The World Health Organization (WHO) considers workplaces as a priority setting for promotion of health and well-being of employees and workers. Occupational Health encompasses actions to ensure the highest degree of physical, mental, and social well-being of all workers, preventing workplace-related hazards, and ensuring a safe and resilient work environment. Workplace hazards, heat, noise, dust, hazardous chemicals, unsafe machines, and psychological stress all contribute to occupational diseases and exacerbate other health problems, having a profound impact on an individual's health. Common occupational diseases lead to increased rates of long-term illness, absence from work, and decreased productivity. Further, occupational diseases and injuries can have significant economic consequences.
In 2021, the World Health Organization along with the International Labour Organization (ILO) jointly estimated that work-related diseases and injuries were responsible for deaths of 1.88 million workers globally in 2016. This amounts to 27.7 deaths per 100 000 worker population. Eighty-one per cent of work-related deaths were due to respiratory and cardiovascular diseases. Occupational injuries caused 19 per cent of deaths (360 000 deaths). The key risk factor for the death was exposure to long working hours (>55 hours/week) linked to approximately 750 000 deaths (40 per cent of all deaths).
According to these estimates, the WHO South-East Asia Region had disproportionately large work-related burden of disease, having highest rate of mortality among all regions of WHO, with 36.5 deaths per 100 000 of the working population. South-East Asia Region also has a significant proportion of the working population in the informal sector. Workers in informal sectors often lack access to occupational health supports leaving them vulnerable to health risks, especially noncommunicable diseases (NCDs) and injuries. These sectors rely on public health systems to meet their occupational health needs and are challenged by access and availability of occupational health services.
In Sri Lanka, 26 out of every 100 000 people of working age die from diseases due to occupational risks every year, ranking the country as the 3rd highest among the 11 South-East Asia Region (SEAR) countries. Nearly 67 per cent of the working population in Sri Lanka is from the informal occupational sector. Almost 12 per cent of the working population in Sri Lanka is exposed to long working hours leading to negative impacts on both physical and mental health. While Sri Lanka has yet to ratify the three key international labour conventions on occupational safety and health, the above figures suggest the need to address and improve occupational health and safety challenges in the country.
The Regional workshop on Occupational Health was conducted to review the situation and challenges of occupational health in the region, and to identify priority actions in progressing towards improving occupational health as part of the “Regional Plan of Action for the WHO Global Strategy on Health, Environment, and Climate Change for the years 2020-2030” endorsed by the WHO Regional Committee for South-East Asia in 2019. This Plan of Action has called for efforts to address the occupational health risks, including strengthening medical surveillance for early detection of occupational diseases, hazard identification and case management.
The participants noted that occupational health policies and their implementation vary across the countries. Wherever policies exist, these are generally implemented in larger and more formalized workplaces. The countries also have insufficient resources to implement the policies and plans on occupational health. Most of the countries in the region have limited institutional frameworks on occupational health and safety. In addition, some of Member States have inadequate monitoring or surveillance systems for occupational risks and hazards and this is especially observed in the informal sector.
The participants also discussed the challenges and considered actions to reach the disadvantaged informal sectors. It is estimated that nearly two-thirds of the workers in the agriculture sector and three-quarters of workers in non-agricultural sector belong to the informal sector. Workers in the informal sector are disproportionately vulnerable, have fewer workplace protections and higher vulnerability to economic shocks compared to formal workforce that usually benefits from social protection systems. Informal workers tend to be paid less than formal workers, in part because they are lower-skilled.
The workshop provided a platform for participants to share their knowledge and experiences related to occupational health programs and services. After reviewing individual countries, participants identified the priority areas of actions, and indicators and targets to monitor the progress. Emphasis was made in addressing the needs of the informal sector, and to improve access to public health services. Participants agreed to discuss the issues of long-working hours with labour ministry, being one of the key factors responsible for high burden of occupational health diseases in the countries. The workshop also took note of impact of COVID-19 on health workforce. Countries agreed to take actions to review and implement occupational health programmes specifically for protection of healthcare workers. Regional workshop also provided a platform for the delegates to gain new knowledge and understanding on determinants of occupational health including emerging issues on building climate-resilient occupational health services.
The Ministry of Health Sri Lanka also arranged field visits for the workshop participants to three workplace settings around Kalutara, including a large-scale garment industry, a medium-scale industry, and occupational health services linked to a District General Hospital. Participants were apprised of the current procedures and processes that link the current occupational health system to the Primary Health Care through the Medical Officers of Health staff. The regional and global experts attending the workshop also provided feedback on current practices and options to improve those. It was noted that while the formal sector was well integrated with the Primary Health Care, the occupational needs of the informal sector also need to be prioritized in Sri Lanka, that caters nearly two-thirds of its national workforce.
Taking note of the deliberations, the Ministry of Health, Sri Lanka has identified priority areas to improve occupational health services in the country, for the coming years. A comprehensive National Occupational Health, Safety, and Well-being program tailored for health workers in Sri Lanka will be developed and implemented by the Ministry of Health. The Ministry of Health has also prioritized to develop a national occupational health program to extend its reach out to informal occupational groups as another priority. Situational analysis of small enterprises to assess their occupational health arrangements has also been identified as a priority. WHO Country Office will support Ministry of Health to implement the identified actions to address the existing gaps in occupational health services in the country.
Field visit to a large scale industry; Occupational health programme being implemented at a large scale industry in Kalutara district. Photo Credits: WHO SEARO
Field visit to occupational health services in a medium scale industry in Kalutara district. Photo credit: WHO SEARO