International Occupational Health

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International Occupational Health Safety

• Tim Morse, Ph.D.
• University of Connecticut Health Center,
  Farmington, CT, U.S.
• Spring 2002

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Outline

• Economic positions
• Theories of determinants of occupational health
• Estimates of occupational injury and illness
• Approaches to prevention
• Maquiladoras (Mexico)
• NAFTA (North American Free Trade Agreement)

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Per Capita GNP (1987, World Bank)
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Labor Force Distribution, 1988, ILO
80
70
60
50
40
Cameroon
30
Tunisia
20
Portugal
10
Sweden
0
Mfg
Services
Agriculture
Unemployed
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World System Theory (Wallerstein, Elling)

• Position in world system
• Economic resources
• Strength of worker movement

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First World

• Tripartite structure
• Standards vs. guidelines

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Sweden (Elling, 1988)

• Labor strong
• 85 organized
• Labor party
• National law (Co-determination)
• Committee majority union
• Stop production process
• Hire/Fire company physician
• 110,000 trained union reps
• Linkage to health system

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Third World

• Combined with effects of poverty, nutrition
• Priority of economic development
• Agric (60-80) primary production
• Development led to dislocation
• High unemployment

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Third World

• Emphasize labor-intensive industries
• Control technologies not affordable
• Low or no workers compensation
• Highest risk have low access to social resources

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Injuries/ Fatalities

• 100 million workplace accidents
• 180,000 fatalities
• Developing countries
• 20 injuries
• 30 fatalities
• Fatal rate 3-4X in developing
• Source Takala, 1989
• 1.1 million fatalities injuries and ill (ILO)

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Injury Fatality Rates (ILO, 1998 Cited in
Herbert and Landrigan, 2000)
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Global Burden(Leigh, et al, Epidemiology, 1999)

• Indirect Method
• 100,000,000 occupational injuries
• 100,000 deaths
• 11,000,000 occupational illnesses
• 700,000 deaths
• Finish OD, Australian Injury rates
• Apply age/sex-specific rates to population
• Double rates for less developed

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Occupational Disease

• Higher risk in LDCs in occupations
• Pesticide poisoning
• 3 million acute poisonings/yr (Jeyaratnam, 1985)
• 220,000 fatal
• Concentrated in LDC
• Organic dusts

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Occupational Disease

• Noise
• Heat Stress
• Reduces use of PPE
• Bloodborne diseases
• 2 billion hep B carriers (world)
• HIV in Africa

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Regulations

• Alma Alta declaration, WHO
• Incorp occ health services in primary care
• Colonial history
• Use modified western standards
• Lag behind knowledge
• Not suited to conditions

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National Strategy should include (Reich Okubo)

• Institutional development
• Info management
• Training
• Safety Standards
• Enforcement
• Social values

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ILO (Intrl. Labor Office)

• Standard setting
• Training materials
• CIS Centers
• Chemical safety data sheets
• Information exchange
• Technical cooperation

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Multi-nationals

• Tension with US workers (jobs, NAFTA)
• Lower wages, less job security, weak unions
• Lower national standards enforcement
• Usually better conditions than other local plants
  (corporate policy)

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Maquiladoras (1995)

• 2,200 Maquilas along Mexican border
• 90 US owned
• 550,000 employed, 65 women
• 48 hour standard work week
• Ave. take home 15-25 per week
• government unions

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Maquiladoras (Moure-Eraso, 1997)

• 65 women
• Little industrial experience
• Labor turnover high (14-180 per year in
  different provinces)
• Mixed studies on reproductive hazards

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Maquiladoras Survey(Moure-Eraso, 1997)

• 267 maquila workers interviewed in home, 1992
• 81 female, mean age 25
• Living conditions generally good 80 indoor
  plumbing, 75 cement floors
• 45-48 hour work week
• Ave weekly wage40 US (0.93/hr)

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Exposures

• Dust 51
• Gas 60
• Poor ventilation 51
• Skin contact 50

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Symptoms

• 56 headache
• 53 unusual fatigue
• 51 depression for no reason
• 41 forgetfullness
• 41 chest pressure
• 39 difficulty falling asleep
• 37 stomach pain
• 36 dizzy
• 33 numbness/tingling

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Lead among radiator repair Dykeman et al, 2002

• Radiator repair workers in Mexico
• 35.5 ug/dl vs 13.6 for working controls
• Risk factors
• Smoking
• radiators repaired/day
• Use of a uniform (not laundered)

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Mexican Safety Regulation GAO

• Survey of 8 auto plants (of 12 selected)
• advance notice
• 2-day walkthrough
• Interviews with Mexican officials, OSHA
• 6/8 had parent company support for HS
• Use of older equipment
• Had been visited by STPS
• US 80 of auto parts plants with OSHA violations

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GAO Results

• Lack of hazard-specific programs
• Hazards present at all 8 plants
• 42 workers reported hand/arm pain
• 70 worked less than 6 months
• machine guarding
• 6 plants emerg exit problems
• lack of safety signs some English only

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GAO Findings

• 6 facilities over 90 dB noise
• had plugs, many not using
• Lead, silica, solvents, welding gases
• Respirators not used properly

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GAO Hazard Programs
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GAO Hazard Programs
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Mexican Regulation

• Law strong in some respects
• HS Committees
• Problems
• No first instance penalties
• Specific standards weak in key areas
• Max fine 1,500
• Low WC costs

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NAFTA Chapter 11 (Moyers)

• Allows suits by companies or shareholders if
  tantamount to expropriation
• Methanex 1 bil suit vs. California for
  regulating MTBE
• Metalclad 16 mill settlement vs Mexico for not
  allowing haz waste plant to open
• Ethyl !3 mil settlement for temp ban on MMT gas
  additive, withdraw ban, letter
• Secret tribunals
• Expanded Free Trade Agreement for Americas
• Diminish value of investment