slightly
modified in order to mGct -thQ cir_cumstancos of agr'icultUl'al workers.
No programme can justify its existence unless its short-range and Ion£;-
r"nge objectives can be cl""rly den-ned. In the Cilse of many countries of
the Region, " short-term .objective m"y be us simple as the est"blishmcnt of
a b"sic occupation"l hv"lth unit to "ssist in defining tho occupational
health problems of the country. A long-range objective would aim at the
provision of n full range of occupationnl hec.l th services for the entire
employed population.
E. Pattern and scape ofthc service
The ways in v/hich oc:cupc.tiono.l heo.1 th can bL organized to meot the: noccJ.s
of Ghe countries in the Region will very extensively depending c>n the socie.l,
. culturr:.l end economic conditions of cr:.ch cotll1try. They vlill .-ols:o dcp~nd)n
the pcttern' of government ma~h1nery. Tht.;.;r0 cc:n, thvrc fcro, be no simpl.:::;
single blue-print for l.U1ivcrsc.l applic.:::.tion and tm 1'lnal dcciS10n conccrnlng
the pattern of an occup~tion~l health service and the scope of its activities
can only be medc by individunl countries in the light of existing circumstances.
The time is no" opportune for the countries of the Region to extend or
adapt their health services to ceal with the hC:Llth problems of the gainfully
employed segment of their population. It would naturally be desirable to
h"vc all the 'spectrum of activities in occupational health, including legis
lation and inspection, undo I' one governmental administration. This may not
be feasible on account of-administrative ~.ndpoliticcl factors. However,
the existence ofle.bour inspection services out:side the health services should
not necessarily lcud to oirerlapping,Md aUplication because the nature of tro
EM;RC21/6 page 13
OccupGtional health service provided by public health will be different
from ~d complementary to the labour inspection scrvic~s as it will lmve
different demensions.
The Joint ILO/WHO Committee on Occupational HeGlth in its third report
made a number of recommendations concerning th" scope ~d organization of
an institute of occupational health, thEe establishment of which represents
in the Committee's opinion a usoful and wise approach to providing for the
specific requirements of an occupational health programme; However, this
term might be misleading in that it suggests an elaborate type of organi-
1
zr.tion which might be beyond the, means of developing countries. Therefore:,
it is proposed to start with ['. limited unit which may be called a "&sic
Occupc.tiono.l Hcr.lth Uni til .. Such a unit could be staffed by a sme.ll number
of trained staff and would only need limited space and basic laboratory and
field equipment. The total cost involved in establishing such a unit is
certainly within tho re,,-eh ofJ:lost countr:!.es of the Region. Such a
specL:lizod unit could b" a'scction, a division or a dqmrtment in tho
n,-cti.m"l public hoal th service anC. would bO! responsible for the planning,
execution and technical sup0rvision of'progr=e 1mplemonto.tion.
Consideration should be given to the addition of occupational health to
thc functions of the health services, both at intermediate and local levels,
throughout the country particularly in the productive creas.
Direct day-to-day services to workers in tho workplaces, including
pre-employment and periodic m"dical examination, monitoring of tho working
environment, health edncatien, nutritional progremmus =d mass health
campaigns can be provided through special arrangements with employers of
large enterprises or through co-operative schemes, for small ones. In
c~ses whero such urrangements are not possible the basic health services
must be responsible f~r providing c comprehensive health programme to the
workers within the reach of the health units.
~ld Hlth Org. Techn. Rep. Ser., 1957, ~.
D1jRC2lj6 page 14
In all the above arrangements, the national health services should
supervise the services provided to ensure compliance with different health
standards, including pr8vention of diseases and injuries as well as the
compilation of ndequate hoalth st"tistics.
IV THE PROGRAfIME IN OCCUPATIONAL llEALTH FOR THE EASTERN MEDITERRANEAN REGION
Since its inception, tho Regional Office programme in occupational
hcnlth has been directed towards halping Member States to develop their
occupational health services to meet the challenge imposed by rapid indus-
trial development. The approach differed from one country to another
depending on the need and the stage ef development of the country concerned.
Since the lack or shortage of trained personnel in the manifold disciplines
with which occupational health is associated is " mnjor difficulty fncing
all countries of tho RQgion whQn developing their progrommes, high priority
wns given to the education and training of persoanel in this important field
of public health to ensure tl1Ct countries would have a nucleus of trnined
st~ff qunlificd to develop the occupational health services. Apart from the
granting of fellowships and assistance to medicnl and public henlth insti
tutions, the Regional Office has orgnnized n number of regional and inter
regional seminars !lI1d tro.ining courses to arouse interest in and spread
knowledge of occupational henlth problems. Physicians, engineers, chemists
and nurses have been invited to participate in those meetings and the
faculties have also been drawn from different professions in order to promote
team spirit among all those concerned with tho health of the gainfully
employed.
The assistance provided so far could bo summarized under the following
headings:
(a) Consultants
Th0se wore provid6d in response to requests fer advice from
governments, ranging from advice in solving specific occupational health
EM/RC21/6 pe.ge 15
problems to advic~ on the: organization of 0. nation-wide occupational
health service. \-iliO consultents wcr", provided to Irnn, Kuwait, Lebenan,
Sudan end the United Arab Republic,
(b) Fellowships
More then seventy long-term and short-term WHO fellowship were
awarded to thirteen countries of the R~gion.
(c) Seminars and Tl'aining Courses
In addition to participation in ten inter-regional 8emtnars end
training courses the Rogional Office was responsible for the following:
(i) Regional Training Course on Industrinl Health, Alexandria, 1959.
(ii) Inter-Regional Training Course in Occupational Health, Alexandria, 1961.
(iii) Inter-Regional Seminar· on .the Health Aspects of Industrialization, Dacca, 1963.
(iv) Inter-R.ogional Joint FAO/IID/WHO Semin(lI' on Industrial Feeding, Al~xundria, 1965.
(v) Regional InQustrial Hygiene Course, Zagreb, 1970.
It should be mentioned in connexiol1 with the last course that the
Regional Office is fully aware of the increaSing recognition of the
importnnce and in fact the indispensability of industrial hygienists
in occupational health und the lack of this important category. of
personnel in the Region. Realizing that formal teaching in this field
is available only in a few institutions in highly industrialized
countries and that the courses offered are not suitable for preparing
graduates to meet the needs of developing countries, due consideration
has been given to finding a meuns whereby these sp0cialists can be
trained to deal with the types of occupational health problems encoun-
tered in the Region. Finally, it was agreed with the AndriJa Stampar
Ef1/RC2lj6 page 16
School of Public Hec.lth, Zc.greb, to orgnnize " specially tailor.cd t011
months' course loading to a Diploma in Industrial Hygiene. Ten cc..n-
didates (from Irnn (2), Iraq (1), P2kist~n (2), Sudnn (2), Unit"e. A'rc.b
Republic (1), Philippines (1) =d Ceylon (1)) completed the C.ourso in
August 1971. It is pl=ed to repeat thE: SiOJllC course in 1972 to give
"n opportunity to the other countriGs of the R<:gion to m2ke usc of this
courSe~
(d) Assist"nce to divisions of occupational 1'iclllth in national health administration
Assistance was provided in the form of advisory services, supplies
nne. equipment and f£llowships to:
(i) The Division of Occupational Hedth, Kuwait
(ii) The Division of Occupational Health, Sudan
(0) Assistance to departments of occupational health in teaching institutions
Assist2.nC8 ..,l0.S providcc in the fGrm of 2.dvisory services, suppliC!s
c..nd (;quipm":,nt o..nd i-'..:.:llowships to:
(i) The High Institute of Public H8alth, AIGxandric.
(ii) The School of Public Health, Tchornn
(iii) The InstitutQ of Hygiene c.nd Preventive Medicine, Lahore
(iv) The School of Tropical Medicine, Dacca
The R~gional OfficF, within the limits of its regular budget and the
contribution that could be made av"ilable from the UNDP/TA and Special Fund,
is planning to expand its programme of assistance in occupational health to
respond to requests from countries of the Region.
ANNEX II
RESOLUTION ADOPTED A'I' THE TI"ENTY-FIRST SESSION OF 'I'HE IlliGIONAL Cmll4ITTEE IN 1971
OCCUPATIONAL HEALTH PROGRAMHES (EM/RC21A/H. 12)
The Sub-Committee,
E!-I/RC28/8 Annex II
Having considered the document submitted by the Regional Director on the subject
of Occupational Health Programmes (Document EM/RC2l/6);
Recalling resolution EM/RC16/R.6 l on the Health Aspects of Industrialization;
Considering that national health and national wealth are inevitably interwoven
and that the protection and promotion of the health of the gainfully employed is an
essential requirement for improving productivity;
Being aware that the experience in developed countries has exposed the weakness
of setting up ad hoc occupational health services;
Believing that measures for the protection and promotion of the health of the
workers and their families can best be planned effectively and economically when they
are integrated into the health programmes of the community where they are working;
Cognizant of the present situation of occupational health services in the Region,
10 RECOMMENDS that countries in the Region should give a high priority to the pro
vision of occupational health services designed to meet the health needs of the gain
fully employed segment of their populations;
2. URGES countries in the Region to give due consideration to the extension of exist
ing health services into the field of occupational health rather than trying to build
up a completely new structure which might result in duplication, overlapping of efforts
and some confusion of ""esponsibility;
30 REAFFIRMS the need for better co-ordination of all governmental departments con
cerned with occupational health at the national level and between United Nations Agen
cies at the international level;
40 REQUEST~ the Regional Director to continue to assist governments in collaboration
with other United Nations Agencies concerned in planning and developing their occupa
tional health activities within the framework of public health services.
lENRO Handbook of Resolutions and Decisions, 1.7 0 1, page 111 Rev.l.
ANNEX III
RESOLUT.IOl'I hDOPTED A'l' THE SIXTEENTh SESSION 0F THE REGIONAL COMi1ITTEE IN 1966
IlLAiJl'tI ASPEC'l.'S OF INDUS'l'RIALI ZA'l'IOii/ "l'l'H 51' ECIhL Iilil:'LREi,CL TO AIR POLLU'1'lmr
(l;11/RC16/R.6)
The Regional -Committee,
EH/RC28/8 hnnex III page i
having considered the document on Health ASpects of Industrialization with
Special Reference to Air Pollution (Documents EM/RCl6/Techn.Di'c./1-2); • Realizing that human beines are the most important single development resource
and the central fat tor in development;
Recognizin3 that modern public health now has the tools required to achieve
marked improvement in the health of the people during the transition from an agra
rian to an industrial economy.;
ilelieving that any country wishing fa achieve rapid industrialization without
paying an excessive pri'ce in human values should accord a very high priority to
measures for the protection and prdrilotion of the health of the gainfully-employed
seement of the population and their families,
I(ECOHMENDS that
a. the health of the nation be considered an essential element in all social
and economic development programmes;
b. a close 'l1orking relationship be established between the health authorities
and other authorities responsible for the economic and social development to
ensure the participation of health authorities in the planning and implementa
tion of the industrialization programme at all levels;
Co in planninb ~ew industrial projects, due consideration be given to the inte
gration of these projects in the community's general development programme to
ensure a healthy environment through the provision of both preventive and cura
tive health services, healthy housing, safe community water supply, sanitary
methods for the disposal of sewage, refuse and industrial waste;
EN/RC28/8 Annex III page ii
d. where industries are well established and environmental and public health
p~oblems exist, detailed studies pertaining to these problems be undertaken and
corrective measures initiated without delay;
e. adequate consideration be given to the training of the medical, paramedical
and auxiliary personnel needed for the full range of health services;
f. countries of the Region accord a reasonably high priority to the provision
of occupational health services, since the ~intenance of health of the workers
is an essential requirement •
effective measures for
for improving productivity;
the prevention and control of environmental pollution g. (atmospheric, riverine and marine) be initiated and maintained;
h. adequate legal provision be made by governments in the Region at an early
stage to safeguard the health of the people and ensure the control of the working
environment;
i. a health education programme be designed to encourage the general public to
adapt themselves to the new way of life imposed by industrialization and to ensure
the proper use of health services and other measures provided to promote health.
