Indicators of death, disability and disease at work  
SafeWorkThe Global Programme on Safety, Health and the Environment

Occupational injuries and diseases

Accidents

The statistical figures on fatal occupational injuries from the ILO show a serious picture as can be seen in Table 1. (1,2,3)

Table 1. Fatal occupational injuries in the world - estimates.

Work-related diseases

A recent study in the United States (4) estimated that there are 60,300 job-related deaths caused by disease. Applying the same methodology and percentage estimates for the whole world of working age, the figures in Table 2 for fatal work-related diseases were obtained.

Table 2. Global estimated work-related disease mortality 1990.

The pattern of diseases varies in different regions of the world, particularly in developing countries. Overall estimates are only based on non-communicable diseases, which are still less dominant in the developing world, although rapidly increasing with urbanization and industrialization. In addition, in developing countries many communicable diseases, such as schistosomiasis, malaria, viral and bacterial infections, are clearly linked to work, such as agriculture and fishing where major parts of the active labour force in developing countries are employed. Close to 50% of the deaths attributed to work take place in Asia.

The trends in both accidents and diseases are mixed. In industrialized countries we have seen a clear decrease of serious injuries. This is caused by both structural changes resulting in fewer workers in hazardous agricultural, industrial, construction and mining activities - and by real improvements in making work healthier and safer. Another contributing factor is the increasing capacity to provide first aid and emergency care which saves lives, although it does not reduce accidents. While the rate of traditional accidents is going down musculoskeletal problems, stress and mental problems, asthmatic and allergic reactions and problems caused by hazardous materials, including carcinogens, such as asbestos, are increasing.

The economic costs of work-related injuries and diseases are rapidly increasing. While it is impossible to place a monetary value on human life, compensation figures give a rough idea of how an estimated 4% of gross domestic product disappears with the costs of diseases through absenteeism, medical treatment, disability and survivor benefits (5).

Figure 1. Cost of occupational and work-related diseases.

In developing countries, the trends are even less favourable. People are migrating to cities, more industries are being set up - often informal and dangerous ones (6), globalization involves workers without previous experience in industrial work, new housing and premises are needed which increases construction work, infrastructures, such as roads, dams, telecommunication facilities and power generation installations are built up, road traffic increases, agriculture is increasingly mechanized and pesticide use increases, and new products and synthetic materials are produced using chemicals, fibres and minerals. All these factors influence the rates and numbers of injuries and diseases, for which upward trends are visible in many developing countries - if realistic recording systems exist.

Death, disability and disease burden in Asia

(World Bank regions: India, China and Other Asia and Islands)

The ILO has estimated that, although very few fatal accidents are recorded, 186,000 fatalities caused by accidents occur each year in Asia. These figures are supplemented by commuting accidents and, in particular, by fatal work-related diseases. The ILO's estimate is that by the year 1990 there were 580,000 deaths and by the year 2000 there could be as much as 600,000 work-related fatalities annually in Asia (Japan excluded).

During an expected working life of 35 years 186,000 annual fatal occupational injuries mean a loss of 6.5 million lives of every working generation in Asia.

A fatal accident represents a tip of an iceberg. It has been calculated that for every fatal injury there are at least 750 other accidents causing either temporary or permanent disability. This would be 140 million non-fatal injuries caused by accidents in a year in Asia. In Finland it has been calculated that the average temporary disability time or absence from work is 14 days. The lost days would then total 5.4 million years. Table 3 counting years lived with disability caused by both injuries and diseases comes to 7.4 million years (YLD's) and seems to underestimate the lost years.

Table 3. Burden of disease and injury attributable to occupation in Asia in 1990 (7).

It is likely that these figures are growing as other causes of disability and disease are gradually reduced. The communicable diseases will have a clearly smaller impact in both mortality and disability rates in the future while the relative and absolute share of problems caused by work - and other non-communicable diseases - will be higher as already experienced in industrialized countries. This trend is clearly visible in many newly industrialized countries in Asia. For example, the fatal injury rate caused by accidents in the Republic of Korea was 34/100,000 workers, which is a realistic number and shows the increasing importance of safety and health in rapidly industrializing Asia. The average for the world was 14/100,000 workers (Table 1).

Coverage

The coverage of the occupational safety and health policies and laws is not satisfactory in many parts of the world. While occupational safety and health law enforcement covers practically 100% in the Nordic countries, the figure for many developing countries is close to 10% or less, leaving major hazardous sectors and occupations uncovered, such as agriculture, small-scale enterprises and the informal sector. Often even very hazardous sectors, such as fishing, forestry and construction are not covered. The same applies to basic compensation in cases of accidents. Occupational and work-related diseases are seldom covered and are often not even recorded. Denmark records and compensates annually some 15,000 such diseases while many industrialized countries record only a fraction of that and a large number of countries practically none, although the problem is clearly there. Some 80% of the workforce in Finland are covered by occupational health services, 50-60% in Sweden, while 80-90% of the countries in the world have neither ratified the ILO Convention on Occupational Health Services nor enacted other mechanisms to provide such services. The WHO estimates that this inaccessibility can be as high as 50% even in industrialized countries. Those countries which have ratified most of the ILO Conventions tend to have the highest legal coverage and the lowest number of injuries.

Table 4. The number of ratifications out of 20 key ILO occupational safety and health conventions.

Sources: http://www.ilo.org/

http://ilolex.ilo.ch:1567/public/english/50normes/infleg/iloeng/iloquery.htm

Environment and the world of work

In the follow-up to the 1992 United Nations Conference on Environment and Development and in the 1997 Special Session of the United Nations General Assembly aimed at promoting sustainable development based on social justice and meaningful, healthy and decent employment, environmental issues have become integral to many of the ILO's activities, intrinsically linked with occupational safety and health.

An Australian estimate of the magnitude of mortality due to occupational exposure to hazardous substances produced a number (2,290 deaths) that was four times higher than that caused by occupational accidents (8). When the same methodology is applied to the world, exposure to hazardous substances could cause some 340,000 deaths per year without counting the acute injuries caused by chemicals. The Asian share is estimated to be 50%.

Table 5. Estimated annual average number of deaths attributable to occupational exposure to hazardous substances by condition, world 1990 (7,8)

Targets and indicators

The targets and indicators must be tailor-made for each country, organization and purpose.

The indicators could be achievement indicators if specific objectives are set and may include:

• indicators of capacity and capability, such as the number of inspectors or health professionals dealing with occupational safety and health
• indicators of activities, such as trainee days, number of inspections
• indicators of outcome, such as number of diseases and accidents and mortality rates.

Table 6 provides a variety of targets and indicators on occupational safety and health.

Table 6. Global and national targets and indicators of achievement in occupational safety and health 

¹Accidents is here considered the same as injury.

I would like to propose that we set the following targets which can be measured by fairly simple indicators:

1. Improved policies and legislation that result in better coverage of enforcement (inspection) and compensation in case of accidents and diseases.

Indicators: percentage of labour force covered by legal requirements, by inspection and by compensation

2. Occupational health services available

Indicators: percentage of labour force covered

3. Improved infrastructure and manpower

Indicators: number of inspectors, specialists, safety officers, safety representatives, information centres, research specialists in relation to the labour force

4. Better recording and notification systems (3)

Indicators: Fatal injuries / 100,000, fatal occupational diseases / 100,000, fatal work-related diseases/ 100,000, disabling injuries and disease rates by sector and occupation, costs of accidents and diseases in relation to the gross domestic product of the country

5. Advisory bodies and voluntary mechanisms established

Indicators: number of tripartite advisory bodies, number of safety committees, safety representatives, number of occupational safety and health
management systems, number and quality of codes of conduct, in relation to the labour force

The ILO's SafeWork Programme indicators include several of these indicators and, in particular:

• the number of ratifications of ILO conventions on occupational safety and health
• the number of governments and/or enterprises that have adopted new policies and programmes consistent with ILO principles and policies
• coverage of legislation, enforcement and compensation systems, and recording and notification systems, and occupational health services
• rates of accidents and diseases collected through reporting systems and specific surveys.

An index or a set of indices that combine a number of individual indicators would be useful in order to compare results between countries, sectors and enterprises. An occupational safety and health index could facilitate evaluations and follow the model of the United Nations Development Programme's Human Development Index and provide an overall view of the global, national and enterprise levels on safety and health at work. Comparable international auditing of a country's occupational safety and health system could provide additional qualitative information for setting new national policies and programmes. With better information and indicators of achievement we can show the importance of our work and obtain more visibility leading to better safety and health all over the world.

References and reading

1. Takala J. Global Estimates of Fatal Occupational Accidents. Epidemiology 1999;10(5):640-6.

2. International Labour Office: Yearbook of Labour Statistics 1996, 55th issue, Geneva 1996. 1145p. (in English, French, Spanish).

3. International Labour Office: Recording and Notification of Occupational Accidents and Diseases, Code of Practice, Geneva 1996, 97p.

4. Leigh JP, Markowitz SB, Fahs M, Shin C, Landrigan P. Occupational Injury and Illness in the United States. Arch Intern Med 1997;157:1557-68.

5. Sosiaali- ja terveysministeriö: Työolot numeroina. Tampere, 1997. 82 p. (Ministry of Social Affairs and Health: Working conditions and environment in figures. Tampere, Finland 1997. 82p).

6. Loewenson R. Health Impact of Occupational Risks in the Informal Sector in Zimbabwe. An ILO report issued in Internet: http://www.ilo.org/public/english/protection/safework/papers/infzimb/index.htm

7. Murray CJL, Lopez AD. The Global Burden of Disease II, Global Health Statistics, World Health Organization, World Bank, Harvard School of Public Health, Harvard, Cambridge, MA, 1996.

8. Morrell S, Kerr C, Driscoll T, Taylor R, Salkeld G, Corbett S. Best estimate of the magnitude of mortality due to occupational exposure to hazardous substances. Occup Environ Med 1998;55:634-41.